Florida Court Reverses Ruling Permitting Hospital To Repatriate Undocumented Patient

IMMIGRANTS & PUBLIC BENEFITS

Health Care

Florida court reverses ruling permitting hospital to repatriate undocumented patient
Immigrants' Rights Update, Vol. 18, No. 3, May 20, 2004

Florida’s Fourth District Court of Appeals has reversed a guardianship court’s determination that a hospital could discharge an undocumented person who required ongoing care and return him to his home country, Guatemala.

Luis Alberto Jimenez, an undocumented worker from Guatemala, suffered a traumatic brain injury and was admitted to Martin Memorial Medical Center. He remained in the hospital after being readmitted on an emergency basis after a discharge to a nursing home. Jimenez was incapacitated by his injury, necessitating the appointment of a guardian.

Jimenez’s guardian filed a guardianship plan with the court, in accordance with its procedures. The plan stated that Jimenez would need twenty-four-hour nursing care at a hospital or skilled nursing facility. Martin Memorial intervened in the guardianship court’s proceedings, claiming that the guardian was not acting in Jimenez’s best interests, and sought permission to discharge Jimenez and transport him to Guatemala. Following an evidentiary hearing at which the court heard conflicting evidence about the Guatemalan medical system’s ability to care for Jimenez’s injuries, the court approved the hospital’s petition.

In reversing the lower court’s order, the court of appeals considered the regulations governing the discharge of patients from hospitals that treat Medicare patients, as well as the hospital’s own discharge policies. The regulations require that hospitals develop a written discharge plan for any patient likely to suffer adverse consequences upon discharge and that patients be transferred to “appropriate facilities, agencies or outpatient services, as needed, for followup or ancillary care.” 42 C.F.R. § 482.43. The hospital’s discharge policies similarly required hospital staff to develop a discharge plan that identified the next level of appropriate care, to identify a specific facility where the patient could receive appropriate care, and to confirm that the care would be provided.

In reviewing the evidence introduced at trial in the guardianship court, the court found that only a letter from the vice minister of public health in Guatemala supported Jimenez’s return to Guatemala. The court determined that the guardianship court erred in considering the letter, which could not have been admitted into evidence under the rules that govern evidence admissible at trial. Even if the letter could have been admitted, the court concluded, it was not specific enough to satisfy either the regulations or the hospital’s discharge policies.

The court also determined that the trial court did not have subject matter jurisdiction to deport Jimenez, because federal immigration law preempts the deportation arena. While it appears unlikely that Jimenez will be able to return to the U.S., this case provides an important clarification of law in a situation that is likely to recur.

Montejo Gaspar Montejo v. Martin Memorial Medical Center,
Case No. 4D03-2638 (4th Dist. Ct. Apps., Fla).