A 2021 report prepared by the Free Migration Project and University of Pennsylvania Law Students entitled “Fatal Flights: Medical Deportation in the U.S.” is eye-opening and shocking.
Usually, when one hears the frightening word “deportation”, one thinks of governmental action, officials dragging people from their homes and sending them out of the country. With medical deportation though, it is a hospital taking the action when faced with an often undocumented and usually uninsured immigrant patient that the hospital does not want to treat.
The report contains citations for all cases referred to in this blog.
According to the report, medical deportation is the physical removal by a non-government entity of an immigrant patient who is critically injured or ill from one country to another without the informed consent of the patient or the patient’s authorized caregiver. This practice is usually not in the patient’s best medical interests and typically results in poorer health outcomes or even death for the removed patient. Hospitals disguise the practice as medical repatriation—when a patient who is traveling or working abroad wants to return to their home country to receive medical care. But this is not medical repatriation. Medical deportations happen all across the U.S. but are rarely reported. To carry out medical deportations, hospitals hire medical transport companies to fly patients to their countries of citizenship. Just one flight can cost as much as $50,000. These deportations typically happen without any involvement by immigration courts or the Department of Homeland Security. Once undocumented immigrants leave the U.S., it may be difficult or impossible to return.
Medical Deportation occurs in the shadows. Hospitals are not subject to reporting requirements and because of their precarious situation, undocumented patients and their families are leery about asking for outside help or resisting a medical “recommendation”. Thus, data is scant.
In December 2012, the Center for Social Justice at Seton Hall Law School and the Health Justice Program at New York Lawyers for the Public Interest documented more than 800 cases of attempted or medical deportations in just six years. The identified cases included deportations from hospitals in fifteen states—Arizona, California, Florida, Georgia, Illinois, Maryland, Michigan, Nebraska, Nevada, New Jersey, New York, North Carolina, Ohio, Tennessee, and Texas—to El Salvador, Guatemala, Honduras, Lithuania, Mexico, the Philippines and South Korea.
As an example of these cases, in 2011, a hospital in Chicago deported a young Mexican laborer in his twenties who fell from a roof and became quadriplegic, without his consent. The hospital in Mexico where he was sent couldn’t afford new filters for his ventilator and would simply clean them daily. The man died just over a year after he was flown from the United States.
In 2016, NPR reported on an undocumented and uninsured man who had suffered a stroke and required months of intensive therapy. After three months of therapy, the hospital described facing “a real financial burden” in continuing to care for the patient, and rehabilitation facilities refused to admit him. A doctor involved in this case described the hospital’s choice as follows:
From the hospital’s point of view, it was easy to see that this large one-time expense [to fly the patient by air ambulance out of the country] would be worthwhile. The transfer to Mexico would put a stop to the indefinite, uncompensated costs of continued hospitalization. Further, the transfer would open up the patient’s bed to a new (and presumably insured) patient.[i]
In 2020, Jefferson Torresdale Hospital attempted to deport a member of the Philadelphia community identified as A.V, after he suffered catastrophic brain injuries from a motorcycle accident. This attempt was fortunately unsuccessful due to the advocacy spearheaded by family.
The report states that medical deportation is an issue that sits at the intersection of healthcare and immigration policy. There is an omission here. Medical deportation is an issue that sits at the intersection of healthcare, disability and immigration policy. The cases mentioned in the report all involve people who will probably have long-term disabilities. A hospital has no incentive to incur the expense of medical transportation for “one and done” patients, patients who can be quickly treated and who then will cause no further issues.
The flaw in the otherwise insightful report is the lack of explicit awareness of the disability dimension to all this. For example, the report calls for effective discharge planning without recognizing this means more social commitment to in-home support and outpatient services. It mentions the need for language interpreters so the patient will understand what he is being asked to agree to, but ignores a possible need for bilingual sign language interpreter. Significantly, while the report states that more research is needed to determine if international human rights laws could be used to stop medical deportation, it overlooks the possibility that state and federal civil rights protections for people with disabilities could be relevant. (NOTE: I have not studied this issue).
Nonetheless, the report has done a tremendous service in bringing attention to the reprehensible practice of medical deportation. Its recommendations include universal access to healthcare and expanding the breadth of emergency Medicaid in the interim, regulatory efforts to end these deportations and stepped up advocacy.
The Free Migration Project is working on a National Directory of advocates who are available for patients and fellow advocates dealing with the issue of medical deportation. Instructions on how to join is given in the report. This is an emerging issue.
Endnote:
[i] Fatal Flights: Medical Deportation In the U.S., page 4; And see, John Henning Schumann, When the Cost of Care Triggers a Medical Deportation, NPR (Apr. 9, 2016, 7:00 AM), https://www.npr.org/sections/health-shots/2016/04/09/473358504/when-the-cost-of-care-triggers-a-medical-deportation