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Hospitals Deporting Immigrant Patients?

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  • abeltranjurisdr@aol.com
    in this e-mail: (1)    Hardliners Try to White-Wash Their Own Immigrant Pasts by Redefining Immigration    (2)   The New York Times  -  Immigrants
    Message 1 of 1 , Aug 3 5:34 AM
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      in this e-mail:

      (1)   
      Hardliners Try to White-Wash Their Own Immigrant Pasts by Redefining 'Immigration'   

      (2)  
      The New York Times  -  Immigrants Deported, by U.S. Hospitals   

      (3)     CNN - 
      Commentary: Killing of immigrant a senseless, barbaric act

      (4)     
      Protect Americans Abroad - Urgent Action Needed!

      (5)      
      Family Immigration Legislation Moves Forward 

      (6)    
      Women Vets of Color Speak Out  

      (7)      
      Iowa immigration raid case scrutinized      

      (8)    
      Aliens challenging deportation cannot be imprisoned for long periods without a bail hearing  

      (9)     
      latimes.com   -    Iowa immigration raid case scrutinized

      (10)   
      Obama Launches Massive Latino Voter Drive     

      (11)    
      Gonzales aides politicized hirings, investigators find - CNN.com*

      ========================================================================

      http://www.alternet.org 

      -------------------------------------

      http://www.alternet.org/immigration/85551

      Redefining the word "immigrant" is an attempt to differentiate between those
      they hate and their own grandparents.
      -------------------------------------
      ==================================================================

      The New York Times<  br>
      
      August 3, 2008

      Immigrants Deported, by U.S. Hospitals

      By DEBORAH SONTAG

      JOLOMCÚ, Guatemala — High in the hills of Guatemala, shut inside the
      one-room house where he spends day and night on a twin bed beneath a seriously
      outdated calendar, Luis Alberto Jiménez has no idea of the legal battle that
      swirls around him in the lowlands of Florida.

      Shooing away flies and beaming at the tiny, toothless elderly mother who is his
      sole caregiver, Mr. Jiménez, a knit cap pulled tightly on his head, remains
      cheerily oblivious that he has come to represent the collision of two deeply
      flawed American systems, immigration and health care.

      Eight years ago, Mr. Jiménez, 35, an illegal immigrant working as a gardener
      in Stuart, Fla., suffered devastating injuries in a car crash with a drunken
      Floridian. A community hospital saved his life, twice, and, after failing to
      find a rehabilitation center willing to accept an uninsured patient, kept him
      as a ward for years at a cost of $1.5 million.

      What happened next set the stage for a continuing legal battle with nationwide
      repercussions: Mr. Jiménez was deported — not by the federal government but
      by the hospital, Martin Memorial. After winning a state court order that would
      later be declared invalid, Martin Memorial leased an air ambulance for $30,000
      and “forcibly returned him to his home country,” as one hospital
      administrator described it.

      Since being hoisted in his wheelchair up a steep slope to his remote home, Mr.
      Jiménez, who sustained a severe traumatic brain injury, has received no
      medical care or medication — just Alka-Seltzer and prayer, his 72-year-old
      mother said. Over the last year, his condition has deteriorated with routine
      violent seizures, each characterized by a fall, protracted convulsions, a loud
      gurgling, the vomiting of blood and, finally, a collapse into unconsciousness.

      “Every time, he loses a little more of himself,” his mother, Petrona
      Gervacio Gaspar, said in Kanjobal, the Indian dialect that she speaks with an
      otherworldly squeak.

      Mr. Jiménez’s benchmark case exposes a little-known but apparently
      widespread practice. Many American hospitals are taking it upon themselves to
      repatriate seriously injured or ill immigrants because they cannot find nursing
      homes willing to accept them without insurance. Medicaid does not cover
      long-term care for illegal immigrants, or for newly arrived legal immigrants,
      creating a quandary for hospitals, which are obligated by federal regulation to
      arrange post-hospital care for patients who need it.

      American immigration authorities play no role in these private repatriations,
      carried out by ambulance, air ambulance and commercial plane. Most hospitals
      say that they do not conduct cross-border transfers until patients are
      medically stable and that they arrange to deliver them into a physician’s
      care in the ir homeland. But the hospitals are operating in a void, without
      governmental assistance or oversight, leaving ample room for legal and ethical
      transgressions on both sides of the border.

      Indeed, some advocates for immigrants see these repatriations as a kind of
      international patient dumping, with ambulances taking patients in the wrong
      direction, away from first-world hospitals to less-adequate care, if any.

      “Repatriation is pretty much a death sentence in some of these cases,” said
      Dr. Steven Larson, an expert on migrant health and an emergency room physician
      at the Hospital of the University of Pennsylvania. “I’ve seen patients
      bundled onto the plane and out of the country, and once that person is out of
      sight, he’s out of mind.”

      Hospital administrators view these cases as costly, burdensome patient
      transfers that force them to shoulder responsibility for the dysfunctional
      immigration and health-care systems. In many cases, they say, the only
      alternative to repatriations is keeping patients indefinitely in acute-care
      hospitals.

      “What that does for us, it puts a strain on our system, where we’re unable
      to provide adequate care for our own citizens,” said Alan B. Kelly, vice
      president of Scottsdale Healthcare in Arizona. “A full bed is a full bed.”

      Medical repatriations are happening with varying frequency, and varying degrees
      of patient consent, from state to state and hospital to=2 0hospital. No government
      agency or advocacy group keeps track of these cases, and it is difficult to
      quantify them.

      A few hospitals and consulates offered statistics that provide snapshots of the
      phenomenon: some 96 immigrants a year repatriated by St. Joseph’s Hospital in
      Phoenix; 6 to 8 patients a year flown to their homelands from Broward General
      Medical Center in Fort Lauderdale, Fla.; 10 returned to Honduras from Chicago
      hospitals since early 2007; some 87 medical cases involving Mexican immigrants
      — and 265 involving people injured crossing the border — handled by the
      Mexican consulate in San Diego last year, most but not all of which ended in
      repatriation.

