Thread: SOB-For some ill migrants, free care has a price

For some ill migrants, free care has a price
Some hospitals eventually send them out of U.S.
by Daniel Gonzalez - Aug. 3, 2008 12:00 AM
The Arizona Republic
When Fidel Delgado arrived at a Catholic hospital in Phoenix in mid-June after a heart attack, doctors performed life-saving bypass surgery, even though Delgado is an undocumented immigrant with no way to pay his medical bills.

Federal law requires hospitals to provide emergency care regardless of immigration status or ability to pay.

But once Delgado had been stabilized, officials at St. Joseph's Hospital and Medical Center faced a serious dilemma: As a hospital certified for acute, or short-term, care, St. Joseph's determined that it couldn't keep Delgado any longer. But the severely diabetic and obese man was still too sick to go home.

Sending Delgado to a rehab facility also was not an option because Medicaid would not pay for the care.

Transferring him to a hospital in Mexico could be traumatic: Delgado, 64, hasn't lived in his native country for more than 40 years.

The decision St. Joseph's would make initially - to send Delgado to Mexico - represents one of the most wrenching policy approaches taken in recent years as part of a state and national crackdown on illegal immigration.

St. Joseph's now sends an average of seven uninsured immigrants a month back to their native countries for treatment, often against the wishes of family members, hospital officials say. Before 2000, the hospital rarely transferred any patients out of the country, perhaps only two or three times a year, the officials said.

Not all patients who are sent back are undocumented immigrants. The hospital also is sending back legal immigrants who don't qualify for long-term Medicaid. Hospital officials attribute the practice to stricter laws and tighter controls at the state and federal levels that have made it harder for immigrants to obtain non-emergency Medicaid care, for which U.S. citizens are eligible. The hospital says the changes have forced it to transfer more immigrants to their native countries when they require long-term care and lack insurance.

The patients transferred back to their homelands typically have spent weeks and sometimes months at the hospital and have racked up huge medical bills that they cannot pay, officials say. The hospital bill for Delgado, for example, reached $837,950.

Some critics suggest that St. Joseph's, a non-profit hospital that is exempt from taxes and must provide some charity care, is simply dumping patients to save money. The hospital denies the allegation.

Immigrant advocates fear that other hospitals around the country will follow St. Joseph's lead as a way of dealing with the most vulnerable of the nation's 46 million people who lack health insurance. About 1.1 million people in Arizona are uninsured.

For the patients' families, the transfers can be devastating.

When members of Delgado's family were told that he might be sent to Mexico, they were shocked. His wife is a U.S. citizen, and all of his close relatives live in Arizona.

"He is going to die if he has to go to Mexico," said Delgado's sister, Rosa Aguirre of Phoenix. "He has no family there."


Others do the same

St. Joseph's is not the only Valley hospital that sends uninsured immigrants to Mexico for long-term care, but its number of transfers is much higher.

Maricopa Medical Center has sent five non-citizens out of the country for treatment since October, hospital officials said. Banner Good Samaritan Medical Center sent seven in 2007 and six the year before, officials said.

St. Joseph's officials said they don't track the numbers on an annual basis.

"These are not easy decisions," said Sister Margaret McBride, vice president of St. Joseph's Mission Services. "Our legal responsibility is to provide a safe discharge. Whether the family agrees or not, we have to provide for a safe discharge," even if that means out of the country.

The patients being transferred are typically either severely ill or have been severely injured. Like Delgado, many of them have lived in the United States for years, so transporting them to another country can mean uprooting an entire family. And hospitals, including St. Joseph's, don't track what happens to the patients after they have been evacuated.

"The problem is hospitals can't properly guarantee that the proper level of care will be provided," said Sonal Ambegaokar, the health-policy attorney at the National Immigration Law Center, a public-interest law group in Washington, D.C.

Several recent transfers have drawn intense media attention, especially in the Spanish media, and have put St. Joseph's hospital under scrutiny.


• In December, Jose Abraham Arvizu, an 18-year-old undocumented North High School student and a member of the Junior ROTC, died of a highly curable form of leukemia after St. Joseph's sent him to a hospital in Mexico. One parent of a North student called the boy's death "an absolute community disgrace."


• In May, the family of Sonia del Cid Iscoa, a legal immigrant who has been living in the U.S. for 17 years, went to court to block St. Joseph's from shipping the comatose woman back to her native Honduras. The hospital eventually agreed to allow Iscoa to remain at the hospital, and she later became well enough to go home.


• In June, St. Joseph's arranged to transfer Antonio de Jesus Torres Aguayo, 19, a legal permanent U.S. resident who had suffered a head injury in a rollover accident near Gila Bend, to a hospital in Mexicali, just over the Mexican border from California. But at the border, family members had to call for a Mexican ambulance to meet them, and officials at the hospital in Mexico gave conflicting reports about whether they knew Torres was coming.

Torres was later accepted at a hospital in El Centro, Calif., and a rehabilitation center in San Diego. California is paying his medical bills through an assistance program, according to his father, Jesus Torres of Gila Bend.

