Pennsylvania hospital wants to send woman in coma to Dominican Republic, against her family’s wishes
On Dec. 29, 2022, a 46-year-old Dominican mother of two was admitted to Lehigh Valley Network’s Cedar Crest hospital when she suffered an aneurysm that required immediate surgery. The procedure, generally considered low-risk, did not go as expected due to complications, so medical personnel induced the undocumented woman into a coma, according to the patient’s husband.
After more than two months of trying to find a long-term care facility to accept this patient, hospital administrators now want to transfer the woman to a care facility in the Dominican Republic against her family’s wishes. After community outcry, the hospital granted a seven-day extension. But it is unclear whether the hospital will decide to work with the family to find other solutions.
Junior Rivas – who asked that his real name not be published due to his immigration status – said logistics for his wife’s care began to go south when the hospital administration began inquiring about his family’s immigration status.
Lehigh Valley Health Network declined to comment for this story due to patient privacy.
A letter from the hospital shared with WITF dated March 1 states the hospital’s case manager learned that Rivas’s wife was a citizen of the Dominican Republic in early January while investigating options for continued care. The letter says it was going to be difficult to find a long-term acute care hospital because such facilities “do not accept medical assistance or patients who are not in the United States on a valid visa.”
The case manager was unable to find an appropriate facility and explained to Rivas via an interpreter that his wife might have to return to the Dominican Republic for care. The hospital, which does not have the facilities to handle the patient’s condition, said it contacted 258 facilities in Pennsylvania but could find none to take her. A team of hospital workers met with Rivas and his sons each month since late December.
By early February, the hospital was collaborating with MedEscort, a private medical transportation company that specializes in what hospitals usually refer to as “medical repatriations.” According to the letter, hospital staff and MedEscort learned additional information about the family’s visa status in a Feb. 6 meeting.
“At this point, we explained that as your wife was not a valid citizen, rehabilitation facilities will not accept her for long-term care needs. During this meeting, we explained how returning to the Dominican Republic with the assistance of MedEscort might be the only option.”
Rivas said he does not want his wife to travel by plane while she is in a coma and is concerned she could pass away during the journey.
“If I take my wife to the Dominican Republic in the state that she is now, what would I tell my sons?” Rivas said. “I’m going to fight until the end, so that my sons can say – even if God decides to take my wife – at least dad did all that he could.”
Aside from finding another facility or consenting to having his wife flown to a hospital in the Dominican Republic, Rivas has another option. The hospital administration told Rivas he could pay $500 dollars a day for equipment to continue his wife’s care at home. Rivas said he cannot afford that.
A coalition of immigrant rights groups, including the Pennsylvania Immigration and Citizenship Coalition, Free Migration and Make the Road Pennsylvania, offered support to Rivas and his family and tried to raise awareness about the hospital’s practices. Last week, a few dozen people gathered to protest the hospital’s intention to deport Rivas’ wife. Julio Rodriguez, political director for the Pennsylvania Immigration and Citizenship Coalition in Philadelphia, said the protesters “were met with resistance” and that security threatened to call police.
Daniel Cortes, an immigration attorney from Reading who has been advising the family, said medical deportations or medical transfers of undocumented patients usually happen without the involvement of the Department of Homeland Security or law enforcement officers. Usually, there are other options for uninsured undocumented patients at hospitals who are being pressured into giving consent to put their loved ones on a plane back to their home country.
“They can do what’s called an emergency medical assistance application for a nursing home or specialized care, and if the state approves that, they would have to determine that the care that this patient requires at a nursing home or a facility is necessary to sustain or maintain her life,” Cortes said. “I think that’s going to be an easy lift.”
Cortes said he believes the hospital is “going to give it a good-faith try in terms of submitting an application” for emergency medical assistance.” Rivas will meet with the hospital again this week to figure out next steps, but he does not know if the hospital will extend his wife’s stay while he finds another hospital. He said he has refused to sign paperwork to consent to have his wife flown to the Dominican Republic, but also said a hospital case worker told him a signature is not needed.
