In April 2003, Leo came to the United States from Liberia. He landed at JFK International Airport in New York and when walking through Customs & Border Protection (CBP), his passport was stamped, with a notation that he may only visit the United States and must leave before the end of October 2003.
October quickly approached. Leo was driven by his cousin to the airport on the day Leo was required to depart. On the way to the airport, Leo’s cousin drove through a red light and their car was sent into the air after a tractor-trailer hit the passenger side of the cousin’s car.
While emergency response teams were able to stabilize Leo, he required nearly one-million dollars in surgeries, rehabilitation, medication, and long-term care.
Leo was now an undocumented patient on a visa overstay. He did not have international travelers insurance or health, auto, or catastrophic care coverage. He had already incurred $200,000 in provided medical services. Leo’s cousin only had the state minimum medical coverages under his auto insurance policy which meant that the hospital’s only possible recovery was $15,000.
The hospital was faced with a conundrum: continue to treat Leo at a loss or charter a plane for $20,000 and send (“medically repatriate”) him back to Liberia knowing that Leo may not survive due to shortcomings of the Liberian medical system (even though he has been stabilized).
Medical repatriation is “the transfer of undocumented patients in need of chronic care to their country of origin.” The transfer of stabilized, undocumented civilians is unregulated. And, often, patients have not given their consent. Decisions are made by insurance companies, doctors, hospital financial offices, and administrators. The decisions often lack transparency with the patient and family not privy to the discussion.
It is well-established that hospitals in the United States have a legal mandate to provide emergency care regardless of the patient’s immigration status. Federal Medicare programs reimburse the hospital for minimal emergency care treatment. Reimbursements stop at emergency care. Therefore, other services such as long-term care, hospice, rehabilitation, extended hospital stays, non-emergency procedures, and surgeries will not be covered.
In response, healthcare facilities have increasingly “medically repatriated” patients. The facility hires a charter plane and flies the patient home. Yes, it really is that easy. One report is of a young man who was in coma after a terrible car accident and was taken to a local, U.S. hospital. A week later, the patient awoke from coma in a Venezuelan state hospital with no one around him. The patient died three days after he awoke.
Medical repatriations pose significant risks to both the healthcare facility and the patient. For the patient, repatriation to a country that lacks adequate healthcare infrastructure could very well lead to the patient’s death. Also, the patient will suffer collateral immigration consequences, although unintended. For undocumented individuals, like Leo, the repatriation may very well amount to deportation, which has severe and often permanent consequences including inability to ever reenter the United States, forced separation from family, loss of employment, and more. A lawful permanent resident may be barred from establishing necessary continuous residence in the United States for purposes of naturalization, or if the absence from the United States exceeds a certain duration, the permanent residency may be deemed abandoned.
For the healthcare facility, medical repatriations can open the door to years of litigation, including federal Section 1983 claims against private and public facilities, due process violation issues, civil false imprisonment allegations, and breach of the Federal Discharge requirements.
Given the current financial climate and the minimal federal assistance for providing the legally-mandated emergency services, healthcare facilities should not shy from considering medical repatriations. It is crucial, however, that the process must proceed with great care to limit potential liability and the public scrutiny. Decisions should not fall solely only on administrators and doctors; rather, competent legal representation throughout the process is a must.