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WHEN HOSPITALS ACT LIKE ICE  
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Liset Cruz
August 14, 2025
Type Investigations
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_ These patients needed long-term care. Instead, the hospitals pushed
for them to be deported. _

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_This article was produced in partnership with The Nation, with
support from the Gertrude Blumenthal Kasbekar Fund and the Fund for
Investigative Journalism._ _Liset Cruz was a 2023-2024 Ida B. Wells
Fellow at Type Investigations._

Key Findings

* By law, hospitals must provide life-saving care to anyone who
visits an emergency room. But they have long sought to limit their
costs by discharging patients as soon as they’re in stable
condition—particularly when a patient doesn’t have health
insurance.
* Patients and their relatives say hospitals failed to obtain
“informed consent” before discharging them, and pressured them to
agree to transfers. “If you don’t sign for us to remove him,
we’re going to leave him on your doorstep,” one hospital told a
patient’s niece.
* Donald Trump has made hospitals a focus of his mass deportation
agenda, lifting restrictions that had discouraged agents from
arresting undocumented immigrants in “sensitive areas” like
medical facilities.
* And ICE officials reportedly will be given access to the personal
data of 79 million Medicaid enrollees—to help agents track down
undocumented immigrants.

Junior found himself facing an impossible decision. One morning soon
after Christmas in 2022, his wife, Soledad, had woken up feeling dizzy
and nauseous; Junior hurried her to an emergency room in Allentown,
Pennsylvania, where doctors determined that the 45-year-old had
suffered a cerebral aneurysm and quickly ordered her to be transported
to nearby Lehigh Valley Hospital, where she underwent a series of
surgeries. The operations were successful, but there were
complications. Soledad was left in a medically induced coma.

Eight weeks later, administrators at Lehigh Valley presented Junior
with three options, none of them good: He could pay $500 a day to rent
medical equipment so Soledad could continue treatment at home; he
could find another facility to admit her; or he could agree to have
her flown to a hospital in their home country, the Dominican Republic.

“My wife is still in a coma, and you’re telling me she’s ready
for discharge?” Junior said he asked the hospital officials.
(Because of their immigration status, both Junior and Soledad have
been given pseudonyms in this article in order to protect their
identities.) Before migrating to the United States in 2022, Soledad
had worked as a psychologist and led a Bible study group. Junior
described her as positive, easygoing, and determined. “She liked to
work a lot,” he said. In Allentown, Junior found a job as an
industrial mechanic. Together they had raised two sons, now adults,
who had traveled with them to the United States.

Junior is active and strong-willed, but he didn’t have the money or
the medical skills to care for Soledad himself. And he feared what
would happen if she were transferred out of the United States. “If
my wife boarded a plane,” Junior said, “that’s how she’ll
die.”

As Soledad hovered near death, she had entered a hidden medical
netherworld, one where the failures of our healthcare system meet the
cruelties of our immigration system. Even before President Donald
Trump made hospitals a locus of his mass deportation agenda, lifting
the federal restrictions that had discouraged government agents from
arresting undocumented immigrants in “sensitive areas” like
schools, churches, and medical facilities, hospitals had become risky
spaces for undocumented immigrants like Soledad—places where a
serious illness, a slow recovery, or the need for long-term care could
put them on a path to deportation. 

The problem begins, as it so often does in the United States when
healthcare is concerned, with money. Federal law requires hospitals to
provide lifesaving care to anyone who enters an emergency room,
regardless of their immigration status or whether they have health
insurance. But hospitals have long sought to limit their costs by
discharging patients as soon as they’re in stable
condition—particularly when a patient doesn’t have health
insurance, as was the case with Soledad. In their rush to send
patients on their way, hospitals have been known to pressure
undocumented patients and their families to consent to transfers back
to their home countries. Lawyers and immigrant rights advocates call
this practice “medical deportation.”

Now, as the Trump administration steps up its immigration enforcement
measures, the number of people facing medical deportation is likely to
grow.

“We have noticed that under the Trump administration, hospitals are
getting more comfortable with threatening medical deportation,” said
Adrianna Torres-García, the deputy director of Free Migration
Project, a Philadelphia-based nonprofit that provides legal assistance
to immigrant communities and works to stop deportations. “Hospitals
are taking this opportunity—this anti-immigrant climate—to become
a little more bold about not wanting to work with immigrants who
don’t have health insurance.”

