Hospitals Fly Immigrants Back To Native Countries
MICHEL MARTIN, host:
I'm Michel Martin, and this is Tell Me More from NPR News. Coming up, our international briefing focuses on Africa today. We'll get an update on the coup in Mauritania and new charges of French collaboration in the Rwandan genocide. But first, we want to talk about healthcare and illegal immigration.
Healthcare has become a major front in the battle over illegal immigration, as many Americans have become convinced that long waits in emergency rooms are the result of uninsured illegal immigrants getting care they can't pay for and don't deserve. And indeed, healthcare providers already struggling to pay for other uninsured patients are facing tough questions about how to balance ethical and legal obligations with their rising costs.
Now, the New York Times reports that some institutions have become unlikely immigration enforcers, effectively deporting seriously ill undocumented immigrants who cannot pay for long-term care. Joining us to talk about this issue is NPR health correspondent Joanne Silberner. We also hope to be joined by Dr. Jay Wolfson, who is a professor of public health and law at the University of South Florida. Welcome, thank you for talking to us.
JOANNE SILBERNER: Well, thank you.
MARTIN: Joanne, this recent New York Times report says that some hospitals have begun transporting seriously ill illegal immigrants and, in fact, some legal immigrants who require long-term care back to their home countries. I think most people are under the impression that hospitals have to treat people regardless of their status or ability to pay. So how is this possible that they can even do this?
SILBERNER: It's the long-term care part of it. They are required to stabilize - to treat and stabilize anyone who comes through their doors. If they've got an open working emergency room, they have to take care of them, but once the person is stabilized, they can transport them. I'm not aware of any federal law that says that they can't transport them out of the country.
MARTIN: So the issue is that there's a gray area there or a lack of guidelines, if you will?
SILBERNER: There's a lack of guidelines in terms of the transport. Afterwards, there is some case law now in Florida that - there's been a judicial decision there, but there's no - the federal government has not addressed this issue in any way except to say that, if you show up in an emergency room, and you're having a heart attack, or you're having some other extreme immediate problem, they have to take you in. They have to stabilize you.
MARTIN: But once that you've been stabilized, that's kind of where it's sort of up in the air.
SILBERNER: That's where that gray zone begins.
MARTIN: But the Times focus on the case of a man named Luis Jimenez. He is an undocumented immigrant. He was sent back to Guatemala by Martin Memorial Hospital in Florida. I should mention that we invited a representative of Martin Memorial to join our conversation, and they declined. But can you tell us a little bit more about this case? Joanne, what is it that - why did the hospital feel that they need to transport him back?
SILBERNER: Well, it's really an interesting case and a lot of ethical angles and it - I'll start at the very beginning, and it was eight years ago that Mr. Jimenez was hit by a drunk driver who is driving a stolen car. This guy was uninsured. The hospital couldn't - when Mr. Jimenez came to the door, he was in very bad shape. In fact, he was in a coma for a year and a half. They had to take him in. They had to stabilize him.
Then they started looking for somewhere else to go. They ended up spending a million and a half dollars on him. That's a lot of money. And somebody has to pay that money. They couldn't find a place for him. They contacted the Guatemalan government, which finally agreed to take him in. They put him into a clean and nice - in Guatemalan terms, a nice rehab hospital, the nicest one that they had there. In our terms, visitors said that there wasn't a lot of sophisticated equipment like you would find in the U.S. hospital.
So and then that hospital, after treating him pretty well, discharged him to a public hospital that, according to all accounts, was not a place anybody would want to be or be sent. And then finally, his family came and saw him there. They took him home. Then the story gets interesting in its own right because you're thinking this a tragedy. This is horrible.
But a group who went out to see him, including a priest and a lawyer and a paralegal, came away saying, in this little home, this little tiny hilltop home in Guatemala where he was with his mother, he was actually happy. He seemed to be doing well. So in the end, it might have been a good thing for him, but you can see where it could be a tragedy if things had gone wrong.
MARTIN: But the particular issue was at this hospital in Guatemala, which was not able to match the level of care he was getting in the U.S., but there was nobody in the U.S. to pay for this care.