      Over all, there is enough traffic to sustain at least one repatriation company,
      founded six years ago to service this niche — MexCare, based in California
      but operating nationwide with a “network of 28 hospitals and treatment
      centers” in Latin America. It bills itself as “an alternative choice for
      the care of the unfunded Latin American nationals,” promising “significant
      saving to U.S. hospitals” seeking “to alleviate the financial burden of
      unpaid services.”

      Many hospitals engage in repatriations of seriously injured and ill immigrants
      only as a last resort. “We’ve done flights to Lithuania, Poland, Honduras,
      Guatemala and Mexico,” said Cara Pacione, director of social work at Mount
      Sinai Hospital in C hicago. “But out of about a dozen cases a year, we
      probably fly only a couple back.”

      Other hospitals are more aggressive, routinely sending uninsured immigrants,
      both legal and illegal, back to their homelands. One Tucson hospital even tried
      to fly an American citizen, a sick baby whose parents were illegal immigrants,
      to Mexico last year; the police, summoned by a lawyer to the airport, blocked
      the flight. “It was horrendous,” the mother said.

      Sister Margaret McBride, vice president for mission services at St. Joseph’s
      in Phoenix, which is part of Catholic Healthcare West, said families were
      rarely happy about the hospital’s decision to repatriate their relatives.
      But, she added, “We don’t require consent from the family.”

      In a case this spring that outraged Phoenix’s Hispanic community, St.
      Joseph’s planned to send a comatose, uninsured legal immigrant back to
      Honduras, until community leaders got lawyers involved. While they were
      negotiating with the hospital, the patient, Sonia del Cid Iscoa, 34, who has
      been in the United States for half her life and has seven American-born
      children, came out of her coma. She is now back in her Phoenix home.

      “I can think of three different scenarios that would have led to a fatal
      outcome if they had moved her,” John M. Curtin, her lawyer, said. “The good
      outcome today is due to the treatment that the hospital provide d —
      reluctantly, and, sadly enough, only in response to legal and public
      pressure.”

      Unlike Ms. Iscoa and Mr. Jiménez, most uninsured immigrant patients in
      repatriation cases do not have advocates fighting for them, and they are
      quietly returned to their home countries. Sometimes, their families accept that
      fate because they are told they have no options; sometimes they are grateful to
      the hospital for paying their fare home, given that other hospitals leave it to
      relatives or consulates to assume responsibility for the patients.

      Mr. Jiménez’s case is apparently the first to test the legality of
      cross-border patient transfers that are undertaken without the consent of the
      patients or their guardians — and the liability of the hospitals who
      undertake them.

      “We’re the rhesus monkey on this issue,” said Scott Samples, a spokesman
      for Martin Memorial.

      A Life-Changing Accident

      Mr. Jiménez’s journey north was propelled by the usual migrant’s dreams.
      When he pledged thousands of dollars to pay the smuggler who delivered him to
      the United States, he envisioned years of labor on the lawns of affluent
      America and then a payoff: the means to buy land of his own, to cultivate his
      own garden, back in Guatemala.

      But fate — in the person of Donald Flewellen, a pipe welder with a drug
      problem and a long criminal record — intervened. At lunchtime on Feb. 28,
      2000, Mr. Flewellen was loitering in the parking lot of a Publix supermarket in
      Palm Beach Gardens, Fla., when the employees of an irrigation company ran
      inside, leaving the keys in their van. Seizing the moment, Mr. Flewellen, a
      thorn in the side of local prosecutors with at least 14 arrests, jumped into
      the van and drove off.

      In the next few hours, Mr. Flewellen consumed enough alcohol to produce a
      blood-alcohol level four times higher than the legal limit. But drive he did,
      along the back roads that connect the affluent Treasure Coast to the
      agricultural interior where Guatemalan Mayan immigrants have settled in a
      place, coincidentally, called Indiantown.

      About 4 p.m., Mr. Flewellen was heading east on a rural road just as Mr.
      Jiménez and three compatriots were returning home from a day of landscaping.
      His stolen van and their 1988 Chevrolet Beretta crashed head-on, instantly
      killing two of the Guatemalans and severely injuring the driver and Mr.
      Jiménez, a back-seat passenger.

      Identified first as John Doe, Mr. Jiménez arrived by ambulance at Martin
      Memorial, a not-for-profit hospital on the banks of the St. Lucie River in
      Stuart. He was unconscious and in shock from extensive bleeding, with two
      broken thigh bones, a broken arm, multiple internal injuries, a terribly
      lacerated face and a severe head injury. A doctor noted his prognosis as
      “poor.”

      But Mr. Jiménez, after intensive surgical and medical20intervention, survived.
      “He was no longer Luis; he was another person,” Montejo Gaspar Montejo, his
      cousin by marriage, said, describing a previously husky and industrious laborer
      who was also a soccer enthusiast. “He didn’t talk. He didn’t understand
      anything. He stayed curled up in a ball. But he was alive.”

      During that time, Martin Memorial asked Michael R. Banks, a local lawyer who
      specializes in estate planning, to set up a guardianship for Mr. Jiménez. “I
      said, ‘Sure, what can come of such a case?’ ” Mr. Banks said. “Then it
      took on a life of its own. They probably regret they ever called me.”

      Mr. Jiménez, whose common-law wife and two children remained in Guatemala, had
      been living for just under a year with Mr. Gaspar’s family. Mr. Gaspar, who
      works in golf-course maintenance, agreed to serve as guardian.

      At first, things were amicable. In the summer of 2000, Mr. Jiménez was
      transferred to a nursing home in Stuart, which may have accepted him because an
      insurance payout was possible.

      Mr. Flewellen, who eventually pleaded guilty to D.U.I. manslaughter, D.U.I.
      injury and grand theft auto, was not insured. But the Guatemalan families
      sought to hold the irrigation company liable since its employees left the keys
      in the car. Their lawsuit ultimately failed.

      In the nursing home, Mr. Jiménez began wasting away. His relatives grew
      anx ious. Then, Robert L. Lord Jr., Martin Memorial’s vice president of legal
      services, said, “Mr. Jiménez was put back on our doorstep.”

      He arrived by ambulance, this time emaciated and suffering from ulcerous bed
      sores so deep that the tendons behind his knees were exposed. With infection
      raging, “the question to be answered is if the patient’s condition is
      terminal,” a doctor wrote in his file.