A spokesperson from the Pennsylvania Department of Human Services said undocumented immigrants may receive federally-funded Medicaid, otherwise known as Emergency Medical Assistance (EMA), to cover a specific emergency medical condition if the individual meets the income, resources, and category requirements of Pennsylvania’s Medicaid program. DHS usually processes applications in five business days. If additional information is needed, the application would have to go through a county assistance office, which can take up to 45 days.
EMA coverage covers the individual only for the period of time required to treat the emergency, which the patient, or their representative, has to specify in the application. The program can cover care at a long-term acute care hospital as long as the individual continues to have an emergency medical condition and the condition requires treatment in such a facility, according to DHS.
Maripat Pileggi, supervising attorney at Community Legal Services has provided support for a handful of medical deportation cases in Philadelphia.
“Unfortunately, whenever I have been involved in these cases in the past, folks don’t find me until after the threat of being transported back to their country of origin has been made, and they’re feeling a lot of pressure, like the hospital has been on countdown to either find some other place to go or get on the plane,” Pileggi said.
She said she has never encountered a case in which a hospital ended up deporting the patient, but in all cases she has worked on, the hospitals were pushing medical deportation and were unable to show documentation that the patient was consenting to a deportation. Pileggi says patients are usually able to get approval for Emergency Medical Assistance and continue their care at the same hospital or somewhere else.
One of the main challenges is working with hospital administration to get the information needed in order to apply for EMA. Usually, Pileggi said, the hospitals refuse to share patient documents, citing patient privacy laws. The patients often have language barriers and are unaware that emergency medical insurance through the state is an option.
“The thing that’s most frustrating for me often as a public benefits lawyer is people are told that they have no possible way to get any kind of insurance coverage for the health care that they need here, because they are completely uninsurable, they will not be able to access the health care they need here. And so they just have to go to another country, which oftentimes is false,” Pileggi said.
There is not much data available about medical deportations, since the federal government is not involved and they are usually carried out by a private company and hospitals can use patient privacy laws to conceal the practice.
“What’s really concerning is how many other cases have there been? How many of them are flying under the radar?” Rodriguez said. “Hospitals should not be allowed to do this. They’re getting a state license to operate. They’re getting funding from the state.”
The American Medical Association denounces forced medical repatriation of undocumented patients.
“This practice can lead to serious medical consequences for patients. Health care providers should not be in the business of immigration enforcement,” said AMA Trustee Thomas J. Madejski in a statement.
Medical deportation can be profitable for the medical transportation companies that do business with the hospitals looking to discharge undocumented patients, according to a 2021 report from immigration rights group Free Migration Project and University of Pennsylvania’s Law School Legislative Clinic. The report found that each medical deportation flight can cost up to $50,000. Some of the companies specifically advertise their medical repatriation services.
MedEscort, the company working with Cedar Creek to transfer Rivas’s wife to the Dominican Republic, advertises its main goal on the home page of its website: “Solving the Problem of Unfunded Foreign Patients in American hospitals.” It promises to provide a “tailored, systemic, stop-loss solution” to the financial losses resulting from “unfunded foreign patients,” whom the company refers to by the acronym UFPs.
One section of the website features a side-by-side comparison of hospital costs for uninsured undocumented patients and insured patients. The company uses the jargony language of financial risk analysis to show how and why undocumented patients lead to higher hospital revenue loss.
“UFPs are admitted via the ER without the hospital’s ability to deny care. The higher the acuity, the greater the loss,” according to MedEscort. The company claims to have “successfully repatriated” over 6,000 patients to 100 countries.
Rivas says he is feeling mistrustful and fears the hospital might send his wife away while he’s not there. That is why he has been sleeping on the floor of his wife’s hospital room every night.
“The only thing I have to lose is my life and I don’t care if I lose it,” Rivas said. “The other half of my life is lying on that bed, so right now all I have is half of my life.”