Uninsured Immigrant Patients Sent Home for Care Against Their Will

May 22, 2008 — -- Hundreds of legal and illegal immigrants in Arizona are being sent back to their home countries, sometimes against their will, for medical treatment because they lack insurance.

In some cases, the FBI and police, responding to allegations of kidnapping, have been called in to halt such forcible removals, according to patients' lawyers. In one recent case, a sick baby who is a U.S. citizen born to an illegal immigrant was being transferred by helicopter to a waiting air ambulance for a flight to a hospital in Mexico when Tucson police intervened and brought the child back to the hospital.

The forcible removals are the result of federal and state law mandating that only U.S. citizens and legal residents are eligible for Medicaid. As a result, state hospitals are pressured to transport noncitizens, even if they're legally in the U.S., at the hospitals' expense, back to their home countries, at a cost of up to $100,000.

The alarming scenario has come to light in recent weeks with the dramatic case of Sonia Iscoa Del Cid, a house cleaner in the country legally under temporary protected status, who woke up from a coma last week only to realize that she was going to be forced back to her native Honduras because she lacked insurance for long-term care. The case galvanized the immigrant community in Phoenix.

On May 9, hours away from being flown to a small hospital in Honduras, where Del Cid no longer has any family or friends except for an elderly father, her lawyer filed a temporary restraining order preventing the move. Family and friends raised money through car washes, and received significant financial assistance from dozens of trial lawyers in Arizona, to pay the $20,000 bond ordered by a local judge.

This morning, the story seems to have produced a happy ending. Because of Del Cid's remarkable recovery -– she is talking and has been taken off dialysis -– she likely won't require further treatment, and the hospital will no longer need to transport her.

"We reached an accommodation with the hospital," said attorney John Curtin. "Sonia has improved markedly. It's been a week without dialysis and she's starting to eat softer foods, and she's talking. So the hospital is not contemplating moving her to Honduras."

The hospital declined to discuss Del Cid's particular situation because of medical privacy laws but clarified its policy on transporting uninsured patients.

"About eight times a month, we make arrangements to transfer patients to their country of origin," said Sister Margaret McBride, vice president for mission services at St. Joseph's Hospital and Medical Center in Phoenix. "We've had transfers to Asia and Africa by air ambulance, and we pay for transportation, which starts out at about $25,000 up to $100,000."

She said that the hospital is an acute-care facility, and it is obligated to plan for a safe discharge to the next level of care, which may involve months and years of treatment. Most long-term care facilities in the state want a year's payment upfront, which is a hardship for many of the uninsured who are not U.S. citizens..

"It's hard on us to make that decision," Sister McBride said, adding that the hospital would fight for changes in the law. "We don't feel good about this because we're caught in the middle, and we don't have any recourse. ... We've talked to legislative folks and told them that we're stuck in the middle."

Del Cid, who has been in the United States for 17 years and has a valid work visa, fell into a coma after an emergency Caesarean section and hysterectomy April 20. Her newborn daughter, Juliani Milagros Mitchel, who was delivered prematurely, remains stable in the hospital's pediatric intensive care unit.

Soon after the hospital told Del Cid's family that she would be flown to Hospital Escuela in Tegucigalpa, Honduras, family friend Maria Adame called Curtin and his law partner, Joel Robbins, to stop the transfer. A spokesman for Hospital Escuela told the Arizona Republic that its intensive care unit has only four beds and lacks a dialysis unit.

"She doesn't want to go back," Adame said. "Sonia's lived here for half her life, and she has seven kids, all born here in Phoenix. And she works legally -– she has her license to clean houses and she worked for a furniture company."

The scenario was not unfamiliar to Fernando Gaxiola, an attorney who said he has prevented three attempted forcible removals of uninsured clients.

"One was a baby born in Arizona and because the parents couldn't pay and they were Mexican, University Medical Center in Tucson tried to fly the child to a hospital in Mexico," he said."They were waiting to move the child from the helicopter to an air ambulance when the police intervened."

In another case, Gaxiola said one of his clients visiting the country on a tourist visa was transported from Tucson to a small town on the Mexican border.

"I called the FBI and the police," he said. "When the ambulance got to the border, the border patrol agent asked to speak to the passenger in the vehicle, who said he didn't want to be transported. The police responded, and he got back to Tucson."

A spokesman for University Medical Center, Katie Riley, declined to discuss specific cases but explained that the hospital has transported hundreds of patients back to their home countries.

"There are certainly some who are not happy," she said. "In most cases, long-term care [facilities] won't take people if they don't pay. And we have no choice."