      Again, Martin Memorial’s doctors provided life-saving care. Hospitals are
      mandated to treat and stabilize anyone suffering from an emergency medical
      condition, and the federal government does provide emergency Medicaid coverage
      for illegal and new immigrants.

      But hospitals say that emergency Medicaid covers only a small fraction of those
      expenses: $80,000 in Mr. Jiménez’s case, according to court papers.

      Mr. Jiménez remained in a vegetative state, coiled in a fetal position, for
      “one year, two months and 15 days,” Mr. Gaspar said with precision.

      Stunning his relatives and medical officials, though, Mr. Jiménez gradually
      woke up and started interacting with the world. “One day,” Mr. Gaspar said
      in Spanish, “we arrived for a visit, and he said to me, ‘You are
      Montejo.’ ”

      Not long afterward, the battle began between Martin Memorial and Mr. Gaspar, a
      reserved man whose Indiantown living room is decorated with a “We Love
      America” clock, a beach towel from the ancient city of Tikal and a hammered
      metal image of the Virgin Mary.

      A Hospital’s Dilemma

      The average stay at Martin Memorial, a relatively tranquil hospital which
      features a palm frond design in its gleaming lobby floor and white-coiffed
      volunteers in its gift shop, is 4.1 days and costs $8,188. Patients rarely
      linger.

      Those like Mr. Jiménez who outstay their welcome are an oddity but not an
      anomaly. Mr. Jiménez had a roommate from Jamaica, a diabetic who lost both
      legs. Martin Memorial eventually flew him back to his native country, too.

      In addition to trauma patients, there are uninsured immigrants with serious
      health problems. “In our emergency room, we don’t turn anyone away,” said
      Carol Plato Nicosia, the director of corporate business services. “The real
      problem is if we find an underlying problem, and now we have six of them —
      six patients who showed up in renal failure and that we are now seeing three
      times a week for dialysis.”

      One of the six, she said, voluntarily returned to Guatemala after receiving a
      poor prognosis. But she showed up at Martin Memorial again after her relatives
      insisted that she undertake the trek over the borders a second time because she
      could not get treatment in Guatemala, Ms. Plato Nicosia said.

      “I don’t want to sound heartless,” Ms. Plato Nicosia said. “A community
      hospita l is going to give care. But is it the right thing? We have a lot of
      American citizens who need our help. We only make about 3 percent over our
      bottom line if we’re lucky. We need to make capital improvements and do
      things for our community.”

      Martin Memorial reported a total margin of 3.6 percent over its bottom line
      last year and 6 percent in 2006. According to the most recent statewide data,
      the nonprofit medical center also reported assets of $270.6 million in 2006,
      with its senior executives earning more than $4 million in salaries and
      benefits.

      Tax-exempt hospitals are expected to dedicate an unspecified part of their
      services to charity cases, and Martin Memorial devoted $23.9 million in 2006,
      about 3 percent, which was average for Florida, according to state data.

      Mr. Jiménez was a very expensive charity case. In cases like his, where
      patients need long-term care, hospitals are not allowed to discharge them to
      the streets. Federal regulations require them — if they receive Medicare
      payments, and most hospitals do — to transfer or refer patients to
      “appropriate” post-hospital care.

      But in most states, the government does not finance post-hospital care for
      illegal immigrants, for temporary legal immigrants or for legal residents with
      less than five years in the United States. (California and New York City are
      notable exceptions; Medi-Cal, the state’s Medicaid program, spends $20
      mil lion a year on long-term care for illegal immigrants, as does the Health and
      Hospitals Corporation of New York City.)

      Martin Memorial’s lawyer, Mr. Lord, said hospitals should not be forced to
      assume financial and legal responsibility for these cases. “It should be a
      governmental burden,” he said, “or the government should step in and
      otherwise exercise its authority for deportation or whatever it wants to do.”

      In Mr. Jiménez’s case, the hospital’s doctors determined that appropriate
      post-hospital care meant traumatic brain injury rehabilitation. Much to the
      surprise of the hospital staff, Mr. Jiménez had regained cognitive function to
      about the level of a fourth-grade child.

      Hospital discharge planners searched to no avail for a rehabilitation program
      or nursing home. “Unable to take patient” was the response to many queries,
      as noted in Mr. Jiménez’s files, which also state: “At this time, patient
      remains a disposition problem.”

      Representing Mr. Jiménez’s guardian, Mr. Banks took the position that the
      hospital had a responsibility to provide Mr. Jiménez with the rehabilitation
      he needed — even if it meant paying a rehabilitation center to provide it.
      That, he noted, could have benefited both the hospital and the patient.

      “It would have been more cost-effective for them,” Mr. Banks said, given
      that daily patient costs in long-term car e are far lower than in acute-care
      hospitals. “And if the rehab worked, then Luis might have become a functional
      person and nobody’s charge.”

      But the hospital declined, as Mr. Lord put it, “to take out our checkbook”
      and subsidize his care at another institution.

      “Once you take that step, for how long are you going to do that — a year,
      10 years, 50 years?” Mr. Lord, the lawyer, asked.

      At that point, the hospital intensified its efforts to involve the Guatemalan
      government in the case. In a memorandum obtained by The New York Times, a
      consular official wrote that the hospital “informed us of how expensive it
      was becoming to care for Luis given that there was no insurance and that he is
      illegal and that the state won’t assume responsibility for his charges.”

      Eventually, the Guatemalan health minister wrote a letter assuring Martin
      Memorial that his country was prepared to care for Mr. Jiménez. Gabriel
      Orellana, who was foreign minister at the time but did not have direct
      knowledge of the case, said the Guatemalan government was disposed to assist an
      American institution. “If a hospital in Florida asks if we can take care of a
      Guatemalan patient, the tendency is to say yes,” Mr. Orellana said.

      Mr. Gaspar was dubious, believing the public health care system in his homeland
      to be grossly inadequate.

      So the guardian and the hospital r eached an impasse, and Martin Memorial
      finally took the matter to court, asking a state judge to compel Mr. Gaspar to
      cooperate with its repatriation plan. In June 2003, a hearing was held before
      Circuit Judge John E. Fennelly.