MARTIN: That's the issue. Dr Wilson, I understand he has joined us. Dr. Wilson, I'm sorry, Dr. Wolfson, thank you for joining us. And I guess, we've lost him again. So Joanne, we'll stick with you. How wide - Dr. Wolfson, are you with us?
Dr. JAY WOLFSON (Professor of Public Health and Medicine, University of South Florida): I'm there. I'm here with you, yes.
MARTIN: All right. Thank you so much for joining us. Dr. Wolfson, you're familiar with the - sort of the facts of the cases reported by the New York Times. How widespread do you think this practice is of hospitals transporting seriously ill patients because they don't have any other way to pay for their care and transporting them back to their home countries?
Dr. WOLFSON: Well, we don't really know a lot about how often it happens except for those documented cases that were presented in the Times article. If it happens, oftentimes, it'll be done quietly. It'll be done between the family and the hospital or between the hospital and the government, and it really is going to depend on the country.
I think it would be very different doing things with Europe, Eastern Europe and other parts of the world than it might be with places in South America. It will be different between Argentina and Guatemala because of the political realities. So I think what you're seeing is probably just the tip of an iceberg.
But it really relates to something fundamentally more important, and that is, for many years in this country, we've had a problem with how do we pay for care to the medically indigent, whether people are citizens or immigrants or illegal immigrants or otherwise. We don't have the resources, the time, the energy oftentimes to provide care, especially for the chronically ill.
So hospitals and healthcare providers for many years have had to juggle the tough decision about their obligation to care and the need to follow through with complete care. So questions of cost, quality, access, and equity come in across the board in this nation's health care system.
MARTIN: I have to say that, even as we were talking about the story among ourselves, it just occasioned some very intense feelings. I mean, on the one hand, you know, some people would say this is just horrible. How could any - how could a medical professional essentially discharge someone to the unknown without even knowing whether there was appropriate care? Others say, you know, what else are they supposed to do because the care has to be paid for somewhere, and if the federal government intended for people in these circumstances to be cared for, then they should pay for them. Dr. Wolfson, what do you say about that?
Dr. WOLFSON: Well, that's, again, a two-edged sword. These are not-for-profit healthcare organizations that have as an obligation the provision of care to people in need. But it can only go up to a certain point. The hospital did all it could and all it should to care for this man, brought him back to life twice, saved his life twice, invested a great deal of resources.
But then they were not able to place him in a setting that would allow him to remain in skilled care, basically. He didn't need hospital care. He needed skilled nursing care, and there's no means by which to pay for that here because Medicaid pays for that. And most nursing homes are private, and they don't have the same obligation of care that a not-for-profit hospital does.
So the hospital fund is often in a bit of a quandary. And I think each of us would feel the same kind of difficult pulls. You know, the guy needs care. He doesn't need hospital care. The hospital spent millions of dollars on him, hundred of thousand of dollars. They need the resources to provide care to other people in their community. Their profit margins have diminished dramatically in the last few years. All hospitals have experienced that.
MARTIN: I'm sorry, but I thought most hospitals were operated as not for profits.
Dr. WOLFSON: No, they're not. Most hospitals are. Some hospitals are not. For example, Hospital Corporation of America…
MARTIN: Is not.
Dr. WOLFSON: For profit investor on hospital corporation, there are a number of those.
MARTIN: But most long-term care facilities are for profit and that's...
Dr. WOLFSON: Many long-term care facilities are for profit...
MARTIN: I see.
Dr. WOLFSON: And they don't have the same tax obligation that a not-for-profit does to provide community based services free of charge.
MARTIN: OK. I just need to pause here just to say that, if you're just joining us, you are listening to Tell Me More from NPR News. I'm speaking with NPR health correspondent Joanne Silberner and Dr. Jay Wolfson about the whole issue of hospitals deporting immigrants who need - illegal immigrants who need long-term care and can't pay for it.
