Tucson CitizenTucson Citizen

Feds to end funding of ER care for migrants

Hospitals say they will not deny treatment

Paramedics work on illegal immigrants hurt in an accident along Interstate 10 last month. Medicare reimbursements for local hospitals dealing with emergency care for illegal immigrants is ending in October, but the hospitals vow to continue providing care as needed.

Paramedics work on illegal immigrants hurt in an accident along Interstate 10 last month. Medicare reimbursements for local hospitals dealing with emergency care for illegal immigrants is ending in October, but the hospitals vow to continue providing care as needed.

Tucson-area hospitals estimate that providing emergency care for illegal immigrants has cost them more than $66 million since 2005.

The federal government has reimbursed them for $13 million of that through a Medicare program that began in 2005.

But on Oct. 1, the beginning of the federal 2009 fiscal year, even that financial help will go away when the reimbursement program ends.

Hospitals are federally mandated to treat anyone needing care, and most health-care professionals feel a moral responsibility to do so. Caught between concerns about their own financial health and the tensions over the nation’s immigration policies, local hospitals try to send illegal immigrants who need expensive or long-term care back to their country of origin.

Patients’ families have challenged such transfers by hospitals in Phoenix, and The New York Times reported earlier this month about a Florida case in which a hospital transported a patient to Guatemala while the transfer was being challenged in court.

Local hospital officials say they transport patients only with patient or family consent and with approval of officials from the country of origin.

University Medical Center has been unable to transfer an unidentified patient it calls Adobe – who can’t communicate as the result of a brain injury from an April rollover – because it has been unable to find his family or establish his country of origin.

“You can’t just put somebody on an airplane,” said James Richardson, UMC’s vice president and in-house counsel.

UMC, which has the only Level 1 trauma center in southern Arizona, shoulders the greatest expense among local hospitals for treating illegal immigrants. It lobbied unsuccessfully in Washington, D.C., in July to extend the federal reimbursement.

“This is a federal problem,” said hospital CEO Greg Pivirotto. “This should not be an Arizona, Tucson or UMC issue. I’m sorry that (the federal reimbursement is) going to go away.”

But, he said, “we’re never going to turn away somebody who needs care.”

Under Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the government designated $250 million a year to be divided among the 50 states for emergency care of illegal immigrants. Arizona received $44.5 million in fiscal year 2007.

Hospitals that want Section 1011 funds have to prove that administrators tried to collect from the patient and other funding sources. Section 1011 is to be used as a last resort, said UMC spokeswoman Katie Riley.

UMC received $2 million from Section 1011 in both 2007 and 2006. According to information submitted to Medicare, UMC spent $11 million and $8 million in 2007 and 2006, respectively, on care for illegal immigrants. The costs do not include care given after a patient is considered stable.

Pivirotto estimates UMC has seen a 50 percent increase in illegal immigrant patients this year, partly because of the many rollovers of vehicles transporting them in the state. He expects the hospital to spend even more on patient care for foreign nationals in 2008.

The government has not given hospitals any guidance on what to do with illegal immigrants. It is up to the hospitals to decide the best practice, said Bill Pike, director of public policy and community affairs for Carondelet Health Network, the parent of Tucson’s St. Joseph’s and St. Mary’s hospitals.

Pivirotto estimates UMC transfers about 50 patients a year to their home countries, the majority to Mexico. UMC has been transporting patients for about 20 years, he said.

Pike estimates Carondelet’s two Tucson hospitals send fewer than a dozen patients a year to their countries of origin, and knows only of two patients sent from St. Mary’s so far this year.

Tucson Medical Center sends five or six patients a year, said spokesman Mike Letson.

Hospitals are not required to ask patients about their immigration status and do not automatically turn patients over to border authorities.

Rich Polheber, CEO of Holy Cross Hospital in Nogales, said only patients arrested by Border Patrol agents are turned over. And that’s after their care is concluded.

“(The Border Patrol) will never say they are their patients,” he said. “If (the patients) are under arrest, (the Border Patrol has) to pay for them.”

Instead, Polheber said, he will sometimes see Border Patrol agents waiting outside the hospital entrance for a specific patient. But it doesn’t happen often. If patients can leave on their own, they usually just walk out the door.

Pivirotto said the same thing happens at UMC because agents seem interested only in finding out who the driver was when there is a rollover with illegal immigrants. In most cases, patients are allowed to walk away.

UMC’s Richardson said that to send a patient to another country, the hospital has to receive permission from that country’s consulate and also locate adequate care for the patient. Until that process has been completed, a patient can’t be discharged.

Letson said that at TMC, no patients will be transported to another country without their consent.

How quickly those patients leave for their home country depends on the hospital’s relationship with that country.

Barbara Felix, UMC’s international patient services coordinator, said that if a patient can be transported to northern Mexico, the discharge plan can be started almost immediately. Her husband, a retired doctor from Hermosillo, Son., can often direct her to a former colleague who can care for the ill patient. She has also established relationships with many of Mexico’s hospitals and the Mexican consulate in Tucson, which makes it easier to get permission to transport a patient and design a discharge plan.

However, Felix said she is seeing more patients from Guatemala, El Salvador and Ecuador, where she has not established professional relationships.

Felix is arranging for UMC’s first transport of a Salvadoran patient, one of three sent to the hospital after a crash near Florence on Aug. 7. The other two patients have gotten better and have left on their own, but because of the extent of his brain damage, UMC is unable to release him.

A family member from the East Coast has come to be with him, and the man’s mother, who is in El Salvador, recognized his picture from a broadcast about the crash in her country. He is still at UMC while the Salvadoran consulate completes the paperwork that would allow him to be taken to a hospital in El Salvador. It may be another week before he leaves, UMC’s Riley said.

Polheber, the CEO of Holy Cross in Nogales, is also a member of the health services committee of the Arizona-Mexico Commission, which is a collaboration between Arizona and Mexico. Through the commission, Polheber has organized training in Arizona for nurses and doctors from Mexico and vice versa.

“The Arizona-Mexico Commission serves as developing linkages and friendships when you need to work on the transfer piece,” Polheber said. “We, particularly in our hospital here, have developed a relationship with Hospital General across the border.”

Both Polheber and Pivirotto expressed a desire to transfer patients to hospitals where the patient can receive advanced care. For both hospitals, that includes donating equipment and services that will enhance the level of medical care provided.

“I think it would be helpful if there was a methodology and agreement developed between Mexico and the United States on how patients would be transferred,” Polheber said. “It would be nice to say, ‘Lets develop a system.’ At this point everyone is doing the best they can.”

With or without federal guidance or funds, Tucson-area hospital administrators say they will continue to care for everyone who needs care and will continue to transport patients across the border, when appropriate.

“Section 1011 won’t change our actions,” Carondelet’s Pike said. “It will just create a bigger financial strain.”


On the Web

Section 1011 allocations by state


Medicare Prescription Drug, Improvement and Modernization Act of 2003 explanation



Online Poll: Should the federal government pay for hospitals to transfer patients out of the country ?
Yes, it's the feds' fault for not securing the border.: 18%
Yes, the feds should be helping with hospitals' costs, too.: 19%
No, the home country should be paying for their transfer.: 56%
No, it's the hospitals' responsibility.: 2%
Other.: 2%
419 users voted

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