JOLOMCÚ, Guatemala —
Eight years ago, Jimenez, now 35, an illegal immigrant working as a gardener in Stuart, Fla., suffered devastating injuries in a car crash with a drunken Floridian. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him as a ward for years at a cost of $1.5 million.
What happened next set the stage for a legal battle with nationwide repercussions: Jimenez was deported, not by the federal government but by Martin Memorial Hospital. After winning a state court order that would later be declared invalid, Martin Memorial leased an air ambulance for $30,000 and "forcibly returned him to his home country," as one hospital administrator described it.
Since returning home, Jimenez, who sustained a traumatic brain injury, has received no medical care or medication — just Alka-Seltzer and prayer, said his 72-year-old mother. In the past year, his condition has deteriorated with routine seizures.
"Every time, he loses a little more of himself," said his mother, Petrona Gervacio Gaspar.
Jimenez's benchmark case exposes a little-known but apparently widespread practice. Many U.S. hospitals are repatriating seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid does not cover long-term care for illegal immigrants, or for newly arrived legal immigrants, creating a quandary for hospitals, which are obligated by federal regulation to arrange post-hospital care for patients who need it.
U.S. immigration authorities play no role in these private repatriations. Most hospital officials said that they do not conduct cross-border transfers until patients are medically stable and that they arrange to deliver them into a physician's care in their homeland.
But the hospitals are operating without governmental assistance or oversight, leaving ample room for legal and ethical transgressions.
Some advocates for immigrants see these repatriations as a kind of international patient dumping.
Hospital administrators view such cases as costly, burdensome patient transfers that force them to shoulder responsibility for the dysfunctional immigration and health-care systems. In many cases, they said, the only alternative to repatriation is keeping patients indefinitely in acute-care hospitals.
"What that does for us, it puts a strain on our system, where we're unable to provide adequate care for our own citizens," said Alan Kelly, vice president of Scottsdale Healthcare in Arizona.
Medical repatriations are happening with varying frequency, and varying degrees of patient consent, from state to state and hospital to hospital. No government agency or advocacy group keeps track of these cases, and it is difficult to quantify them.
There is enough traffic to sustain at least one repatriation company, MexCare, operating nationwide with a "network of 28 hospitals and treatment centers" in Latin America. It bills itself as "an alternative choice for the care of the unfunded Latin American nationals."
Many hospitals engage in repatriations of seriously injured and ill immigrants only as a last resort. "We've done flights to Lithuania, Poland, Honduras, Guatemala and Mexico," said Cara Pacione, director of social work at Mount Sinai Hospital in Chicago. "But out of about a dozen cases a year, we probably fly only a couple back."
Other hospitals routinely send uninsured immigrants, legal and illegal, back to their homelands. One Tucson, Ariz., hospital tried to fly a U.S. citizen, a sick baby whose parents were illegal immigrants, to Mexico last year; the police, summoned by a lawyer to the airport, blocked the flight.
Sister Margaret McBride, vice president for mission services at St. Joseph's in Phoenix, which is part of Catholic Healthcare West, said families were rarely happy about the decision to repatriate relatives. But, she added, "We don't require consent from the family."
In the spring, St. Joseph's planned to send a comatose, uninsured legal immigrant back to Honduras, until lawyers got involved. While they were negotiating with the hospital, Sonia del Cid Iscoa, 34, who has been in the United States for half her life and has seven U.S.-born children, came out of her coma. She is back in her Phoenix home.
Unlike Iscoa and Jimenez, most uninsured immigrant patients in repatriation cases do not have advocates fighting for them, and they are quietly returned to their home countries.
Jimenez's case is apparently the first to test the legality of cross-border patient transfers undertaken without the consent of the patients or their guardians — and the liability of the hospitals who undertake them.
"We're the rhesus monkey on this issue," said Scott Samples, a spokesman for Martin Memorial.
The average stay at Martin Memorial is 4.1 days and costs $8,188. Patients rarely linger. In addition to trauma patients, there are uninsured immigrants with serious health problems.
"In our emergency room, we don't turn anyone away," said Carol Plato Nicosia, director of corporate business services. "The real problem is if we find an underlying problem, and now we have six of them, six patients who showed up in renal failure and that we are now seeing three times a week for dialysis.
"I don't want to sound heartless. A community hospital is going to give care. But is it the right thing? We have a lot of American citizens who need our help. We only make about 3 percent over our bottom line if we're lucky."
Martin Memorial reported a total margin of 3.6 percent over its bottom line last year and 6 percent in 2006. According to the most recent statewide data, the nonprofit medical center also reported assets of $270.6 million in 2006, with its senior executives earning more than $4 million in salaries and benefits.
