Immigrants’ Hospital Care Forces Tough Choices

A 42-year-old Chinese man was taken to Yale-New Haven Hospital after suffering a heart attack and a massive stroke at Foxwoods Resort Casino in February 2004. Doctors, therapists and a nearly ‘round-the-clock translator helped him improve. He was soon ready to leave the hospital.

Most patients on the road to recovery would do a short stint in a rehabilitation facility and then head home, perhaps with help from visiting nurses and other professionals.

But the man was an undocumented immigrant who didn’t qualify for federal Medicaid or Medicare to pay for post-hospital care. Hospitals are required to keep patients until they can be discharged to a medically safe situation. Most private nursing homes won’t take such charity cases.

Two months and about a half-million dollars in care later, Yale-New Haven officials spent about $50,000 flying the man and a medical escort back to his home in Tianjin, China’s third-largest city. His wife, who was already caring for her aging parents, eagerly welcomed her husband home and agreed to get him the local follow-up care he required.

“Logistically, that was the only alternative we could come up with,” said William Gedge, senior vice president of Yale-New Haven Hospital.

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Bianchi said that St. Vincent’s has tried to send patients back to their home countries, but sometimes finds that the country will not take them back or will not promise to provide needed care, “which means we would be sending them into a situation where they could die,” he said. “This is something we cannot and would not do.”

A woman from Nigeria who needs a bone marrow transplant is currently hospitalized at Yale-New Haven. She will need ongoing immunosuppressive drug therapy, which she can’t afford and which may not be available to her in Nigeria. A man from Ghana who has serious intestinal illness is likely to die in a month without daily, intravenous nutrition, which could give him six to seven years more. But he may not be able to get this in Ghana. Gedge said that Yale-New Haven officials are working on solutions for both patients.

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Fowler said that each year Hartford Hospital typically has a dozen or so tough cases involving undocumented immigrants, costing the hospital several million dollars. The Hospital of St. Raphael in New Haven reports five to eight cases. St. Vincent’s Medical Center estimates five to eight a year.

Dr. Matthew Miller, chief medical officer and vice president of medical affairs at Danbury Hospital, observes that it is a national issue. “Obviously it’s less of a problem in Connecticut than it is in the border states,” he said.

A study done for the U.S./Mexico Border Counties Coalition, a policy forum established by 24 U.S. counties along the Mexican border, showed that border hospitals in the Southwest alone spent $190 million in 2000 on care for illegal immigrants — about a quarter of the hospitals’ total uncompensated care. In Connecticut, a smaller fraction of uncompensated care goes to treat undocumented immigrants, according to local hospital administrators, but some believe that fraction is growing.

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The lack of adequate reimbursement means that hospital care for undocumented immigrants “is essentially an unfunded mandate at this time,” said Kim Hostetler, vice president for administration and communications at the Connecticut Hospital Association.

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