Illegal Immigrants

NY-area hospitals see increased number of uninsured immigrants

Anne Zieger — Mon, 13 Oct 2008 12:50:34 -0400

Hospitals in the New York area are seeing an increased number of uninsured or underinsured immigrants, a trend that is proving to be an enormous financial burden. For example, the 29 hospitals in the Connecticut Hospital Association are estimated to have spent $93.3 million in 2006 on uncompensated care. This is compared to the $78 million spent on uncompensated care in 2002.

Given their situation, it's little surprise that immigrants are showing up at hospital emergency departments. For one thing, many immigrants find that there is a shortage of specialists willing to see them, or any other low-income patients for that matter. Meanwhile, for illegal immigrants, Medicaid will cover emergency care, but virtually no other services.

Under these circumstances, hospitals often provide services knowing that they may have to absorb the costs themselves if they are not covered. One particular hospital, Greenwich Hospital, estimates that it loses between $8 million and $10 million per year because of charity care, or uncompensated medical care.

To learn more about this problem:
-read this New York Times piece

Judge orders disclosure of immigrant medical records in criminal case

Anne Zieger — Wed, 20 Aug 2008 15:17:53 -0400

As medical professionals, many FierceHealthcare readers struggle hard to make sure the privacy of medical records are protected. However, providers can be forced to share medical records if a judge orders them to be disclosed. That's what happened recently in North Carolina, where a judge ordered a public health provider to turn over a patient's medical records in a criminal proceeding against library worker Marxavi Angel Martinez.

Martinez, who was brought to North Carolina by her parents as a toddler, faces federal felony charges for using the Social Security number of a dead person. As part of a State Bureau of Investigation inquiry, a judge required Alamance County Health Director Barry Bass to turn over medical records on five patients, including those of Martinez. Legal observers in the community say they're aware of civil matters in which the court has ordered medical record disclosure, but believe that demanding them in a criminal investigation is a first.

Public health departments, meanwhile, argue that this case has set a precedent that could scare illegal immigrants away. If this happens, officials say, infectious diseases could rise dramatically among this population, infant mortality could shoot up, and emergency costs could rise. Early intervention in public health settings is the key to controlling these public health threats, they say.

To learn more about this decision:
- read this News & Observer report

Related Articles:
Debate continues on illegal immigrant health costs
Trend: Hospitals deporting uninsured immigrants

U of IL hospital sending back Mexican immigrant

Anne Zieger — Wed, 20 Aug 2008 12:05:22 -0400

Recently, we ran an article which stirred up some serious discussion on the subject of how to pay for the care of undocumented, medically-indigent immigrants, and how to handle things when a provider feels they can no longer foot the bill. The article detailed the practice, engaged in by some U.S. hospitals, of sending uninsured immigrants with costly, long-term medical needs back to their home countries--sometimes without the immigrant's permission.

Now, an Illinois case has come up which brings this practice into the spotlight. In this case, the University of Illinois Medical Center at Chicago is planning to return a 30-year-old Mexican man in a coma back to his home country over the objects of two of his family members. Francisco Pantaleon, who suffered a severe brain hemorrhage in mid-July, has lived in the U.S. for 11 years and has two children. After treating him for a while, UIMC plans to transfer Pantaleon to a hospital in Acapulco at its own expense. Though the facility has the consent of his immediate family to transfer the comatose man, his sister and cousin have hired lawyers to stop the transfer, saying that he won't survive the trip, or that if he does, he won't get adequate care in Mexico.

With large numbers of undocumented, uninsured immigrants doing physically dangerous jobs in this country, expect to see this issue arise more frequently. Short of a sudden switch to universal coverage or single-payer system, which presumably would make allowances for this situation, the issue's not going away anytime soon.

