New York Times: Deported in a Coma, Saved back in U.S.

DEBORAH SONTAG

November 8, 2008

GILA BEND, Ariz. — Soon after Antonio Torres, a husky 19-year-old farmworker, suffered catastrophic injuries in a car accident last June, a Phoenix hospital began making plans for his repatriation to Mexico.

Mr. Torres was comatose and connected to a ventilator. He was also a legal immigrant whose family lives and works in the purple alfalfa fields of this southwestern town. But he was uninsured. So the hospital disregarded the strenuous objections of his grief-stricken parents and sent Mr. Torres on a four-hour journey over the California border into Mexicali.

For days, Mr. Torres languished in a busy emergency room there, but his parents, Jesús and Gloria Torres, were not about to give up on him. Although many uninsured immigrants have been repatriated by American hospitals, few have seen their journey take the U-turn that the Torreses engineered for their son. They found a hospital in California willing to treat him, loaded him into a donated ambulance and drove him back into the United States as a potentially deadly infection raged through his system.

By summer's end, despite the grimmest of prognoses from the hospital in Phoenix, Mr. Torres had not only survived but thrived. Newly discharged from rehabilitation in California, he was haltingly walking, talking and, hoisting his cane to his shoulder like a rifle, performing a silent, comic, effortful imitation of a marching soldier.

"In Arizona, apparently, they see us as beasts of burden that can be dumped back over the border when we have outlived our usefulness," the elder Mr. Torres, who is 47, said in Spanish. "But we outwitted them. We were not going to let our son die. And look at him now!"

Antonio Torres's experience sharply illustrates the haphazard way in which the American health care system handles cases involving uninsured immigrants who are gravely injured or seriously ill. Whether these patients receive sustained care in this country or are privately deported by a hospital depends on what emergency room they initially visit.

There is only limited federal financing for these fragile patients, and no governmental oversight of what happens to them. Instead, it is left to individual hospitals, many of whom see themselves as stranded at the crossroads of a failed immigration policy and a failed health care system, to cut through a thicket of financial, legal and ethical concerns.

That creates a burden. "It's a killer," said Brian Conway, spokesman for the Greater New York Hospital Association. But it also establishes the potential for neglectful and unethical if not illegal behavior by hospitals.

"The opportunity to turn your back is there," said Dr. Stephen Larson, a migrant health expert and physician at the Hospital of the University of Pennsylvania. "You're given an out by there not being formal regulations. The question is whether or not litigation, or prosecution, catches up and hospitals start to be held liable."

In October, the California Medical Association, responding to an article in The New York Times about the medical deportation of a brain-injured Guatemalan, passed a resolution opposing the forced repatriation of patients. The American Medical Association is to take up the matter on Sunday at a national meeting in Orlando.

"While we empathize with hospitals that must provide uncompensated care to undocumented immigrants," said Dr. Robert Margolin, a trustee of the California association, "we overwhelmingly oppose the practice of repatriating patients without their consent."

An examination by The Times of cases across the country involving seriously injured and ill immigrants shows patients at the mercy of hospitals and hospitals at the mercy of a system that provides neither compensation nor guidance. Taken together, the cases reveal a playbook of improvised responses, from aggressive to compassionate.

In the case of Elliott Bustamante, a hospital in Tucson moved speedily, and ultimately unsuccessfully, to transfer a sickly infant to Mexico, ignoring the mother's opposition and the fact that Elliott was an American citizen born with Down syndrome and a heart problem at that very hospital.

In the case of Kong Fong Yu, in contrast, a Manhattan hospital has proceeded less decisively, keeping Mr. Yu, a stroke victim, as a boarder for 18 months now as it grapples with whether to send him back to China or to subsidize him in a nursing home indefinitely.

And in the case of Darwin Castro, an illegal immigrant from Honduras, an Oklahoma City hospital forwent repatriation yet discharged Mr. Castro, a brain-injured patient who needed 24-hour care, to a young relative who also happened to be an illegal immigrant, living in the shadows and ill-equipped to care for him.