Members of Free Migration Project demonstrate outside the Philadelphia
City Hall in 2023. Image: Brian Erickson/Free Migration Project

The scale of the problem is not easy to track. Hospitals and the
companies they hire to facilitate such removals are not required to
report international transfers to state or federal regulators.
However, interviews with patients, immigrant rights advocates,
lawyers, and other experts, along with an analysis of news articles
and academic studies, suggest that medical deportation is a
frighteningly common occurrence that has likely affected thousands of
patients. And given the current political realities, transfers that
might once have been surreptitious affairs may now happen more openly.

“We know that it’s a real problem,” said Torres-García.
“We’ve had people from Wisconsin, Indiana, and DC reach out to us
for help.”

Under the Trump administration, hospitals are getting more comfortable
with threatening medical deportation.
Adrianna Torres-García, the deputy director of Free Migration Project

Under Trump’s presidency, undocumented immigrants have become more
concerned about their safety in hospital settings. A recent survey by
KFF, a health policy research nonprofit, found that many undocumented
immigrants said they would avoid seeking healthcare out of fear of
being detained by US Immigration and Customs Enforcement agents.

Yet even before Trump’s return to the White House, the threat was
significant. For Junior, the hospital’s efforts to transfer Soledad
left him terrified for her health and scrambling for a solution.
“They gave me an ultimatum,” Junior said. “They said, ‘We send
her to the Dominican Republic, or you take her home.’”

Even without the prospect of deportation, the treatment for
Soledad’s aneurysm was traumatic. Junior recalls surgery after
surgery, during which doctors shaved her head, removed a piece of her
skull, and placed her on a respirator so she could breathe. “She had
so many devices connected to her,” he said.

For three weeks, doctors kept her on a sedative in the hopes that it
would allow her body to heal. At the end of January 2023, they
gradually took her off the medication, but instead of waking up,
Soledad remained unresponsive.

It was during this time, Junior said, that his meetings with hospital
staff became increasingly fraught as they began to inquire about her
immigration status. Then, during a meeting with Lehigh Valley
administrators and staff from the medical transport company
Med­Escort in early February, Junior said they raised the possibility
of transferring Soledad to the Dominican Republic.

For Junior, the idea was a nonstarter. He felt that hospitals in the
Dominican Republic wouldn’t be able to provide the level of care
that Soledad needed. Indeed, the lack of adequate healthcare was one
of the reasons they had sought a new life in the United States.

“I wasn’t going to sign any kind of document to authorize it,”
Junior said of the transfer.

Medical records obtained by _The Nation_ and Type Investigations
suggest that Lehigh Valley continued to make plans for Soledad’s
transfer, however, despite Junior’s repeated objections. According
to these records, the hospital first documented its plan to send
Soledad to the Dominican Republic on February 8, 2023, after meeting
with MedEscort two days earlier. Over the next three weeks, doctors
regularly evaluated whether Soledad’s condition made her stable
enough for discharge, while MedEscort worked to coordinate the
transfer and connect with a hospital in the Dominican Republic that
could accept her.

Lehigh Valley Hospital did not respond to multiple requests for
comment on Soledad’s case.

Under the federal Emergency Medical Treatment and Labor Act, passed in
1986, hospitals are required to ensure that medical transfers meet
certain conditions designed to safeguard patients. Such
transfers—whether to a domestic facility or an international
one—must involve minimal health risks and be carried out via an
appropriate mode of transportation, such as an ambulance or a private
plane outfitted with medical equipment. The receiving facility must
have both the space for the necessary treatment and personnel who are
qualified to provide it.

Beyond these immediate requirements, discharge plans must be
consistent with a patient’s health goals and treatment preferences
as well as designed to reduce factors that could lead to a preventable
hospital readmission. In Pennsylvania, hospitals must also ensure that
patients are informed about follow-up care and are given guidance on
accessing financial assistance for their hospital bills.

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A Hidden System of Exploitation Underpins US Hospitals’ Employment
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Almendral
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Finally, the US Department of Health and Human Services’ regulations
dictate that patients, or their representatives, have a right to
participate in “planning for care after discharge.” And hospitals
are required to provide information in a patient’s native language.
The idea is that hospitals must engage in a process that allows for
“informed consent.” In Soledad’s case, however, as in many cases
of medical deportation, the question of consent soon gave way to
pressure.