      The Journey Home

      In the courthouse in Stuart, a low-key, upscale town that boasts world-class
      fishing, George F. Bovie III, a lawyer for Martin Memorial, addressed the
      judge: “This case is not simply a case, as some would try and paint it, of
      money. This is a case about care for a man in this country illegally who has
      reached maximum medical improvement at our hospital and is ready to be
      discharged and whose home government” is prepared to receive and treat him.

      Mr. Banks responded: “Your honor, this is a case about a hospital that has
      failed to do its job properly,” adding that the hospital sought to “have
      this court legitimize its patient dumping.”

      By the time of the hearing, Mr. Jiménez was essentially a boarder at the
      hospital, wheeling around the hallways and hanging out at the nursing stations.
      Diana Gregory, a nurse who supervises case management and discharge planning,
      said in a recent interview that Mr. Jiménez — “I will affectionately call
      him Louie” — became “like family” to hospital staff members, who bought
      him birthday cakes, knitted him blankets and gave him toys.

      According to hospital records, however,20it was not all pastries and presents.
      Mr. Jiménez grew depressed as he gradually became more cognizant of his
      situation. He showed signs of regression, too. Emotional and behavioral
      volatility often follow serious head injuries, and Ms. Gregory said that Mr.
      Jiménez had developed some disturbing habits, including spitting, yelling out,
      kicking and defecating on the floor.

      In court, his doctor, Walter Gil, testified that Mr. Jiménez would benefit
      from returning to the intimacy of his family. In his case file, the doctor had
      noted that Mr. Jiménez had told him, “Estoy triste,” meaning, “I’m
      sad.”

      Dr. Gil said he asked Mr. Jiménez, “Why are you sad when you have basically
      everything that could be offered to you?” And, he said, Mr. Jiménez replied,
      “I miss my family and my wife.”

      Mr. Banks’s witnesses challenged what they described as Guatemala’s vague
      offer to care for Mr. Jiménez.

      Dr. Miguel Garcés, a prominent Guatemalan physician and public health
      advocate, said in a deposition that serious rehabilitation “is almost
      nonexistent” in Guatemala outside private facilities. He predicted that Mr.
      Jiménez would be taken in and then released from the country’s one public
      rehabilitation hospital within a matter of weeks.

      “I don’t want him to go home and die,” Dr. Garcés said.

      “Nobody wants h im to go home and die,” the hospital’s lawyer responded.

      A few weeks later, Judge Fennelly ruled. “This Court,” he wrote, “sails
      on uncharted seas.” He acknowledged that his decision might provoke dissent
      but opined, “As Aquinas once stated, ‘The good is not the enemy of the
      perfect,’ ” inverting and misattributing Voltaire’s famous quote, “The
      perfect is the enemy of the good.”

      And then he granted the hospital’s petition, ordering that Mr. Gaspar stop
      “frustrating” the hospital’s plan to “relocate the ward” back to
      Guatemala.

      Mr. Banks was stunned. He filed a notice of appeal and asked for a stay of the
      court’s order while the appeal was pending. The judge asked the hospital to
      file a response by 10 a.m. on July 10 before he ruled on the stay.

      Four and a half hours before that response was due, shortly before daybreak on
      July 10, 2003, an ambulance picked up Mr. Jiménez at the hospital and drove
      him to the St. Lucie County airport, where an air ambulance waited to transport
      him back to Guatemala. Mr. Gaspar was not apprised.

      “We went to see him at the hospital, and his bed was empty,” he said.

      The hospital’s lawyer declined to comment on why the hospital did not wait
      for the judge to rule on the stay.

      Diana Gregory, the nurse, traveled to Guatemala with Mr. Jiménez, bringing a
      wheelchair, a week’s worth of medications, “lunch/snacks/juices/treats,”
      and an emergency passport signed with a fingerprint, according to discharge
      records. Mr. Jiménez wore a Florida Marlins cap and carried a toy cellphone.

      During the flight, the records said, Mr. Jiménez dozed, paged through picture
      books, pushed the window shade up and down and pointed outside, saying,
      “Look, look!” When he arrived in Guatemala, an ambulance took him to the
      National Hospital for Orthopedics and Rehabilitation, which occupies the
      converted stables of an old villa in the historic center of the capital city.

      Ms. Gregory accompanied him there, turned over his records and toured the
      hospital. In a recent interview, Ms. Gregory said she was impressed by the
      place and especially by the staff’s pride in it, despite equipment that
      looked “like it could have been donated to the Smithsonian.” She added,
      “That facility could have taken care of me any day.”

      While Ms. Gregory was taking her tour, Mr. Jiménez was holding court,
      according to her notes in his file, “telling everyone that he was from Miami,
      Florida, and showing them his toy cat.” At her request, a physician told Mr.
      Jiménez in Spanish “that he would be staying with his new friends in
      Guatemala and that I was leaving.” His response, according to her notes:
      “O.K., O.K., adiós.9 D

      Glad that she had helped reunite Mr. Jiménez with his homeland, she said, “I
      left Guatemala quiet in my heart.”

      Care in Guatemala

      Immaculately clean but dilapidated, Guatemala’s National Hospital for
      Orthopedics and Rehabilitation operates on a shoestring budget of approximately
      $400,000 a year, according to Dr. Harold Von Ahn, who was director when Mr.
      Jiménez arrived.

      Half the hospital is devoted to orthopedic care and the other half serves as an
      “asylum” for profoundly disabled Guatemalans. Although it is the only
      public rehabilitation hospital in the country, it dedicates just 32 beds to
      rehabilitation and does not offer the specialized brain injury treatment that
      Mr. Jiménez needed.

      The Guatemalan foreign ministry said that it knew of 53 repatriations by
      American hospitals in the last five years. During a visit by The Times to the
      National Hospital in June, the most recent arrival was an 18-year-old, Diana
      Paola Miguel, transported there by the University Medical Center in Tucson nine
      days after a van accident crushed her pelvis, which the Arizona hospital
      repaired. Supine on a gurney, she Ms. Paola was too tremblingly upset to talk.

      Dr. Von Ahn said he believed that American hospitals were dumping patients that
      should be their responsibility. “It’s the same as the classic fall on the
      stairs, right?” he said. “You go to my home, you fall on my stairs an d then
      you sue me. I am responsible.”