The Dilemma

Hospitals consider these fragile patients to be a vexing challenge. Theirs are protracted, expensive cases that force hospitals to make fateful decisions or assume long-term responsibility for needy immigrants who are, essentially, left at their doorsteps.

The two American hospitals treating Antonio Torres approached his case from distinctly different perspectives. St. Joseph's in Phoenix, with a focus on keeping down the rising cost of uncompensated care, repatriates about eight uninsured patients a month.

"We're trying to be good stewards of the resources we have," said Sister Margaret McBride, a hospital vice president. "We're trying to make sure that the acute-care hospital is available for individuals who need acute care. We can't keep someone forever."

By contrast, the other hospital, El Centro Regional Medical Center in California, said it never sends an immigrant over the border. "We don't export patients," said David R. Green, its chief executive. "I can understand the frustrations of other hospitals, but the flip side is the human being element."

Hospitals are required to screen and treat all those who arrive at their emergency rooms. But they receive only partial compensation for illegal immigrants, through emergency Medicaid and, for the last few years, through Section 1011 of the Medicare Modernization Act of 2003, a program that expired in October. That partial coverage ends when the patient is stabilized.

But hospitals are also required to discharge safely patients who need continuing care, leading to their quandary: they generally cannot find nursing homes to accept illegal immigrants, or legal ones with less than five years' residency, because long-term care is not covered by emergency Medicaid.

Some states and localities provide their own long-term care coverage for uninsured immigrants, and those exceptions demonstrate the demand. In California, the Medi-Cal program spent about $20 million on about 460 patients last year. In New York City, illegal immigrants occupy about a fifth of the 1,389 beds in the public nursing home on Roosevelt Island.

Hospitals have limited options in discharging immigrant patients who need continuing care: keeping them indefinitely, with or without providing rehabilitation; finding them charity beds or subsidizing them at nursing homes; sending them home to relatives; or repatriating them.

"We have to be very, very creative," said Cara Pacione, director of social work at Mount Sinai Hospital in Chicago.

Foreign consular officials say that areas with longstanding immigrant populations tend to handle such patients more humanely — with the exception of Arizona, where hostility toward illegal immigrants is high and state financing for their care is low.

"We put an asterisk by Arizona," said a Mexican diplomat in Washington.

Hospitals need consulates' assistance in finding relatives and health care options in patients' homelands as well as in obtaining travel documents. The relationship is complicated and often contentious, as expressed bluntly by Alan Kelly, vice president of Scottsdale Healthcare in Arizona.

"The Mexican consulate here is — how do I put it? — obstructionist," Mr. Kelly said.

He described the situation with illegal immigrant patients as he sees it: "Somebody falls out of a walnut tree. They show up in our Trauma One center. We don't have any problem with treating or stabilizing them. It's the humane thing to do. That's not where the costs run up. The costs run up after they're moved out of the trauma unit into a regular bed. Nobody, no nursing home, wants to take them. Then, it's like, 'Mexican government, take responsibility for your own citizens!' But you play games with them. They turn away. They basically say, 'No habla.' "

Mexican officials, unsurprisingly, see it differently. "We cooperate with the families, not with the hospital," Jorge Solchaga, a Mexican consular official in Phoenix, said. "Our principal objective is to help our compatriots."

Still, Mr. Solchaga said that his office worked collaboratively with hospitals and oversaw 80 medical repatriations from Phoenix to Mexico in 2007.

An Infant at Risk

Elliott Bustamante was born at University Medical Center in Tucson on March 14, 2007, with Down syndrome and a heart defect. Two days later, when he was in neonatal intensive care, the hospital made arrangements to transfer him to a hospital in Mexico.

The fact that he was a United States citizen was immaterial, the hospital's spokeswoman, Katie Riley, said. The hospital's policy is to transfer patients to their "community of residence" for continuing care, Ms. Riley said. And Elliott's parents, the hospital believed, were residents of Mexico, as indicated by their Mexican driver's licenses. Also, the hospital said, the mother initially told a social worker, through an interpreter, that she was visiting Tucson when she went into labor. Therefore, the hospital said, it was in the baby's interest, from a continuity of care perspective, to move him to Mexico.

