March 2017

The Crime of Medical Deportations

Chinese immigrant Kong Fong Yu being wheeled into court in September 2008 as New York Downtown Hospital sought to deport him over objections of court-appointed guardian.
(Josh Haner/New York Times)

The fact that American society is gravely ill is now taken for granted even by its own pundits. Its acute political and social crisis is a symptom of the advanced decay of capitalism, a system long overdue for extinction. Today, political “debate” in Donald Trump’s Washington is focusing on how to ramp up the capitalist assault on health care, while escalating deportations even beyond the record number carried out under Barack Obama.

What American capitalism does to health care is shown by a particularly sinister form of deportations that has been taking place for over a decade. Cynically dubbed “medical repatriation,” the practice involves deporting undocumented immigrants – many of them workers injured on jobs with little-to-no safety standards – to their countries of origin while in a comatose or non-responsive state. While private hospitals “dumping” poor patients onto public ones has led to some widely-reported scandals, this deadly dumping-by-deportation has largely flown under the radar.

A 2012 report shed light on the practice that, at the time of the report’s release, accounted for “more than 800 cases of attempted or successful medical repatriations across the United States in the past six years.” Among the cases it documents are those of:

“a nineteen-year-old girl who died shortly after being wheeled out of a hospital back entrance typically used for garbage disposal and transferred to Mexico; a car accident victim who died shortly after being left on the tarmac at an airport in Guatemala; and a young man with catastrophic brain injury who remains bed-ridden and suffering from constant seizures after being forcibly repatriated to his elderly mother’s hilltop home in Guatemala.”

– Center for Social Justice at Seton Hall Law School and the Health Justice Program at New York Lawyers for the Public Interest, Discharge, Deportation, and Dangerous Journeys: A Study on the Practice of Medical Repatriation (December 2012).

The figure of 800 is certainly a vast underestimation, since a single hospital in Arizona, “St. Joseph’s in Phoenix, with a focus on keeping down the rising cost of uncompensated care, repatriates about eight uninsured patients a month,” or about 100 patients a year (New York Times, 9 November 2008).

Most instances of medical deportation are carried out by private firms that specialize in colluding with hospital administrators to tear undocumented patients from the long-term care they need, and send them back to their countries of origin where specialized care is either non-existent or out of reach. One company, “Mexcare,” boasts of a network of 28 hospitals south of the border, promising “significant saving to U.S. hospitals” seeking to get rid of “unfunded Latin American nationals.” A social worker at Mt. Sinai Hospital in Chicago reported that “We’ve done flights to Lithuania, Poland, Honduras, Guatemala and Mexico” (“Immigrants Facing Deportation by U.S. Hospitals,” New York Times, 3 August 2008).

The Seton Hall/Health Justice report notes that “when critically ill or catastrophically injured immigrant patients are transferred to facilities abroad, their lives and health are often jeopardized because these facilities cannot provide the care they require and the transfers themselves are inherently risky, resulting in significant deterioration of a patient’s health, or even death.” A particularly horrifying case was that of Quelino Ojeda Jiménez, a 20-year-old construction worker from Mexico who in 2010 fell from a twenty-foot roof on a job site in Chicago. Having gone into a coma for three days, Jiménez woke up paralyzed and on a ventilator:

Quelino Ojeda Jiménez in Chicago hospital in 2010. Hospital disconnected him from equipment and deported him three days before Christmas.  He died a year later in horribly underequipped Mexican hospital.

“The hospital cared for Quelino for four months before deciding it was ‘best to return him close to his family,’ although his family contested his repatriation. Three days before Christmas, hospital staff disconnected him from equipment and rolled him away on a gurney as one of his caregivers pleaded for them to stop. Crying and unable to speak, Quelino could do nothing…. Quelino languished for more than a year in a Mexican hospital that had no rehabilitation services and lacked the funding for new filters needed for his ventilator. After suffering two cardiac arrests and developing bedsores and a septic infection, Quelino died there on January 1, 2012.”

Countless more undocumented workers have been left for dead because of the foul practice of literally throwing patients out of hospitals. According to a CBS News report (23 April 2013), some hospitals lie to patients, saying their families want them home, and lie to their families, saying the patient wants to return home. All this to extort a consent for deportation. And if there is none? Well, the hospital can just make it up!

The New York Daily News (25 June 2013) reported on the case of an undocumented Polish immigrant who, after living in this country for 30 years, “fell unconscious after a stroke in the U.S. and woke up back in Poland” without ever giving consent, after a New Jersey hospital had him dumped “like a sack of potatoes” onto a plane operated by Air Escort Medical Flight.

Juxtaposed to this macabre picture is the practice of “red blanket” or “pavilion” treatment for wealthy patients. This includes “private hotel-like rooms on the top floor, which come with gourmet food, plush bath robes and small business centers,” together with doting attention from hospital staff, according to an indignant op-ed by a young Boston physician (“How Hospitals Coddle the Rich,” New York Times, 26 October 2015). The author reports that of the 15 top hospitals, as rated by U.S. News and World Report, at least 10 offer such luxury treatment “options.”

In 1894, the French novelist Anatole France wrote with bitter irony that “the law, in its majestic equality, forbids rich and poor alike to sleep under bridges, to beg in the streets, and to steal their bread.” As the horrific stories of the health-care industry’s cruelty for profit illustrate, U.S. capitalism can boast that it gives rich and poor alike the “freedom” to pay up or die.

