From dislocated knees to broken arms, humans are inexplicably prone to injury. More often than not, everyone at some point has found themselves lying in a hospital bed, nervously awaiting a doctor’s examination while a nurse offers them a calming smile and a comforting array of cafeteria snacks. For many people, hospital visits are a normalized aspect of one’s adolescence, certainly unenjoyable yet dually inevitable.
However, for many immigrants, hospitals possess a much more sinister representation. In the span of a single one–hour visit, immigrants are liable to expulsion back to their native country, where they could be forced to endure persistent warfare, regional violence, or impoverishment. For many immigrants, hospitals can act as a physical embodiment of their single greatest fear: deportation. In a practice known as medical deportation, hospitals have been deporting critically ill immigrants back to their birth countries without their (or their caretaker's) consent. Consequently, in his new bill, PhiladelphiaCity Councilmember At–Large Jim Harrity aims to eradicate all medical deportation in Philadelphia and raise greater awareness surrounding medical exploitation of immigrants and refugees within the medical community.
In the United States, hospitals are legally obligated to provide life–sustaining treatment to every individual, regardless of their race, sex, immigration status, etc. Nationwide laws such as the Emergency Medical Treatment and Labor Act ensure that anyone in need of emergency medical care receives hospital treatment, regardless of their immigration status. Despite these laws, many hospitals in Philadelphia have continued to covertly perpetuate the practice of medical deportation, often misleadingly referring to it as ‘medical repatriation.’
Although the federal government is the only entity that has the authority to sanction medical deportation, hospitals consistently arrange for terminally ill patients to be deported back to their native country, even when the patient’s critical condition means that they will be unable to survive the duration of the flight. Often, hospitals exacerbate the deterioration of the patient’s condition by deporting them to countries where there is limited access to health care.
Even though medical deportation has continued to persist in Philadelphia for decades, there have been few attempts to regulate it until recently. On Sept. 28, Harrity introduced a new bill whose ultimate objective is to ensure that “no hospital in Philadelphia may engage in medical deportation, either directly or through a designated agent.”
If his bill passes in Philadelphia, immigrant and refugee patients will be able to have greater medical autonomy in where they choose to receive their medical care. According to the bill, the patient must be informed in oral and written form of all of their treatment options, the deportation process, and the potential danger of travel on their health in their primary language. Only after they have received this information can the hospital begin arranging transportation back to their native country. The crux of the bill resides on the fact that medical deportation can only occur after the patient has given their informed consent.
Harrity’s bill will increase regulation of hospitals’ medical deportations. In the event that a patient does consent to being repatriated, all hospitals will be required to document and submit all deportation requests to the Department of Public Health and the City Council for approval.
From Harrity’s perspective, the issue of medical deportation is not only about enforcing hospital accountability, but also about re–examining the broader context of the prejudice and exploitation immigrants typically face after moving to the United States. “I believe that medical deportation is a civil rights issue, and it’s a human rights issue,” Harrity says. “This bill will put an end to the practice of international patient dumping.”
Beyond political measures, local nonprofit organizations in Philadelphia, such as the Free Migration Project, work as advocates against medical deportation and call for the abolition of all involuntary deportation. Founded in 2016, the Free Migration Project provides legal services to immigrants, organizes political campaigns centered around protecting immigrant rights, and works to educate others about ongoing issues entrenched within the immigration process.
The Deputy Director of the Free Migration Project, Adrianna Torres–García, became an advocate against medical deportation when a young woman named Claudia contacted the organization in 2020 and requested legal services after her uncle was being threatened with deportation by Jefferson Torresdale Hospital. After being hit by a motorcycle, her uncle had sustained a variety of traumatic injuries including brain injuries, multiple fractures, and eventually entered a coma. Due to the time–sensitive nature of the situation, they reached out to community members, contacted the media, and stood in front of the bus to physically block the ambulance from taking away Claudia’s uncle.
“He was at the hospital for a month, and the hospital after that threatened his family saying that they were going to deport him back to Guatemala, where he hadn’t been for more than twenty years,” Torres–García says. “His home is here in Philadelphia. We didn’t know that this was happening in Philadelphia. We didn’t realize it was still happening.”
