Thread: Illegal immigrant care puts hospitals, families in costly di

Illegal immigrant care puts hospitals, families in costly dilemma
The case of Orlen Rosales: How soaring treatment costs for illegal immigrants put families and hospitals in a bind.
By Franco Ordoñez
fordonez@charlotteobserver.com
Posted: Saturday, Sep. 11, 2010

More than two dozen medical staples hold together the left side of Orlen Rosales' head after he was struck by a train on July 4, his family says.

Few thought the 26-year-old Honduran would survive, but doctors and nurses at Carolinas Medical Center have worked nonstop to save him.

After weeks close to death, he's now up and talking.

But the bills for his treatment have far exceeded what the family can pay. The first day of his care cost more than $15,000, the family says. Another bill was more than $30,000.

Rosales doesn't have insurance. In fact, he's not even in the country legally. He was deported in 2008 after a DWI arrest. And he's not eligible for Medicaid beyond emergency care.

"Yes, he doesn't have papers, but he's a human being," says Oneyda Lopez, Rosales' cousin.

His case reflects another challenge arising from the nation's troubled immigration system.

Roughly 11 million illegal immigrants live in the United States, including 250,000 in North Carolina. Many are uninsured.

Hospitals are confronting a dilemma they didn't create. They've been hit with mounting unpaid medical bills from seriously injured illegal immigrants. Some have sought to send these patients home for more care because they can't find long-term facilities in the U.S. to accept them without insurance.

But advocates for injured immigrants say some U.S. hospitals are dumping patients in places where they're likely to receive little care.

In a landmark case last summer, a Florida jury decided that Martin Memorial Medical Center near West Palm Beach acted reasonably when it repatriated a severely brain-injured Guatemalan man over the objections of his family and legal guardian.

Rosales' family and friends say they've felt pressure from CMC administrators to move him to a facility in Honduras.

Citing federal patient-confidentiality laws, hospital officials would not talk about Rosales' case. But they say returning patients to their home countries has nothing to do with their legal status or cost of care.

Barb DeSilva, vice president for clinical care management at Carolinas Healthcare System, which operates CMC, says it's strictly about giving patients the best long-term care possible. That often means moving them closer to family and loved ones.

The decision, she says, is always made in consultation with the family and doctors in both countries.

A terrible collision

Rosales arrived in Charlotte about five years ago after his mother suffered a stroke and could no longer work.

In Honduras, considered one of the poorest countries in Central America, 28 percent of the population is unemployed. In Charlotte, Rosales worked in carpentry and also cleaned condominiums. Every month, he sent money to his mother.

On the night of the accident, family and police suspect he had been drinking.

A Norfolk Southern train was speeding toward Charlotte when it passed the intersection of South Boulevard and Sharon Lakes Road. The engineer told police he didn't notice a man lying on the tracks until he was about 50 feet away. By then, it was too late.

It was 3 a.m. Rosales never moved. He lost his right hand and suffered head injuries.

For two weeks, he was in a coma. A priest came to his room to pray with the family.

Amy Cruz, his girlfriend, says administrators told her about a week after Rosales arrived that he should be sent home.

"He was breathing from a freaking tube and they're talking about sending him to Honduras," says Cruz, 22, who is from Puerto Rico. "He wasn't even awake."

According to the family, the hospital contacted the Honduran consulate to discuss possible hospitals and how to get him there.

CMC wouldn't talk about Rosales, but DeSilva says doctors tell families early on about the expected course of their loved one's care, whether that means sending a patient home, to a skilled nursing center, or to a hospital here or abroad.

His cousin, Lopez, who is in the country legally, feels caught in a bind. She says Rosales needs more care, which she's unable to provide, yet she also worries about the treatment he'd get in Honduras. Quality of care

Carolinas Medical Center staffers help a few injured patients return to their home countries each year, DeSilva says. She notes that CHS runs its own nursing facilities, where some indigent patients already receive free long-term care.

Rosales' cousin, Lopez, says hospital staffers have talked about these facilities, but never told them he could receive free care.

Sonal Ambegaokar, a health-policy attorney at the National Immigration Law Center, says some hospitals work through the consulates hoping the family will volunteer to have their loved one repatriated. Many hospitals, she says, never look into the quality of care the patient would receive. "It's worse than patient dumping on a grand scale since you're really sending them out to the boonies," she says. "It's out of sight, out of mind, basically."

DeSilva says there is no international accreditation that measures quality of hospitals: CMC doctors consult with peers in the home country, then make clinical decisions.

"If we're satisfied that the facility agrees that it can provide the clinical care needed, then we accept that."

Officials at Novant Health, which operates Presbyterian Hospital, say they sometimes work with foreign-born patients who seek to return to their home country for care. Some are international travelers who get ill or injured here. Others are terminally ill. Like CMC, Novant spokeswoman Kati Everett says patients are never sent to their home country against their will or because of costs.

A national issue

Caring for uninsured patients has imposed financial burdens on public hospitals.

