Immigration activists say Jefferson Health is trying to “medically repatriate” an undocumented Guatemalan man with a serious brain injury in an effort to rid itself of his care.
The drama began Tuesday evening and spiraled into Wednesday, with medical students starting an online petition to stop the removal of the man, who was injured in a motorcycle accident in May, from Jefferson Torresdale Hospital. On Wednesday morning, activists gathered at the hospital for what they said would be a physical attempt to block any vehicle carrying him to the airport.
That turned out to be unnecessary. By Wednesday afternoon, any plan to remove the 48-year-old man, whose name was withheld by his family, had been put on hold.
His niece Claudia Martinez told reporters he would not be moved for four weeks. It was unclear what might happen in the interim or where he might go.
A statement issued Tuesday night by the health system did not deny that the man, dubbed “Patient X” by supporters, was being in effect privately deported. It said that it could not discuss specific cases, but that all decisions about care are made by patients in consultation with medical staff.
“We explore all options and engage in a patient-centered, collaborative process,” the health system said. “We do not, nor would we ever, make an independent decision related to a patient’s care or their placement. While those decisions are informed by the patient’s clinical needs, final decisions are made by the patient, or if the patient cannot make such decisions, their family or legal representative.”
The Free Migration Project, directed by Philadelphia immigration lawyer David Bennion, responded, “This is false, according to family members with direct knowledge.”
The health institution issued a two-sentence statement on Wednesday afternoon that repeated its assertion about patient consent and added, “We have no out-of-country transfers scheduled from Jefferson Health-Northeast.”
Jefferson did not respond to follow-up questions about who may have given consent in this case, or whether an out-of-country flight was scheduled but then canceled.
Advocates say the man, who has lived in the United States for about 20 years, could die if returned to Guatemala.
Federal immigration authorities are not involved in the situation, according to advocates who said the hospital was chartering a private flight to Guatemala.
The issues around the patient’s removal emerge in the middle of a lethal pandemic and amid ongoing national protests over systemic racism. Doctors and nurses in Philadelphia and other cities have marched in the streets to demand an end to health disparities and better treatment for Black Americans and others, including immigrants, who often lack access to quality care.
“Medical repatriations” have gone on quietly for a long time in the U.S., occurring when hospitals transfer undocumented patients who need chronic care back to their home country. The practice is unregulated, and often patients have not given their consent to be removed, according to the Norris McLaughlin law firm, which practices in Pennsylvania, New Jersey, and New York.
Decisions are made by insurance companies, doctors, hospital financial officers and administrators, and patients and their families may not necessarily be part of those discussions, according to the law firm.
Hospitals are bound by federal laws to arrange post-hospital care for patients who need it. But these kinds of cases present financial predicaments, particularly with patients whose brain injuries mean they will require lifelong care.
Undocumented patients generally are ineligible for long-term, government-paid services, so hospitals may not be able to discharge them to nursing homes or home-care agencies. Community agencies won’t take on huge costs with no chance for reimbursement. So hospitals can see their choices as limited: Keep the patients forever, or remove them to their homelands in a medical repatriation.
The practice has been criticized as “international patient dumping,” carried out through an informal policy of “screen, stabilize and ship.” Hospitals rent air ambulances and send uninsured, undocumented immigrant patients — whose catastrophic injuries require continuous care — to home countries including Mexico, Honduras, and Guatemala.
When patients arrive, it’s usually only a matter of time before they die, because they’re too poor to afford the care needed to survive, according to a study by Jennifer Smith, a law professor at the Florida A&M University College of Law.
The online petition by Jefferson medical students calls the man’s removal “unjust, unethical, and medically dangerous.”
“Deporting Patient X with no contingency plan or support system is blatant medical harm,” the petition stated. “When you forcibly separate an individual from their family, especially without their consent, you are doing harm. … When you fly an individual across the border in the midst of a catastrophic pandemic that could take the life of them or anyone they encounter, you are doing harm.”
The petitioners said Dr. Stephen Klasko, president of Thomas Jefferson University and CEO of Jefferson Health, has spoken out for racial justice and diversity, saying in a recent note to students and employees: “As an institution, we are united, and we are clear: The suffering of any community injures us all. Racism is unacceptable. We stand together against racial oppression.”
The health system did not respond to requests for comment from Klasko.
City Councilmember Helen Gym went to the hospital to support the family and seek more information about what was occurring.
“Jefferson remains an essential partner in delivering compassionate and excellent care to residents in Philadelphia, and we will be staying on top of this situation moving forward,” Gym said late Wednesday. “We want to ensure that all decisions are determined by the patient’s best interest and not by their immigration status.”
Philadelphia is a “sanctuary city,” meaning that its government strives to treat all residents the same, whether or not they are U.S. citizens.
The hospital wants to deport him “because it’s cheaper to spend $50,000 to send him to Guatemala than continue to care for him,” Jasmine Rivera, a leader of the immigrant advocacy group Shut Down Berks, posted on Facebook. “Despite his family saying no to this. And despite the fact that he can’t walk and has a brain injury, therefore can’t consent.”