This project was undertaken as a USC Annenberg Center for Health Journalism National Fellowship Fund Grantee for Conecta Arizona.
When Junior visits his wife, he sprays on the perfume she always loved, plays the songs they used to sing together, and sometimes wears the shirts she once said made him look handsome. On her good days, Solida recognises the music. She’ll open her eyes from her bed in the care facility and hum along.
In December 2022, Solida began vomiting every morning. The headaches came next: the kind that made her grab her head and feel that she was going to die. Junior wanted to take her to the hospital, but fear kept him frozen. Fear of medical bills they couldn’t pay in a country they had just arrived to. All the stories he had heard about how going to a hospital in the United States could end in a deportation, even before mass deportations appeared in the headlines with the second term of Donald Trump.
On December 28th, one of Solida’s eyes suddenly dropped closed. Their 16-year-old son rushed her to the emergency room. The next day, at Lehigh Valley Hospital in Pennsylvania, doctors diagnosed a brain aneurysm and took her into emergency surgery.
She hasn’t been home since.
What happened next—and what might still happen to Solida—sits at the intersection of two failing systems: the U.S. healthcare system and the country’s labyrinthine immigration regime.
About two months after Solida was placed in a medically induced coma, still unresponsive and dependent on machines, hospital officials called Junior into a meeting. They told him he had two options: “Either you take her home, or we will send her to the Dominican Republic in two days.” It was March 6th, 2023.
Junior remembers sitting there, stunned. The hospital suggested he could care for her at home for $500 a day. He had no medical training, no equipment, and even more baffling: “Where am I going to find USD 15,000 per month?” Junior thinks out loud. On the other hand, he was certain that sending Solida back to the Dominican Republic would be a death sentence.
Hospitals across the country have signed off on such medically dangerous removals many times before, especially in states along the border like Arizona.
Hospitals quietly deporting sick patients to their deaths
Across the nation, hospitals routinely engage in what advocates call “medical deportation”: transferring severely ill, uninsured patients to hospitals in another country rather than arranging long-term care in the United States.
According to organizations and academics who track this practice, most patients are undocumented, but previous reports show that some hospitals have also attempted to deport lawful permanent residents and even U.S. citizens. Some of these transfers cost tens of thousands of dollars and require complex logistics to fly patients in critical condition.
Hospitals in Phoenix and Tucson are known to have attempted to medically deport critically ill patients to hospitals in other countries, sometimes with a simple ambulance ride across a checkpoint.
In a rare disclosure, Sister Margaret McBride, former Vice President of Mission Services at St. Joseph’s Hospital, told The New York Times in 2008 that St. Joseph’s repatriates about 8 patients a month, or 96 patients a year.
Banner University Medical Center Tucson came under fire for attempting to deport a two-week-old citizen infant with Down syndrome and a heart condition in 2007. These hospitals have not publicly shared their repatriation statistics since, and did not respond to our requests for comment.
It is unknown how many people are medically deported by hospitals each year. According to research done by the Seton Hall Law School and New York Lawyers for Public Interest, there were more than 800 cases of successful or attempted medical deportation in hospitals across the country between 2006 and 2012. Nobody has counted since, not least the government. All of it happens without federal oversight, in the shadows of the law.
“That’s called kidnapping,” explained David Bennion, a practicing immigration attorney and the executive director of Free Migration Project. “Coercive medical repatriation is illegal in that it really fits the legal definition of kidnapping and related criminal offenses, if you are coercively forcefully taking somebody and transporting them against their will.”
Adrianna Torres-García, who manages Free Migration Project’s national medical deportation hotline, has watched the practice escalate. Since 2020, the organization has received calls from Pennsylvania, Michigan, Maryland, New Jersey, Indiana, Wisconsin, Kentucky, Texas, New York, and Florida, and has documented nearly 20 cases to date. “Last year [in 2024], we received only two calls,” she said. “This year we are already at eight. In April, we had three cases in a single week.”
To Adrianna, the pattern is unmistakable. “Hospitals have gotten really creative and bold about what ‘discharge planning’ looks like now,” Torres-García said.
In one recent case, a hospital’s entire discharge plan was to buy a visually impaired patient a tent and drop them in a homeless encampment, even though the patient had lost their vision due to chronic illness and could not live independently. “We wouldn’t have seen that even a year ago,” they said. “But because of the political climate, there’s this sense of, ‘Well, nobody’s going to give a shit,’” they admit.
Ambulances across the border
In Arizona, which shares roughly 370 miles of border with Mexico, advocates and attorneys have pointed to geographic proximity as a factor that makes it easier for hospitals to arrange the transfer of patients across the border.
or hospitals to arrange the transfer of patients across the border.
