“Doing No Harm” in an Age of Medical Repatriations: Challenges and Opportunities for Health Professionals – Juliana Morris
Harvard Medical School
How often do doctors cause harm to their patients when they discharge them from the hospital? For a sizeable group of immigrant patients who are “discharged” to their countries of origin each year, the answer may be: more often than not. The story of Quelino Ojeda Jimenez, an immigrant from Oaxaca, Mexico, who became quadriplegic after a fall at his roofing job in Chicago, Illinois, is case in point.
Following his injury in the fall of 2011, Mr. Ojeda was brought to Chicago’s Advocate Christ Medical Center, where he began receiving health care and rehabilitative services. But as an uninsured, undocumented immigrant, Mr. Ojeda was unable to pay his hospital bills and did not qualify for federal assistance. The hospital was losing money on his care, and after four months, a decision was made to send Mr. Ojeda back to his home country.
Hospital administrators coordinated with a hospital in Mexico to take over his rehabilitation and contracted with a private medical transport company to make the transfer. The hospital claims that financial pressures notwithstanding, Mr. Ojeda was ultimately discharged for “medical reasons.” Mr. Ojeda, however, said he never consented to repatriation, and reports from Mexico allege that the receiving hospital was unable to provide the same quality of care or the therapy he required. Mr. Ojeda suffered a number of complications, including septic infection from preventable bedsores. A little over a year later, he was dead.
While it would have been difficult to predict the specific course of Mr. Ojeda’s health at the time of his discharge, the very fact that his health care providers’ actions put him at risk of receiving inadequate care flies in the face of the mandate of medical ethics: “above all, do no harm.” And Mr. Ojeda’s case is not an isolated incident. Since at least 2001, hundreds of reported medical repatriations from the U.S. have taken place each year. In many of these cases, harm is done and patients do suffer as a result of repatriation.
As a medical student just beginning my career, the thought that I might be forced to make decisions that end up harming patients is both scary and infuriating. There is clearly a need for change.
Thus far, advocates such as New York Lawyers for the Public Interest have called for reforms to hospital policies and clear repatriation guidelines to avoid potentially dangerous transfers. Academics have pointed to the need for more research into the practice. Before the problems associated with medical repatriation can be fully addressed, however, their root causes – U.S. immigration and social service policies – must also be challenged. If Mr. Ojeda had had access to health insurance like Medicaid/Medicare despite his immigration status, he could have been placed in a skilled nursing facility and received care that was much more cost-effective than his hospital-based care. Had he been able to apply for a visa to come to the U.S. or to adjust his immigration status once here (both possibilities that are tightly limited under current policies), he would have had many more options to stay in the U.S. and see his care reimbursed.
Health professionals and students have important roles to play in identifying and advocating for policy changes that can improve the health of immigrant patients they serve. Hearing stories like Mr. Ojeda’s should inspire us to action. We must advocate within our professional organizations and within our institutions to stop the process of unethical repatriations and ensure that immigrants are given opportunities that best support their health and well-being. But as health professionals, we must also take this advocacy a step further.
Those of us who work with immigrant patients bear daily witness to the stress, health risks, and health care limitations our patients experience as a result of U.S. immigration policy and social service policies. Every time an immigrant cowers in fear when a police officer crosses her path, or a young man works without protective equipment because he’s afraid to report a safety violation, or a child cries for his recently deported father, these social determinants contribute to poorer health outcomes for that individual.
Immigrant rights groups across the U.S. have long been fighting for changes to immigration law and social service policies that would increase opportunities and respect for immigrants. Most recently, they have been calling for the termination of the Secure Communities policing program; increased pathways to citizenship; an end to deportations of upstanding community members; expanded access to critical health care services; and other initiatives that honor immigrants’ rights.
To truly effect positive change in the health of the communities we serve, health care providers must add our voice to these calls for change. Given our keen understanding of the impact of U.S. policies on immigrant patients’ health, we can offer unique perspectives to strengthen advocacy efforts. We must have conversations with our colleagues, lobby our representatives, and go out to the streets with our message. We must advocate for changes within our institutions, our professional organizations, and our communities.
United with the communities we serve, health professionals can help achieve changes to policies and practices that will improve the health of immigrant communities. These changes will help prevent unnecessary deaths like Mr. Ojeda’s. And over time, it is my sincere hope that the policy changes we achieve together will alter the social determinants at the root of immigrant health inequity, thereby fostering improved health and well-being for immigrants in our own communities and beyond.
Juliana Morris, BA is a third-year student at Harvard Medical School pursuing a career in family medicine. Before entering medical school, she worked for three years with immigrant-serving non-profits in the U.S. and Mexico. Her research interests include immigrant health, access to care issues, and social determinants of health.
Morris, Juliana. 2012. “’Doing No Harm’ in an Age of Medical Repatriations: Challenges and Opportunities for Health Professionals.” Accessed [date] at http://accessdeniedblog.wordpress.com/2012/06/20/doing-no-harm-in-an-age-of-medical-repatriations-challenges-and-opportunities-for-health-professionals-juliana-morris/.