According to the New York Times, hospitals have taken the problem of what to do with seriously ill (i.e., renal failure) and/or "catastrophically injured" (i.e., brain injured) patients. Spend $30,000 for a flying ambulance and send them back to their country of origin.

So, what's wrong with that? Well, for one thing, it's against federal law for a hospital that receives Medicare or Medicade money to release a patient onto the street. If the patient needs longer term care and/or rehabilitation, the hospital must transfer the patient to an appropriate facility.

The problem with that appears to be that most secondary care facillities won't take uninsured patients. They are for profit while most hospitals are not for profit organizations. So the hospitals have taken it on themselves--pack 'em up and ship 'em out.

The question then becomes a legal one. Are cross-border repatriations--done without control or over-sight--legal? Or is it 'patient dumping?'

Interesting story, as much for what it doesn't say as for what it does.


"Country of origin?" Huh? Is there a wee itty bitty part of this story that is somehow getting left out of the account here? Hmmm?

No, not unless you think I deliberately left out that a lot of the patients are undocumented. I did that because not all of them were undocumented. One was a sick baby, born in the US and, therefore an American citizen, who was going to be shipped to Mexico before the police stopped the flight.

Are the hospitals following any legal procedures? No, because there are none.

So, Liz, if there is no legal procedure can we assume the hospitals in question are not in fact breaking the law?

For the record, most hospitals are indeed "for profit" organizations and they have an obvious vested interest in ensuring the service hey provide is actually paid for...

I might also point out that you are misrepresenting the anti-dumping laws. They do not, generally speaking, require a hospital to transfer a patient to a secondary care facility. If a patient is stable and not in need of immediate life saving treatment the hospital can quite legally discharge that patient.

I think what we have here is a creative pre-emption of future uncovered expenses by the hospitals in question. By transferring their uninsured and undocumented patients back to their country of origin they not only avoid the likelihood of having to treat that patient again in the near future but they also generously the opportunity for that patient to enjoy the benefits of the socialized medical system of their home nation...After all, most of those countries have socialized medicine. Thats what the left tells us all the time when it says the US is almost the only nation that fails to provide free health care.

Bingo! That is precisely what was being left out of the story. And I'm rather skeptical about the "sick baby" story, but I'll let it go. The point is, these hospitals are seemingly trying to hold down their un-reimbursed expenses by trying NOT to end up getting stuck providing long-term care for non-U.S. citizens.


Indeed. This remarkable plus side of the story escaped my notice entirely. If we could just expand the program to be a medical option for U.S. citizens we'd be killing two birds with one stone: Even with the transportation costs, we could end up lowering health care costs over-all. And think of all those Americans who would get the opportunity to enjoy the health care they envy so much in other countries.

Hey, in Mexico you don't even need a doctor. You can just walk into your local pharmacy and buy all the pain killers you want.

So I'm with you on this one.

A funny thing happened on the way to the forum, tonight. I may talk about it, I may not.

Anyway, here's a part of what I found. Not all of the patients are undocumented and not all of them come from south of the border. A Chicago hospital admitted to repatriating patients to Lithuania and Poland, as well. And how do you define socialized medicine or universal health care, as it's also called? Many countries have 'some form' of universal health care but the definitions and extents of that care vary widely.

Guatemala, the country to which the test case patient was repatriated, doesn't. Futhermore, there's only one rehabilitation facility in the entire country. It has 32 beds and doesn't offer the specialized treatment needed for brain-injured patients.

Please don't get me wrong, I'm not dissing the hospitals. They, for the most part, can and do spend hundreds of thousands of dollars every year caring for un-insured patients, documented or not. Luis Jimeniz, the brain-injured patient, was kept as a ward of Martin Memorial Hospital in Florida to the tune of over a million dollars. No secondary care facility would take him although the release coordinators tried to find a place for him.

That really isn't the point. The point is that hospitals are being forced to do the work of Immigration with no guidelines, no oversight and no legal procedure to go by.

This is, to me, why the lawyers have now stepped in, in an effort to force the establishment of the needed guidelines, oversight and procedures.

And Law, please don't try to draw me away from the subject.

LOL...I would need to see the regulation that stated what you claim, Liz. This would not be the first time you said something that was not entirely in accordance with the facts. Which federal regulation requires hospitals to arrange post hospital care for patients who need it? On more than one occassion, I or family members, have been discharged from the hospital with instructions to make specific follow up appointments. The hospital did not arrange to have me transferred to a secondary care facility...where they violating your interpretation of federal law?