      Shortly after Mr. Jiménez arrived, the Guatemalan hospital contacted his
      common-law wife, Fabiana Domingo Laureano, who lived in the city of Antigua
      with their two young sons, and asked her to come get him. Ms. Domingo, who was
      27 at the time, was shocked to learn that her husband was back and terrified by
      the request. Then as now, she was eking out a living, selling traditional woven
      clothing in a marketplace while sharing a spare, concrete room with her sons in
      her parents’ humble home.

      “I was already living from hand to mouth,” she said in an interview in
      Antigua, where her sons now supplement her income by selling cigarettes after
      school. “How could I possibly have given him what he needs?”

      The couple met as teenagers in the highland village of Soloma. In the
      mid-1990s, Mr. Jiménez migrated with his wife’s family to Antigua, a
      volcano-ringed colonial city where tourism sustains the local economy. While
      she sold clothing, Mr. Jiménez worked as a bus driver’s assistant. Together,
      they earned about $6 a day, which was not enough to support their family, so
      Mr. Jiménez, with his wife’s brother, Francisco Gaspar, decided to follow a
      well-traveled path to the north. That is when he changed his name from Gervacio
      Gaspar to Luis Jiménez, which is how he is now known, even by his family.

      After pledging to pay a coyote, or smuggler, about $2,000 each to ferry them
      into the United States, they crossed into California under cover of darkness
      and made their way to Encinitas, where Mr. Jiménez’s older brother lived,
      Mr. Gaspar said.

      After the two men failed to find regular work, Mr. Gaspar began suffering panic
      attacks and returned to Guatemala; Mr. Jiménez decided to try his luck in
      Florida.

      “Lamentably,” Mr. Gaspar said, “luck eluded him.”

      After the hospital contacted Ms. Domingo, Telemundo, the Spanish-language
      network, called Ms. Domingo and offered to take her to Guatemala City. Shortly
      thereafter, the network showed her reunion with her husband.

      “You are Maria by chance?” Mr. Jiménez said to his wife as the television
      cameras rolled.

      “Fabiana,” she replied. Their two sons stood by her side, wide-eyed.

      A few weeks later, Dr. Von Ahn said, the hospital discharged Mr. Jiménez
      “because we needed the bed,” transferring him to another public hospital,
      San Juan de Dios. That is where Mr. Jiménez’s brother, Enrique Lucas
      Gervacio, found him when he made his way down from the mountains by bus.

      “He was lying in the hallway on a stretcher, covered in his own excrement,”
      Mr. Lucas said. “So we cleaned him up and we brought him home.”

      In Favor of Jiménez

      In May, 2004, a Florida appeals court overruled Ju dge Fennelly.

      The Fourth District Court of Appeal found that the Florida state judge had
      overstepped his bounds because deportation is the prerogative of the federal
      government. The court also declared that no evidence supported the hospital’s
      assertion that Mr. Jiménez would receive appropriate care in Guatemala; the
      discharge plan, the ruling said, was not detailed enough to satisfy federal
      requirements or the hospital’s own rules.

      The appeals court voided the judge’s order although, given that Mr. Jiménez
      was already back in Guatemala, that action came too late for him.

      It might affect others, though. The decision has become what is known legally
      as a case of first impression on the issue of hospital repatriations.

      John DeLeon, a lawyer who advises the consulates of Mexico, Honduras and
      Guatemala in Miami, said he now referred to it when he received calls from
      hospitals looking to discharge seriously injured or ill immigrants.

      “I now write I call my Montejo Gaspar letter,” he said. “It’s a letter
      that says, ‘Listen, don’t take action to dump this individual because
      you’ll be risking legal action. The law is now that hospitals can’t dump
      immigrant patients without securing appropriate after-care. If somebody has a
      serious illness and needs continuing care, a hospital can’t simply discharge
      them onto the street, much less put them on a plane.’ ”
      =0 A
      Mr. DeLeon said that he was “bombarded by such cases,” adding that he was
      investigating another medical repatriation by Martin Memorial, which took place
      two weeks ago “behind the back of the Mexican government.”

      Martin Memorial confirmed that on July 16 they flew Neptali Díaz, a severely
      brain-injured patient to Mexico. A court order authorized Mr. Diaz’s transfer
      to an unspecified Mexican hospital, ending the man’s 859-day, $2 million stay
      at Martin Memorial.

      After the ruling in Mr. Jiménez’s favor, Martin Memorial did not appeal. But
      the case did not go away. The appeals court ruling set the stage for a personal
      injury lawsuit, taken on by of Searcy, Denney, Scarola, Barnhart & Shipley in
      West Palm Beach.

      With that established firm behind him, Mr. Gaspar initiated a false
      imprisonment action claiming that his cousin was essentially kidnapped by the
      hospital and smuggled out of the country in a kind of medical rendition. Since
      then, appeals judges have again ruled in Mr. Jiménez’s favor, stating the
      hospital can be sued for punitive damages as well as for the cost of his
      medical care.

      This infuriates Ms. Plato Nicosia, the hospital administrator, who said it was
      Mr. Jiménez’s family who owes the hospital money and not vice versa.
      “Should they win, we would like them to take those damages and pay his
      hospital bill,” she said.

      Jack Sc arola, representing Mr. Jiménez’s guardian, said that he empathized
      with the hospital’s “significant economic burden” but said that it was
      the “quid pro quo” of accepting Medicare and Medicaid funds to help finance
      the hospital’s services. (About 45 percent of Martin Memorial’s net
      operating revenues came from Medicare and Medicaid last year, based on state
      data.)

      “Also,” he continued, “they chose the wrong way to deal with it. The
      right way would have been through the Legislature. There is no program in place
      to appropriately distribute care to undocumented persons who are
      catastrophically injured, and there should be. But you don’t stick a
      brain-injured immigrant on a private plane and spirit him out of the country in
      the predawn hours.”

      Weighing Quality of Life

      The journey to Jolomcú is an arduous one, as Mr. Jiménez’s new legal team
      discovered when several members — a lawyer, a paralegal, a priest and a
      bioethicist — first traveled there to meet him.