But Gricelda Mejía Medehuari, Elliott's mother, said that either the hospital misunderstood her or that she failed to express herself accurately.

Ms. Medehuari said that she had been living in Tucson for about a year prior to Elliott's birth, and that her husband had been working construction there for two years. The hospital also said that Ms. Medehuari initially agreed to her baby's transfer, then "equivocated."

Ms. Medehuari said she was pressured: "We were so scared. They said we had no rights, the baby neither. They said they would send the baby with or without me. When Elliott was two weeks, they told me to gather my things because the baby was leaving in 15 minutes with a lady. It was very ugly. We contacted the Mexican consulate. They got us a lawyer."

The lawyer, Fernando Gaxiola, asked the hospital to delay sending the baby across the border, and faxed a letter saying that he would be seeking court protection to avert "the abduction of my client under the guise of medical care." A hospital lawyer, he said, told him that it was too late, that the baby was already heading to the airport.

Mr. Gaxiola summoned the police, who called the hospital, which ended up switching gears and bringing the baby back to University Medical Center.

Nine days later, the hospital asked a judge to order Elliott's parents to consent to his transfer to Mexico. His parents had made no arrangements to pay $28,000 in hospital charges or to transfer their child, the hospital said. Legally, the hospital argued, the baby could be considered to be trespassing.

Eventually, after the Arizona Medicaid system approved Elliott for coverage, University Medical Center was reimbursed for the baby's care and dropped its effort to send him to Mexico. "The medical pretext for the transfer disappeared once they found the money," Mr. Gaxiola said.

Ms. Riley, the University Medical Center spokeswoman, said Elliott's case "is not representative of U.M.C.'s long history of successful medical transfers of patients both to and from northern Mexico, but it does underline the complex dilemmas that border hospitals face every day."

New Yorker in Limbo

Hospitals in New York City face equally complex dilemmas, with the added dimension of a more diverse immigrant population and prospective repatriations to Africa and Asia. The case of Kong Fong Yu has stymied a community hospital in Lower Manhattan.

Mr. Yu, 53, suffered a stroke on May 14, 2007. He awoke with slurred speech and then collapsed on his bathroom floor. By the time he arrived at New York Downtown Hospital, it was too late to try to reverse damage to the brain, the hospital said in court papers.

The hospital admitted Mr. Yu for tests and to regulate his high blood pressure, which he had been treating with Chinese herbs. Almost immediately, Mr. Yu was considered medically stable and ready for discharge to a skilled nursing home. But since he was uninsured and ineligible for Medicaid, no nursing home would take him. He had no relatives in the United States.

So he stayed, and stayed. And he was not the only one. Jeffrey Menkes, the hospital's president, said Downtown housed a few uninsured immigrants like Mr. Yu at any given moment, which costs the hospital $1.5 million to $2 million annually. It also costs patients like Mr. Yu the chance to receive the intensive rehabilitation that they need.

Mr. Yu, according to a hospital document, can "perform some independent activities of daily living, including turning in bed and feeding himself." But he is "dependent on staff for other daily necessities" and suffers from "limited cognition and limited independent judgment."

One day last summer, he lay in his fourth floor bed watching a soundless "Clifford the Big Red Dog" cartoon with his roommate, a tiny, elderly Chinese man who has been boarding at the hospital for years.

Mr. Yu said that he entered the United States legally 11 years ago and then overstayed his visa to work "on the black market" as a cook. Speaking in Mandarin that was translated by a hospital employee, Mr. Yu said he was grateful to Downtown. "American hospitals are very humane," he said. "I have no money. This hospital is giving me food, a bed and care."

But the hospital does not want him to stay indefinitely. Last winter, Mr. Menkes said, at a moment when he had patients "stacked up in the emergency room," he realized that he needed to find a way to discharge patients like Mr. Yu. Shortly thereafter, the hospital went to court to get a guardian appointed.

"He is utilizing valuable hospital resources," the hospital said, "when the hospital is overburdened and cannot and is not equipped to provide rehabilitation or long-term care."

