Undocumented Patients

nutella, MSN, RN · Dec 28, 2016

I do not know in which parallel universe you live but there have always been undocumented people coming to the ER or being admitted to the hospital.

What I did notice since the election, is that people now voice their anger openly about feeling disadvantaged and specifically blaming "foreigners" who are often legal residents and for example refugees. I work in an area with a high refugee and immigrant population and they all qualify for some minimum insurance. Most of them came from countries that were or still are in some war situation, a lot of them traumatized. They are legal residents and have access to some services but not as comprehensive, it depends on their insurance and overall situation.

There are of course also undocumented people living in this country - I bet you have taken care of plenty of them without knowing.

What you point towards is actually an underlying emotions and underlying feeling that is coming out much more since the election.

It basically sounds to me that you are pointing to

- somebody who is undocumented should at least be pleasant because they get something "for free"

- should somebody who is undocumented get "all services" or should we deny somebody certain services

- should undocumented people have the right to access the system in a way they do ?

- envy ( I hear that a lot lately) - basically putting anger over their own situation or unfortunate situation onto the undocumented person and implying that the undocumented person is to blame for other people's misfortune

- fairness - is it fair that somebody who is undocumented is allowed to access all kind of care for free while the "normal" person has to pay and sacrifice something in order to pay their medical bills or pay for insurance?

So besides verbalizing your anger over having to "put up" with somebody who has or has not "the right" to give you a hard time you point to all kind of ethical concerns. There is plenty of information out there regarding your concerns / opinion, some of it older. This is not a new situation.

This article from 2009 explores the financial and ethical dilemma that arises from providing care to undocumented people with chronic illness for example needing dialysis. They also state that this is a problem that should be addressed by immigration policy and not by health policy because access to healthcare is a basic human right.

Denying Care To Illegal Immigrants Raises Ethical Concerns | Kaiser Health News

The next article, although long and not an easy read, is very good and explores an ethical dilemma and the underlying ethical principles and the law

How Should Clinicians Treat Patients Who Might Be Undocumented?, Mar 16 - AMA Journal of Ethics

The next piece is easy to read and a "real life" story on National Public Radio

Medical Deportations For The Uninsured And Undocumented : Shots - Health News : NPR

This article talks about "medical repatriation", which includes to send a patient after the acute care phase is finished to their home country because they need longterm care that is not covered by anybody and the hospital has no way of getting paid for "longterm care"

Unable To Afford Long-Term Care, US Hospitals Deport Undocumented Immigrants

Generally speaking, a lot of problems come from the patchworked regulations. For example, that a hospital has to provide emergency services but once stable they are also required to discharge a patient to an appropriate setting - if the patient requires rehab or longterm care and has no insurance and no family takes them home - the hospital and patient are stuck because facilities like nursing homes or rehabs are not required to accept a non acute patient.

OP - if you are angry or disgruntled about the way you feel treated by a patient you can bring that up to your manager if the patient behavior is unacceptable and the patient lacks boundaries. If the behavior is part of a medical condition (delirium and such) that underlying illness needs to be treated and if it is a matter of "bad behavior" with acting out, appropriate boundaries are essential and perhaps you manager / supervisor needs to get active to create a plan.

TruvyNurse · Dec 28, 2016

Lack of a valid social security number is often the first clue.

This is how we know who is undocumented in the prison system as well. Plus we have a short biography of their birthplace, parents, etc.

Ruby Vee, BSN · Dec 28, 2016

I don't understand how someone who is "undocumented" meaning they do not have any type of government issued number/permit/ID/social security or ID numbers in order to pay any kind of taxes with - how these people are paying taxes?
I know that DOCUMENTED temporary immigrants who are not necessarily citizens, but who have work visas, or temp visas for which they must reapply, or if they are here on another status such as political asylum -etc - all those people have numbers are are paying taxes - they are DOCUMENTED. they are also eligible for Medicaid/medicare and would not be in the predicament I am speaking of.
Undocumented do not have ANY VALID id numbers, and there fore are not paying any kind of taxes (except sales tax at a store where they pay cash). They get jobs down at the corner and are usually hired under the table to split funds from someone who is documented-and those people can't claim them or file taxes for them because they have no valid ID's. they do not have insurance, because they don't have numbers - they are undocumented. They do NOT pay any kind of taxes, nor do they qualify for any kind of medical programs which is why they are stuck in our system.