And we're also interested in what you think. We're particularly interested if you have a personal experience with this issue. If you're a medical professional who's been confronted with the question of caring for a patient, particularly an undocumented patient who cannot pay, or if you are an immigrant who needs long-term health care but doesn't have insurance, you can join the conversation by calling our comment line at 202-842-3522. Or you can go to npr.org and click on Tell Me More.
Joanne, is there any sense of policies catching up with this dilemma (unintelligible). Is there any, are there any, is there any discussion in Congress? Is there any discussion in the policy realm of this issue and how this issue should be addressed?
SILBERNER: I think the numbers are small enough. The answer is no or nothing, no buzz that I have heard. Nothing is really heard above the water line on this. When you think about it, the public hospitals have so many other issues going on, crowded emergency rooms, taking care of other uninsured. This is a small proportion, so this isn't their main focus. The advocacy groups may be active on this, but I haven't heard that much. It will be interesting to see whether this article has an effect.
Dr. WOLFSON: I agree with Joanne.
MARTIN: Yes, I was going to ask you, Dr. Wolfson. What do you think?
Dr. WOLFSON: Yeah, I agree with Joanne. This is a relatively small issue compared to the challenges of operating public hospitals in the United States.
MARTIN: Do you have a sense that medical professionals are - feel themselves ethically challenged by this?
Dr. WOLFSON: Of course they do, and I think hospitals do as well. But there is the ethical dilemma of obligation to provide necessary care, which they did, and then the obligation to figure out how you follow through in paying for a long-term chronic expensive care and where the obligation of a community or public institution ends and that of someone else begins.
MARTIN: I thought, generally, you accept this whole ethical guidelines about treating non-citizens?
Dr. WOLFSON: You know, a hospital has an obligation, whether it's public or private, in many of our views, to treat anybody who walks in the door, especially with an emergency, and to stabilize them, and the federal government requires them to do that. And that's why they received certain additional funds through Medicare and Medicaid while they received tax-exempt status.
But after somebody has been stabilized, as it was the case here, there comes the question, what's the obligation of the institution and the community and the individual practitioners? What do they do? Who's going to pay for it? That's a big question. It's an ethical question as well as a financial question.
MARTIN: And Joanne, a final word to you with the minute that we have left. It's terrible to ask reporters to predict things. But I do want to ask, do you feel - is this is an issue that's so, I don't know if the word is shocks the conscience or so sort of pulls ethics - sort of competing ethical and moral and financial concerns of these hospitals that this will sort of occasion a policy response, or is it just, you think, that the numbers are so small that people just can't wrap their heads around it, given all else that we're dealing with?
SILBERNER: I think there's so much more going on in healthcare, with the, you know, the 48 million uninsured. This is a drop in the bucket, but it's an important one because when you think about it, do you want hospital personnel making these decisions, being able to turn people away? That's a hard call for them.
MARTIN: Joanne Silberner is a health correspondent for National Public Radio. She was kind enough to join us here in our Washington studio. Dr. Jay Wolfson is a professor of public health and law at the University of South Florida. He joined us on the line from his office. I thank you both so much for joining us.
SILBERNER: Oh! Thank you.
Dr. WOLFSON: Thanks.
NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.
Self-Deportation Program Raises Skepticism
MICHEL MARTIN, host:
We're going to continue our conversation about the Schedule Departure program with Charles Kuck. He is president of the American Immigration Lawyers Association. We invited him to give a national perspective, and in just a few minutes we'll also be joined by Jay Marks. He's also an immigration lawyer and he hosts a weekly call-in show on Spanish-language radio in Washington D.C. We hope he can give us sort of a more grassroots perspective. First, Mr. Kuck, thank you for joining us.
Mr. CHARLES KUCK (President, American Immigration Lawyers Association): Thank you for having me. It's nice to be with you.
MARTIN: Now you heard Mr. Hayes saying that this is a more humane approach. It's a response to people who say that these raids on workplaces and homes, it's cruel, it's difficult, it's traumatic. What do you say to that?