      After a five-hour drive north from Guatemala City to Huehuetenango and then a
      winding trip, filled with hairpin turns on cliff-hugging roads up and over the
      Cuchumatán Mountains, they arrived at the provincial city of Soloma.

      From there, the road to Mr. Jiménez’s hamlet only goes so far, and the trip
      must be completed on foot, up and down a rutted dirt path20through goat-strewn
      meadows. The Americans arrived at the top panting. There, awaiting them, in an
      idyllically situated one-room brick house, was Mr. Jiménez, a broad grin
      lighting up his face.

      “The first striking thing was his disposition: He was very, very happy,”
      said the Rev. Frank O’Loughlin, who pastored migrant workers in South Florida
      for decades. “Then, the second thing, he was well cared for. What I did was I
      got down over him and hugged him but also smelled. And there were no bedsores.
      Nothing was malodorous.”

      As they drove back to Huehuetenango, Marnie R. Poncy, a nurse-lawyer who runs a
      bioethics law project in Palm Beach County, offered her view: “I said, ‘His
      quality of life is better than it would be in an American nursing home.’ ”

      “But I hazarded a guess that his longevity of existence was probably severely
      curtailed,” she said.

      Still, the team reached a conclusion that surprised them: “There was no real
      compelling reason to think of bringing him back to Florida,” Father
      O’Loughlin said. “We needed to focus on getting help to him or him to help
      in Guatemala.”

      Help has been slow in arriving.

      When The Times took the trek to visit him in late June, Mr. Jiménez had not
      budged from his hilltop home since returning there and no medical professional
      had visited him, either. With his mother too20frail to move him into his
      wheelchair, his life had shrunken to the confines of his bed, across from his
      mother’s.

      During the visit, Mr. Jiménez, wearing a nubby Adidas hat and a ski jacket,
      sat wrapped in a Guatemalan blanket; his mother, who wore a traditional woven
      skirt, with a floral scarf braided through her long gray hair, stood by his
      side. She patted his head; he reached out to pick lint from her sweater.

      A few days prior, he had suffered a particularly violent seizure.

      “He was almost dead,” his mother, Mrs. Gervacio, said in Kanjobal, which
      was translated into Spanish by a school principal serving as interpreter.
      “For many years, I am caring for him like he is a baby, changing his diaper,
      washing him. But this is worse. I am worried to leave him alone at all.”

      She is right to worry, said physicians consulted for this article. Patients
      suffering seizure disorders run the risk of injuring themselves — and of
      increasing their brain damage.

      Still, Mrs. Gervacio does leave from time to time, she said, to go to Mass,
      shutting the door behind her and hoping for the best.

      “It scares me a lot when you leave, Mama!” Mr. Jiménez blurted out,
      revealing that he was intently following the conversation that at first took
      place as if he were not there.

      Given that Mr. Jiménez’s mother’s health is failing, the family worries
      abou t the future, too. And Mr. Jiménez shares their concern. “The day my
      mother is no longer, what’s going to happen to me?” he said. “This is
      what I have on my mind.”

      Mr. Jiménez, whose memory is patchy, said he remembered nothing about his time
      in the United States — not Indiantown, not his job as a gardener, not the
      accident and not the hospital.

      He does, remember the dreams that propelled his migration, and he expressed
      them eloquently: “I headed north like a peasant with a heavy bundle on his
      back, bent over, determined to better himself,” he said. “Other people had
      things so I thought, ‘Why not me?’ But now I regret it. Maybe God was
      punishing me for my illusions.”

      “No, Luis,” the interpreter interjected, “it was just chance, an
      accident, a car accident.”

      In Guatemala City, Dr. Garcés, the public health advocate, said that he was
      not surprised that, as he had predicted, Mr. Jiménez never received further
      medical care. “That’s the usual story of patients that are released from
      the National Orthopedic Hospital,” he said.

      Dr. Garcés called Mr. Jiménez’s repatriation “inhumane.”

      “In cases like that, if you cut the medical care, you’re hurting that
      person,” Dr. Garcés said. “You’re doing just the opposite of what the
      medical syst em should do. That goes against every international convention of
      human rights and health. To send him to Guatemala was to send him to very poor
      living and health conditions and probably he will die because of that, and
      that’s not fair.”

      Without evaluation, doctors cannot know what potential for rehabilitation —
      or survival — Mr. Jiménez possesses.

      If Mr. Jiménez’s guardian were to prevail in the lawsuit, “it would be
      possible to set up a good health care arrangement for him because in private
      practice we have all types of specialties that he needs,” Dr. Garcés said.
      “And transportation could be arranged.” But the case could drag on for
      years.

      On the day of The Times’s visit, before Mr. Jiménez ate a lunch of eggs,
      tortillas and sugar water, Mr. Banks, the lawyer, gave him a present from his
      cousins in Florida — a plastic bag bulging with tube socks, undershirts and
      oversize sweatpants. Mr. Jiménez fingered the clothing with little interest
      but when a reporter began to read him the accompanying letter in Spanish, he
      snatched it excitedly from her hands.

      Much to the surprise of his visitors, Mr. Jiménez, despite his brain injury,
      could read. He smoothed out the yellow legal paper from Mr. Gaspar and began:
      “I am sending you some little things. Luis, I hope that you like them.”

      At first, Mr. Jiménez read haltingly,20then more fluidly. Later, when all his
      visitors had gone outside, he read the ending aloud again to himself.

      “I want to tell you,” he read, “that we miss you and love you a lot. May
      God continue to bless you.”

      Mr. Jiménez smiled, and repeated, softly, “May God continue to bless you.”

      Pilar Conci contributed reporting.

      Copyright 2008 The New York Times Company

      http://www.nytimes.com/2008/08/03/us/03deport.html

      ================================================
      ========================================

      Commentary: Killing of immigrant a senseless, barbaric act

      * Story Highlights
      * Illegal immigrants in America are exploited and preyed upon, Navarrette
      says
      * Navarrette: 25-year-old's death in Pennsylvania was a senseless, barbaric
      act
      * At least six attackers beat him, shouted racial and ethnic slurs, he says
      * Writer: Where do people learn hate? At the dinner table


      By Ruben Navarrette Jr.
      Special to CNN


      SAN DIEGO, California (CNN) -- To listen to the immigration debate, you would
      think illegal immigrants have it easy.
      Ruben Navarrette says the beating death of Luis Ramirez is dramatic proof that
      lives of illegal immigrants are=2 0hard.