When Katherine B. Huang, a Chinese-American lawyer, was appointed his guardian last spring, the hospital planned to transfer Mr. Yu to a Brooklyn nursing home and support his stay. Ms. Huang sought to clarify what the hospital was promising.

"I said, 'You're going to pay for him for the rest of his life?' " she recounted. "I said, 'Does your negotiated rate with the nursing home cover his rehabilitation and health care needs, too? What about burial costs?' I mean, you have to think this all through. They told me the lawyers were hammering it out."

But the hospital later changed course.

In late September, Mr. Yu entered the courtroom of New York State Supreme Court Judge Lottie E. Wilkins on a taxi-yellow gurney. Dressed in a hospital gown, he smoothed his thin hair and saluted the judge in English. Squeezing a small rubber ball for exercise, he was then wheeled behind closed doors, accompanied by his guardian, for what Judge Wilkins called a status conference, closed to the news media.

No record was made of the proceeding. But the guardian said that she learned then that the hospital was contemplating sending him back to his relatives in China.

"All of a sudden, it became, 'Great, the family wants him back,' after the hospital repeatedly told me the family did not," Ms. Huang, the guardian, said.

The hospital declined to discuss the case, citing patient confidentiality. Mr. Menkes said, "We are not going to force people back" to their homelands.

Whether, as a person declared incapacitated by the court, Mr. Yu possesses the ability to consent to a repatriation remains to be seen. Ms. Huang said the case lay on ground ungoverned by guidelines, where hospitals are neither required to nor prohibited from doing anything with such patients.

"My position is that I need to look out for what is in his best interest," Ms. Huang said.

After the September hearing, The Times contacted Mr. Yu's 30-year-old son in Ningbo, China. The son, Cheng Jun Yu, said he and his mother had been estranged from Mr. Yu since he left for the United States. "The family situation wasn't merry," the son said.

"We do not wish for him to return," he continued. "He will be a burden for me, and I do not have the time or resources to care for him. My mother has established a new family, and I do not wish for this matter to disrupt her life. If they want to send him back, they will have to negotiate with the Chinese government to see if the government will care for him."

Into the Unknown

Hospitals say the federal government ignores the burden posed by these patients. In fact, Immigration and Customs Enforcement does not assume any responsibility for the health care of illegal immigrants unless they are in federal immigration detention, said a spokeswoman, Kelly Nantel, and it does not get involved in repatriations undertaken by hospitals.

For some hospitals, such repatriations are routine, for others a last resort. And, just as some forcibly repatriate patients, others do so only with consent — although consent is a murky concept when patients are told they have no alternative. While some hospitals pay for an immigrant's repatriation and for their care in their homelands; others never make any inquiries into how deported patients have fared.

"We don't do any follow-up," said Sister McBride at St. Joseph's in Phoenix.

Even patients at hospitals that never repatriate immigrants can find themselves embroiled in discharge plans of considerable complexity, as the case of Darwin Castro demonstrates.

One day last May, Mr. Castro, a 21-year-old illegal immigrant from Honduras, was getting a ride home from his construction job in Oklahoma City when the driver crashed into a tree. By the time he arrived at the Oklahoma University hospital, he was in shock from extreme blood loss and rushed into an operating room for surgery on a badly wounded liver. He also suffered a traumatic brain injury, facial and arm cuts and a broken hand.

Alerted by Honduran friends to the accident, Mr. Castro's cousin, Wilmer Ubener Reaños, 25, called the hospital from New Orleans, where he too worked in construction. Mr. Reaños asked a bilingual colleague for help in communicating with the hospital. From that point forward, the colleague, David Ruiz, became the family liaison, and the hospital believed that David — listed in the records with no last name — was the patient's cousin.

After six weeks, Mr. Castro was ready for discharge, said Allen Poston, the hospital spokesman. With a feeding tube and bladder catheter, Mr. Castro needed round-the-clock care but the hospital failed to find him a charity bed in a nursing home. Since it never repatriates patients, the only other option was to discharge Mr. Castro to his relative in New Orleans, Mr. Poston said.