“That’s the crux of the issue and what differentiates medical
deportation from medical repatriation,” Torres-García said.
Patients may consent to medical repatriation for any number of
reasons: An executive who falls ill while traveling abroad for
business, for example, or a tourist on vacation who has an accident
might prefer to receive medical care in their home country. These
patients elect to be treated outside of the country where they were
injured. But in cases of medical deportation, Torres-García said,
“people are not given that choice.”

Toward the end of February 2023, doctors determined that Soledad was
medically stable, but they were not ready to sign off on sending her
to another hospital in the Dominican Republic, according to her
records. Then, at the beginning of March 2023, Lehigh Valley Hospital
declared that Soledad’s time was up and that MedEscort was moving
forward to facilitate the transfer. 

Founded in 1986 and based in Allentown, MedEscort says it has
repatriated over 6,000 patients to more than 100 countries. And it
expects the demand to increase. “As immigration policies and
healthcare priorities evolve, American hospitals are likely to
experience a higher volume of cases requiring tailored care discharge
plans for uninsured and/or undocumented patients,” Med­Escort’s
website states. A 2022 version of the site put it more bluntly:
MedEscort’s services, it said, are designed to help hospital CEOs
and CFOs who are “looking to solve the problem of unfunded Foreign
Patients in American Hospitals.” Top destinations for the company
have included Mexico, Haiti, and the Dominican Republic.

“Hospitals have scarce resources. When a patient is stable or only
needs custodial care, the hospital has an obligation to consider
lower-­cost settings,” said Mark Weller, an attorney and
spokesperson for MedEscort. “Perhaps that could be having a patient
go back to their home country.”

Weller said the company follows the American Medical Association’s
guidelines on safe discharges, including requiring that a patient is
stable, that a discharge plan is in place, and that the receiving
facility has the resources to meet the patient’s needs. “We do not
support or engage in involuntary discharges,” Weller said. He said
MedEscort relies on hospitals to obtain the necessary consent from
patients. 

Weller declined to discuss Soledad’s case but said that MedEscort
exists “to help hospitals do this the right way”—something, he
acknowledged, that might not be true of other companies.
“Unfortunately, some vendors remove patients from US facilities
without any assurance of continued care, putting both patients and
hospitals at risk,” he said.

When Lehigh Valley Hospital decided it was time for Soledad to move
on, it informed Junior, despite his repeated objections, that her
transfer to the Dominican Republic would happen in less than a week.
The date was set for March 8.

Alexandra Santos, an attorney with Free Migration Project, attended
several meetings between Junior and hospital staff. She said that,
despite state and federal regulations requiring informed consent from
patients, hospital administrators told Junior, “We don’t need your
consent.”

There is no official data on medical deportations, but researchers and
immigrant rights advocates say the practice is surprisingly common. In
2012, researchers at Seton Hall University School of Law and New York
Lawyers for the Public Interest released a report documenting more
than 800 cases of successful or attempted medical deportation in the
United States between 2006 and 2012. It remains one of the most
significant reports on the practice to date.

The report is filled with horror stories: a 19-year-old girl who died
shortly after being transferred from Arizona to Mexico; a victim of a
car accident in Las Vegas who died after being left on the tarmac at a
Guatemala airport; a baby, born with Down syndrome and a heart
condition, whose transfer from an Arizona hospital to Mexico was
halted at the 11th hour.

In one case from 2008, a hospital in New Jersey, seeking to transfer a
stroke victim to Guatemala, contacted the man’s sister there. When
she refused to give her consent, the hospital falsely led her to
believe that her brother was near death in order to convince her to
agree to his transfer. The following year, a man who suffered a stroke
and brain hemorrhage in North Carolina was also transferred to
Guatemala, where no arrangements for his continued care had been made.
He spent one night in a hospital
before he was taken to his family’s home, where he died about two
weeks later.

The report is scathing in its assessment of hospital practices in the
United States. “There is enough information to establish that the US
is in systematic violation of its human rights obligations under a
variety of treaties that the US has signed and/or ratified,” the
authors wrote.

John Sullivan, a former Fulbright scholar in Mexico, said he tracked
nearly three dozen cases of medical deportation during a research
project on the issue in 2013 and 2014. In one case, a 28-year-old man
who had been left in a vegetative state after a physical assault was
sent from Chicago to Mexico City, where medical personnel left him on
a makeshift bed in his sister’s apartment. Sullivan said he did not
know what ultimately happened to the man, but the fact that he was not
transferred to a healthcare facility shows how medical deportation can
leave patients in dire straits. “Medical repatriation shifts the
burden of care onto families with few resources,” Sullivan said.
“Patients and their families struggle to find adequate and
affordable treatment.”