I think you have a basic misunderstanding about paying taxes. While it is true that many illegal aliens work "under the table" for minimum wages (less than minimum wage) in cash, many also share social security numbers or tax IDs. They pay taxes on their earnings, just like everyone else.

Sales tax is a regressive tax, meaning that the poor are taxed a disproportionately high percentage of their income for their basic needs. Increasing sales tax doesn't hurt the wealthy or even the middle class, really. Maybe you or I buy one less pair of shoes or designer bag. But when you're living on the edge, a higher gas tax may mean the difference between putting gas in the tank to get to work to earn that minimal wage to put food on the table . . . And NOT.

As nurses, it really isn't up to us to decide who gets care and who doesn't. We take care of the patient in front of us to the very best of our ability. It isn't up to us to know about a patient's immigration status. Or whether or not they have insurance. The hospital is a business; there are more than enough bean counters to count those particular beans.

Ruby Vee, BSN · Dec 28, 2016

How, exactly, do you propose to deport a patient who is too ill to leave the hospital?

Some hospitals have critical care transport teams who will fly the patient back to their country of origin. This is how I know that you really CAN fit two people into an airplane bathroom and that "Don't pee on the wall" is a very useful phrase in any language.

WKShadowNP, DNP, APRN · Dec 28, 2016

The premise of the question is divisive and unsettling, and I suspect it was intended to be. As an emergency room nurse I see all walks of citizens and non-citizens in various strata of status. None of it matters to me nor has bearing on their reason for being there. More often than not, the immigrants I see speak Spanish and regardless of their status, they report to the Emergency Room because of barriers to access for primary care or other services that could be achieved without a second thought for those with insurance and adequate means (whether it's a subsidy or employer-offered insurance). Because so many organizations do the bare minimum requirement with providing interpretation or translation services (there is a difference), instructions are not verified as understood.

A majority of migrant workers in my area left grade or middle school to work out of necessity to support their families so they are completely illiterate in their native language or only read at a grade school level. Additionally, translated material whether written or verbal might miss the nuances integral to communication. Furthermore, follow up questions go unanswered because you give the paperwork or verbal instructions, but you can't communicate anything else without certified assistance (having the CNA from another floor translate is not acceptable).

These unfortunate individuals are trying to stay under the radar and make a better life for themselves, isn't that the American way? Even when they do utilize appropriate channels (and many really do), they still have trouble negotiating our infrastructure and receive so much resistance to seeking help. They show up in the ED because they know there will be care offered, and usually without attitude. Unfortunately, xenophobia and bigotry is still present at times, which makes me sad. We are no more enlightened than we ever were.

Kooky Korky, BSN, RN · Dec 28, 2016

But that doesn't mean we treat them worse compared to someone who is legally here. Whatever your views are, you need to drop them at the door.

We should treat everyone humanely. I have never, ever said or believed otherwise.

Do you mean I should drop my views at the door? Is so, which door is that? What are you saying?

While being humane, there are still limits. It's a hard truth, but a truth nonetheless.

Kooky Korky, BSN, RN · Dec 28, 2016

The premise of the question is divisive and unsettling, and I suspect it was intended to be. As an emergency room nurse I see all walks of citizens and non-citizens in various strata of status. None of it matters to me nor has bearing on their reason for being there. More often than not, the immigrants I see speak Spanish and regardless of their status, they report to the Emergency Room because of barriers to access for primary care or other services that could be achieved without a second thought for those with insurance and adequate means (whether it's a subsidy or employer-offered insurance). Because so many organizations do the bare minimum requirement with providing interpretation or translation services (there is a difference), instructions are not verified as understood.
A majority of migrant workers in my area left grade or middle school to work out of necessity to support their families so they are completely illiterate in their native language or only read at a grade school level. Additionally, translated material whether written or verbal might miss the nuances integral to communication. Furthermore, follow up questions go unanswered because you give the paperwork or verbal instructions, but you can't communicate anything else without certified assistance (having the CNA from another floor translate is not acceptable).
These unfortunate individuals are trying to stay under the radar and make a better life for themselves, isn't that the American way? Even when they do utilize appropriate channels (and many really do), they still have trouble negotiating our infrastructure and receive so much resistance to seeking help. They show up in the ED because they know there will be care offered, and usually without attitude. Unfortunately, xenophobia and bigotry is still present at times, which makes me sad. We are no more enlightened than we ever were.

