For Some Ill Migrants, Free Care Has a Price

When Fidel Delgado arrived at a Catholic hospital in Phoenix in mid-June after a heart attack, doctors performed life-saving bypass surgery, even though Delgado is an undocumented immigrant with no way to pay his medical bills.

Federal law requires hospitals to provide emergency care regardless of immigration status or ability to pay.

But once Delgado had been stabilized, officials at St. Joseph's Hospital and Medical Center faced a serious dilemma: As a hospital certified for acute, or short-term, care, St. Joseph's determined that it couldn't keep Delgado any longer. But the severely diabetic and obese man was still too sick to go home.

Sending Delgado to a rehab facility also was not an option because Medicaid would not pay for the care.

Transferring him to a hospital in Mexico could be traumatic: Delgado, 64, hasn't lived in his native country for more than 40 years.

The decision St. Joseph's would make initially - to send Delgado to Mexico - represents one of the most wrenching policy approaches taken in recent years as part of a state and national crackdown on illegal immigration.

St. Joseph's now sends an average of seven uninsured immigrants a month back to their native countries for treatment, often against the wishes of family members, hospital officials say. Before 2000, the hospital rarely transferred any patients out of the country, perhaps only two or three times a year, the officials said.

Not all patients who are sent back are undocumented immigrants. The hospital also is sending back legal immigrants who don't qualify for long-term Medicaid. Hospital officials attribute the practice to stricter laws and tighter controls at the state and federal levels that have made it harder for immigrants to obtain non-emergency Medicaid care, for which U.S. citizens are eligible. The hospital says the changes have forced it to transfer more immigrants to their native countries when they require long-term care and lack insurance.

The patients transferred back to their homelands typically have spent weeks and sometimes months at the hospital and have racked up huge medical bills that they cannot pay, officials say. The hospital bill for Delgado, for example, reached $837,950.

Some critics suggest that St. Joseph's, a non-profit hospital that is exempt from taxes and must provide some charity care, is simply dumping patients to save money. The hospital denies the allegation.

Immigrant advocates fear that other hospitals around the country will follow St. Joseph's lead as a way of dealing with the most vulnerable of the nation's 46 million people who lack health insurance. About 1.1 million people in Arizona are uninsured.

For the patients' families, the transfers can be devastating.

When members of Delgado's family were told that he might be sent to Mexico, they were shocked. His wife is a U.S. citizen, and all of his close relatives live in Arizona.

"He is going to die if he has to go to Mexico," said Delgado's sister, Rosa Aguirre of Phoenix. "He has no family there."

St. Joseph's is not the only Valley hospital that sends uninsured immigrants to Mexico for long-term care, but its number of transfers is much higher.

Maricopa Medical Center has sent five non-citizens out of the country for treatment since October, hospital officials said. Banner Good Samaritan Medical Center sent seven in 2007 and six the year before, officials said.

St. Joseph's officials said they don't track the numbers on an annual basis.

"These are not easy decisions," said Sister Margaret McBride, vice president of St. Joseph's Mission Services. "Our legal responsibility is to provide a safe discharge. Whether the family agrees or not, we have to provide for a safe discharge," even if that means out of the country.

The patients being transferred are typically either severely ill or have been severely injured. Like Delgado, many of them have lived in the United States for years, so transporting them to another country can mean uprooting an entire family. And hospitals, including St. Joseph's, don't track what happens to the patients after they have been evacuated.