Mr. KUCK: Well, it's kind of a low-hanging fruit program. I mean, with only six individuals coming in out of a possible population of, let's say, 600,000, that's a pretty minimal rate of return, particularly in the light of the fact they've apparently spent a hundred thousand dollars on this program. This is simply not an effective way to run an enforcement program, acknowledging the fact that ICE has to do his job. It has to enforce the law and nobody is begrudging the actual enforcement of the law. It's simply the way that it's carried out that is problematic at times.
MARTIN: But it's only been on for three weeks though. Do you think that's a fair measure of its effectiveness? I mean, why isn't this what Mr. Hayes called it, a reasonable compromise? Is it that?
Mr. KUCK: Sure, it's reasonable compromise for those that want to leave the United States, but what's stopping them from simply leaving the United States? You know, that's the interesting part of this program. Why have it if you can just get on an airplane and leave, which you can do? One of the problems we have with the statistics that ICE puts out in regards to its fugitive population is first of all, we don't know how many of these folks are actually still in the United States. ICE has actually no idea, which is why I'd love these people to come forward and say, hey, I actually am here and please mark down on your sheet that I'm gone from the United States.
The other problem is the presumption that every one of these people have had due process, which is simply not true. Every year there are over 100,000 individuals that are ordered deported in absentia - that is, they didn't go to their hearing. And many times it's not because they chose not to go, it's because they did not know they had a hearing. Our immigration laws are such that you could be served with a notice of your deportation hearing by regular mail, no proof that you actually received this is necessary. And so many hundreds of thousands of these 600,000 people don't know they have a deportation order.
MARTIN: And if that happens, what's your recourse?
Mr. KUCK: Well, very limited. There is a very limited period of time in which you can file in absentia or request a motion to reopen an in absentia hearing, and many of those requests simply are not granted because, again, the required statutory mode of service is simply regular mail. How do you prove you didn't get regular mail? Very, very difficult.
MARTIN: What are the members of the association saying about this?
Mr. KUCK: Well, the vast majority say they would never bring their client in voluntarily on a program like this. If one of their clients wanted to leave the United States, they would simply tell them, get on an airplane and leave the United States. One of the problems that we have seen with this program, or at least the implementation of this program...
MARTIN: But sir, what would be the benefit of that if you know you have - wouldn't that make it harder for you eventually to potentially come to the U.S. legally?
Mr. KUCK: Well, the reality is...
MARTIN: If you have a deportation order, that's not going to happen, anyway.
Mr. KUCK: You're not coming back for ten years, anyway. I mean, whether you leave under this program or you just leave, you're not coming back for ten years minimally, anyway, and you're likely never again getting a visitor visa to the United States.
MARTIN: Mr. Kuck, we need to take a short break right now. But we're going to ask you to stay with us for a couple minutes after the break. Can you do that?
Mr. KUCK: I'd love to do so.
MARTIN: OK. Charles Kuck is the president of the American Immigration Lawyers Association. He's going to stay with us after the break when we'll be joined by immigration lawyer Jay Marks from Washington, D.C.'s Radio El Sol.
(Soundbite of music)
MARTIN: I'm Michel Martin and this is Tell Me More from NPR News. Coming up, a tribute to a broadcasting pioneer, Ragan Henry. We'll tell you more about him in just a few minutes.
But first, we're going to continue our conversation about ICE's new self-deportation program called Schedule Departure. Charles Kuck is still with us. He's president of the American Immigration Lawyers Association. We're also joined by Jay Marks. He's an immigration lawyer who offers advice every Wednesday on the show "Pedro Biagi and La Manana(ph)" in Washington, D.C. Thank you both for joining us.
Mr. JAY MARKS (Immigration Lawyer; Spanish-language Radio Host): My pleasure. Thank you.
Mr. KUCK: Great to be here.
MARTIN: Jay, let me start with you. Are people talking about this on the show? And I should mention that this pilot program is in five cities - Santa Ana, California, San Diego, Phoenix, Chicago and Charlotte, North Carolina. It's not in the Washington, D.C. area. But is this something people are talking about?
