ImmigrationU.S. hospitals shipping sick immigrants back to their home countries

Published 24 April 2013

Hundreds of immigrants who are in the United States illegally end up in the hospital only to find out they will be sent home through a removal system run by hospitals trying to avoid the high cost of treating illegal immigrants.

Critics see medical repatriation as deportation // Source:

Hundreds of immigrants who are in the United States illegally end up in the hospital only to find out they will be sent home through a removal system run by hospitals trying  to avoid the high cost of treating illegal immigrants.

According to a report by the Center for Social Justice and New York Lawyers for the Public Interest, at least 600 immigrants were removed over a five-year period. Researchers  believe there were many more. The number is based on data from the hospitals, humanitarian organizations, news reports, and specific cases.

Michigan Livereports that the process, known as “medical repatriation,” allows hospitals to put patients on chartered international flights and the hospital typically pays for the flight.

“The problem is it’s all taking place in this unregulated sort of a black hole … and there is no tracking,” law professor Lori Nessel, director of the Center for Social Justice at Seton Hall Law School, told Michigan Live.

Now immigration advocates are concerned that the practice could expand as a result of federal health care reform, which includes deep cuts to the amount of money hospitals will receive to take care of the uninsured, but health care experts say are stuck between a duty to accept all patients and the political arena.

“It really is a Catch-22 for us,” Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System, told Michigan Live. “This is the area that the federal government, the state, everybody says we’re not paying for the undocumented.”

Civil rights groups believe that the provision violates U.S. and international laws and takes advantage of a defenseless group of people.

“They don’t have advocates, and they don’t have people who will speak on their behalf,” Miami attorney John De Leon, who has been arguing such cases for a decade, said.

By law, hospitals must care to all patients who need emergency assistance, whether they are insured or not and regardless of citizenship. Once a patient is stabilized however, the obligation no longer exists. Most immigrant workers who do not have citizenship are ineligible for Medicaid, which is why hospitals usually send patients back to their home countries.

Gail Montenegro, a spokeswoman for U.S. Immigration and Customs Enforcement, said the agency “plays no role in a health care provider’s private transfer of a patient to his or her country of origin.”

These transfers “are not the result of federal authority or action,” Montenegro stated in an e-mail, nor are they considered “removals, deportations or voluntary departures” as defined by the Immigration and Nationality Act.

According to De Leon, in these situations, patients are frequently told that their families want them to return home and if the patient is unconscious, the family is contacted and told their relative would like to return and in certain situations the family is told the patient might die, prompting relatives to agree to a transfer.

Some hospitals “emotionally extort family members in their home country,” De Leon told Michigan Live. “They make family members back home feel guilty so they can simply put them on a plane and drop them off at the airport.”

The American Hospital Association said it does not govern immigrant removals, and it does not track how many hospitals encounter the issue.

In 2009, the American Medical Association’s Council on Ethical and Judicial Affairs issued a directive to doctors around the country urging them to not urging them not to “allow hospital administrators to use their significant power and the current lack of regulations” to send patients to other countries.

Doctors cannot expect hospitals to provide costly uncompensated care to patients indefinitely, the statement said. “But neither should physicians allow hospitals to arbitrarily determine the fate of an uninsured noncitizen immigrant patient.”