Medical Deportation: Outsourcing “Removal” to Private Hospitals – Luis F.B. Plascencia
Luis F.B. Plascencia
Arizona State University
Since at least 2001, an important phenomenon has emerged that has drawn some attention from the media but remains to be more fully examined by anthropologists and other social scientists: the actions of local private hospitals to remove/deport “undocumented” migrants from U.S. territory without interference from federal agencies. These actions appear to have involved primarily migrants from Central American and Mexico.
The passive role adopted by the Bush administration and now the Obama administration, and the generally unpublicized efforts by hospitals involved, mean that an unknown number of migrants have been involuntarily and “voluntarily” deported/removed despite the accepted principle of Federal preemption in the regulation of migration.
On July 27, 2009, in the case of Montejo Gaspar Montejo, Guardian for Luis Alberto Jiménez v Martin Memorial Medical Center, Inc, a Florida jury rejected the challenge of Montejo and his attorneys to the deportation/removal of Jiménez on the grounds that it was done under “false imprisonment” (i.e., involuntarily). The case was of much interest to hospital administrators who had “transported,” “repatriated,” or “reunited” patients with their families in their “home” countries, or were considering such actions.
Jiménez’s story is a complex case that involves not only bioethical questions, but also a host of federal actions and inactions regarding: (1) the current debate on health care reform; (2) federal requirements regarding mandatory emergency and trauma care and their enforcement; (3) Medicaid rules regarding how hospitals are compensated for unpaid care; (4) the power of private corporations to deport/remove individuals; (5) the jurisdiction of federal circuit courts to authorize private entities to remove individuals; and (6) the discretion of federal agencies mandated to regulate migration to informally authorize private corporations to carry out deportations by not interfering in the removals.
Luis Alberto Jiménez, a migrant from Guatemala of Mayan descent, came to the United States without formal authorization and was working in Indiantown, Florida, for a landscape business. On February 28, 2000, he was involved in a head-on crash with a van driven by Donald Flewellen, who had stolen the van and was found to have been driving with an alcohol blood level four times the Florida limit. Two of the other passengers in the car were killed, and the driver was seriously injured. The 31-year old Jiménez suffered serious brain injuries. For most of the period between February 2000 and July 2003, Jiménez was given medical attention by the Martin Memorial Medical Center hospital. According to the hospital, Jiménez’s care totaled close to $1.5 million; they received about $80,000 under the Medicaid program.
Based on the cost and the problem of not finding an “appropriate” facility to provide long-term rehabilitation that would take Jiménez, the hospital pursued obtaining court approval to “discharge” him to Guatemala. The court approved the action but also granted a stay of the order until 10:00 am, July 10, 2003. On the morning of July 10 (before 10:00 am) the hospital chartered a plane to transport Jiménez to Guatemala. Montejo, who had been granted guardianship, challenged the action. In 2004 and in 2006, a Court of Appeals voided the original judge’s order, based on lack of jurisdiction to issue such an order, and found the hospital not to have immunity from further court actions, but the July 2009 ruling against Montejo and Jiménez ended the legal battle. Jiménez now spends most of his time in his bed in the Guatemalan highlands, cared for by his 73-year-old mother; he has recurring seizures and is said to rely on Alka-Seltzer as medication.
Though in the case of Jiménez the hospital took action directly to deport him, some hospitals now use a subcontractor to assist with the process. In 2001, Bob Barraza and George Ochoa created NextCare (later renamed MexCare), a for-profit corporation based in Chula Vista, California, that assists hospitals in their “discharge” of what MexCare labels “unfunded members of the community” or “Unfunded Latin American National[s].” Although the majority of the individuals they have “transferred” have been taken to Mexico, they advertise having affiliations with hospitals in Latin American countries and refer to the company as the “Gateway to Latin America.” Their sales promotion indicates that they help hospitals reduce costs related to “unfunded” individuals “by as much as 50%,” and that they are able to provide culturally sensitive attention and care to persons being “transferred.” By early 2009, they had contracts with seven San Diego hospitals, with plans to expand.
The phenomenon of extraordinary medical rendition is a fertile area for transnational research that can encompass a wide array of theoretical, human rights, legal and biopolitical issues. It is an issue to which anthropology can particularly contribute.
Reprinted from Anthropology News, Vol 50, issue 8, with the permission of the American Anthropological Association.
Luis F.B. Plascencia, PhD is Assistant Professor of Social & Behavioral Sciences at Arizona State University. Prior to joining ASU, he was Project Coordinator/Research Associate for the Public Policy Institute in the Government Department and Lecturer for the Center for Mexican American Studies at The University of Texas at Austin. In addition, he co-directed a national research project that estimated the size and distribution of the U.S. migrant agricultural workforce for the 50 states and Puerto Rico whose results were used by the U.S. Congress in the allocation of Migrant Legal Services funds. He has also served as Policy and Budget Analyst at the Texas Governor’s Office and Associate Director of the Texas Office of The Tomás Rivera Policy Institute. His publications and research focus on citizenship and migration, and on popular culture topics such as lowriding in the Southwest and the death of Selena.
Plascencia, Luis F.B. 2009. Medical Deportation: Outsourcing “Removal” to Private Hospitals. AccessDenied: A Conversation on Un/authorized Im/migration and Health. Accessed (date) at http://accessdeniedblog.wordpress.com/2009/12/18/medical-deportation-outsourcing-removal-to-private-hospitals-luis-f-b-plascencia/