Undocumented Patients Wary of Offers to Return to Home Countries

Madison Park, CNN, September 30, 2009

Going back to Mexico is not an option, said the 43-year-old man, kneeling next to his wife’s wheelchair.

His wife, 45, lost her eyesight to diabetes. She also has high blood pressure. And her kidneys are failing.

For years, he has taken her to a dialysis clinic attached to a public hospital in Atlanta, Georgia. The facility that gave her free care plans to close Saturday.

They are illegal immigrants with no health insurance and, they say they have nowhere to go for his wife’s vast medical needs. The closing clinic offered to help return them to Mexico.

The Atlanta clinic is the latest known case of a medical institution that’s offering to send illegal immigrants who can’t afford treatment back to their native countries–a practice that critics liken to patient dumping.

Returning to the country of origin is completely voluntary, said Matt Gove, a spokesman for Atlanta’s Grady Memorial Hospital. {snip}

‘Latino in America’

{snip}

Hospitals have offered medical transfers to foreign countries, but there are no nationwide data tracking the practice. It’s unclear how many undocumented patients have returned and whether the repatriations are voluntary.

{snip}

Medical repatriations are happening because hospitals bear the financial burden for uncompensated care, said one expert.

“When they have a large volume of uncompensated care or people who aren’t able to pay their bills, and they have limited resources coming in from the government and from insurers, they have to do the best they can,” said Carla Luggiero, a senior associate director of federal relations for the American Hospital Association.

Some question who should be responsible for the medical care of illegal immigrants.

“There is no reason why the U.S. taxpayers should have to pick up the tab- when the person is a citizen of another country–it ought to be the responsibility of that government,” said Ira Mehlman, a spokesman for Federation for American Immigration Reform or FAIR, a group that favors strict limits on immigration.

{snip}

“In Mexico, dialysis does not guarantee life like it does here,” G.L. [an otherwise unidentified illegal] said. “Maybe they live one year. Here, people can last up to 10 years or more. . .&nbsp. To go back to Mexico would be a death sentence.”

{snip}

A judge ruled last week that Grady could close this week, rejecting a legal request by 36 patients who sought to keep the clinic open until they could find permanent treatment elsewhere. The hospital agreed to pay for three more months of dialysis at a different clinic, according to a court document.

{snip}

By federal law, hospitals must treat emergency patients regardless of citizenship or ability to pay. But emergency care is more expensive than regular care. Dialysis is a lifelong treatment and the only alternative is a transplant.

Financial challenges

Grady’s dialysis clinic provides care to the poor and uninsured regardless of citizenship.

Crippled by the economy and growing financial pressures, the public hospital, which served about 724,000 patients last year, has a $33 million deficit. Its dialysis clinic has a $2 million deficit and needs another $2 million to upgrade its equipment, said Grady’s attorney, Bernard Taylor. More than half of its 96 patients were illegal immigrants

{snip}

Patients said the clinic gave them three options: Use emergency rooms, move to another state or leave the country.

Paul Root Wolpe, director of Emory University’s Center for Ethics, said that when it comes to repatriating patients, the choices are not always black and white.

“To have an illegal immigrant sent home to their death where they don’t have access to proper care is ethically indefensible,” he said. “Assuming they can get proper care, it’s no different than sending anyone home if they are in a country illegally. The gray area has to do with sending someone home to significantly inferior care.”

{snip}

A Grady spokesman declined to say how many of its dialysis patients returned to their countries. At least six patients returned to Mexico, and one is in the process, according to the Mexican consul in Atlanta.

Sonal Ambegaokar, a health policy attorney at the National Immigration Law Center, which protects the rights of low income immigrants, expects medical deportations to increase as long as health care problems remain unresolved. {snip}

{snip}

[Editor’s Note: More information about the closing of Grady Memorial’s dialysis services can be read here.]

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