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St. Joe’s struggles to help the uninsured
Legal status, high health care costs present challenges
By J.D. Long-García, jdlgarcia@catholicsun.org
January 1, 2009
Maria Villela doesn’t have health insurance. Still, for the last five years she’s received regular checkups at St. Joseph’s Hospital and Medical Center.
“I care about my health,” she said. “I come here and they treat me well. I have no reason to complain.”
St. Joseph’s women’s wellness center began in 1996 to provide cervical and breast exams for uninsured, low-income women like Villela. The center is seeing more women now because people are losing their jobs and insurance, according to Gail Brown, a nurse practitioner.
“Most of our women are from the Hispanic population,” she said. “They live and work here. They’ve raised their children here and have no other source of health care.”
The center sees between 1,200-1,500 women a year, three days a week. But the care doesn’t stop at the screenings.
“Anywhere there’s an abnormal breast exam, we follow through — giving them the care they need,” Brown said. That includes treating the cancer, even if the hospital has to pay all the costs.
The treatment costs range from $25,000-$75,000.
“We’ve never not taken on a patient,” Brown said. “We just find a way.”
Roadblocks to care
People expect Catholic hospitals to maintain a higher standard, according to Sr. Margaret McBride, RSM, vice president of mission integration at St. Joseph’s.
“You advocate and take care of the poor. You advocate and take care of the uninsured. You advocate for individuals who are vulnerable,” she said. “But there’s a limit to what we can do.”
St. Joseph’s dedication to the uninsured sometimes hits a roadblock when the patient is not a citizen of the United States.
The acute care hospital is the largest in the state, licensed for more than 700 beds. Being an acute care hospital means St. Joseph’s cares for patients who require specialized attention from a physician.
Say a person is in a severe accident and is brought to St. Joseph’s for care. Once stabilized, if the injuries are serious enough, the patient is then transferred to a long-term care facility or is taken care of at home.
That is, unless the patient is uninsured.
“Our problem is that we get those same, severely injured patients, and have nowhere to send them,” said Matt Boettcher, St. Joseph’s director of case management, who helps arrange discharge needs for patients.
“We can’t safely discharge the patient anywhere in the state without a payer source,” he said, referring to the insurance problem. “In some cases we become the payer source.”
After the hospital provides the surgery and the intensive care, it often pays for a patient’s home care, medicine and other supplies.
“When we’re talking about the coverage issue, we’re not talking about us being paid,” Boettcher said. “This is payment for services the patient needs for a safe discharge. We’re not getting paid. We’re trying to get people who no longer need to be in a hospital safe for the rest of their recovery.”
In Arizona — unlike in California, for example — undocumented immigrants are not eligible for state-funded long-term care.
“You have all these different things — hospitals, nursing homes, hospices, home care agencies. The only one that’s mandated by law to take care of patients is hospitals,” Boettcher said. “Everyone else picks and chooses and is legally allowed to do that.”
These medical facilities don’t often choose the uninsured.
In such cases, St. Joseph’s personnel find themselves torn between their mission of serving the poor and transferring a patient back to his home country, where health care is available. Transferring to another state is against the law.
And it isn’t just immigrants here illegally who are repatriated.
Repatriation and the media
St. Joseph’s decision to repatriate immigrant patients hasn’t received fair coverage, according to Sr. Margaret.
In November, The New York Times published an article about Antonio Torres, a farm worker who suffered serious injuries in a car accident in June. St. Joseph’s teams cared for him and he was stabilized.
After five days — the average length of a stay at an acute care hospital — St. Joseph’s began making arrangements to transfer Torres to a hospital in Mexico. He would require long-term care, something that the Catholic hospital is not equipped to handle. While Torres was here legally, he did not have the five years of residence required to receive Arizona Medicaid coverage.
Eventually, Torres’ family brought him to a hospital in California, where he was eligible for the state’s Medicaid.
The Times characterized St. Joseph’s Hospital as having “a focus on keeping down the rising cost of uncompensated care.”
The Arizona Republic also published a piece on St. Joseph’s struggle with repatriation. Their story profiled Fidel Delgado, an undocumented immigrant who suffered a heart attack.
St. Joseph’s doctors saved Delgado’s life with a bypass surgery. Once stabilized, though, the hospital sought repatriation. Eventually Maricopa Medical Center, which transferred Delgado to St. Joseph’s in the first place, took him back, according to The Republic.
The media coverage hasn’t been even-handed, Sr. Margaret said.
“We’ve been telling our story very fairly, but we’ve been given a one-sided view of what’s going on,” she said. “Sometimes we are limited in what we can say because of patient confidentiality. We can’t tell you the whole story because we’ve not been released to do that.”
Of the New York Times piece, McBride explained the hospital could not legally transfer Torres to California.
“If the family did that, well good for them,” she said. “But we can’t transfer a patient for medical services to another state. Nobody understands that.”
She also explained that St. Joseph’s deals with the issue of patient transfer more often because it handles patients with more complex conditions. Once stabilized, the patients will often need long-term care. But with many of the uninsured, St. Joseph’s simply doesn’t have a place to send them.
The cost of transfer
Sr. Gay Morehead, RSM, who works in St. Joseph’s mission services department and researches ways of dealing with post-acute care, noted immigrants here with temporary protected status.
Immigrants are granted such status because the U.S. government believes it’s unsafe for them to return to their home countries.
“They are here legally, they can work here legally, yet no provision of health care or any kind of government benefits is provided,” she said.
Sr. Gay also noted a recent case of a South Korean woman the hospital cared for but had to repatriate.
The hospital paid for the flight to Korea, arranged medical personnel for the journey, and paid for air transport once they landed in Seoul.
“We paid for every single part of the entire transfer,” Boettcher said, estimating the cost at more than $80,000.
Transferring a patient to a Latin American country is also expensive. Boettcher estimated an air transfer to northern Mexico between $19,000-$26,000. A transfer to southern Mexico could total $35,000.
With such a high price tag, why doesn’t the hospital just keep the patient?
“When we have no other alternative, we do what’s best for the patient,” Boettcher said. Staying in the hospital near other sick people could expose patients to infections.
But there are also future patients to consider.
“If this hospital isn’t available for the next accident — for the bus rollover, for the fire, for the cop that gets shot — that’s a problem for the Valley,” Boettcher said.
It’s an even bigger problem, given that St. Joseph’s receives so many transfer patients, yet rarely transfers patients to other Valley hospitals.
“We spend all night getting patients from other facilities because we’re a higher level of care,” Sr. Margaret said, noting that St. Joseph’s has numerous areas of expertise — from neurology to heart and lung treatment.
“That’s why we get those complex patients,” Sr. Margaret explained. “We won’t need to transfer them to another facility.”
St. Joseph’s formed a Hispanic leadership group to deal with the issue of the uninsured, many of whom are undocumented immigrants from Latin American countries. They’ve also hired an international patient coordinator to help families in stressful situations understand their options.
The hospital also educates the public in order to prevent serious accidents. Their ongoing, bilingual safety campaign teaches community members about alcohol, drugs, helmets and seatbelts.
While Arizona doesn’t provide prenatal care for the uninsured, St. Joseph’s sends out a mobile maternity unit to care for mothers and their unborn children.
“These are moms. They aren’t any different than you and I,” said Brown, who works the maternity unit when she’s not caring for patients at the women’s wellness center.
“We’re not sending people back to their country, we’re working with them,” she said. “We feel strongly here about caring for the community.”
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