"It is outrageous. It's just a total lack of humane treatment for these people," Democratic state Rep. Ben Miranda said of the patient transfers. Miranda's west Phoenix district has many Latino immigrants.


Revising procedures

St. Joseph's officials say they have improved their procedures for transferring patients out of the country and are working more closely with Mexico's consul general in Arizona and other foreign consulates to avoid confusion and ensure that facilities in other countries can provide adequate care.

In the wake of the negative publicity, the hospital also has hired a public-relations firm to help address questions about the transfers and has appointed a panel of Latino leaders to look for possible alternatives.

In the meantime, the transfers continue. Joe Mislove, St. Joseph's senior attorney, said the recent growth in out-of-country transfers is the result of a surge in the Valley's undocumented population and a series of changes, dating back to 1996 federal welfare reforms, that have made it harder for immigrants to qualify for non-emergency Medicaid. The joint state and federal program, which pays for medical care for the poor, is known in Arizona as the Arizona Health Care Cost Containment System, or AHCCCS.

"We do not look for these opportunities," Mislove said. "Hospitals are increasingly seeing this as the only alternative."

The 1996 Welfare Reform Act restricted Medicaid benefits to legal immigrants, requiring them to wait five years after receiving a green card to become eligible. It also closed a loophole that had allowed many undocumented immigrants to receive Medicaid benefits, even though they technically were not eligible, Mislove said. That's because, prior to the law, immigrants had only to sign a paper declaring that they were eligible and to show documents indicating that they resided in the state, Mislove said.

"The focus was on residency vs. immigration status," he said. As a result, "chances were much more likely that you could qualify for benefits if you were undocumented."

In 2001, Arizona voters passed a proposition that expanded AHCCCS benefits to more people. The law absolved counties from having to pay for a medical-care program for indigents that had served as a safety net for immigrants, Mislove said. In 2005, Arizona adopted a federal law that required Medicaid applicants to verify their citizenship, further ensuring that ineligible immigrants did not receive benefits, he said.

Some states, such as California, have created their own programs with state tax dollars to continue providing benefits to immigrants. But Arizona has passed laws that further restrict benefits for immigrants.

Hospital officials say there are other reasons that St. Joseph's is shipping so many immigrants back to their native countries: The hospital receives a high number of severely ill or injured immigrants because of its trauma center. Many immigrants also choose to go to St. Joseph's because they know it is a Catholic-run hospital devoted to charitable care.

St. Joseph's mission statement says the hospital is devoted to "serving and advocating for our sisters and brothers who are poor and disenfranchised."

Last year, the hospital spent about $17 million on charity care for indigents, more than double the amount that it spent two years earlier, according to hospital figures. The 2007 amount represented 2.3 percent of its net patient revenues, which hospital officials said was significant and attributable to the growing number of uninsured.

St. Joseph's declined to provide its financial statements, but its parent company, Catholic Healthcare West of San Francisco, has done well in recent years. From 2005 to 2007, its operating income rose 43 percent, to nearly $300 million.


Bounced around

Fidel Delgado's hospitalization didn't start at St. Joseph's. On June 4, Delgado's sister, Rosa Aguirre, drove him to Maricopa Medical Center, the county public hospital, after Delgado woke up that night with chest pains and trouble breathing. On June 13, the county hospital transported Delgado to St. Joseph's for heart surgery because the county hospital doesn't have a cardiac surgeon, said McBride, who oversees St. Joseph's Missions Services.

The surgery was successful, but Delgado suffered kidney failure and needed dialysis as well as long-term treatment for other problems tied to his diabetes, McBride said.

St. Joseph's contacted Maricopa Medical Center, she said, but the county hospital refused to take Delgado back. So on July 8, a social worker at St. Joseph's called Delgado's wife, Noelia Guillen, in Phoenix and explained the situation. Delgado still needed more treatment, but since he was an undocumented immigrant without insurance, no facility in Arizona was going to take him. The hospital was going to send him to a facility in Mexico, perhaps in Nogales or Hermosillo.

On July 10, Noelia and her husband's sister met with a reporter and said they were afraid that Delgado wouldn't receive adequate care if he was transferred to Mexico and that he would die. Noelia also said she could not travel with her husband because she has epilepsy.

The next day, Noelia received another call from the social worker. St. Joseph's wasn't going to send Delgado back to Mexico after all. Instead, he was going back to Maricopa Medical Center.

Delgado's family was relieved. McBride said the hospital's decision not to send Delgado to Mexico had nothing to do with the interview Delgado's relatives had with the reporter. She said the patient was transferred to the county hospital only after officials there called and said they were willing to take Delgado back.

Warren Whitney, a spokesman for Maricopa Medical Center, said Delgado's condition had improved enough for the hospital to take him back.

"We'll continue to provide the care for him as long as he needs it," Whitney said.

At some point, he said, the hospital hopes to place him in a home setting.


La Voz reporter Angel Larreal contributed to this article. Reach the reporter at daniel .gonzalez@arizonarepublic.com or 602-444-8312.



http://www.azcentral.com/news/articles/ ... s0803.html

"The problem is hospitals can't properly guarantee that the proper level of care will be provided," said Sonal Ambegaokar, the health-policy attorney at the National Immigration Law Center, a public-interest law group in Washington, D.C.