Mr. MARKS: Oh, yeah. People are definitely interested. They want to know, you know, what is it about, how does it affect me, should I do it, what's going to happen to me. And I'll tell you, as Chuck mentioned earlier, I tell folks, you know, if you want to go, first make sure you don't have a defense to deportation that you don't know about. Make sure you get your case fully vetted by an immigration attorney who knows what she or he is talking about and can try and help you. If you have a way to stay in the United States lawfully, you should have that opportunity. And if not, then you can decide whether you want to go yourself or not, but I don't see a reason or a logical reason to sort of give yourself over to the authorities not really knowing what the next step will be. Will you be handcuffed? How long will you be in custody before they send you, et cetera?
MARTIN: We tried, I should mention, to find any of the six people who have offered themselves to this program. We were not able to find any of them. I don't know - Mr. Kuck, I don't know if any of your members have talked to any of these folks because we'd like to know why, what was the - you know, what went into their thinking?
Now, we did go around in the community in the Washington, D.C. area, one of our producers went around and talked to people who are undocumented, and here's a short clip I want to play you from an interview with the young man who gave his name as Francisco Galvez(ph), and he was asked about the program and this is what he said.
Mr. FRANCISCO GALVEZ: (Through Translator) We came with a dream and we're not going to leave until we see it happening. I think people that are tried of this life will leave. I think that if you don't have income that may get you depressed and make you feel pressured. And if you don't go crazy, you turn yourself in.
MARTIN: Charles Kuck, what about that? I mean, is that part of what your members or your lawyers are hearing, is that people are sort of getting desperate and they're considering this as a way to perhaps just end the anxiety?
Mr. KUCK: Well, sure, for folks that might be at that phase in life. But the reality is the vast majority aren't at that part in their life at this point, regardless of the current enforcement situation in the United States. Plus, you add the fact that you could still be arrested by ICE. The fact that they say they will let you go is a wonderful thing but if there's something in your background that maybe you don't talk about or maybe they just don't think that you are actually going to leave in the long run, they reserve the right to put you in jail, and the reality is they don't deport you in one day. It takes three, four, five, six, eight weeks for them to deport many people from the United States so that's something that folks have to consider and are considering before they turn themselves in.
Mr. MARKS: If not months. May I say, if not months. Chuck is absolutely right. There is absolutely no - when you give yourself over to them, you are giving yourself over to the - one of the strongest, most powerful police organizations within the executive branch. You have no rights at that point. It's very difficult.
MARTIN: Jay, what about the humanitarian argument? You heard Mr. Hayes say that people criticize the raids as being abusive, inhumane and this is a humane alternative. What's your take on that?
Mr. MARKS: OK. First of all, I need to give folks a really clear picture of what these raids are like. These are a massive show of force by people, by immigration officers who are armed with rifles, and they point those rifles literally inches from your face. The fact that your children are there screaming and frightened out of their wits, traumatized, the fact that your wife is weeping and crying and trying to protect the children, there could be an aged person in the house.
Immigration knows who it is they're going after. They've done an investigation of the house. They know that, for example, in a home enforcement, who's there. They've been following these people. This is not just a whim. These raids are planned. They're investigators so they know who's there. Why they have to - as has been widely reported and it's very common because my clients come to me with these stories frequently, constantly - why they have to take people out in their underwear from the shower, handcuffed, outside, not let people use the bathroom, force them prostrate on the ground and their children are told to shut up and be quiet, people who need medicine are, you know, separated from their medicines. Why it has to be with this level of force is beyond me.
MARTIN: I think that they would say that - and of course, as you heard, I asked Mr. Hayes about that. He says he is not aware of those particular tactics being employed. So that's what he said. But when we've asked other officials about this, they'll say that those kinds of enforcement efforts are aimed at persons who have criminal records and if by chance the persons who are fugitives, who do not have criminal histories apart from their immigration violations, happen to be in that environment, well, that's unfortunate. What do you say to that?
Mr. MARKS: Well, you know, for example, the 50 or so people that were picked up in a raid recently in Annapolis...
MARTIN: Annapolis, Maryland.