Sullivan also noted that, in the cases he studied, elderly parents
typically, and unexpectedly, were the ones who took on the role of
caretaker for their ill adult child, who had often been the family
breadwinner. These children had traveled to the United States not only
to secure their own livelihoods but also, in many cases, to support
their families back home. 

Armed and untouchable: ICE’s history of deadly force
[[link removed]] Lila
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There have been more recent stories as well. In 2020, the case of an
undocumented patient at Philadelphia’s Jefferson Torresdale Hospital
sparked a local outcry. The man, known as A.V., was walking from his
apartment to a nearby grocery store when he was struck by a
motorcycle, leaving him with multiple fractures and severe brain
injuries. A few weeks later, A.V.’s niece, Claudia Martinez,
received a call from a social worker at the hospital inquiring about
his immigration status. When the worker learned that A.V. was
undocumented, she informed Martinez that her uncle would be
transferred to Guatemala later that month.

“How is that possible?” Martinez recalls asking.

She said the hospital told her it had obtained the consent of A.V.’s
wife, Juanita, an assertion that both women dispute. Juanita said she
never received a call in 2020 regarding her husband’s transfer.

“It’s like they took advantage of the situation,” Martinez said.
“They could say they received authorization from his wife…but that
was a lie.” Martinez said that a hospital official continued to
pressure her into agreeing to the transfer, threatening to simply drop
her uncle off at her home. “He told me, ‘If you don’t sign for
us to remove him, we’re going to leave him on your doorstep.
You’ll wake up one morning and just see him outside your
house,’” she recalled. “I didn’t know what to do. It drove me
crazy.”

Claudia Martinez and her uncle, who was threatened with medical
deportation after he was struck by a motorcycle. Image: Courtesy of
Claudia Martinez

A.V.’s story might have ended there, like those of so many other
seriously ill undocumented immigrants. But in June 2020, medical
students at Jefferson Torresdale Hospital circulated a public petition
highlighting the health risks that A.V. could face if he were
transferred to Guatemala. “As healthcare professionals, we are
taught to ‘First, do no harm.’ This much is egregiously
clear—when you deport a medically at-risk, disabled individual to a
country which may not have the means to care for them, you are doing
harm,” the petition said.

Free Migration Project also organized a protest to keep A.V. in the
country. Dozens of people gathered outside the hospital to raise
awareness of the case, linking arms and vowing to block any ambulance
that attempted to take A.V. to the airport. Soon, local media arrived,
putting Jefferson Torresdale in the spotlight. 

Finally, in the face of this growing opposition, the hospital canceled
the transfer and kept A.V. in its care until alternate plans could be
made. He was eventually discharged to a nursing home. 

He told me, ‘If you don’t sign for us to remove [your uncle],
we’re going to leave him on your doorstep.’ Claudia Martinez

Jefferson Torresdale Hospital did not respond to requests for comment
about A.V.’s case.

At the nursing home, A.V.’s condition improved dramatically, but he
still required help to perform daily functions. He remained at the
nursing home for four years before ultimately consenting to an
international discharge back to Guatemala last year. His care in the
United States had allowed his health to improve to the point that he
could manage the transfer, and in Guatemala he was able to reunite
with his wife and continue his recovery.

A.V.’s story, and the advocacy around it, shattered the silence that
had long surrounded medical deportations—and soon shook free other
instances of families trying to keep their loved ones from being
deported. Maripat Pileggi is a supervising attorney at Community Legal
Services who worked on A.V.’s case. She said she’s worked on about
10 similar cases since then. “Most of them have occurred since
A.V.’s case was publicized so widely in 2020, which tells me that
this likely happens a lot more often than anyone knows,” Pileggi
said. “People often don’t realize they have any right or power to
fight against it.”

One of the people who’d heard about A.V.’s case was Junior. As his
discussions with Lehigh Valley Hospital grew increasingly acrimonious,
he connected with Free Migration Project and organized a local media
campaign denouncing the attempted transfer. On March 2, 2023, dozens
of protesters gathered outside the hospital’s main entrance. A
second demonstration was held less than a week later.

In response to the outcry, the hospital backed down and allowed
Soledad to remain in its care.

“I wouldn’t have thought another family was going to go through
this again,” said Claudia Martinez, who began working with Free
Migration Project as a volunteer after connecting with the
organization through a social worker. “Especially not so close to
home.”

