1. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 1 International Patient Dumping Private Hospital “Deportations” of Uninsured Immigrants Nisha Agarwal, Director, Health Justice Diversity Rx Conference October 19, 2010

2. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 2 Overview The cases NYS workgroup on medical deportations What role for law? How to message?

3. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 3 The cases

4. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 4 Luis Jimenez - Florida Originally from Guatemala; undocumented; uninsured; hit by drunk driver & hospitalized Hospital incurs $1.5M in costs; unable to find rehab center willing to take uninsured patient; also unwilling to pay costs Hospital decides to send patient back to Guatemala above objections of guardian; litigation ensues Now: in Guatemala, receiving virtually no health care; jury found hospital did not behave unreasonably; attorneys filed for new trial

5. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 5 Kong Fu Yu - New York Originally from China; undocumented; uninsured; elderly; suffered stroke & hospitalized Hospital unable to find facility to accept patient; decide to send him back to China above guardian’s objections Hospital files motion to have court proceedings closed to media, to have guardian removed Now: hospital looking into obtaining PRUCOL status for patient, in hope of getting benefits

6. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 6 NYS workgroup

7. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 7 Goal: Understand problem, develop solution “We really need a definitive answer on how to proceed in cases like these.” - William Phillips, jury foreman, Jimenez case

8. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 8 Approach Multi-sector; national, state & local partners; some providers included; NYIC, NYAM & NYLPI coordinate Sub-committees: Legal, policy, messaging/communications, data collection, services/appropriate care Structured interviews with social workers, advocates and other service providers Legal research & creation of rapid response team

9. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 9 Initial Findings Social workers reporting 4-5 cases per year in which patient threatened with forced repatriation Hospitals lack understanding of inter-relationship between immigration law & benefits eligibility; patients lack knowledge about discharge rights; language barriers impact discharge Resources are wholly inadequate for hospitals and patients Lack of knowledge among providers & advocates about the resources that do exist

10. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 10 Role for law?

11. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 11 Rapid Response Team Multi-sector (attorneys, social workers/providers) Connect patient, advocate & hospital to available resources, if possible Provide limited, emergency legal representation - e.g. discharge appeals, TROs Catalog cases, introduce some accountability into system for hospitals

12. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 12 Impact Litigation? Anti-patient dumping laws Discharge planning laws Preemption Tort law

13. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 13 How to message?

14. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 14 Possibilities Engage financial arguments? Ethical/human rights framework? More than just about undocumented immigrants Draw links to “traditional” patient dumping, build alliances

15. N Y L P I Proprietary & Confidential © New York Lawyers for the Public Interest 15 Thank You! Nisha Agarwal, Director, Health Justice 212-244-4664 x353 nagarwal@nylpi.org www.nylpi.orgwww.nylpi.org / healthjustice.wordpress.com twitter: @healthjustice