On Aug. 3, a lengthy New York Times story detailed extraordinary deportations carried out by hospitals across the United States.
In a quiet but apparently common practice, these facilities are returning undocumented immigrants to their own countries, often without the immigrants' consent. Critics call it international patient-dumping that occurs beyond the oversight of federal agencies, such as U.S. Immigration and Customs Enforcement.
But the government is beginning to take notice: a Florida state appeals court has ruled that only the federal government has the power to remove a person from this country.
The Times story mentioned at least two Arizona hospitals that participate in these back-channel deportations, including St. Joseph's in Phoenix, and Tucson's University Medical Center. Among other facilities that repatriate undocumented immigrants is Tucson Medical Center. Officials from the Carondelet Health Network--which includes St. Mary's and St. Joseph's hospitals in Tucson--say Carondelet does not deport patients to Mexico or other countries.
TMC spokesman Michael Letson confirmed that his hospital returns people to their home communities, but only with their consent and participation. "We have for many years had a program in place where, if a person is interested in repatriation, we work with them to do that," he says. But the patient's desire to return home "is really the driving force--parental consent and our interest in having them back home if there are medically suitable facilities in their home place. So we work with them and with the consulate."
If somebody doesn't want to go back home, "then they won't go back," he says. "This is not intended to be a (compulsory) program."
Though local hospitals argue that all repatriations are voluntary, it's not clear that consent is always given. Given the growing controversy surrounding these cases, UMC attorney Jim Richardson says his hospital will start seeking a judge's approval before transferring international patients. However, he won't confirm whether all past transfers were consensual.
"Almost all of the time, we discuss this with patients, and it works out fine, because they want to go home," Richardson says. "Sometimes it doesn't, and that's where we run into difficult situations. We handle those on a case-by-case basis."
In fairness, such cases are also a no-win proposition for hospitals. The cost of treating uninsured immigrants can easily top $2,000 a day, and border-area hospitals in particular spend millions of dollars annually providing such care.
While these hospitals are required to handle emergency cases--and can receive emergency Medicaid funds for treating illegal immigrants--there is no federal assistance for the immigrants' long-term care. Still, facilities that receive any Medicare funds are required to procure adequate follow-up care for those patients.
There's something distinctly distasteful, however, about shipping catastrophically ill or injured patents to inevitably subpar facilities in Third World countries. And incidents such as those reported in The New York Times can become a public-relations nightmare; consider St. Joseph's in Phoenix, which sparked a firestorm by attempting to deport a comatose Honduran woman.
Likewise, the Times story mentioned a case where UMC attempted to deport a baby to Mexico. It remains unclear whether the hospital had obtained the parents' consent, and to whom the baby, a U.S. citizen, would be sent. Only with a lawyer's intervention at the airport was the flight stopped.
The same article referred to a young Guatemalan woman who suffered a crushed pelvis in an auto accident; UMC succeeded in dispatching her back to that country's threadbare National Hospital for Orthopedics and Rehabilitation.
Meanwhile, these deportations are occurring in a legal twilight, with little or no governmental oversight. That troubles people like Mac Nayeri, a Phoenix immigration attorney who last spring assisted in the Honduran woman's case. (The woman was proven to be in the U.S. legally.)
Nayeri says the case opened his eyes to the hushed frequency of such deportations. "I'm an immigration lawyer, and even I had never heard of such a thing. I think it's happening quite a lot under the radar, and it sounds very devious and un-American--it just doesn't comport with the principles of our country."
Nor does he consider it legal. But short of a definitive case ruling, Nayeri says that lawyers fight back by whatever means they can. For example, attorneys routinely contact authorities in Mexico, alerting them that someone is being brought across the border involuntarily. "Really, this almost becomes a kidnapping," he says.
But others contend that hospitals go to great legal lengths to ensure their patients' well-being. Among them is Barbara Swanson-Felix, UMC's longtime international outreach coordinator. She says the UMC program began years ago as a means to provide care for premature or ill babies born at inadequate, border-area Mexican hospitals. Once those infants were stabilized, UMC began returning them to their home communities, and the practice grew to include patients of all ages.
Today, the hospital repatriates an average of two to three patients a month, says Swanson-Felix. But she denies that those removals are driven by the bottom line. She says the hospital writes off about $6 million annually in uncompensated care for undocumented immigrants. In addition, UMC has provided both equipment and extensive training for medical facilities in Mexico. "So we feel very comfortable sending people to hospitals that we know--where we know the doctors and know exactly what's going on. When we go further afield, of course, we do depend upon the consulates. After all, they are the legal representatives of (the immigrants) while they're in this country."
Regardless, UMC doesn't forcibly return patients to their homelands, she says. "We've never had a situation where we have physically taken anybody down. We've had people that aren't happy about it, but once they realize that this is the way it is, they agree to go.
"Our interest is that the individual get the care they need, and we try to find that for them."