Does your ER have a translator available on call?

OrganizedChaos, LVN · Dec 28, 2016

We should treat everyone humanely. I have never, ever said or believed otherwise.
Do you mean I should drop my views at the door? Is so, which door is that? What are you saying?
While being humane, there are still limits. It's a hard truth, but a truth nonetheless.

The work door. I have worked at a detention center that only received illegal immigrants. Did I care why they were there? No. I left all my prejudices at the door before I started work. If they aren't harming anyone, why should it bother me? I dated a Border Patrol Agent a long time ago, even he had a heart & knew that not everyone coming to the US is a rapist/murder/etc. He still had a job to do & did it - up until he quit.

Kooky Korky, BSN, RN · Dec 28, 2016

I think you have a basic misunderstanding about paying taxes. While it is true that many illegal aliens work "under the table" for minimum wages (less than minimum wage) in cash, many also share social security numbers or tax IDs. They pay taxes on their earnings, just like everyone else.
Sales tax is a regressive tax, meaning that the poor are taxed a disproportionately high percentage of their income for their basic needs. Increasing sales tax doesn't hurt the wealthy or even the middle class, really. Maybe you or I buy one less pair of shoes or designer bag. But when you're living on the edge, a higher gas tax may mean the difference between putting gas in the tank to get to work to earn that minimal wage to put food on the table . . . And NOT.
As nurses, it really isn't up to us to decide who gets care and who doesn't. We take care of the patient in front of us to the very best of our ability. It isn't up to us to know about a patient's immigration status. Or whether or not they have insurance. The hospital is a business; there are more than enough bean counters to count those particular beans.

Are you saying they file tax returns?

Kooky Korky, BSN, RN · Dec 28, 2016

The work door. I have worked at a detention center that only received illegal immigrants. Did I care why they were there? No. I left all my prejudices at the door before I started work. If they aren't harming anyone, why should it bother me? I dated a Border Patrol Agent a long time ago, even he had a heart & knew that not everyone coming to the US is a rapist/murder/etc. He still had a job to do & did it - up until he quit.

OK, so what makes you think I don't feel their pain or try to help them? Much of my career has been spent working in jails and other insitutions where wealthy people are almost never found. I loved it. I got along well with 99% of the patients and that was not for being rude or disrespectful toward them.

That still doesn't mean that their care is free or that, as a US citizen and payer of a lot of taxes, I should not care who pays for the patients' care.

And although there are plenty of decent, good people in any group you name, there are also some bad apples. One small example - on a visiting day at the jail, I saw a woman visitor who changed her baby's diaper right near a trash can where she could easily have disposed of the dirty diaper. Where do you think she left it? In the trash can that was 2 steps from her? No. On the grass. And I heard her remark to her friend. It was to the effect that she wasn't going to clean up after herself and baby because her purse and diaper bag had been searched and the authorities were all s***heads. Never mind that all purses and bags always get searched and that doing so helps prevent weapons and drugs and other contraband from being smuggled in.

heron, ASN, RN · Dec 28, 2016

Are you saying they file tax returns?

Unable to say, since the IRS isn't allowed to give out the information. Besides, filing a return isn't the same as paying the taxes, which are normally withheld automatically. It also doesn't take into account all the other taxes paid in undocumented money: sales, property, gas, etc.

WKShadowNP, DNP, APRN · Dec 28, 2016

Does your ER have a translator available on call?

.

Our hospital system has contracted with an agency for many languages and we use the "language line." Unfortunately, it can be tedious and is not always utilized at all or appropriately.