Philadelphia Acts to Keep Medical Deportations from Flying Under the Radar

 

In a nationwide first, the Philadelphia City Council has voted in favor of a new bill prohibiting medical deportations. The bill is expected to be signed into law by the mayor. Medical deportations occur when health care organizations arrange transportation out of the country for seriously ill, undocumented patients who lack health insurance. It is less expensive for a hospital to pay for a medical transport flight out of the U.S. than for the hospital to continue to provide care. 

 

The word “deportation” is used by critics to describe forced or coerced repatriations. The transfer of patients is a de facto deportation, as the U.S. immigration court system is not involved. Medical deportation differs from the voluntary return of people back to home countries which have robust medical and health insurance systems. Patients who are medically deported lose the social support of family members and friends who remain in the U.S. In addition, the patients are frequently unable to afford follow up care in their home countries, and often die as a result. Critics of medical deportations say that transfers out of the U.S. are often done without the consent of the patient. Critics also say that if consent is obtained, it is often obtained coercively, without adequate language services or without providing enough information for the patient to make an informed decision. 

 

 

Philadelphia’s new ordinance prohibits hospitals from repatriating patients without the consent of the patients themselves. Patients must be informed of their treatment options and the risks of transportation to a foreign country. The information must be given in oral and written form and must be translated for patients who are not proficient in English. Patients who are mentally incapable of making their own decisions cannot be transported outside of the U.S. without the consent of their caregivers. The hospital is required to verify that the receiving foreign hospital is capable of providing appropriate medical treatment. A follow-up report describing compliance with the city’s repatriation protocol must be sent to the Philadelphia Department of Public Health. 

 

Critics of medical deportations point out that only the federal government has the power to deport. In bypassing immigration court proceedings, medical deportations deny patients due process. Medical deportations may also cause undocumented persons to fear the medical system and discourage them from seeking care before their illnesses become serious. Supporters of the Philadelphia ordinance say that patients should not fear coercion and deportation when they are hospitalized for serious illnesses. 

 

 

Hospitals, on the other hand, are understandably concerned about providing uncompensated care. The American Hospital Association reported that over half of hospitals ended the year 2022 with negative operating margins. Hospitals are under financial pressure to minimize the amount of uncompensated care that they provide. Meanwhile, half of likely undocumented immigrants are uninsured compared to 18% of lawfully present immigrants and 8% of U.S. born citizens. Medical deportation provides hospitals with a means of discharging patients who are unable to pay for care. 

 

 

One of the cases which brought the issue of medical deportation to the forefront was that of A.V., a man from Guatemala who had lived in the U.S. for twenty years. A.V. suffered severe brain injuries in a motorcycle accident. A.V.’s family said that a Philadelphia hospital failed to provide adequate language services and attempted to pressure the family into consenting to move A.V. back to Guatemala. Due to the severity of his injuries, A.V. will require long term care. A.V.’s family said that the hospital misrepresented the follow-on care that would be available in Guatemala. The family also felt that the medical transportation company hired by the hospital intimidated them. With legal assistance, the family was able to prevent A.V.’s deportation, and he was placed in a U.S. nursing home. The new ordinance prohibits hospitals from taking further steps towards repatriation if patients or their caregivers refuse consent. Proponents of the ordinance believe that its consent requirement will help prevent situations similar to the one encountered by A.V. and his family. 

 

 

The Philadelphia ordinance establishes a procedure for providing healthcare to seriously ill undocumented immigrants. The larger question of how to pay for this care remains a politically charged topic. Universal healthcare coverage that is not tied to immigration status would eliminate financial issues for both undocumented persons and hospitals. However, political and cost considerations have stalled measures that would expand access to healthcare for undocumented persons. For example, U.S. Senate Bill 2646, the Health Equity and Access under the Law for Immigrant Families Act of 2023, has not achieved any traction in Congress. 

 

Federal law (42 U.S.C. § 1396b(v)(3)) authorizes emergency Medicaid coverage of an immigrant who ordinarily would be ineligible for Medicaid, but only if the immigrant is suffering from a serious medical condition. However, decisions regarding how much care must be provided have thus far been left to the states. Some states provide extensive coverage, while others limit coverage to emergency room visits only. (The Emergency Medical Treatment & Labor Act [EMTALA], 42 U.S.C. § 1395dd, mandates emergency room care for all persons, regardless of ability to pay.) In the case of A.V., Pennsylvania approved payment for his long-term care. 

 

The problem of how to provide medical care for undocumented immigrants is likely to continue to be a source of controversy at the local, state, and national level. The city of Philadelphia has taken an important step towards developing a clear policy for dealing with the care of undocumented persons. It remains to be seen if other cities, states, or Congress will follow Philadelphia’s lead. In the absence of a coherent public policy, however, hospitals will continue to fly under the radar while arranging medical deportations.