      Ruben Navarrette says the beating death of Luis Ramirez is dramatic proof that
      lives of illegal immigrants are hard.

      That's nonsense. America has a long tradition of animosity toward legal
      immigrants, let alone illegal ones. The undocumented are preyed upon by thugs,
      cheated by swindlers, exploited by employers, harassed by Minutemen, and made
      into scapegoats for society's ills by opportunistic talk radio blowhards and
      cable news fear-peddlers.

      The life of an illegal immigrant shouldn't be a walk in the park. But what most
      Americans don't realize is that, far from being easy, that life is quite
      difficult.

      In fact, prosecutors say, for Luis Ramirez, it was murder.

      The 25-year-old undocumented immigrant from Shenandoah, Pennsylvania suffered
      head injuries after he was viciously beaten July 12 by a pack of at least six
      teenagers. Ramirez was left in convulsions and foaming at the mouth. His
      attackers stomped him so hard that an imprint of the Jesus medallion he wore
      was embedded on his chest.

      Town pooh-bahs and police -- putting public relations before public safety --
      at first tried to downplay the incident by insisting that this was simply an
      adolescent fight with tragic and unfortunate consequences.

      Would they also say that lynchings in the South were just horseplay that got
      out of hand?

      Sorry. You don't get off that easy. I bet just about everyone in that small
      town of 5,000, northwest of Philadelphia, knows exactly what happened to Luis
      Ramirez.

      That includes the retired Philadelphia cop who lives on the block where the
      beating occurred; she told authorities that afterward, she heard youths warning
      other Latinos to leave town or suffer the same fate as Ramirez.

      And it includes Luis' 24-year-old fiancee, Crystal Dillman, who is white and
      grew up in Shenandoah. Dillman, who had two children with Ramirez, told The
      Associated Press: "People in this town are very racist toward Hispanic people.
      They think right away if you're Mexican, you're illegal, and you're no good."
      She said that her husband-to-be was often subjected to ethnic slurs, including
      being called a "dirty Mexican" and told to go back to Mexico.

      As it turns out, because of a senseless and barbaric act, Luis is going back to
      Mexico after all -- for burial.

      Authorities now allege that the thugs who beat Luis shouted racial and ethnic
      epithets. They've charged 16-year-old Brandon J. Piekarsky and 17-year-old
      Colin J. Walsh as adults with homicide and 18-year-old Derrick M. Donchak with
      aggravated assault. All three were charged with ethnic intimidation. Another
      juvenile, whom police haven't named, was charged with assault, and police are
      continuing to investigate.

      Meanwhile, the Mexican-American Legal Defense and Education Fund (MALDEF) has
      called for the U.S. Justice Department to open a federal civil rights
      investigation into the case to determine if this was a hate crime and , if so,
      to prosecute the young men under federal hate crime laws. And on Wednesday, the
      Justice Department announced that its civil rights division has opened a
      criminal investigation.

      I'll second that. If the accused are guilty, the punishment should be swift and
      harsh. But government isn't the solution, because it didn't create the problem.
      Where did these little monsters pick up their prejudices? You know where it
      usually happens.

      Racism begins and ends at the dinner table. And thanks to how poisonous the
      immigration debate has become, some of what is being served up across America
      will turn your stomach.

      Ruben Navarrette Jr. is a member of the editorial board of the San Diego
      Union-Tribune and a nationally syndicated columnist. Read his column here.

      The opinions expressed in this commentary are solely those of the writer.


      http://www.nytimes.com/2008/08/03/us/03deport.html


      ================================================================================================

      Protect Americans Abroad - Urgent Action Needed!


      Target: Congressional Representatives

      Sponsored by:  Andrew Levin


      The letter below will be sent to Congressmen calling on them to support H.R. 6481 or the "Avena Case Implementation Act of 2008".

      This Act is in response to the International Court of Justice's Avena decision, which determined whether the Vienna Convention rights of 51 Mexican nationals had been violated when they were detained in the United States.  According to the Vienna Convention, local authorities are required to notify consular officers without delay of=2 0the detainment of one of their foreign nationals.  The ICJ determined that American officials had not done so, violating the foreign nationals' Vienna Convention rights.  The US was ordered to provide judicial reviews to determine if those violations affected their convictions or sentences.  H.R. 6481 would p rovide these Avena-mandated judicial reviews.  Secretary of State Condoleezza Rice, US Attorney General Michael Mukassey, and all nine Supreme Court Justices agree that the US has an international obligation to obey the Avena decision.     

      The impact of the "Avena Case Implementation Act of 2008" will extend to all Americans detained abroad.  As the Dallas Morning News' editorial on July 29th noted:

      The State Department calculated that 4,456 Americans were arrested abroad in 2006, up from 3,614 in 2005. The bulk of those arrests occurred in Mexico. For an American sitting in a filthy, dark jail cell in a foreign land, it's easy to be overwhelmed by hopelessness. One thing makes the nightmare bearable: the guaranteed visit from an American consular official.

      But this guaranteed visit by an American consular officer is contingent on the weight foreign authorities give to the Vienna Convention right to have consular authorities notified without delay.  What goes around comes around with international law, and H.R. 6481 would be noticed by foreign governments, bettering the chances that Ameri cans are ensured their rights when traveling abroad.

      One problem is that there is not enough time to pass H.R. 6481 before one Avena defendant, Jose Ernesto Medellin is scheduled for execution on August 5th in Texas.  In order to give adequate time for H.R. 6481 to be passed and a judicial review applied to Medellin's case, the letter calls on Congressmen to support a temporary reprieve from execution. For without it, a dangerous precedent would be set that would jeopardize all Americans abroad.

      Nevertheless, H.R. 6481 is a necessary piece of legislation that will help bring the US back into compliance with international law, thus ensuring those same rights are granted to Americans abroad when they are most vulnerable.  Sign below to show your support!