In this case, though, the relative was an illegal immigrant who worked a 12-hour day and shared a room in a boarding house with another laborer. The hospital, Mr. Reaños said, had no idea where it was sending Mr. Castro. And Mr. Reaños had no idea what delicate condition his cousin was in, that he was barely ambulatory, brain-injured and could not talk, he said.

An air ambulance flew Mr. Castro to New Orleans and delivered him to David Ruiz. Several hours later, when Mr. Reaños got off work and arrived to pick him up, he found Mr. Castro sitting in his own waste in a wheelchair, groggy and unresponsive.

"He was so dirty," he said. "I cleaned him. I changed his diaper. But that was all I could do. I did not know how to feed him, how to open the tube. I felt like they left me completely in the lurch. All I could do was cry."

Mr. Reaños later learned that the transport company had trained Mr. Ruiz to use the medical equipment but Mr. Ruiz had not understood the instructions.

After two days, Mr. Castro appeared "on the verge of death," Mr. Reaños said. He called an ambulance, and the cost of Mr. Castro's care was thus shifted from Oklahoma to Louisiana, where a New Orleans hospital taught Mr. Reaños how to take care of him.

That proved arduous. Mr. Castro could not be left alone. Although his cousin assembled a patchwork community of caretakers, he missed so much work that he lost his job. Then his landlady kicked him out because his cousin "smelled sick," he said.

At wit's end, Mr. Reaños made plans to repatriate his cousin himself. He raised the money for a single ticket, but not enough for an escort. Through the Honduran consul, he arranged for a flight attendant to look after his cousin en route. But that arrangement disintegrated during a change of planes in Houston. When Mr. Castro did not arrive as scheduled in Honduras, his cousin furiously worked the phones, eventually discovering that Mr. Castro had been abandoned in the Houston airport. It took several more days for him to get back to his homeland.

By the time Mr. Castro arrived on Aug. 4, his suitcase, medical records and wheelchair had been lost in transit. He was exhausted, incoherent and too weak to stand, his aunt, Nolvia Rodríguez, said. But she took him into her modest home, and Mr. Castro has improved, Ms. Rodríguez said. A nurse in the neighborhood is helping out, and a clinic is tending to his medical issues when the family, which does not have a car, scrounges together the money to get him to the city.

To Mexico and Back

Antonio Torres's journey through the American — and Mexican — health care systems began at dawn on June 7, when the 19-year-old, driving to work across a rutted, gravelly dirt road on the ranch where his family lives, flipped his pick-up truck. He was found, unconscious, about 150 feet from his vehicle by a ranch hand.

For two decades, his father, Jesús, a legal immigrant, had lived on both sides of the border, harvesting the fields of Arizona while traveling regularly to visit his family in northern Mexico. Last year, his wife, Gloria, and their four children received their green cards and joined him in a farmworkers' community outside Gila Bend.

That June morning, the Torreses followed behind an ambulance that took Antonio to St. Joseph's, the flagship hospital of Catholic Healthcare West, where he was admitted to the intensive care unit with a severe traumatic brain injury, bruised lungs and abdominal injuries. Two days later, his parents, "frozen with fear," the elder Mr. Torres said, were unprepared for a hospital social worker's frank assessment of their son's prognosis.

"She said there was no hope for our son and that it would be best to unplug him," Mr. Torres said. "She said, 'You have to think what kind of life this is, hooked up to a ventilator. And if he wakes up, he will not be able to do much.' When we said, 'No!' the social worker said that, well, then, without insurance, they couldn't keep him."

According to the social worker's notes, the hospital anticipated that the patient would need long-term ventilator care and that, as a legal immigrant with less than five years in this country, he would not qualify for Arizona's Medicaid coverage.

Five days after the accident, the social worker, using an interpreter, called the public hospital in Mexicali to arrange Antonio Torres's repatriation. "Patient accepted for admission," her notes say.

The following day, the notes add, "Parents upset."

During that time, the elder Mr. Torres contacted Tom Espinoza, a Hispanic leader in Phoenix who had been battling the hospital's repatriation of another comatose legal immigrant. Accompanying them to a meeting at the hospital, Mr. Espinoza, president of the Raza Development Fund, pledged to raise money for Antonio Torres's care.

