Stuart, Fla. (AP) - All sides agree on one thing in the case of a South Florida hospital that secretly repatriated a seriously brain injured patient back to Guatemala.
During the early hours of a steamy July 2003 morning, Martin Memorial Medical Center chartered a private plane and sent Luis Jimenez back to the Central American country without telling his relatives in the U.S. or Guatemala - even as his cousin and legal guardian, Montejo Gaspar, frantically sought to stop the move.
There, things get murky. Gaspar is suing the hospital for essentially deporting Jimenez, who was an illegal immigrant. The hospital, which spent more than $1.5 million on his care over three years, says Jimenez wanted to go home.
Underlying the dispute is the broader question of what do Americans expect a hospital to do with a patient who requires long-term care, is unable to pay and doesn't qualify for federal or state aid because of his immigration status. Health care and immigration experts across the country are watching the case, which could set precedent in Florida and possibly beyond. Lawyers for Jimenez said this appears to be the first time a lawsuit has been filed in such a case.
In closing arguments Thursday, a lawyer for Gaspar and Jimenez said the hospital wanted to send Jimenez back to Guatemala to halt what would have been a long and expensive appeals process.
"The plan was designed once and for all to stop the meter from running, to stop the expenses ... to stop the case from going all the way up to the Supreme Court _ because Luis Jimenez was gone," attorney Jack Hill told a packed courtroom in the sleepy South Florida town of Stuart, just north of the exclusive community of Palm Beach.
The case also raises the question of whether a hospital and a state court should be deciding whether to deport someone - a power long held by the federal government.
"Regardless of the decision, it will heighten the awareness of hospitals nationwide. The next time they debate shipping a patient overseas, they're going to have to do their homework because it's going to leave them open to a lot of legal challenges and questions," said Steve Larson, an assistant dean at the University of Pennsylvania's School of Medicine and medical director of a nonprofit clinic for Latino immigrants.
But Linda Quick, president of the South Florida Hospital & Healthcare Association, says hospitals may become even more wary about providing extended care to uninsured immigrants.
Hospitals are already struggling under the staggering costs of treating the nation's roughly 47 million uninsured. Illegal immigrants make up an estimated 15 percent of this group, according to the Pew Hispanic Center.
"I think they'll do what's required according to physician orders," she said, "but I think they will be more pro-active and aggressive in finding a discharge plan."
Like millions of others, Jimenez, now 37, came the U.S to work as a day laborer, sending money home to his wife and small children. In 2000, a drunk driver crashed into a van he was riding in, leaving the robust soccer player a paraplegic. For more than a year he lingered in a vegetative state before he began to recuperate, eventually reaching a fourth grade level in cognitive ability. The hospital sent him to a long-term care facility for a brief stint, but eventually he was returned to the hospital for care.
Because Jimenez has diminished capacity to make decisions, Gaspar was named as his legal guardian. Initially he supported Jimenez's return to Guatemala, but after a court-appointed attorney for Jimenez questioned whether any hospital there could take him, Gaspar grew concerned.
Then, armed with a vague letter from the Guatemalan minister of health stating the poverty-ridden country could care for Jimenez, the hospital got a county judge to OK the move.
While Gaspar sought an emergency order to stop the move so he could appeal the decision, the hospital put Jimenez on a $30,000 charter flight home.
Gaspar eventually won his appeal, with the court ruling a state judge doesn't have the power to decide immigration cases. By then, it was too late. Jimenez had been released from the Guatemalan hospital and was living with his 73-year-old mother in a one-room home in the mountainous state of Huehuetenango _ a steep hike from the village center and 12 hours from the Guatemalan capital.
Jimenez's lawsuit seeks nearly $1 million to cover the estimated lifetime costs of his care in Guatemala, as well as damages for the hospital's alleged "false imprisonment" of his cousin.
A South Florida Roman Catholic priest described a visit to Jimenez in an e-mail to The Associated Press: "He was clean, glad of the visit and occasionally made apparently good sense comments," wrote the Rev. Frank O'Laughlin. "It seemed that he was cooperating with his caregiver and would survive, I guessed, until his first pneumonia."
O'Laughlin said he wasn't sure that Jimenez should be returned to "medical care in an alien Florida institution."
But he said the lawsuit is important because hospitals should not be allowed to deport people.
He and Larson also say a country that relies on cheap immigrant labor for everything from agriculture, to clothing to construction, should factor in the cost of catastrophic injuries to those providing these essential services - whether it means requiring employers to offer coverage for day laborers or ensuring public and nonprofit hospitals can care for them.
Carla Luggiero, a senior associate director for American Hospital Association, said that cases such as Jimenez's are rare. Most of the time, hospitals are able to work with the families to find acceptable care.
And most of the time families don't have pro bono lawyers working for them as Jimenez does.
But she also warned the issue is serious, and it is one Congress has yet to address in its health care reform proposals.
"There is absolutely no discussion about it," Luggiero said. And yet, hospitals that receive Medicare reimbursements are required to provide emergency care to all patients and must provide an acceptable discharge plan once the patient is stabilized.
"It's a complicated, huge issue. Without repatriation, the issue of undocumented immigrants is already a hand grenade and so is health care," Larson said. "So together, you're really walking a tightrope."
All sides agree on one thing in the case of a South Florida hospital that secretly repatriated a seriously brain injured patient back to Guatemala.