“DSH,” Deportations and Capitalism’s Death Spiral

Antonio Torres (center), a farm worker and permanent U.S. resident, was left comatose after June 2008 auto accident. Catholic hospital in Phoenix first tried to unplug him, saying he had no chance of survival, then deported him to Mexico over parents’ objections. However, his parents contacted Jehovah’s Witnesses, who arranged for him to be brought back to U.S. and treated in city-owned hospital in El Centro, California. Having survived this ordeal, three months later Antonio was walking (shown here with his family outside farm worker barracks in Gila Bend, Arizona). 
(Josh Haner/The New York Times)

Hospitals are legally required to admit and treat patients in need of urgent care, regardless of immigration or insurance status, under the Emergency Medical Treatment and Active Labor Act of 1986. Facilities categorized as “disproportionate share hospitals” in terms of the percentage of uninsured and low-income patients they treat receive additional funds from Medicaid, known as “DSH” payments. However, hospitals are not required to keep patients after they stabilize. Since most long-term care facilities will not accept uninsured and undocumented patients, hospital administrators are eager to ship these undocumented patients off – out of sight and out of mind.

Today, as Republicans scramble to “repeal and replace” Obamacare, praising “Obama’s signature achievement” is de rigueur for Democrats. While Obamacare increased eligibility for Medicaid, it included many regressive measures, including the tax on the better health coverage (derisively dubbed “Cadillac” plans) won by some unionized workers. It also provided a billions-rich trough of new profits for the insurance companies. Meanwhile, employers were not required to offer company health plans to employees working less than 30 hours a week – so in response, many bosses responded by cutting workers’ hours (see “Obamacare Screws Workers, Windfall for Insurance Companies,” The Internationalist No. 41, September-October 2015).

Under Obamacare, hospitals received less from DSH payments: since the number of uninsured people dramatically decreased, the federal government cut the DSH funding it gave to the states, which then cut the DSH funds disbursed to hospitals. Public hospitals were hit particularly hard. The result for undocumented immigrant patients? The Seton Hall/Health Justice report predicted that under Obamacare, “the reduced allocation of federal funding ... will lead to more medical repatriations as hospitals, particularly those that provide a disproportionate amount of care to uninsured and publicly insured patients, face additional financial strain.”

The anti-immigrant drive ramped up by Obama, now being escalated even further by Trump, has devastating effects on health, as noted in “The Health Implications of Deportation Policy,” a study published in the Journal of Health Care for the Poor and Underserved (May 2015). Authors Juliana E. Morris and Daniel Palazuelos note:

“Physicians and public health professionals are growing increasingly concerned about the effects of U.S. deportation policy on human health. Children who lose their parents to deportation are at increased risk for behavioral, mental, and physical health problems. Immigrant communities that have experienced raids and deportations have higher rates of stress, fear, and decreased health care utilization.”

Immigrants held in detention often face “inadequate medical attention” as well as the effects of isolation and acute stress. Having carried out extensive research in Central America, the authors note that “the effects of deportation extend well beyond the individual and family unit,” often with devastating consequences for entire communities, and for poor countries dominated by U.S. imperialism.

“We Will Continue to Serve All Those in Need”

Today, with Donald Trump vowing to deport people for even the smallest of legal infractions (like smoking in a public park), the ante has been upped. Capitalism in its decaying, imperialist stage throws into sharp relief the disjunction between the vast wealth and luxury of the parasites who exploit workers like Quelino Ojeda Jiménez, and the savagery which is required to sustain that wealth. While hospital administrators cry poverty, billionaire capitalists amass vast profits at the expense of the working class. The only way out of this junction is through a socialist revolution, in which the working class – of all national origins and races, with or without “papers” – seizes the means of production and establishes a planned economy in which production is for social need, not profit.

While the crisis of health care is inextricably linked to the crisis of capitalism and the need for revolution, militant workers and defenders of immigrant rights can do something about this now. Obstacles to effective action must be overcome, centrally the chaining of labor’s power to the Democrats – like NYC mayor Bill de Blasio, who just expanded the number of offenses for which the NYPD will cooperate with immigration cops to 170. The social power of the working class needs to be unchained and mobilized to fight against deportations –medical and otherwise,

With pressure mounting to slash the number of undocumented patients, an important example has been set by NYC Health Care Employees Local 768 of AFSCME DC 37. In early February, the local unanimously passed a motion resolving that it “will not go along with demands to cut care to undocumented patients,” but instead will “continue to serve all those in need and oppose any attempt to use immigration status against them, or to collect such information.” It also called for NYC-area unions to organize “a massive protest showing the power of labor to stand up against any and all ant  i-immigrant, anti-Muslim and other racist attacks” (see box).

As we have repeatedly emphasized, the organized power of the multiracial, multiethnic working class is key to jamming the wheels of the capitalist deportation machine. Health-care workers throughout New York and nationwide should take up, pass and put into practice the kind of motion approved by the sisters and brothers of Local 768, standing in defense of their undocumented patients. And if an emboldened ICE tries to target medical facilities, all defenders of immigrant and labor rights should join with health-care and other city workers to stop the immigrant-hunters – and as part of this struggle, fight to put an end to medical deportations. ■