The Emergency Medical Treatment and Active Labor Act (EMTALA) only requires that a hospital stabilize a patient until the patient can be discharged or transferred to the nearest facility that will accept the patient.

So, what you are telling us, CG, is that Liz's opening post was in error? Federal law does not require what she claims it requires? How interesting...

What exact;y is the subject as you see it, Liz?

Yes LM!

Hospitals are closing their doors for many reasons. Several hospitals in my area have gone bankrupt in the last few years for reasons that had nothing to do with illegal immigration. Bush's incessant cutting of Medicare reimbursement so he can use the money to pay for your war plays a huge role.

First of all, Law, I didn't make the claim, I was simply quoting the article in the New York Times.

Secondly, since you and yours obviously didn't need a secondary care facility, you weren't transferred to one.

Third, you don't need insurance because you and your dependents have the full services of military hospitals and medical/dental care wherever they're available.

Finally, if you need to "see the regulation," look it up. You're much better equipped to do so than I am, since you've more experience with Google than am I.

In the meantime, I'll look up the difference between 'not for profit' and 'tax-exempt.' Hospitals, other than private facilities, are tax-exempt. I may be wrong, but knowing the requirements for a tax-exempt designation in this state, I know that tax-exempt means a not-for-profit organization.

When you find the regulation, please let me know where you found it so that we can start on the same page.

In the meantime, can we talk about why

Immigration involvement is only, please remember, in those cases wherein the patient is undocumented. Even legal immigrants are being repatriated, if they have no insurance. Why don't they have insurance? Could it be that they earn too much to qualify for Medicade but not enough to pay insurance premiums?

Medicare cut reimbursement rates for hospitals and nursing homes also...

The Bush administration has repeatedly increased Medicare premiums and deductibles while simultaneously cutting the reimbursement rates those premiums are supposed to cover. He is using Medicare money to pay for his war.

I am so sick of this. We are losing ERs now! Within the past 8 years, three near me have shut down. And we're losing more than hospitals; we are losing nursing homes too, just as our population is aging.

And no, Liz, they were not overcrowded with illegal aliens. It is VERY easy to "google" The Emergency Medical Treatment and Active Labor Act (EMTALA). I encourage you to do so...

Who was president when deinstitutionalization of the mentally ill occured, thereby turning thousands out into the street? It happened in the mid-fifties, so it was probably Eisenhower, a Rep.

The EMTALA has only to do with emergency care, CG, and what's happening now has much more to do with long term care. Let's see what Law can come up with to refute the claims made by the New York Times. If he comes up with nothing, it'll be because he can't, and, if he's pressed, he'll say it's because what I've posted isn't important enough for him to bother with. *sigh*

Not at all, Liz. I was merely pointing out that you are so frequently "in error" that one must take what you say here with a grain of salt. You also like to post things and then claim you were just repeating what the New York Times or whatever wrote...As if everything in the paper or on the net or on TV is the unstinting truth. I do not need to refute the New York Times...YOU are the one who parroted their claim...can YOU support it? I do not think think so.

I will repeat my question. What "point" are you try to make, Liz?

The Federal Emergency Medical Treatment and Active Labor Act(EMTALA), also known as COBRA or the Patient Anti-Dumping Law.

According to "State Legislatures Magazine" in an article from 2007:


I guess this is another example of the unintended consequences thing. We let the mentally ill out of institutions out of some sort of altruistic urges, then whine about how many of the recently de-institutionalized end up on the streets and/or eventually re-institutionalized, but in prison.

http://204.131.235.67/magazine/articles/2007/07SLApr07_Criminals.htm

Reagan began deinstituionalizing the mentally ill patients in Cali in the 60s. It's popularity caught on...becoming national and even international. Reagan was part of the Richmond Report era. This filtered down to Australia. The premise was to close all institutions etc and "integrate". I could debate this with you endlessly.

Nothing wrong with the mentally ill being institutionalized. We need to stop kidding ourselves that people like them are normal, they're not and why should they be? "The least restrictive environment" is what it's really all about. I'm sure you've heard of this.

Much of the emptying of the asylums and state hospitals came about because it was believed that for many mental illnesses, psychotropic drugs could be used to manage the patients.

And while this is probably true, people don't always like the effects of their medication, or simply forget to take them.

