Sunday, December 13, 2009
On Entitlements (part II)
I recently came across a story that highlights the difficult dilemma inherent in the issue of health care entitlements. Over a period of three years, a hospital spent over $1.5 million dollars to provide health care for an undocumented immigrant who was seriously injured by an errant driver. The hospital felt that it had no choice and chartered a $30,000 flight to send this young man back to his native Guatemala. After briefly being treated by a Guatemalan hospital, they also decided to release him.
It deeply saddens me to see a human being's dreams of a better life tragically shattered. And the hospitals actions are unsettling on an emotional level, because we know that this young man will experience deprivation and vastly inferior medical attention in rural Guatemala. But, my rational side says that our system is one of limited resources that cannot provide unlimited care to an unlimited number of individuals, which necessitates painful decisions. All individuals are equal in the eyes of G-d, but in a world of limited resources our first obligation must be to our own families and then to our countrymen.
One troubling side note, rather than show gratitude for all the time and money that the hospital spent caring for this young man, the family sued the hospital for $1,000,000. Of course they did not sue the Guatemalan hospital that released him from their care, because they know that outside of the United States there is no chance that their sense of entitlement would be validated by the courts of by society at large. And surprisingly, an American jury ruled in favor of the courts.
I do not entirely blame this family for their ingratitude, because it stems from the inflated sense of rights that they developed in the United States, not in their native Guatemala. It reflects the pervasive sense of entitlement that plagues modern American society and has even taken root among undocumented immigrants. I must emphasize that the issue at hand is not America's decision to provide free medical attention to its native born and immigrant populations, but the fact that so many individuals demand these services and feel that have unlimited rights to the limited resources of others. And dare we withhold these entitlements, we provoke rage, indignation and endless lawsuits. Clearly Milton Friedman was correct "you cannot simultaneously have free immigration and a welfare state."
US jury favors hospital that deported immigrant
Thu Jul 23, 2009
MIAMI — A hospital that sent a seriously brain injured illegal immigrant back to Guatemala — over the objections of his family and legal guardian — did not act unreasonably, a jury found Monday.
Deputy Court Clerk Carol Harper said the unanimous six-member jury found in favor of the Health care and immigration experts across the country have closely watched the court case in the sleepy, coastal town of Stuart. The hospital had cared for Jimenez, who was uninsured, for three years. But it was unable to find any nursing home to take him permanently because his immigration status meant the government would not reimburse his care. Hospital and against the guardian of 37-year-old Luis Jimenez, a Mayan Indian from Guatemala.
"Hospitals are not intended to become long-term housing," said Linda Quick, president of the South Florida Hospital & Healthcare Association. "The issue is that there are no long-term providers required to take people for whom they know they are not going to be paid."
She said that as a result of the case, hospitals will likely begin planning for discharge as soon as they admit patients they suspect cannot pay and could require long-term care.
The lawsuit filed by Jimenez's cousin and legal guardian sought nearly $1 million to cover the estimated lifetime costs of Jimenez's care in Guatemala, as well as damages.
The hospital said it was merely following a court order — which was being appealed at the time — and that Jimenez wanted to go home.
Jimenez's cousin, Montejo Gaspar, was named his legal guardian because of his brain injury. Gaspar's attorney Bill King said he was extremely disappointed with the ruling and was reviewing all options including whether to appeal.
"There is no doubt that the state government and the federal government has to address the situation," he said. "They can't let something like this happen again."
Martin Memorial Medical Center's CEO and president Mark E. Robitaille said in a statement the hospital was pleased with the ruling.
"We have maintained all along that we acted correctly and, most importantly, in the best interests of Mr. Jimenez," Robitaille said.
But he agreed lawmakers must step in to ensure hospitals are not put in the same position in the future.
"This is not simply an issue facing Martin Memorial. It is a critical dilemma facing health care providers across Florida and across the United States," he added.
Robitaille, who was not yet head of the hospital when Jimenez was send back to Guatemala, said he was concerned that none of the health care reform proposals being debated in Congress address the issue.
Like millions of others, Jimenez came to the United States to work as a day laborer, sending money home to his family. In 2000, a drunk driver crashed into a van he was riding in, leaving him a paraplegic with the cognitive ability of a fourth grader. The man who caused the accident — which killed two people — was driving a stolen van. An insurance policy ended up paying a total of $30,000 in compensation to Jimenez and the families of the three other victims.
Under federal law, hospitals that receive Medicare reimbursements are required to provide emergency care to all patients regardless of their ability to pay and must provide an acceptable discharge plan once the patient is stabilized. But the hospital couldn't find anyone to take Jimenez. Eventually, backed by a letter from the Guatemalan government, the hospital got a Florida judge to OK the transfer to a facility in that country.
Fearing the Guatemalan letter held an empty promise, Gaspar appealed. But without telling Jimenez's family — and the day after Gaspar filed an emergency request to stop the move — Martin Memorial put Jimenez on a $30,000 charter flight home early on July 10, 2003.
Gaspar eventually won his appeal, with the court ruling a state judge doesn't have the power to decide immigration cases and that Jimenez should not have been sent back. By then, Jimenez had been released from the Guatemalan hospital and was living with his 73-year-old mother in her remote one-room home in the mountainous state of Huehuetenango.
King said he believed some good had come from bringing both the initial appeal and the most recent case.
"We've shown that state judges cannot authorize what is tantamount to private deportation of undocumented immigrants, and that hospitals have to follow the federal requirements that are in place for the discharge of all people, including undocumented immigrants," he said.