Carolinas HealthCare System spent $182 million for patients who couldn't pay in 2009. That is 4 percent of the hospital system's $4.6 billion total revenues. The system also reported $151 million in bad debts, or bills that could not be collected. The Pew Hispanic Center estimates that 59 percent of illegal immigrants are uninsured. That's about 15 percent of the nation's 47 million uninsured people.

Illegal immigrants are not eligible for Medicare, the federal insurance program for people 65 and older. They can get emergency care through Medicaid, the federal-state program for the poor and disabled. The new health care law specifically excludes illegal immigrants.

Some argue that hospitals are in this position now because the government has failed to properly enforce immigration laws.

Ron Woodard of N.C. Listen, an advocacy group, says he is sensitive to Rosales' injuries, but notes that taxpayers will ultimately pay. "If we were just so flush with money, I guess we could just take care of the rest of the world's health care," he says. "But we're not."

Larry Gage, president of the National Association of Public Hospitals and Health Systems, says the high costs of caring for injured illegal immigrants without insurance is an issue for many hospitals.

Hospitals in other states, have sent patients back to their home countries for continued care.

"In an environment in which nobody is paying the bill, there is a point beyond which, if you do too much of that kind of care, you can't carry out your underlying mission to everyone in the community," Gage says.

In October, Grady Memorial Hospital, a public facility in Atlanta, closed a dialysis unit that treated 90 patients. Many were illegal immigrants. Grady officials said the clinic was losing up to $4 million a year.

Rosales is talking and eating, though he can't remember the accident. The family says CMC doctors and nurses have worked wonders.

Cruz says Rosales doesn't want to return to Honduras, but Lopez says she sees no other option to get him additional help.

"He still needs 24-hour care," Lopez says. "We can't do that here. It's too much money."

Read more: http://www.charlotteobserver.com/2010/0 ... itals.html

Unlike my citizen sister-in law who would have had NO care for cancer except I paid for it.

I just can't feel sorry for this man. Not one little bit. Send him and all his illegal money-sucking thieving relatives back.

If citizen-hating Obama wants to help these folk, then press their oligarchy governments to help their own people and stop setting it up for our own citizens to die from lack of care.

He snuck into the country and was kicked out for a DWI. He snuck back in, got wasted again, and passed out on a train track. Then a train nailed him, but he lived. So now, the others using that hospital have to pay his bills until he’s OK. Am I missing something? Am I supposed to feel sorry for this guy?

The open borders people are always saying that illegal aliens contribute more than they consume. I think this guy is a pretty good example of why they’re wrong.

This is absurd! I guess I’m cranky because I’m having trouble paying my medical bills and I have insurance!

Anyone know the policy that would be used towards a poor American?

Would they have to keep giving free Med. attention or could they send him home?

Although having to pay for injured illegals is costly, it is but a drop in the bucket compared to taxpayers footing the bill for the thousands of illegals giving birth in U.S. hospitals every day.

I am a senior citizen on medicare .

A few months ago I had a MIR and my co-pay was $150.00. I had been paying twenty five dollars a months until I recived a notice that I had to pay the bill in full or it would be turned over to collections................

REMEMBER..........I was paying my bill and had insurance. I am an American citizen. I was making an attempt to pay....

Illegals know they will never pay a dime and the hospital go after the people who try!!

Originally Posted by Ratbstard

Anyone know the policy that would be used towards a poor American?

Would they have to keep giving free Med. attention or could they send him home?

Read about my sister in law above.

Originally Posted by ChiWatcher2

He snuck into the country and was kicked out for a DWI. He snuck back in, got wasted again, and passed out on a train track. Then a train nailed him, but he lived. So now, the others using that hospital have to pay his bills until he’s OK. Am I missing something? Am I supposed to feel sorry for this guy?

The open borders people are always saying that illegal aliens contribute more than they consume. I think this guy is a pretty good example of why they’re wrong.

This is absurd! I guess I’m cranky because I’m having trouble paying my medical bills and I have insurance!

You're not cranky, you're dead on. You are being robbed of your money and your rights by IA freeloaders and politicos. It makes me angry for you and every citizen.

In my state, taxpayers pay an average $700 each to support IAs. Washington gives you $300 back to pump up the economy and thinks it's a big deal--just think what it would do to get $700 back plus the federal taxes and to stop about 15% of what these folks do earn that leave the country as remittances that could help OUR economy.

My dad got caught in this conundrum....massive sinus infection, 11 days in the hospital. Ended up with a bill in the tens of thousands. The hospital kept calling- even tried to get his KIDS (me and my brother in our 20's at that time) to sell our cars to pay for my dad's bill. My dad went ballistic on the collector ( a mexican woman). To make a long story short, he was able to pay the bill off at $8,000....this was at the expense of much stress which likely contributed to him picking up smoking again when he'd previously quit for the first time in his life....

God bless you, Watson, for helping out a family member.

Proud to have you here on this forum and a supporter of only legal immigration.