That’s what happened to Antonio Torres, a 19-year-old permanent resident who lived with his family in Gila Bend, Arizona. His story was reported and included in a book chapter by sociologist Lisa Sun-Hee Park. On June 7, 2008, he went to work with his father in the alfalfa fields when a car accident left him hospitalized with a severe brain injury, lung contusions, and abdominal damage.
Two days later, the staff at St. Joseph’s Hospital in Phoenix pressured Torres’ family to take their son off life support. They told the family there was little hope for him. When the family refused, the hospital arranged to transfer Torres against his parents’ wishes to a public hospital in Mexicali, Mexico. In the middle of transit, the unconscious 19-year-old man was left in the summer sun at the border, kept alive by a portable ventilator, for hours before a Mexican ambulance picked him up.
Once he arrived at the Mexicali public hospital, there were no beds available. Torres’ infection spread. Meanwhile, the family and Latino community leaders in Arizona fundraised for Torres’ transport back to the United States to a California hospital that was willing to treat him.
By the time Torres arrived back in the U.S., his body was in septic shock, a life-threatening medical emergency triggered by severe infection that risks organ dysfunction and death. Yet eighteen days after arriving in California, Torres awoke from his coma and asked, “Where’s my mother?”
Not all patients are so lucky to block, reverse, or survive a medical deportation.
Here’s what we know about José Abraham Arvizu, affectionately known by his classmates and teachers as “Joe D,” before his death. A senior at North High School in Phoenix, he was active in choir and Junior ROTC, and carried the American flag at school assemblies. He had passed the AIMS exam to graduate from high school.
José underwent emergency brain surgery and was diagnosed with leukemia at St. Joseph’s Hospital. A week later, they put José in an ambulance and sent him over the border, according to the local outlet Phoenix New Times. The hospital in Hermosillo, Mexico, was not able to supply blood for a blood transfusion. On December 3, 2007, José died. His short obituary reads: “One of his most important goals was to join the U.S. Army.”
José had no deportation order. He was not wanted by ICE. He was simply uninsured, undocumented, and in need of medical treatment.
Why do medical deportations happen?
Under the Emergency Medical Treatment and Labor Act (EMTALA), all hospitals must provide emergency care regardless of a patient’s ability to pay, insurance status, or immigration status. Hospitals are reimbursed for acute care under Emergency Medicaid.
Once patients are stabilized, hospitals are required under EMTALA to guarantee a safe discharge. However, for conditions that require long-term care, such as rehabilitative care or continued nursing, it becomes hard to find a rehabilitation facility that will accept patients without insurance.
This is when some hospitals decide it is easier to transfer the patient to a hospital in a different country than to find a discharge facility for someone without insurance in the US. Once the patients are in a different country, whether or not they receive adequate follow-up medical care is no longer the hospital’s responsibility, nor subject to legal oversight.
Sana Loue, Professor of Medical Ethics at Case Western Reserve University School of Medicine, consults with hospital systems on medical repatriation cases. Loue explains, “Instead of dumping at another facility or showing someone the door, you are dumping them in another country.”
Legal scholars have argued that medical deportation practices often violate several parts of EMTALA. The law generally forbids the discharge of a patient who is in an unstable condition, unless there is consent from the patient or their legal representative.
Additionally, the hospital must guarantee that the receiving facility has available space and qualified personnel for the treatment of the individual, and has agreed to accept transfer of the individual. A physician must sign off that the medical benefits outweigh the risks, and the transfer must be conducted through qualified personnel and transportation equipment.
Fighting back in court
All too often, families don’t know their rights and how to fight back. They may fear exposing themselves to the government, be unfamiliar with the US legal system, and struggle to navigate language barriers in hospital systems.
A small handful of affected families and advocates have ignited community support and sought legal aid to block medical deportations.
Mac Nayeri, a practicing immigration attorney in Phoenix, remembers getting a call to testify before a judge for a temporary restraining order to block the medical deportation of Sonia del Cid Iscoa.
Iscoa was in a coma at St. Joseph’s Hospital after giving premature birth to a daughter. The family was informed by the hospital in May 2008 that Iscoa would be removed to Honduras within a week.
Iscoa had been in the US legally for years through Temporary Protected Status (TPS), a humanitarian designation from the Department of Homeland Security, when conditions in their home country made it unsafe to return. Iscoa had not lived in Honduras for more than 17 years. She was the mother of seven US-born children.
Nayeri recalls testifying before a judge for the temporary restraining order, with Iscoa’s legal team successfully making the claim that transferring the comatose woman would cause “irreparable harm.”
Nayeri points out that hospitals do not have the authority to deport someone who is legally in the country, when even the federal government does not have this power. “Just as DHS could not remove her because she has a valid status, so the hospital should not be allowed to do what DHS is not able to do themselves. It was definitely against due process. That’s a basic principle of constitutional law.”
