Medical deportation is now unlawful in Philadelphia, but what could implementation look like?

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In December, Philadelphia became the first U.S. city to ban medical deportations. Two months after the new law went into effect, what does it mean for hospital policy?

Medical deportation is used by hospitals to transfer a patient to a medical center in their home country, often without consent, translation, or proper explanation. In 2020, a Guatemalan man living in Philadelphia was nearly deported by Jefferson Torresdale Hospital.

A study published in 2012 found 800 cases of attempted or successful medical deportations in a six-year span. However, experts say the number is an undercount because hospitals were not required to report each case until the new law went into effect.

In 2023, Philadelphia City Council voted to outlaw the practice in the city.

Matthew Butkus, a professor of bioethics, law and hospital administration said while the law sets a precedent for what could serve as a template for hospitals across the U.S., the gears are slow moving.

“It’s a very, very complex topic and actually speaks to some medical framework issues,” he said.

Butkus is referring to how the hospital operates and what influences some of the decisions, like who gets what kind of care or, in this case, who gets transferred out of the country. Funding is a major influencer.

“We need to have a shift in resources so that making these kinds of health care decisions is not dependent upon the money available to us,” Butkus said. “Economic concerns are realities for these institutions. As a consequence, they still have to manage not just the care of this individual patient, but also the patient cohort [and] that patient population.”

The new law seeks to change the long-standing problem.

However, supporters of the new law are focused on the immigrant population, which are already vulnerable to poor access to services, including health care. One of those supporters is Pa. state Rep. Tarik Khan.

The Democrat has been a nurse for 20 years and has worked as a family nurse practitioner at a federally qualified health center for nearly a decade.

“This [medical deportation] practice is going on really in the shadows,” he said.

Khan said barriers, such as lack of insurance options and health care access, often require policy-level interventions.

Khan is now working on a state-wide bill to prevent what he calls “medical dumping,” or the removal of undocumented or uninsured immigrant patients from health care settings.

For months, politicians, law students, medical students, physicians and immigrant rights advocates rallied together for the cause. It was a no-brainer for many medical students, like David O’Connell, who said the majority of medical professionals he’s worked with are more concerned about the patient’s health than the price tag.

Additionally, it is risky to move a severely ill patient, especially out of the country. O’Connell said doing so could destabilize the person’s health, costing hospital systems abroad even more.

He referred to the oath he and all medical professionals take. The new law protects and reinforces the pledge while holding administrators accountable.

“We will never compromise our morals, our commitment to the health and safety of our patients, but without a doubt sometimes medical care is expensive,” he said. “One can imagine a scenario in which the financial interests for certain people might outcompete the pledge to the best interests of the patient.”

The new law serves as a guardrail for hospital policy, and it will be employed on a case-by-case basis. Beginning this month, hospital administrators must adhere to the new guidelines or face a hefty fine.

Representatives from Jefferson Health and Penn Medicine were unavailable for comment at the time of publication. Representatives with Philadelphia County Medical Society declined to comment.

There are two sides to the issue. The first is how safety nets are set up for low-income immigrant communities. The second is the economics of keeping a hospital open. The McGill Journal of Health points out that the only health care rights immigrant and migrant patients have are through the Emergency Medical Treatment and Active Labor Act (EMTALA), an unfunded federal law that requires hospitals “treat all patients, regardless of insurance status or ability to pay, in emergency situations.”

Butkus explained why holding severely ill patients for extended periods of time can put a strain on hospital resources and staffing. Unfunded mandates pose dangers to the viability of medical centers and hospitals, he said.

“Patient hospitals aren’t designed to be long-term care facilities. They’re designed to get you medically stabilized and move you on to the appropriate level of care,” Butkus said. “We also have to ensure that we have a system in place that provides hospitals with the resources they’re going to need to properly implement this.”

The cost to transfer a patient who is undocumented can be upwards to $50,000, a Free Migration Project report stated. However, the report claimed that a one-time, up-front cost is preferable when compared with an indefinite hospital stay.

Hospitals like Jefferson Torresdale use third-party medical transportation companies, such as MedEscort International Inc. MedEscort has flown more than 6,000 patients to around 100 countries, according to the Free Migration Project. There are roughly 350 airplane ambulances in the U.S., many of which advertise their services as cost cutting to insurance providers and hospitals. Immigrant rights advocates say these companies use misleading language to justify their services.

Kelly Mouer, chief operating officer at MedEscort, did not respond to a request for comment.

Hospital administrators contend with negotiations with insurance providers, but if a patient is uninsured the next option is to provide as much care as possible and then advise on an exit plan.

However, immigrant rights advocates point to a flaw in that system. Patients often face language barriers and do not understand what papers they are signing or why. The new law mandates the right to an interpreter.