Paco Alvarez: Let’s start with a definition – what is medical deportation? Can you explain what the rules are regarding hospital discharges and how this type of deportation differs from what the federal government is doing right now with its mass deportation?
Liset Cruz: The difference between medical deportation and medical repatriation is really the key factor of consent here. People can get injured abroad and wanna go home to be treated in their home country, but when it comes to medical deportations, a lot of the patients thought of for this practice are undocumented, uninsured, and oftentimes need chronic care. And so the biggest way that this differs from the mass deportations happening across the country right now is that hospitals are doing this privately and independently. No government entity is involved, honestly whatsoever. Sometimes they involve consulates or embassies to kind of help locate family abroad. But in terms of the Department of Homeland Security or ICE being involved is almost never. I haven’t seen a case where it’s ever actually involved and it’s ever a real deportation that’s backed by a paper trail.
Alvarez: What inspired your investigation into this phenomenon? How did you first hear about it?
Cruz: So I first heard about this, well, three years ago. I had just started my master’s program at Columbia University. I was a Stabile Investigative Fellow at the School of Journalism, and I knew that I wanted to do something regarding immigration. So in my research, I started talking to scholars, lawyers, just anybody who’s directly involved in the immigration process. And in that process, I had spoken to a lawyer based in New York. And one of the random questions that I learned in class to ask at the end of the interview is kind of what prompted her to mention medical deportations to me. It really hadn’t been a part of our conversation whatsoever. So that question was, if you could focus on researching a subject for six months, what would you choose? And she mentioned having attended the seminar on medical deportation. And that just kind of really piqued my interest to follow this through, so she then connected me with my sources at Free Migration Project and it just kind of snowballed from there. So this was never really necessarily like, the intersection of healthcare and immigration was never something I like set out to investigate, but just having come across a topic that is so under-reported and affects hundreds of people a year – it was really interesting and I knew I wanted to get into it a lot more.
Alvarez: You spoke to several families who have been pressured by hospitals to consent to transfers out of the United States. How did you connect with your sources?
Cruz: So the two main families that I was able to kind of follow their story through, I was connected to them through the Free Migration Project. They are based out of the Philly area, and so they kind of have helped families across Pennsylvania, but also across the country, really. And so it’s really hard to find sources because, one, people don’t really know where to look for help. People don’t know that they have options. And that they’re, to a certain extent, legally covered by emergency Medicaid.
So I tried to connect with more sources in Oregon and Indiana and Illinois, but that kind of fear of telling their stories when they’re in such a vulnerable state kind of deterred them from sharing with me. So there were a few more cases that I could have been able to follow, but I didn’t want to necessarily in my own way pressure families to share their stories. So the two families that I did end up connecting with and were very brave about sharing their experiences were because of the Free Migration Project.
Alvarez: Related to that, how did you approach speaking to people whose immigration status could put them at risk of legal action?
Cruz: I’ve reported on undocumented residents across New York and across the country in several different aspects. And I think the biggest thing I try to do the most when approaching these kinds of sources is really just building that trust. I tell them a little bit about myself. I’m the daughter of Mexican immigrants, I know what it’s like to live in a mixed status family. I let them ask me questions, whatever they want. And I also reassure them that nothing in my reporting is ever set out to do any harm. So in the example of this story, we did pseudonyms – I guess that’s really the main factor of protecting people because I know it’s such a vulnerable state to live in a constant fear to live. I always try to make sure that I can do everything I can to reassure sources that they will be okay in telling their story to me.
Alvarez: What does medical repatriation slash deportation process look like from the families and patients’ perspectives?
Cruz: I guess the way that I’ve seen it – it plays out in a couple of different ways. So it depends on how aggressive hospitals are really, because they definitely begin their discharge planning process once a patient is stable. That doesn’t mean that they can be okay on their own. like they probably still need some care. It’s just about being medically stable. So the way that I’ve kind of seen it come across is it’ll be either a couple of weeks or a couple months into being at a hospital receiving care. Hospitals then learn that these patients are uninsured and there’s only so much that they can get in federal funding back. Then they learn their immigration status. And the easiest, not necessarily the easiest but I feel like the top solution for these hospitals to medical repatriation or, without consent, deportation.
