Lori A. Nessel on the Legality and Ethics of Medical Repatriation
As hospitals find themselves unable to discharge uninsured immigrants to other facilities, they are increasingly "deporting" such patients to their native countries. The recent ruling in the first known legal challenge to this practice of "medical repatriation" sends mixed messages concerning the extent of liability hospitals may face: The appellate court had found the hospital's actions to be unlawful, yet the jury found that the hospital's unlawful detention and deprivation of the patient's liberty without legal authority or consent was not unreasonable or unwarranted under the circumstances and thus awarded no damages.
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Impact of Jimenez Decision on Medical Repatriation
What impact will the Jimenez decision have on hospitals seeking to discharge immigrant patients who still need expensive medical treatment? Certainly, the Jimenez litigation garnered public attention to what has been described by the New York Times as a "little-known but apparently widespread practice." But the practice of hospitals engaging in repatriating uninsured immigrants, most often against their wishes, illustrates the failings of both our health care and immigration regimes. When hospitals forcibly send immigrants back to their native countries, they are essential enforcing federal immigration laws absent any federal oversight or accountability.
There are two basic and distinct messages sent by the Jimenez decision. On the one hand, the jury did not find any monetary liability for Martin Memorial Hospital, seeming to signal a green light to similarly situated hospitals debating whether to forcibly repatriate uninsured immigrants. However, the Court of Appeal also ruled that the hospital repatriation was unlawful, as the court was preempted by federal law from immigration regulation and thus lacked subject-matter jurisdiction to rule on what was at its heart an immigration matter. Moreover, the Court of Appeal ruled that the hospital was not protected by the doctrine of qualified immunity, as it was acting to further a private interest. Based on these aspects of the Court of Appeal ruling, hospitals considering following the same course might well be facing liability in the future.
But it is also important to keep in mind that the finding of no liability in the Jimenez case was limited to Florida law on false imprisonment. As a matter of policy, the California Medical Association responded to media coverage of the forced repatriation of Jimenez with a declaration in opposition to the forced repatriation of patients, and the issue is also under consideration by the American Medical Association. While the Jimenez decision is believed to be the first legal ruling on the issue of medical repatriation, attorneys seeking to protect their immigrant clients from medical repatriation have a number of potential arguments.
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