“It shocked me that this was even playing out,” Nayeri said over the phone. “But that was something I learned in that case, that it wasn’t that rare.”
The late immigration attorney Fernando Gaxiola interrupted two eleventh-hour medical deportations, calling authorities to report “international kidnapping” as one patient was being driven to the border, and another patient was being driven to the airport.
“It’s completely lawless,” said Anjana Malhotra, a civil rights attorney who led the Seton Hall report team. Malhotra, Kimberly Krone, and Jennifer Scott spent a year tracing 30 patients who were medically deported to Guatemala.
Malhotra and team’s report found that 90 percent were repatriated while critically ill or suffering from serious medical conditions. Of the cases handled by the Guatemalan consulate, 80% were transferred without valid consent. For the 13 cases in which they could document post-transfer outcome, seven received no follow-up medical care at all. Six patients died following the transfer.
Malhotra and her team took the issue of extrajudicial coerced medical repatriation to the Inter-American Court of Human Rights. The brief proposes, “the U.S. government is responsible for the human rights violations associated with forced or coerced medical repatriations because it has failed to act with the due diligence required to protect the rights of those subject to medical repatriation by hospitals.”
On the ground, protests coordinated outside of hospitals with media crews stationed at hospital exits have sometimes successfully pressured hospitals into delaying and cancelling medical deportations. In response to public outrage in Philadelphia, Pennsylvania, the city became the first in the US to ban coerced medical deportations in December 2023.
“Predatory behavior taking over healthcare”
“There’s a deportation issue and all of these things, but they’re happening in the context of predatory behavior that has taken over healthcare,” said Eric Manheimer, who was the Medical Director of Bellevue Hospital for over thirteen years.
As a former hospital leader, Manheimer dismisses the assertion by hospitals that they simply cannot afford to provide care to uninsured patients. “They will always say we don’t have money to take care of these patients to get more money out of the system.”
In the case of Arvizu, the high school senior with leukemia, St. Joseph’s Hospital’s charity committee had considered and rejected his case for use of the hospital’s charity care budget.
St. Joseph’s Hospital is part of Dignity Health, which had a total revenue of 11.3 billion in 2024, which grew from 9.9 billion in 2023 and 9.5 billion in 2022. The Chief Executive of Dignity Health, Lloyd Dean, was paid $21,187,786 last year.
“The reason people are denied care in this country is a political and social issue. It’s not an economic issue. The system has been built to eliminate certain populations from being insured,” said Manheimer. “And we’re going to see that now get much, much worse as Trump continues to cut public health.”
President Trump’s One Big Beautiful Bill Act, which was signed into law on July 4 this year, and whose major policy changes come into effect in 2026, is slashing an estimated $1 trillion from federal Medicaid funding over the next 10 years, according to the Congressional Budget Office. This loss drastically cuts Arizona’s health safety net, as 81% of the state’s Medicaid spending comes from federal funds.
This translates to an estimated $35 billion loss to Arizona’s Medicaid budget, which covers the mandate of emergency care for all.
“It’s an existential crisis for the system,” said Manheimer. “Existential.”
Sacrificed
With the future uncertain, Junior cradles Solida’s face in his hands, pinches her nose, and whispers softly in his wife’s ear. He says he is here every day, sometimes three times a day when his work schedule allows. Their 24-year-old son, Steeven, leans over the bed, eyebrows furrowed.
“There were times when her head felt like a basketball with no air, and if you squeezed it, it would make a hole in the middle of her head,” said Steeven. “So a person in this condition on a plane, a helicopter, perhaps an eight-hour journey by public transport, could kill her.”
“We spent nights in the hospital on guard duty so they wouldn’t take my mother away,” Steeven said. “We would leave the phone recording on sometimes the whole night in case someone came at night to take her away.”
Junior and his son filter out of the incandescent hallways of Solida’s facility at the end of a long day. In an empty parking lot, they strip off their surgical masks to take in gulps of the crisp wintry night air.
“The first thing you have to understand is that this is a human being. This is a person. This is a life. And around this person, there are also people with love and affection for them,” continued Steven, preternaturally calm. “So basically, you are sacrificing a life for economic interest.”
Do you know of a case of medical deportation?
This investigation is ongoing. If you, a family member, or someone you know has been transferred out of the United States by a hospital while seriously ill—with or without consent—we want to hear from you. We are also seeking testimonies from healthcare workers, hospital staff, social workers, lawyers, and advocates who have information about these practices.
You can share your story or provide information confidentially. We understand the risks and barriers many families face and will treat every contact with the utmost care and journalistic responsibility.
Resources and Legal Support
Free Migration Project – National Hotline Against Medical Deportations: urgent support, legal advice, and assistance for families at risk.
If you are in an urgent situation or know someone who is, seek legal advice as soon as possible. Documenting what happens—dates, names, hospital communications—can make a difference.
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