Difficult discharge needs caution, documentation
Patrick J. Hurd, JD, an attorney with LeclairRyan in Norfolk, VA, has seen cases in which hospitals struggled to discharge illegal immigrants, and he says the keys to success are proceeding cautiously and prudently, documenting the choices made and the rationale behind each.
In one instance, an uninsured indigent patient with no U.S. family members was relocated to a health care facility in his home country because the acute care facility could no longer meet his long-term care needs in a safe and effective manner. The steps the hospital followed included locating and contacting the foreign-based family and letting them know of the patient's hospitalization. For the incapacitated patient, this may involve speaking with neighbors, his/her employer, or other contacts to locate family members.
"As soon as it appeared that long-term care and/or rehab was necessary, case management staff worked with the family to identify an appropriate facility in that geographic region and spoke with physicians and staff at the facility regarding the patient and his care needs," he says. "The treating physician spoke with the physician at the facility, the hospital forwarded his medical record, and the timing and mechanics of the transfer to the facility arranged."
Once the physician and facility agreed to accept the patient and with the family's concurrence, the hospital hired a medical transport service and an RN to transport the patient to the facility and paid for all of the costs of the transfer.
"Because of careful, planned discussions early in the hospitalization, there were few, if any surprises for the patient and his family, thus minimal suspicion that the hospital was 'dumping' the patient or discriminating against him because of his immigration or economic status," Hurd says.
In another instance involving another hospital, Hurd says the patient was incapacitated and required the appointment of a guardian ad litem. The hospital worked closely with the guardian and the court, as well as distant relatives in the patient's home country, to implement a safe transfer of the patient to a facility better equipped to handle the post-acute care needs of the patient. As with the other example, the hospital arranged for and paid the costs of transporting the patient in a manner similar to that described above.
Both cases involved only a few months of acute inpatient care, not the three years involved in the South Florida case. In both instances, Hurd says, hospital staff and treating physicians acted early in the hospitalization to develop and implement a discharge plan. Each step of the process was carefully documented and the actions taken predicated on assuring safe and quality care of the patient. Both cases involved the concerted and coordinated efforts of treating physicians, case management, risk management, patient safety officers, and patient relations, supported by the input and guidance of hospital counsel. Neither case was criticized as the "deportation of an illegal immigrant."
"Granted, in those examples, things seemed to fall into place. Family members may have resisted at first, but did not balk at accepting the ultimate course of action," Hurd says. "The guardian ad litem was a skilled and cooperative professional. The treating physicians were supportive, and the hospital staff courageous. That will not always be the case."
Patrick J. Hurd, JD, an attorney with LeclairRyan in Norfolk, VA, has seen cases in which hospitals struggled to discharge illegal immigrants, and he says the keys to success are proceeding cautiously and prudently, documenting the choices made and the rationale behind each.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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