      ------------ --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- --------- ---------



      ------------ --------- --------- --------- --------- --------- -

      take action - Protect Americans Abroad - Urgent Action Needed!


      http://www.thepetit ionsite.com/ 1/protectamerica ns

      ------------ --------- --------- --------- --------- --------- -

      Protect Americans Abroad - Urgent Action Needed!

      The letter below will be sent to Congressmen calling on them to
      support H.R. 6481 or the "Avena Case Implementation Act of 2008".

      This Act is in response to the International Court of Justice's Avena
      decision, which determined whether the Vienna Convention rights of 51
      Mexican nationals had been violated when they were detained in the
      United States. According to the Vienna Convention, local authorities
      are required to notify consular officers without delay of the
      detainment of one of their foreign nationals. The ICJ determined that
      American officials had not done so, violating the foreign nationals'
      Vienna Conv ention rights. The US was ordered to provide judicial
      reviews to determine if those violations affect ed their convictions or
      sentences. H.R. 6481 would provide these Avena-mandated judicial
      reviews. Secretary of State Condoleezza Rice, US Attorney General
      Michael Mukassey, and all nine Supreme Court Justices agree that the
      US has an international obligation to obey the Avena decision.

      The impact of the "Avena Case Implementation Act of 2008" will extend
      to all Americans detained abroad. As the Dallas Morning News'
      editorial on July 29th noted:

      The State Department calculated that 4,456 Americans were arrested
      abroad in 2006, up from 3,614 in 2005. The bulk of those arrests
      occurred in Mexico. For an American sitting in a filthy, dark jail
      cell in a foreign land, it's easy to be overwhelmed by hopelessness.
      One thing makes the nightmare bearable: the guaranteed visit from an
      American consular official.

      But this guaranteed visit by an American consular officer is
      contingent on the weight foreign authorities give to the Vienna
      Convention right to have consular authorities notified without delay.
      What goes around comes around with international law, and H.R. 6481
      would be noticed by foreign governments, bettering the chances that
      Americans are ensured their rights when traveling abroad.

      One problem is that there is not enough time to pass H.R. 6481 before
      one Avena defendant, Jose Ernesto Medellin is scheduled for execution
      on August 5th in Texas. In order to give adequate time for H.R. 6481
      to be passed and a judicial review applied to Medellin's case, the
      letter calls on Congressmen to support a temporary reprieve from
      execution. For without it, a dangerous precedent would be set that
      would jeopardize all Americans abroad.

      Nevertheless, H.R. 6481 is a necessary piece of legislation that will
      help bring the US back into compliance with international law, thus
      ensuring those same rights are granted to Americans abroad when they
      are most vulnerable. Sign below to show your support!

      http://www.thepetit ionsite.com/ 1/protectamerica ns




      ###
      ------------ --============ ========= =======------- --------- --------- --------- -----

      Family Immigration Legislation Moves Forward

      ASIAN AME RICAN JUSTICE CENTER APPLAUDS CONGRESSWOMAN ZOE LOFGREN'S
      LEADERSHIP

      Recapture Bill Moves Forward

      Washington, D.C. – The Asian American Justice Center (AAJC) today
      applauded the passage of H.R. 5882 by a vote of 8 to 1 in the United
      States House Judiciary Subcommittee on Immigration, Citizenship,
      Refugees, Border Security, and International Law. Co-sponsored by
      Representatives Zoe Lofgren (D-CA) and Jim Sensenbrenner (R-WI), the
      legislation would reclaim old and unused visas from previous fiscal
      years
      and place them into the pool of usable visas. In addition, it
      would create a "roll over" mechanism that would ensure that unused
      visas in subsequent fiscal years would not be lost.

      "This is a victory for family immigration reform advocates and
      lawmakers who support20legal immigration, " said Karen. K. Narasaki,
      president and executive director of AAJC. "We thank the members of
      Congress
      who attended the markup and voted for the legislation. They
      are champions for family unity and the thousands of individuals who
      have been waiting for years to join their spouses and children."

      Some subcommittee membe rs introduced anti-immigrant amendments and
      provisions that would have gutted the legislation. For example,
      Representative Steve King (R-IA) introduced one amendment that would
      have eliminated the fourth family preference category that allows
      United States citizens to sponsor siblings. He also introduced another
      amendment that would have allowed only individuals under the age of 40
      with a college degree to immigrate to the United States.

      Representative King was the only subcommittee member who voted against
      the recapture provision; none of the other minority members of the
      subcommittee were in attendance.

      "In the absence of complete and common-sense immigration reform,
      lawmakers and policymakers who want to stop immigration entirely are
      not balancing the needs of future flow, immense family backlogs, and
      undocumented residents," said Tuyet G. Duong, senior staff attorney of
      AAJC. "Today's victory shows that America can come together and move
      forward with balanced solutions for our broken immigration system."

      bh

      http://lawprofessor s.typepad. com/immigration/ 2008/08/family- immigrat. html

      ###
      ------------ --------- --------- --------- --------- --

      Aliens challenging deportation cannot be imprisoned for long periods
      without a bail hearing


      "The government cannot imprison for prolonged periods aliens
      challenging deportation orders in an appeals court, without providing
      the alien a bail hearing before a judge, a federal appeals court has
      held. The decision by the 9th U.S. Circuit Court of Appeals on July 25
      is likely to affect dozens of cases in the West and will bolster
      aliens making similar arguments in other part s of the country,
      according to Ahilan Arulananeham, director of immigrants' rights for
      the ACLU of Southern California." NLJ, Aug. 1, 2008.

      http://bibdaily. com/

      ------------ --------- --------- ------

      http://www.nytimes. com/

      GETTING TOUGH

      Immigrants Deported, by U.S. Hospitals

      By DEBORAH SONTAG

      Many hospitals are taking it upon themselves to repatriate
      seriously injured or ill immigrants because nursing homes
      won’t accept them without insurance.


      ==========================================================

       Self-deportation plan criticized

      "Angelica Salas, executive director of Coalition for Humane Immigrant Rights of
      Los Angeles, said despite people's fear of being arrested, she doesn't expect
      immigrants to come forward because they have families, jobs, homes and lives in
      the U.S. "It's more of public relations for the agency that has come under
      severe attack for the tactics that they have used, the violations for human
      rights and the d

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