Immigrants put hospitals in costly care dilemma

CHARLOTTE, N.C. -- More than two dozen medical staples hold together the left side of Orlen Rosales' head after he was struck by a train on July 4, his family says.

Few thought the 26-year-old Honduran would survive, but doctors and nurses at Carolinas Medical Center have worked nonstop to save him.

After weeks close to death, he's now up and talking.

But the bills for his treatment have far exceeded what the family can pay. The first day of his care cost more than $15,000, the family says. Another bill was more than $30,000.

Rosales doesn't have insurance. In fact, he's not even in the country legally. He was deported in 2008 after a drunken-driving arrest. And he's not eligible for Medicaid beyond emergency care.

"Yes, he doesn't have papers, but he's a human being," says Oneyda Lopez, Rosales' cousin.

His case reflects another challenge arising from the nation's troubled immigration system.

Roughly 11 million illegal immigrants live in the United States, including 350,000 in North Carolina and 70,000 in South Carolina. Many are uninsured.

Hospitals are confronting a dilemma they didn't create. They've been hit with mounting unpaid medical bills from seriously injured illegal immigrants. Some have looked to send these patients home for more care because they can't find long-term facilities in the U.S. to accept them without insurance.

But advocates for injured immigrants say some U.S. hospitals are dumping patients in places where they're likely to receive little care.

In a landmark case last summer, a Florida jury decided that Martin Memorial Medical Center near West Palm Beach acted reasonably when it repatriated a severely brain-injured Guatemalan man over the objections of his family and legal guardian.

Rosales' family and friends say they've felt pressure from CMC administrators to move him to a medical facility in Honduras.

Citing federal patient-confidentiality laws, hospital officials would not talk about Rosales' case. But they say returning patients to their home countries has nothing to do with their legal status or cost of care.

Barb DeSilva, vice president for clinical care management at Carolinas Healthcare System, which operates CMC, says it's strictly about giving patients the best long-term care possible. That often means moving them closer to family and loved ones.

A terrible collision

Rosales arrived in Charlotte about five years ago after his mother suffered a stroke and could no longer work.

In Charlotte, Rosales worked in carpentry and also cleaned condominiums. Every month, he sent money to his mother.

On the night of the accident, family and police suspect he had been drinking.

A Norfolk Southern train was speeding toward Charlotte when it passed the intersection of South Boulevard and Sharon Lakes Road. The engineer told police he didn't notice a man lying on the tracks until he was about 50 feet away. By then, it was too late.

It was 3 a.m. Rosales never moved. He lost his right hand and suffered head injuries.

For two weeks, he was in a coma. A priest came to his room to pray with the family.

Amy Cruz, his girlfriend, says administrators told her about a week after Rosales arrived that he should be sent home.

"He was breathing from a freaking tube and they're talking about sending him to Honduras," says Cruz, 22, who is from Puerto Rico. "He wasn't even awake."

According to the family, the hospital contacted the Honduran consulate to discuss possible hospitals and how to get him there.

CMC wouldn't talk about Rosales, but DeSilva says doctors tell families early on about the expected course of their loved one's care, whether that means sending a patient home, to a skilled nursing center, or to a hospital here or abroad.

His cousin, Lopez, who is in the country legally, feels caught in a bind. She says Rosales needs more care, which she's unable to provide, yet she also worries about the treatment he'd get in Honduras.

CMC: Care, not money

Carolinas Medical Center staffers help a few injured patients return to their home countries each year, DeSilva says.

She notes that CHS runs its own nursing facilities, where some indigent patients already receive free long-term care.

Rosales' cousin, Lopez, says hospital staffers have talked about these facilities, but never told them he could receive free care.

Sonal Ambegaokar, a health-policy attorney at the National Immigration Law Center, says some hospitals work through the consulates hoping families will volunteer to have their loved ones repatriated. Many hospitals, she says, never look into the quality of care the patient would receive.

"It's worse than patient dumping on a grand scale since you're really sending them out to the boonies," she says. "It's out of sight, out of mind, basically."

DeSilva says there is no international accreditation that measures quality of hospitals. CMC doctors consult with peers in the home country, then make clinical decisions, she says.

"If we're satisfied that the facility agrees that it can provide the clinical care needed, then we accept that."

A nationwide issue

The Pew Hispanic Center estimates that 59 percent of illegal immigrants are uninsured. That's about 15 percent of the nation's 47 million uninsured people.

Illegal immigrants are not eligible for Medicare, the federal insurance program for people 65 and older. They can get emergency care through Medicaid, the federal-state program for the poor and disabled. Anything beyond emergency care isn't covered. The new health care law specifically excludes illegal immigrants.

Some argue that hospitals are in this position now because the government has failed to properly enforce immigration laws.

Ron Woodard of N.C. Listen, an advocacy group, says he is sensitive to Rosales' injuries, but notes that taxpayers will ultimately pay.

"If we were just so flush with money, I guess we could just take care of the rest of the world's health care," he says. "But we're not."