"Picture this," he said. "It's probably in a six-by-eight room. The social worker says, 'Gee, that would be like taking money and throwing it down a black hole because this kid is going to die.' I've got Mom and Dad crying, and she says that other patients would be better suited for that kind of investment."

"At the end of the day," Mr. Espinoza continued, "I realized it was not about the dignity of a person, it was about a bottom line."

The hospital delayed the repatriation for a few days, giving the elder Mr. Torres time to search for a nursing home. He came up empty, so the hospital moved to repatriate his son even though he was not only comatose and dependent on a ventilator but also had a very high white blood cell count, indicating infection.

Antonio Torres had pneumonia. A hospital physician temporarily blocked his transfer.

Two days later, early on June 20, his white blood cell count was still too high to meet the physician's condition for transfer, according to the social worker's notes. Nonetheless, a few hours later, with the same physician's consent, Antonio Torres was placed on a portable ventilator for his departure.

Sister McBride said St. Joseph patients were transferred to Mexico during "a window of time" when they are stable but "still acute" because Mexican hospitals did not want them "down the phase of recovery."

But Dr. Caleb Cienfuegos, director of the public hospital in Mexicali, said, referring to the younger Mr. Torres, "I personally would not have transferred the patient in that state."

Accompanied by his mother, Mr. Torres traveled by ambulance to Calexico, Calif., a four-hour drive; his father, and reporters from La Voz, a Spanish-language weekly published by Mr. Espinoza's wife, accompanied them in cars. At the border, Mr. Torres was wheeled from the air-conditioned American ambulance to a sweltering, World War II-era Mexican Red Cross vehicle.

The Torreses said that officials from St. Joseph's told them that the Hospital General in Mexicali had a room waiting for their son. The social worker's notes indicate that, through an interpreter, she had four conversations with a Dr. Dueñas, chief of the emergency room; the notes refer to him twice as "Dr. Urgencias," or Dr. Emergency.

Interviewed at the bustling Mexicali hospital in early September, Dr. Mario Dueñas said that he did not recall the conversations. "But I would say the same thing to anybody: that my emergency room is open and ready for any patient from anywhere," he said. "I cannot promise anyone a bed."

The hospital director, Dr. Cienfuegos, said American hospitals generally made formal arrangements with him directly and not with his emergency room.

Both doctors were surprised to learn that the patient was a legal resident of the United States. "Generally, they send us the undocumented, the 'wetbacks,' " Dr. Dueñas said.

Antonio Torres spent several days in the emergency room before a bed opened up in a crowded ward. His parents said Mexican doctors advised them to take their son back to the United States if possible. Through their church, the Jehovah's Witnesses, the parents made contact with a church leader in El Centro, Calif., who took them under his wing, introduced them to the local hospital and raised money for "the best ambulances in the border area," the elder Mr. Torres said.

Within a week, his son was on his way back to the United States, where the El Centro hospital was waiting to take him in and write off his care as charity.

"Our mission here is to provide health care access to our community," Mr. Green, president of the city-owned hospital, said, "and anyone who comes to our E.R. is considered part of our community.

"This was a kid who came to this country legally, worked here legally and had an accident," he continued. "For God's sake, don't we take care of our folk? To me, this case shows one of the disastrously broken pieces of our health care system."

Mr. Torres arrived from Mexico in septic shock, a potentially fatal condition caused by overwhelming infection. After 18 days at El Centro, he woke forcefully from his coma. "They took out his trach tube, he cleared his throat and said, 'Where's my mom?' " his father said. "We cried with surprise. We cried with joy. You could have paddled away on our tears. Then, after that, he improved every day. He didn't take baby steps. He jumped. He leaped."

Told of the progress that the younger Mr. Torres had made, Sister McBride said, "That's wonderful," adding that she thought it testament to the emergency care at her hospital. "Maybe if he had been in a different setting, he may not have survived," she said.

The Torreses have filed a detailed complaint against St. Joseph's with the Arizona health department, and the matter is under investigation.

