Sick or injured undocumented immigrants in South Texas face a choice: Medical care or deportation

Procedures implemented in 2018 to streamline the passage of seriously ill or injured undocumented immigrants by ambulance through internal border checkpoints in South Texas in order to get higher-level medical care might lead these patients to refuse access to this care, according to a new study from the Texas A&M University School of Public Health.

“The focus on border security has intensified, with an unprecedented $29.2 billion awarded for this at the federal level last year and with the passage of Senate Bill 4 in Texas, which makes entry into the United States between ports of entry a state crime,” said Christine Crudo Blackburn, PhD, a border health expert who led the study. “One result is that undocumented immigrants could have less access to health care and poorer health outcomes.”

The study by Blackburn, Texas A&M colleagues Mayra Rico, Jessica Hernandez and an epidemiologist with the University of Texas Health Science Center at Houston in Brownsville was published in the American Journal of Public Health.

Texas has 19 internal border checkpoints, where Border Patrol agents verify the legal status of motorists entering or exiting the state. For the study, the researchers interviewed 30 ground crew employees of an emergency medical service that transported patients by ambulance through these checkpoints in the four-county Rio Grande Valley.

In one-on-one interviews, the ambulance crew members answered questions about transporting undocumented individuals through interior border checkpoints to higher-level care facilities and about transporting pediatric patients who were U.S. citizens, but had at least one undocumented parent.

“We learned that prior to 2018, ambulances were held at internal border checkpoints if the patient or the patient’s family member was undocumented,” Blackburn said. “This caused delays lasting from 45 minutes to several hours, which was dangerous for patients and stressful for the emergency responders caring for them.”

In 2018, emergency medical service representatives, hospital administrators and Border Patrol collaborated to develop a new process that eliminated these delays. Now, hospitals must notify Border Patrol of a patient’s immigration status before the patient is allowed to be transferred to a hospital that is beyond an interior border checkpoint. This enabled ambulance crew members to provide better, more timely care to patients.

In addition, Border Patrol now accompanies ambulances that have an undocumented patient or family members from the transferring hospital to the receiving hospital and stays with the patient throughout the care process, Blackburn said. If they don’t have enough agents, Border Patrol arranges for an agent to meet the ambulance at the receiving hospital.

“Patients who refuse to disclose their undocumented status or do not want the hospital to notify Border Patrol of their undocumented status cannot be transported by ambulance to another hospital,” Blackburn said.

For undocumented parents whose children are patients, this creates a painful dilemma: stay with their child and have their undocumented status reported to authorities, or place their child in the care of others. If no relatives are available beyond the internal border checkpoint to meet the child at the receiving hospital, the Border Patrol takes custody of the child.

“One emergency responder recalled a situation when a mother was left behind as her very young child was transported more than 200 miles to Houston for surgery,” Blackburn said. “He said keeping family members apart during such a life-altering event was heart-breaking.”

She noted that future research should focus on whether this streamlined ambulance transfer process increased access to higher-level medical care or whether the requirement to notify Border Patrol leads more undocumented patients to refuse transfer.

In addition, Blackburn said that surveying emergency medical service personnel in border communities across all four southern border states would provide valuable insight into the treatment of undocumented immigrant patients who need higher-level medical care beyond internal border checkpoints.