In Print: Volume 87: Number 6
By Caitlin O'Connell
87 Wash. U. L. Rev. 1429 (2010)
In 2000, Luis Alberto Jimenez, an undocumented and uninsured immigrant, sustained traumatic brain injuries in a car accident with an intoxicated Floridian driver. After the accident, he was hospitalized at Martin Memorial Medical Center, a private community hospital in Stuart, Florida. Because Jimenez, who remained incapacitated, required ongoing care but lacked medical insurance, Martin Memorial was unable to find a rehabilitation facility willing to accept him. Instead, Jimenez remained as a ward of the hospital for several years at a cost exceeding $1.5 million. Of this $1.5 million, Martin Memorial collected only $80,000 from Medicaid for the emergency services rendered to Jimenez; the hospital absorbed the remaining costs associated with his care. Faced with both Jimenez’s continuing medical needs and the financial costs borne of this care, Martin Memorial secured a state court order to authorize the hospital to transport Jimenez to a medical facility in Guatemala, his country of origin. Acting under this court order, which was later deemed invalid on appeal, the hospital leased an air ambulance at its expense and forcibly transported Jimenez back to Guatemala.
Martin Memorial’s actions in returning Jimenez to his country of origin do not represent an isolated incident. Instead, through a practice known as medical repatriation, some hospitals return indigent immigrant patients who are ineligible for long-term Medicaid to their countries of origin to reduce the financial burdens associated with their uncompensated care. Indeed, international medical repatriations have emerged as a creative response to the financial conundrum imposed upon hospitals by virtue of immigration and health care policies. Collectively, these policies restrict immigrants’ access to long-term Medicaid, obligate certain hospitals to render emergency medical services without regard for the patient’s ability to pay, and require hospitals to secure appropriate follow-up care for patients in accordance with federal discharge regulations. While hospitals may recoup some costs through Emergency Medicaid—which covers the treatment of emergency medical conditions without regard for immigration status—the scope of Emergency Medicaid, as demonstrated in Jimenez’s case, may not fully compensate hospitals for the treatment of uninsured, indigent patients. Consequently, medical repatriations provide an alternative method of cost reduction.