Mr. Torres, an Arizona taxpayer who did not qualify for his state's Medicaid program, ended up qualifying for California's simply because his parents had established residency by renting an apartment in El Centro on the advice of their Jehovah's Witness friend. That enabled the hospital there to transfer him after a month to an intensive rehabilitation program in San Diego, which discharged him at summer's end.

Now Mr. Torres walks with a cane and speaks slurred but comprehensible Spanish. He is itching to climb back onto a combine and cut alfalfa alongside his father. For the moment, though, he is commuting with his mother from Arizona to California for therapy.

In September, as he waited for his first session, he reached slowly into his pocket, pulled out his wallet and removed a picture of himself as a toddler. "Dangerous child," his father said teasingly, and Mr. Torres flashed his lopsided smile.

The physical therapist, Darryl Murdoch, asked Mr. Torres how he had injured himself. "I don't remember," he said.

"That's normal," Mr. Murdoch answered gently.

Back in Arizona, Mr. Torres sat stolidly for hours on a worn couch in the concrete barracks-style housing where his family lives, letting the conversation swirl around him. Sitting beside him, a younger cousin held his hand, and toyed with a slingshot. His teenage sister wandered in and out with girlfriends. Crickets chirped loudly as a pinkish dusk settled on the dusty landscape outside.

"Imagine if I had said, 'O.K., disconnect him,' " Jesús Torres said.

Barack Obama and Joe Biden's plan for Immigration

Barack Obama and Joe Biden's Plan for Immigration
(from the official Barack Obama's transition webpage)

http://www.change.gov/agenda/immigration/

“The time to fix our broken immigration system is now… We need stronger enforcement on the border and at the workplace… But for reform to work, we also must respond to what pulls people to America… Where we can reunite families, we should. Where we can bring in more foreign-born workers with the skills our economy needs, we should”

— Barack Obama, Statement on U.S. Senate Floor, May 23, 2007

The Problem

Undocumented population is exploding: The number of undocumented immigrants in the country has increased more than 40 percent since 2000. Every year, more than a half-million people come illegally or illegally overstay their visas.

Immigration bureaucracy is broken: The immigration bureaucracy is broken and overwhelmed, forcing legal immigrants to wait years for applications.

Immigration raids are ineffective: Despite a sevenfold increase in recent years, immigration raids only netted 3,600 arrests in 2006 and have placed all the burdens of a broken system onto immigrant families.
Barack Obama and Joe Biden's Plan

Create Secure Borders

Obama and Biden want to preserve the integrity of our borders. They support additional personnel, infrastructure and technology on the border and at our ports of entry.

Improve Our Immigration System

Obama and Biden believe we must fix the dysfunctional immigration bureaucracy and increase the number of legal immigrants to keep families together and meet the demand for jobs that employers cannot fill.

Remove Incentives to Enter Without Documentation

Obama and Biden will remove incentives to enter the country undocumented by cracking down on employers who hire undocumented immigrants.

Bring People Out of the Shadows

Obama and Biden support a system that allows undocumented immigrants who are in good standing to pay a fine, learn English, and go to the back of the line for the opportunity to become citizens.

Work with Mexico

Obama and Biden believe we need to do more to promote economic development in Mexico to decrease illegal immigration.

Mistaken Immigration Raid

By Jackie Diaz
Tuesday, September 30, 2008 at 8:25 a.m.

Olga Savage said she went through a harrowing life-changing experience that might have been a total mistake.

The 68-year-old woman told Action 4 News that she heard a knock at her door Tuesday morning.

But before she had a chance to get up she said U.S. Immigration & Customers Enforcement (ICE) agents were inside her home.

“They came in with guns, grenades and holding their pistols,” Savage recalled.

When she asked them why they came into her home they allegedly responded, "Show us your papers."

Savage complied by showing them documentation proving that she's been a United States citizen for 40 years.

She said they were shocked to see the paperwork.

“They looked confused and said, 'They told us you didn’t have your papers',” she recalled.

After verifying her documentation, they made copies and left.

Olga said they didn't offer an apology or help.

But the experience left her in bad shape.

Savage told Action 4 News that she had to drive herself to the local clinic since her blood pressure rose to 280.