Well the same "problem" exists when transferring a patient from one American facility to another. It's not hospital A's problem to worry about whether hospital B will provide a proper level of care.

It's a simple problem to solve...stop all tax dollars and monies used to finance health care and medical assistance for illegals....and let illegals know that they are not going to get any health care and/or any benefits here...and if they chose to come here they suffer the conseuences...

We must focus on caring for our own legal citizens. It is no wonder that hospitols are closing and/or turning people away...they are not profiting...they are in the red thanks to the stupid system that forces hospitols to tend to illegals and their ever growing extended familes...

Hearing that hospital are doing this is such pleasant news. I've heard stories of medical crews doing transfers of Mexican national trauma victims at the Mexican - US border and bringing the victim up to a Tucson Hospital. This is so wrong. They should find a facility within their own country as the likely outcome of bringing them to a Tucson hospital is that the hospital will get stuck with the bill. It also seems that more and more are seeking legal injunctions to prohibit the transfer from the US to Mexico. Are they paying off the judges, but no paying the hospitals?

• In December, Jose Abraham Arvizu, an 18-year-old undocumented North High School student and a member of the Junior ROTC, died of a highly curable form of leukemia after St. Joseph's sent him to a hospital in Mexico. One parent of a North student called the boy's death "an absolute community disgrace." SOB - oh well...

Immigrant advocates fear that other hospitals around the country will follow St. Joseph's lead as a way of dealing with the most vulnerable of the nation's 46 million people who lack health insurance. About 1.1 million people in Arizona are uninsured.

I hope the other hospitals accross the country follow suit. Americans are mad as hell that WE have to pay for illegal aliens hospital bills!

WE are not going to pay for you to receive insurance benefits!

When members of Delgado's family were told that he might be sent to Mexico, they were shocked. His wife is a U.S. citizen, and all of his close relatives live in Arizona.

His wife and family KNEW what the consequences would be if he was caught in the U.S. illegally.

"It is outrageous. It's just a total lack of humane treatment for these people," Democratic state Rep. Ben Miranda said of the patient transfers. Miranda's west Phoenix district has many Latino immigrants.

Rep Miranda of all people SHOULD KNOW BETTER! Americans end up paying the bills for illegal imigrants care. VOTE THE GUY OUT OF OFFICE.

Delgado, 64, hasn't lived in his native country for more than 40 years

Please tell me why he did not take the amnesty of 1986? No excuse to still be illegal alien.

• In December, Jose Abraham Arvizu, an 18-year-old undocumented North High School student and a member of the Junior ROTC, died of a highly curable form of leukemia after St. Joseph's sent him to a hospital in Mexico. One parent of a North student called the boy's death "an absolute community disgrace."

He was a citizen of Mexico, not our problem. Demand that Mexican hospitals get their crap together!

• In May, the family of Sonia del Cid Iscoa, a legal immigrant who has been living in the U.S. for 17 years, went to court to block St. Joseph's from shipping the comatose woman back to her native Honduras. The hospital eventually agreed to allow Iscoa to remain at the hospital, and she later became well enough to go home.

As a legal immigrant, why didn't she have her own health insurance? Again, NOT our problem! I believe she went into coma after delivering her SEVENTH child. Here's a hint -STOP HAVING KIDS!


• In June, St. Joseph's arranged to transfer Antonio de Jesus Torres Aguayo, 19, a legal permanent U.S. resident who had suffered a head injury in a rollover accident near Gila Bend, to a hospital in Mexicali, just over the Mexican border from California. But at the border, family members had to call for a Mexican ambulance to meet them, and officials at the hospital in Mexico gave conflicting reports about whether they knew Torres was coming.

As a LEGAL permanent resident, why didn't he have insurance?

Seems all theses stories lead me to believe that legal immigrants think they don't have to pay for health insurance, that it's ok to abuse the ER's? NOT OUR PROBLEM! Pay for your insurance and you will be covered, if not too bad so sad.

As or illegal aliens? There's NO excuse for them getting ANY care beyond stabilizing an emergency situation and deportation.

I have pesonally witnessed 6 hospitals in California that had to shut down to get rid of their indigent illegal alien patients that had filled all the beds and were'nt paying a dime for their care. The question this raises is how many hospitals are experiencing this NATIONWIDE ? How many MILLIONS of Americans will be shortchanged in medical care and higher costs so that the illegals and the businesses that hire them can benefit ? How is it that NO ONE has raised a question about the draining of Medicale and Medicare to pay for these parasites ?
Unfortunately both of our glorious presidential candidates consider this to be a non - issue !

After they have been stabilized, there is nothing wrong with sending an illegal alien back to his or her home country for expensive follow up care -- whether they have been breaking our laws for one week or 40 years.

The reporter is trying to make a story out of something that is not, or should not, be a story.

The real story here is the cost to American taxpayers, and the closing of American ERs and hospitals, due to the tremendous cost burden of caring for illegal foreign citizens.