The way that I learned about it through Junior’s perspective is that his wife wasn’t even out of a coma yet before it was prompted, and he absolutely refused to give any kind of consent for the transfer. He even mentioned that the state of health care in the Dominican Republic was one of the reasons they left. So I knew then that, you know, this was a question that he had been asked and he had been asked multiple times throughout the course of a couple of weeks. And then sometimes hospitals, I guess in Junior’s case, they get other parties involved. They involved MedEscort, which is an air ambulance transfer service. Well, they themselves aren’t an air ambulance company. They help connect hospitals to hospitals abroad. So they themselves don’t fly patients out, but they kind of do the middle work for them. So yeah, because hospitals aren’t as thorough in their work as they should be, they kind of leave it up to the patient or the family to find another solution. So in this case, Junior got the Free Migration Project involved. Their lawyers helped sort out paperwork, which led to his wife being able to stay in the country.
Alvarez: When it comes to the reporting process, what sorts of challenges did you face while reporting the story?
Cruz: I think the biggest challenge that I faced was looking for sources. I definitely wanted more sources in this story. I wanted to be able to really paint a picture of this across the country, across decades that I at least have been able to record through like newspaper clippings and research that this exists and this has been happening for those same amount of decades. But again, people fearing sharing their stories or it’s really just that the attention to themselves that they don’t want and they didn’t want to share and so yeah, just to my own standards as an investigative journalist, I definitely wanted to have more families, but because of everything happening, it was very difficult to get people on board.
Alvarez: Some of the experts you spoke with said that they expected medical deportations to increase given the current political climate, but how have conditions for immigrant patients changed since the start of the Trump administration?
Cruz: I think the biggest thing, even though we haven’t, I haven’t really seen a lot of instances where it’s happened, but those safety protections for certain locations like churches, schools, hospitals has been removed. I think this will kind of give hospitals that extra push of confidence to really go forward with medical deportations. I think the second thing is the decreased Medicaid matching dollars that hospitals heavily rely on to stay afloat. Because at the end of the day, as much as doctors and nurses are set out to help people, it honestly always does come down to money. And so it’s just a matter of the perfect ingredients, like making the perfect storm. And with the overall anti-immigrant climate, I think medical deportation will become even more of a top choice when these kinds of patients enter hospitals across the country.
Alvarez: What are activists and states doing to push back against medical deportations?
Cruz: That’s a good question. I think the only non-profit organization that I have seen make this a front and center campaign is the Free Migration Project in Pennsylvania. Philadelphia was the first city in the U.S. To pass an ordinance to end medical deportations. And I know that the non-profit organization wants to push for statewide bans on medical deportation. I think it’s also just a matter of raising awareness. Throughout the timeline of the story, we were actually able to help a Kentucky man stay in the country as well. Because we had been so far into the reporting process, it wasn’t really an opportunity to add another source to the investigation overall. But having been able to connect folks from this organization to local journalists in Kentucky and kind of raising that awareness, that’s when the hospital backed down because they were put in the spotlight. So, if anything, it really is just kind of making sure that undocumented, uninsured patients have the knowledge to know that they have options and then the kind of, in some way, community support to fight against them.
Alvarez: My last question – do you have any advice for journalists who are reporting on immigration and the intersection between healthcare and immigration right now?
Cruz: Yeah, I think I’ve seen journalists approach immigration from two different ways. You know, there’s very heavily policy at the forefront. And then I think of people and impact in the forefront, so focusing on the big political players in all of this is one way to go about it and kind of documenting the small changes that are happening. But I say, if you have direct access to undocumented communities, again, building that trust is key to really just make sure that your sources feel safe. Because I mean, I know, I think it’s actually one of the standards of the Society for Professional Journalists, but it’s minimize harm. Minimize harm, and I think that’s how I approach immigration reporting. I feel like it’s people first. And policy second, because a lot of things that I feel like are definitely talked about with immigration are just kind of like data points. And people forget that these are real people with families and lives that are in just the crossfire of all of this. And so again, making sure that those connections are thorough and genuine and based on a foundation of trust I think is really important. And the way I kind of, like what I said earlier is I let people ask me questions. I always say like, if there’s any kind of question that makes you uncomfortable, we move past it or I rephrase it in a way that makes them feel more comfortable. So really, again, it’s just about building that trust with undocumented people.
I think the flip side is with policy and politicians and public figures, it’s really their job to answer our questions. And so there, I kind of approach it as the opposite. It’s really pushing for answers. I’m not gonna have or really approach politicians with the same amount of grace as I would people whose lives are in danger. You know, politicians are public servants and they’re there to answer our questions. And I think that pushing back or being a little bit more forward with questions is important when it comes to covering immigration and health care through the lens of politics and policy.