It may take a village to raise a child, but it takes an institution to keep a homeless crazy from standing outside your house at 4:30 in the morning screaming about how Napoleon is alive and running the country of Paraguay.

If you'd read my posts, Law, you'd have seen that I was, in fact, quoting; however, you've won.

Try the following:

It's under The Electronic Code of Federal Regulations and has to do with what's required from hospitals receiving Medicare payments.

You might also want to try Pub. L, #108-173, para. 201(c) of the Medicare Modernization Act of 2003. There are other pertinant paragraphs, but I'm sure you can find those, at least, without my help.

What point am I trying to make, Law? Read my lips posts, why don't you?

Time finally permits at least a rudimentary response...

USC 42 sec 482 covers 66 sebsections. I am not quite sure which one Lizbeth thinks is relevant to her claim or why she thinks I should have to do the work of proving her claim for her but...I was feeling generous. None of the 66 sections of the law Liz referenced require a hospital to arrange long term or secondary care. For instance, section 55 governs Emergency Services and states, in its entirety: Frankly, I think Liz just looked up a few laws that relate to medicare participation and posted those with little or no understanding of what those laws actually entailed. She then expected me to expend time and energy researching those laws to debunk her whereupon she would simply post a new law where again she had no understanding of the conent.

Here is another example drawn from her post above... For those interested in the entire law, here is a link http://www.ustreas.gov/offices/public-affairs/hsa/pdf/pl108-173.pdf The paragraph Liz referenced is produced below: Does anyone else NOT see a reference to patient dumping in that law? Liz must have seen it since she offers this in response to my request that she quote a law that supports her claim about patient dumping. Once again, Liz posts a law seemingly at random and without quoting from the text of that law in an effort to perhas persuade those too lazy or stupid to look that she knows what she is talking about. In the immediate case above, I speculate that perhaps she say the reference to transition in paragraph 201 and concluded it was a reference to transitioning patients from one facility to another...it is not. If you read the passage you will see it is a reference to transitioning from one program name to another.

Liz, be careful what you ask for.

Incidently, Liz, you STILL have not indicated what point you were trying to make in your OP.

Are you not capable of reading, my Sweet?

I may be wrong, but I think lizbeth is asking if cross border repatriations without control are legal, or patient dumping.

The terms, however, are not mutually exclusive, so the question is fuzzy.

lizbeth, don't be smarmy, I'm tired of removing posts like that from the boards. Either answer the question or remain mute; either way refrain from non-answers consisting of attempts at sarcasm coupled with the use of names like "my Sweet".

Regarding the opening post, it contains two separate issues that can and should be addressed sparately.

A) The claim that hospitals (regardless of whther that hospital receives Medicare or Medicaid reimbursements) cannot release a patient if the patient requires long term care and/or rehabilitation. This is patently false. If a patient is sentient and can make his/her own decisions and wishes to be released, a hospital cannot hold that patient no matter what medical condition the patient is in. If the patient is medically stable and has no life-threatening condition, then the patient can be, will be, and must be discharged "to the street", no matter what chronic underlying illnesses and comorbid conditions abound. If the patient is considered "stable", the patient is released so that a hospital bed is freed up for a sick patient. Hospitals are not rooming houses. If a patient is brain-damaged, senile, in dementia, mentally retarded, in coma, or otherwise "stable" but unable to perform self-care, that patient will be transferred to some state-owned managed care facility if no family exists to take the patient home. If a patient is physically disabled and homeless, or otherwise incapacitated by chronic illness and homeless, most hospitals have social workers that coordinate with city agencies to find such patients a place to stay when they are discharged.

But if they aren't actively ill and getting treated for an acute illness, they cannot live in the hospital.

B) The second issue is involuntary repatriation. The claim seems to be that in the case of patients who are brain-damaged, comatose, seriously ill, or "catastrophically injured" people, hospitals are shoving them onto planes that deliver them to their country of national origin. This sounds kind of odd and bogus to me. I suppose I'd need a lot more details from that New York Times story before I'd understand the story or believe it, because the way it's been presented to me doesn't sound credible. Sending someone to another country requires ticketing and a passport. If unconcious with no family involved, the patient is being kidnapped, in a sense. You can't place an unconcious or non-sentient person on a flight without accomaniment, they require handlers. And when they arrive and get wheeled off the plane into the airport, they need someone to get them through customs and supposedly into another hospital in that country.

I don't buy it. Information is missing here.