I am afraid,” says Roman Cabrera, lying tilted up in a hospital bed at the Medical Center of the Rockies in Loveland, his neck swallowed in braces. “I am very scared they will send me to Mexico. I don’t want to go. There are no services there.”
If Cabrera were a U.S. citizen it would be about time that the Loveland hospital, which saved his life following a catastrophic car crash in December, would transfer him to a nursing home or long-term care facility. After one month of care, the now-stabilized Cabrera, who used to love to dance, is paralyzed from the neck down, tied to a ventilator and will need daily medical attention for the rest of his life. But Cabrera came to the U.S. from Mexico illegally, and unlike a U.S. citizen he does not qualify for any public benefits. Without health insurance or money to pay thousands of dollars up front, no domestic long-term care facility is likely to accept him as a patient.
So what would normally be a routine discharge from the acute-care hospital to a long-term care facility has turned into a debacle at the crosshairs of two of the most controversial systems in this country — health care and immigration. The uncertainty of what will happen to Cabrera and where he will be transferred in the next few weeks has left him and his family despondent.
The ventilator that keeps Cabrera alive hisses in the background now and again, and though he can’t audibly speak, he mouths Spanish words his family reads off his lips. When they struggle to understand, his younger brother Diego pulls out a tablet with the alphabet and patiently sounds out each letter.
“Ah. Beh. Ceh…” When he hits the right letter Cabrera clicks his tongue. Ktch. Diego starts over to find the next letter. “Ah. Beh. Ceh…” until Cabrera clicks again — ktch — painfully slowly communicating his fear that the hospital will deport him to Mexico.
“They told me I only have one week to know where to go [to another facility in the U.S.] or they will send me to Mexico,” Cabrera says. “That’s why I am scared. And I want to get better. My son is here.”
Cabrera’s seven-year-old son is not a U.S. citizen, he came to the U.S. as a one-year-old because his father was “just trying to be somebody, to have a life and good things for his family,” says his cousin Jessica Rodriguez. Cabrera crossed the border illegally with his now ex-wife and their baby.
While U.S. hospitals are required to admit any patient in need of emergency care, their obligation and financial reimbursement for an uninsured patient ends when the patient is stabilized. Typically, patients in Cabrera’s condition would be moved to long-term care facilities as soon as they were in a stable condition. But unlike hospitals, rehabilitation centers and nursing homes are under no federal mandate to accept uninsured patients. So they take advantage of the opportunity to refuse.
“If you send him to Mexico he will die,” Rodriguez says. “No ands, if or buts about it. I know how hospitals work in Mexico. There are no regulations like here. They are not going to give him the same care, especially if we don’t have money for a private hospital.”
Known as medical repatriation, the international transfer of undocumented patients like Cabrera is quietly practiced by U.S. hospitals nationwide. Hundreds if not thousands of immigrants have been shipped back mostly to Mexico, Central and South America, oftentimes to grossly inadequate medical care that leaves patients debilitated or dead. All this happens without the involvement of any branch of the federal government, including immigration.
In fact, no federal agency oversees the practice and hospitals are not required to report or track medical deportations, making it impossible to know the number of patients that have been medically deported and leaving room for mistakes and corruption that only a small number of journalists and immigrant advocates have documented: one hospital attempted to repatriate a two-day-old U.S. citizen born to immigrant parents; a Phoenix hospital attempted to repatriate a legal immigrant mother of seven U.S.-born children back to Honduras; a Florida hospital repatriated a Guatemalan national with severe head trauma to a rehabilitation facility that operated on a $400,000 annual budget — the Guatemalan hospital kept the patient for two weeks before discharging him to his elderly mother’s home (because they “needed the bed”), where he received no medical treatment for years and suffered violent seizures, vomited blood and frequently fell unconscious, according to a 2008 New York Times report.
“This is the result of having a health care system based on free market values,” says Longmont Immigration Attorney Ian McKinley. “I wish health care reform would have instituted socialized medicine so everyone would have access to health care. But in order to change that you’d have to go back and re-pass health care reform and obviously that’s not going to happen. Look at the fight in this country just over the changes that were made. It’s the health care system that is to blame here because it allows hospitals to treat people based on whether or not they can pay.”
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After receiving word of her son’s accident, Cabrera’s mother, Gabriela, came to the U.S. in December on a humanitarian visa. Gabriela worries that because she has no money, Cabrera will be worse off in Mexico.
“In Mexico right now it’s really rough,” she says through an interpreter. “There is nothing really. I am a single mom. I don’t have a husband. So right now I am having it rough. In Mexico there is no work, no money.”
She previously worked in a factory cleaning and packing potatoes, or did cleaning jobs, but says she has been unemployed for the last six months. She says that causes her to worry that she will not be able to pay for the care that Cabrera will need in Mexico, the care that she worries he will only be able to get at a costly private hospital.
According to his family, the Medical Center of the Rockies has said they will transfer Cabrera to a Mexican facility with or without his consent.
Boulder Weekly contacted Medical Center of the Rockies, but spokesperson Kelly Tracer said the hospital had no comment.
A spokesperson for the larger University of Colorado Health system also said it could not comment, citing patient privacy. Even commenting on the practice of medical repatriation in Colorado might breach patient privacy, said Dan Weaver, the UC Health media relations director.
Gabriela says the pressure the hospital is putting on her to find a solution makes her anxious.
