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Saturday, October 8th 2011

Out of Hospital Care Lacking

The New York Time has a profile of a gentleman, illegally in the country, who spent 19 months in a New York City hospital because there was no funding for the out of hospital assisted care he was going to need.

[T]he hospital admitted Mr. Fok to the intensive-care unit on the third floor, where workers tried to find out more about their patient — not just his medical history, but his insurance or Medicaid status, his address, his Social Security or taxpayer identification number, the location of family members.

Once his condition had stabilized, the hospital moved him to a regular room on the fifth floor, where staff members expected to treat him for 7 to 10 days before discharging him to a sub-acute-care center for rehabilitation, the usual regimen for stroke victims.

Nineteen months later, Mr. Fok, 58, greeted a reporter from his bed in Room 516, eager to have a visitor. In the previous year and a half, perhaps 100 or more patients had come and gone from the room’s other bed, but Mr. Fok had gone nowhere.

Near the border here in Texas this is not an unusual problem. Plenty of illegal immigrants with serious, emergent problems are seen at my primary teaching facility. Many a times they end up in conditions necessitating long term care. With no funding, with no public non-acute health care system in Mexico there really are no options but to keep them in the hospital until charity funding is identified for them.

To be fair the profile goes over the active measures the patient, Mr. Fok, took to impede his placement and his care. Many times the patients I encounter have family and friends who will actively work to help in trying to get the patient to a better place outside the hospital, but with limited resources and unable to provide the care he needs themselves it proves difficult.

Mr. Fok’s immigration status never kept him from receiving treatment, but it helped make sure that his care would be delivered in the most expensive setting possible and in a place no one wants to spend more time than necessary. He was cut off from his family. On several occasions he showed signs of depression or expressed suicidal thoughts.

If he had been insured or immediately eligible for Medicaid or Medicare, he might have gone to a nursing home after a week or two, where the average daily cost in New York is about $350 — and where he might have had steady companionship. Or he might have received a home health aide in his apartment, which could have cost even less, depending on the required hours.

For hospitals like Downtown that treat many illegal immigrants, the health care plan enacted last year does nothing to solve this liability, Mr. Menkes said. During debates about reform, lawmakers insisted that the plan’s benefits not extend to the nation’s 11 million illegal immigrants.