On the afternoon of February 28, 2000, Luis Alberto Jiménez was returning home from work when he was hit by a drunk driver in a stolen van near Palm Beach Gardens, Florida. Mr. Jiménez was rushed to Martin Memorial Hospital Center (“Martin Memorial”), where he was stabilized, but only after suffering severe brain damage and significant physical injuries. According to his cousin and eventual guardian, Montejo Gaspar Montejo, “He was no longer Luis . . . . He didn’t talk. He didn’t understand anything. He stayed curled up in a ball. But he was alive.” Around the same time, on the opposite coast of Florida, a young woman named Terri Schiavo remained in a persistent vegetative state after suffering cardiac and respiratory arrest. Her situation and Mr. Jiménez’s sparked a several-years-long legal, political and media maelstrom about who should live and who can die in the modern American medical system. In the Schiavo case, the loudest public voices were demanding life, even though, absent a “true miracle,” Ms. Schiavo would “always remain in an unconscious, reflexive state, totally dependent upon others to feed her and care for her most private needs.” Meanwhile, when it came to Mr. Jiménez, the loudest voices seemed comfortable with death. Though Mr. Jiménez eventually came out of his vegetative state, many supported Martin Memorial’s decision to “repatriate” him back to his home country of Guatemala, where access to appropriate long-term care was so uncertain even physicians from the country argued that repatriation virtually assured that Luis Jiménez was “going to die.” That Mr. Jiménez was an undocumented immigrant seemed to be a crucial factor in the public’s moral calculus. As one Florida resident put it, “A huge part of this downward spiral [in the U.S.] is because we have been taking care of people—financially, medically and every other way—who have no business being here.”
This article is about the response of one group of advocates to the practice of medical repatriation, also referred to as medical deportation, in which hospitals choose to send non-citizen patients, usually those in need of long-term care, back to their home countries for treatment without engaging the federal immigration process. Medical repatriation has emerged as one of the most controversial and complicated issues in health policy – a dramatic example of the desperation created for both patients and providers due to the expanding fissures in the U.S. healthcare and immigration systems. Mr. Jiménez’s case is, in many ways, typical: Under federal law, Martin Memorial was required to engage in a discharge planning process for Mr. Jiménez to locate the appropriate post-hospital services. However, patients without insurance or the ability to pay out of pocket are difficult to place into long-term care. Low-wage, undocumented workers such as Mr. Jiménez are not eligible for public benefits programs such as Medicaid, typically do not receive health insurance through their employers, and do not earn enough to pay for services themselves. Not surprisingly, then, Martin Memorial was unable to find a long-term care facility that would receive Mr. Jiménez. The hospital’s proposed alternative was to “discharge” Mr. Jiménez back to his home country of Guatemala, above the objections of his guardian.