“I feel like they are pressing me to make a decision,” she says. “In yesterday’s meeting [ Jan. 14] they said, ‘You have got to find somewhere to put him or he is going to Mexico.’ He [Cabrera] gets really anxious, really nervous. Doctors tell me they have done all they can for him, that he is always going to be on a respirator, obviously, but doesn’t need to be in hospital, that I need to find somewhere to put him. If not, then [going to Mexico] is the consequence. They have not told me to reach out to this person or that person for help. It’s just either I figure it out or else.”
In response to newspaper reports on medical deportation, the American Medical Association Council on Ethical and Judicial Affairs released a statement in 2009 advising hospitals not to repatriate without the patient’s or guardian’s consent.
“Assist a patient who is unwilling to accept the discharge plan to seek independent ethics consultation or other means of resolving ongoing disagreement,” the statement advised. “And refrain from signing a discharge order that would result in an involuntary discharge of a patient who is not a U.S. citizen.”
Colorado Hospital Association spokesman Kevin Downey says that while such a statement is admirable, it might not be enforceable or applicable to all hospital systems.
“That recommendation comes from a well-intended place, but what are hospitals supposed to do then?” he asks. “Are they supposed to continue to care for a patient that has exorbitant costs and no one there to pay for it when there are patients lining up who need that bed? This is not a problem that can be solved by hospitals engaging differently. This particular group was left out of the Affordable Care Act, and that’s virtually the only group not protected in the ACA. This is a public policy and social issue that was not addressed and it’s beyond the sole ability of hospitals to solve. There needs to be enough parties coming together so patients can have all of their other options exhausted before they are asked to get up and move to their country of origin. Obviously, there seems to be incredible roles for states and incredible roles for the federal government as relates to this. It would be wonderful if there were other ways to get this sorted out without hospitals having to do it trial by fire.”
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A Chicago hospital that deported a Mexican national in 2011 came under fire after the patient, Quelino Ojeda Jimenez, was transferred to a Mexican hospital where he died in 2012 after he suffered cardiac arrest, developed bedsores, septic infection and ultimately died of pneumonia and other complications. According to the Chicago Tribune, advocates for Ojeda said they believed he might not have died had he remained in the U.S. and the Tribune called the hospital to which he was transferred “ill-equipped to handle his needs.”
The lack of oversight of these types of international transfers is unsettling, McKinley says.
“Some federal entity should be overseeing this,” he says.
The problem is not particular to any one hospital, it’s systemic. How can it be possible that a hospital should be required to admit everyone, stabilize them, but then nursing homes aren’t under the same statute and can simply refuse patients who can’t pay, leaving hospitals with a patient they cannot discharge and for whose care they are not reimbursed?
“There’s a relatively easy solution to this,” says Joseph Ramos a medical doctor and a Denver-based attorney. “That is for the federal government to say, ‘Look, just like we provide funding through Medicaid for emergency care to hospitals for people who don’t have health insurance or don’t have money, we’re also going to provide for the ongoing care after that emergency treatment.’ That would probably put an end to this.”
But is that likely to happen?
Downey doesn’t think so.
“Just judging by the political landscape nationally, there doesn’t seem to be much of an appetite politically to do what is necessary for this [immigrant] population it terms of offering them protection and things like that,” Downey says. “There needs to be a national conversation and until that happens, hospitals are being forced to make these unique decisions based on the information they have at the time.”
So far, legal repercussions for medically deporting patients against their will is mostly untouched territory. Medical repatriation circumvents the deportation process entirely.
Most patients facing these situations are poor, and once they are sent back to their native country the likelihood for them to pursue legal action is minuscule.
“That’s why hospitals can get away with this,” McKinley says. “It’s a legal gray area.”
Legal action in Cabrera’s case, McKinley says, is unlikely. He doesn’t have U.S.-born children, he hasn’t been in the U.S. that long and according to the police report he was driving under the influence of alcohol and sustained a single-car accident when he ran into a tree fleeing the police.
Marta Moreno is the executive director of El Comité de Longmont, an immigrant advocate organization, and says she hopes that Medical Center of the Rockies is recommending Cabrera be sent to Mexico truly because they exhausted all other options and because it will be best for him, not just to save money. She says the anti-immigrant will argue Cabrera was here illegally and illegal immigrants don’t pay taxes and don’t deserve public benefits, but she asserts that is a false assumption.
“We have an immigrant population that has contributed a lot, and they pay a lot of taxes and they don’t get that back,” she says.
According to a 2013 study published in Health Affairs journal, immigrants contribute billions to Medicare because employers give them fake social security numbers, but they rarely see any of the benefits. Between 2002 and 2009, immigrants contributed $115 billion more to the Medicare program than they drew out. Meanwhile, U.S. citizens draw more from the Medicare program than they contribute — running a deficit of $30.9 billion.
McKinley says that even though Cabrera’s case makes it extremely difficult to pursue legal action, it makes him sick to think the health care system here can just cut him off.
“If I could have it my way we would be a society that recognized some people are going to fall into extremely bad situations and we’ll be there to help out,” he says. “But that’s obviously not the country we live in. Nobody is going to help him here.”
Rodriguez, Cabrera’s cousin, is a U.S. citizen and says she is disappointed in her country.
“The doctor who talked to us yesterday said they checked with Craig Hospital in Denver [to see if he could be transferred there] and they basically said, ‘No money, no service,’” she says. “I told him this is so unfair because if you’re an immigrant or non-status person with no insurance and no money then that means you have no right to any therapy? And he basically said that’s what it boils down to. He was straightforward, like it is what it is. I am very disillusioned with my own country. I thought this country would always say it is all about family, and I don’t see how they could be so… just raw and rude and say, ‘If you don’t have money and you’re not from here, well then it sucks for you.’”
* The names of some sources in this article were changed upon request to protect their identity.