To help make sure families are spared their own medical deportation
horrors, Free Migration Project and other immigrant rights advocates
came together to end the practice in Philadelphia. They drafted
legislation to prevent hospitals from deporting patients without their
consent, and the City Council passed it in December 2023.

The legislation, which is the first of its kind in the country,
forbids hospitals to “engage in medical deportation, either directly
or through a designated agent.” To that end, it designates oversight
of medical repatriation practices to the Philadelphia Department of
Public Health and the City Committee on Public Health and Human
Resources, and it requires hospitals to report patient data, enabling
city officials and others to track the prevalence of international
transfers. The law also gives the city the power to fine hospitals
that engage in the practice, and patients have the right to sue
hospitals for damages.

“I am very happy that this bill was passed, and I am hopeful that it
will help many families,” Martinez said.

Still, even as activists and lawmakers in Pennsylvania have succeeded
in increasing protections for undocumented immigrants, the situation
in other parts of the country is becoming more precarious. Trump has
threatened to penalize states like California, New York, and
Ore­­gon, which offer health insurance to undocumented immigrants,
by reducing the federal Medicaid match dollars that help hospitals and
medical facilities offset their care costs. Without these matching
funds, states will be forced to shoulder the entire cost of care for
undocumented patients—a situation that could strain their budgets
and lead some states to cut health coverage for undocumented patients.
And in July, the Associated Press reported that ICE officials will be
given access to the personal data of 79 million Medicaid
enrollees—to help agents track down undocumented immigrants.

“You will see more medical repatriations and more attempted medical
deportations,” warned Charles Blatteis, a lawyer based in Tennessee
who specializes in medical repatriation.

Some states are even proposing changes of their own to try to appease
the president and head off his punishment. In May, California Governor
Gavin Newsom proposed freezing enrollment for undocumented immigrants,
ages 19 and older, in Medi-Cal, the state’s Medicaid program. All
undocumented residents in the state would still be covered for
emergency medical care—as is required under federal law—but adults
who haven’t enrolled by January 2026 would not have access to basic
health coverage. Without this coverage, immigrant rights advocates
suspect, medical deportations will continue to increase.

Back in Philadelphia, with the battle against Lehigh Valley Hospital
behind him, Junior is optimistic about Soledad’s recovery. At the
end of May 2023, Soledad was moved into a nursing home, and she
emerged from her coma shortly afterward. She is undergoing physical
therapy to try to improve her condition and help her regain cognitive
function and bodily autonomy.

“She’s still there, slowly getting better,” Junior said.
“They’ve removed the endotracheal tube, and she’s able to
articulate more words.”

Still, the danger for Soledad—as well as for Junior himself—has
not disappeared: The Trump administration’s anti-immigrant agenda
has trickled down to the Lehigh Valley. An administrator at the
nursing home “asked me about my immigration status and noted my
situation and the new administration,” Junior said. “I told them I
wouldn’t answer any of their questions—this isn’t an immigration
office. They told me my wife wasn’t good for their business.”

In Soledad’s room at the nursing home, a shelf holds a small
boombox, which Junior has tuned to a gospel music station. On a visit
to see her last year, Soledad lay in bed alert and aware, smiling
often. Junior brushed her salt-and-pepper hair tenderly and secured it
into a ponytail. He visits her every day, he said, often twice a day
on weekends. Together they celebrated their 25th wedding anniversary
in April. Despite the challenges of the past two years, their
connection remains strong. As Junior entered the room to greet her,
Soledad reached out to embrace him, whispering softly into his ear and
pulling him closer.“She’s the love of my life,” Junior
said.

Liset Cruz
[[link removed]] is a
bilingual Mexican-American journalist committed to holding powerful
institutions accountable, creating accessible news, and working on the
ground to engage with underserved communities. She holds two B.A.
degrees from the University of Georgia, and an M.S. from Columbia
Journalism School’s specialized Toni Stabile investigative program.
Her work has appeared in The New York Times, The Marshall Project, The
Atlanta Journal-Constitution, as well as several other local Georgia
publications. She will report on the intersection of immigration and
health care.

_Type Investigations [[link removed]] is a
nonprofit newsroom dedicated to transforming the field of independent
investigative journalism. We produce high-impact reporting that
amplifies new voices and offers reporters unparalleled opportunities
to take risks, break news, and effect change. Type Investigations
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