Article - August 20, 2008 - Chicago Tribune

Sending sick undocumented immigrants back home

By Judith Graham

It's a last resort.

That's how Chicago's Mount Sinai Hospital describes its practice of sending undocumented immigrants back to their country of origin.

Cara Pacione, director of social services, spoke to me about the hospital's experience as I was preparing a story for Wednesday's paper.

The New York Times wrote an extensive piece about the controversial practice two weeks ago, thrusting it into the national spotlight.

The Tribune also examined the topic in articles about a stroke survivor sent to the Philippines by a Des Plaines nursing home because he was uninsured. Orlando Lopez, an undocumented Filipino alien, was afraid he'd die after the Nov. 2005 transfer – and he did.

Pacione says that hasn't happened to Mount Sinai former patients. Over the last six years, the hospital has returned people in the U.S. illegally to Mexico, Poland, Lithuania, Honduras and Guatemala after serious illnesses and accidents. For the most part, the transfers worked out "relatively well," she says.

All were moved with their own consent or that of their families, and in each case Chicago doctors talked to colleagues in the patient's country of origin "to make sure they would offer an appropriate level of care," Pacione explains.

That's not good enough, some advocates argue. Once a patient returns to a country such as Mexico, a hospital that initially accepts him can later transfer him to another, sub-standard facility and he'll have no recourse, said Sonal Ambergaokar, health policy attorney for the National Immigration Law Center.

It's one thing for a patient to give medical consent to a transfer; it's another thing to waive rights to challenge what is in effect a deportation, Ambergaokar argues. She's willing to believe hospitals do the former and doubts they do the latter.

The hard reality is there are no good choices for undocumented immigrants who need long-term medical services.

Staying in a hospital for months or even years can be dangerous; these institutions are breeding grounds for infection and aren't designed for chronic care. Finding another facility willing to take someone without insurance is nearly impossible. (Illinois doesn't pay for nursing home care for illegal immigrants.)

If a patient is in relatively good condition, arrangements can often be made to help them be cared for at home, relying on family members and community supports, Pacione says. Mount Sinai will help by providing home health services and physical and occupational therapy free of charge.

But if an immigrant patient is bad off, requiring extensive nursing care, their family typically won't be able to shoulder the expense of in-home care. That's when the hospital has to start looking for other alternatives, including sending the person back where they came from, Pacione says.

Pacione tells of a Lithuanian man in his 40s who ended up staying at the hospital 13 months after a traumatic brain injury. Eventually, hospital officials located his mother in Lithuania and arranged for him to return to that country, first to spend several months in a rehabilitation facility and then with his mother at home.

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