During the month that he spent in the hospital, Claudia’s family received multiple threats, with one hospital official claiming that they were going to leave her uncle’s dead body on her doorstep if she continued to fight against his deportation. Additionally, they refused to provide her with language support, even though she was responsible for making informed medical decisions on her uncle’s behalf. From the Free Migration’s perspective, it seemed as if the hospital utterly disregarded Claudia’s uncle's health; their responsibility to provide equitable medical treatment was hindered by their own institutional biases.
Due to the lack of regulation surrounding medical repatriation, the Jefferson Torresdale Hospital has been able to exploit undocumented immigrants for decades by illegally authorizing their medical deportation. Although there is no established record of how many medical deportations have occurred at the hospital, recent cases brought to light by the Free Migration Project indicate that Jefferson Torresdale’s Hospital treatment of undocumented immigrants neglects their inherent rights to life sustaining medical care.
“At the time, it was June of 2020, so Guatemala wasn’t even receiving people. It was shut down completely. We are very certain that if he would've been transported at that time, he would’ve died,” Torres–García says.
After working with Claudia’s family, the Free Migration Project was galvanized to create a campaign to advocate for the permanent eradication of medical deportation. The directors of the Free Migration Project worked closely with Temple University Beasley School of Law's Stephen and Sandra Sheller Center for Social Justice to write the first draft of the bill in 2021 and ensure it adequately addressed the variety of issues underlying medical deportation in the United States.
Once the Free Migration Project proposed the bill to the City Council, Harrity took an interest in the measures being set out in the bill, as he felt it aligned with his own vision for healthcare reform. “When we talked to Councilmember Harrity, he was really interested in it,” Torres–García says. “The bill is about human rights and people’s healthcare. It’s not about whether they’re immigrants or not. He’s passionate about it because he believes that healthcare should be available to everyone who needs it.”
Overall, according to Torres–García, the Free Migration Project hopes to see that the “bill not only deters hospitals from doing this to immigrants or non–citizens, but that it holds them accountable and gives us more information.” Currently, there aren’t a lot of statistics available to the public about when or how often medical deportations are taking place. Torres–García hopes that having more data will help inform future measures to prevent medical deportations.
However, other advocates for immigrant and refugee rights, such as University of Pennsylvania Carey School of Law professor Fernando Chang-Muy, assert that the bill should only be the first step in a series of reforms.
Professor Chang–Muy teaches courses based around “Refugee Law and Policy.” Although a strong proponent for an end to involuntary medical deportation, Chang–Muy believes that the issue of medical deportation and its abolition must be approached from a broader perspective that analyzes the balance between the hospital’s financial budget and the patient’s medical needs.
As a result, Chang–Muy recommends that the three sectors of government—city, state, and federal—work together to ensure undocumented immigrants have access to life sustaining healthcare, while simultaneously finding a way to reimburse hospitals for the services that they’re providing to uninsured patients. He proposes that federal programs such as Medicaid be expanded to cover undocumented immigrants who, in the event that they require emergency medical care, can access medical benefits which can then be funneled back into reimbursing the hospital.
To Chang–Muy, Harrity’s bill should ultimately act as a precursor to a much more intensive national reassessment of city, state, and federal medical policies and how these laws can be reformed to encompass immigrants’ right to high quality healthcare. “Yes, Harrity’s bill is a move towards the City of Philadelphia helping folks like these, but the other two sectors of public government—the state and federal government—have to do their bit, too, so that hospitals aren’t just holding the bag and paying all the bills of uninsured, undocumented people,” Chang–Muy says.
As more awareness is spread about the persistence of medical deportation in Philadelphia, it is critical that community members emulate professor Chang–Muy’s sentiment for broader national advocacy as well as Torres–García’s call for greater community engagement with the issue.
“I encourage community members to become part of the campaign, support this bill, show up to City Hall, and call in so that we can bring this law—which would be the first of its kind in all of the United States—to regulate something like this,” Torres–García says. “We’re hopeful that if it passes here then other jurisdictions will take the same language and make it their own and pass it wherever they are.”