Mr. MARKS: Annapolis, Maryland, for example. Those folks - one of them had a shoplifting charge. One of them. The rest had no criminal records. And the use of force was just as I described, the fact that all those examples that I gave you came out of that raid. So it doesn't square, and this whole thing about he's never heard of, you know, those situations and they need to be reported, when Mr. Hayes says that, I throw up my hands and I say, when will the government - please, be honest with us. Please talk about the reality of what's going on, not about - not with some double-speak.
MARTIN: Mr. Kuck, you know, we hear people in the immigrant community say they don't trust ICE, they don't trust what they're being told about what will happen to them. What I'm hearing you say is that there are advocates like yourself who don't trust what they're being told. Is that accurate?
Mr. KUCK: Well, it's certainly true that we are not getting the full picture from ICE on all of their raids, decisions on their arrest record. One of the great concerns we have with this entire process is why are they doing this? What is the ultimate reason for doing this? It's not so they can pick up six people who decide they're tired of living in the United States. What they're doing is they're looking for cover for their raids so they can say, look, we have no choice but to go in with guns blazing because obviously, people aren't going to come forward voluntarily, which is, frankly, a ridiculous way to run a program.
MARTIN: Well, I would say - first of all, I also need to mention that we invited ICE to participate in the conversation with the two of you. They declined, which is why we spoke to them separately. So we would have appreciated if they had the opportunity to answer these questions directly, but I think their argument is that this is, in fact, a response to criticism that if you do not wish to subject yourself to these tactics, because they cannot be assured who in a particular environment may have a criminal history and who does not, if they're looking for someone with a criminal history and you are in that environment, then they have to, for their own safety, treat everybody as if they are sort of part of this population. Then the logical thing to do is to report yourself and be treated in a more dignified fashion. Mr. Kuck, what do you say? And Jay, I want to hear from you, too.
Mr. KUCK: I don't know whether it's dignified to have to walk into an ICE office, give them your plane ticket and say, decide whether you want to hold me until I can leave the United States, or whether ICE could more effectively run their Fugitive Operations Program - and I hate to call them fugitives because many of them don't know they're actually fugitives - whether they can run it in a more efficient fashion.
ICE runs background checks on these people. They've always got their pictures, they usually have their fingerprints in place, they know where they live, they know where they work, they could easily just approach them on the street and say, sir, we'd like to talk to you for a second. We're from ICE and we understand you might be this person. Yes, I am, and off they go. You don't have to go into somebody's house at five o'clock in the morning with guns blazing, scaring the children to death, and that happens not just in Arlington but all over the United States.
MARTIN: But I think the other argument would be that people know if they're out of status. People know if they're out of status so...
Mr. MARKS: Of course they do.
Mr. KUCK: Of course, they know that. Yes.
MARTIN: Jay, what do you want to say about that?
Mr. MARKS: Well, I mean, yes, of course people do and they are desperate to get right. They are desperate to get right with the law. People come to my office in a constant stream and the mantra is, what do I have to do, attorney, please, to get myself right with the law? Is there any hope for me? What can I do? I pay my taxes. I work hard and I've stayed out of trouble.
MARTIN: I'm afraid we're going to have to leave it there. It's an important conversation and hopefully we'll have an opportunity to continue it. Jay Marks is an immigration lawyer. He offers advice on Washington, D.C.'s Radio El Sol on the show "Pedro Biagi and La Manana(ph)." He joined us in our Washington studio. We were also joined by Charles Kuck. He is president of the American Immigration Lawyers Association. He joined us from Georgia Public Broadcasting in Atlanta. And I thank you both for speaking with us.
Mr. MARKS: Thank you very much.
Mr. KUCK: Thanks for having us.
MARTIN: Remember, with Tell Me More, the conversation never ends. We want to know what's on your mind. Is self-deportation the right approach to dealing with illegal immigration? We particularly would like to hear from you if you are an illegal immigrant living in the U.S. or if you know someone who is and if you are considering this program. To tell us more about what you think, you can call our comment line at 202-842-3522. That's 202-842-3522, or you can go to our blog by clicking on the Tell Me More page at npr.org.