To learn more about this debate:
- read this Chicago Tribune piece
- read the Editor's Corner from FierceHealthFinance

Related Articles:
Hospitals deporting uninsured immigrants
Debate continues on illegal immigrant health costs
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Trend: Hospitals deporting uninsured immigrants

Anne Zieger — Mon, 04 Aug 2008 12:13:40 -0400

When an American citizen with health insurance--either commercial or government-backed--is seriously injured or sick, hospitals receive meaningful reimbursement for their care, even if they don't get as much money they want. But when an uninsured illegal immigrant is seriously ill, hospitals may get nothing. And when the patient is ready for discharge, hospitals can seldom find a rehab facility or nursing home to provide follow-up care--which often means that the hospital, without an appropriate place for discharge, keeps patients for months or years as a ward. Nobody pays these million-dollar bills. That's the case, in part, because the government won't pay for care for illegal immigrants, temporary legal immigrants or legal residents with less than five years in the U.S.

Lately, in response to these financial pressures, it's become more common to send such patients back to their home country, with or without their consent. Some patient families and attorneys call this patient dumping, but hospitals say they're just doing what they must to preserve their financial viability. While the practice isn't tremendously common, it does seem to be widespread, according to observers. No statistics exist on how often this happens, but it does appear that hospitals that see high volumes of illegal immigrants a year may engage in dozens of repatriations. The practice is so common that at least one repatriation company, California's MexCare, has emerged to serve these patients and help hospitals rid themselves of their burdens.

Recently, a legal decision in the case of one traumatically-injured Guatemalan worker, Luis Jimenez, may have changed the landscape somewhat. Mr. Jimenez was shipped to Guatemala by Martin Memorial Hospital of Stuart, FL, despite having an attorney who argued that the hospital was duty-bound to pay for his rehabilitation if need be. Since then, a decision by an appellate court held that since the hospital had no evidence Jimenez would get adequate care in Guatemala, they hadn't met federal requirements for discharge. Attorneys believe this case could change the way such deportations are regarded legally.

To learn more about this trend:
- read this piece in The New York Times

Infected MA transplant kills one patient, sickens another

Wed, 14 May 2008 06:59:56 -0400

Two patients received kidneys infected with a difficult-to-detect virus after agreeing to accept organs from a high-risk donor, authorities at Boston hospitals said this week. A 70-year-old woman has died, and a 57-year-old man is critically ill after receiving organs from a 49-year-old homeless man who carried the lymphocytic choriomeningitis virus (LCMV). The homeless man, who suffered terminal brain damage after cardiac arrest, was checked for diseases that can be tested for quickly, including the AIDS virus, hepatitis and a common herpes germ. However, LCMV screening is not part of the standard battery of rapid-fire tests done in the short period before organs perish, as there's no quick test for it available.

When the organs became available, the potential recipients were warned that this was a high-risk donor, but decided to go ahead with the transplant, as the risk of waiting for another suitable organ could have been even higher. The woman received a transplant at Boston Medical Center and the man at Beth Israel Deaconess Medical Center. Later, when the woman came back to the hospital and died, a physician with Boston Medical informed the CDC of the possibility that this could be LCMV. The man is now in treatment for the disease.

To learn more about this situation:
- read this article in The Boston Globe

Related Articles:
IL transplant patients infected by donor
Woman infected by transplant considers legal action
CA struggles with transplant costs for illegal immigrants
Uninsured patient dies after transplant is denied

CA struggles with transplant costs for illegal immigrants

Mon, 14 Apr 2008 06:59:54 -0400

Without a doubt, transplants are an extremely costly business. The question is, can states and counties afford to provide them for illegal immigrants in addition to their own citizens? In California, they're grappling with this issue, one thrown in to particular relief given the high volume of immigrants and the demand for high-prestige institutions in big cities there.

California handles the issue of medical coverage for the indigent--including illegal aliens--by providing state-funded healthcare for children until they're 21. At that point, the county where the person lives is supposed to pick up the tab. The thing is, some counties can't afford the tab for procedures like a liver transplant, which costs almost $490,000 for the transplant itself and the first year of follow-up, not to mention $30,000 annually in medications.

Meanwhile, given that there's often many more people seeking transplants than there are donor organs, some critics are saying that the state should not allow illegal immigrants to receive such organs ahead of citizens. It's a highly charged political issue, and one that isn't likely to be resolved anytime soon, observers say.

To learn more about California's transplant concerns:
- read this Los Angeles Times article

Related Articles:
Uninsured patient dies after transplant is denied. Report
Kaiser fined $2M for transplant problems. Report
National organ transplant system flawed? Report
U of Pittsburgh tries ED donor organ program. Report