“I told the doctor don’t let me die because I had a really bad pain,” she said.

Savage said she wants to know why federal agents kicked in her door like she was a criminal, if she's been a citizen for so many years.

“Why, why did they have to come like they were going to war, if I’m a women living on my own,” Savage asked.

Action 4 News spoke with ICE spokeswoman Nina Pruneda about the incident.

Pruneda said ICE agents would never raid someone's home and adds that the whole confusion started because Olga savage has two alien registration numbers.

One number states that she is a U.S. Citizen and the other states that she is a fugitive.

Pruneda said ICE will continue looking into this issue.

Hundreds of Factory Workers are Held in Immigration Raid - New York Times, 8/25/08

LAUREL, Miss. — In another large-scale workplace immigration crackdown, federal officials raided a factory here on Monday, detaining at least 350 workers they said were in the country illegally.

Howard Industries, one of the largest employers in the region, manufactures electrical transformers, among other products.

Numerous agents from Immigration and Customs Enforcement descended on a factory belonging to Howard Industries Inc., which manufactures electrical transformers, among other products.

As of late Monday afternoon, no criminal charges had been filed, said Barbara Gonzalez, an agency spokeswoman, but she said that dozens of workers had been “identified, fingerprinted, interviewed, photographed and processed for removal from the U.S.”

The raid follows a similar large-scale immigration operation at a meatpacking plant in Postville, Iowa, in May when nearly 400 workers were detained. That raid was a significant escalation of the Bush administration’s enforcement practices because those detained were not simply deported, as in previous raids, but were imprisoned for months on criminal charges of using false documents.

The mass rapid-fire hearings after the Postville raid took place in a temporary court facility on the grounds of the National Cattle Congress in Waterloo, Iowa. An interpreter was later sharply critical of the proceedings, saying the immigrants did not understand the charges against them.

An immigrant rights group in Jackson, Miss., the state capital, was critical of Monday’s raid, saying families with children were involved.

“It’s horrific what ICE is doing to these families and these communities,” said Shuya Ohno, a spokesman for the Mississippi Immigrants Rights Alliance. “It’s just hard to imagine that this is the United States of America.”

In Laurel on Monday afternoon, several dozen family members of immigrants waited for news of their relatives at the Immaculate Conception Catholic Church. There were several small children. A priest at the church who identified himself only as Father Sergio refused to allow interviews with the families or answer any questions, saying only: “People are afraid. We need to calm them. There are mothers and children involved.”

Entrances to the sprawling plant, in an industrial section south of town, had been blocked off by ICE. A nearby fast-food restaurant was full of the blue-shirted agents, one of whom would say only that a “little inspection” was under way at the facility.

A woman entering the church grounds with four small children said several of the youngsters’ parents had been detained. The woman, Mary Troyer, said she was a translator for many of the families.

“I don’t like this at all,” Ms. Troyer said. “I don’t understand it. They have come here to work. It’s very sad.”

The ICE spokeswoman, Ms. Gonzalez, said the workers would be taken to an ICE detention center to “await the outcome of their cases.” She said 50 would be “released into the community” instead of being sent to the center, for “humanitarian reasons,” including medical difficulties or the need to take care of children.

She said no lawyers were present while the workers were being interrogated. “Everyone will have due process under law,” Ms. Gonzalez said.

Late Monday afternoon, the grim-faced workers, some of them handcuffed, were lined up near white and silver buses as the rain poured down.

In a statement issued after the raid, Howard Industries, one of the largest employers in the region, acknowledged that it was “visited” by immigration agents trying to determine if its employees were citizens or otherwise legally authorized to work in the country.

“Howard Industries runs every check allowed to ascertain the immigration status of all applicants for jobs,” the statement said. “It is company policy that it hires only U.S. citizens and legal immigrants.”

Bill Chandler, executive director of the Mississippi Immigrants Rights Alliance, called the Laurel raid a violation of human rights.

“We’re very disturbed at what’s happened,” Mr. Chandler said. “It’s a real contradiction between our proclaimed values of hard work and family in Mississippi and the actions of local law enforcement, and ICE. I think it’s a real affront to our values. They’re creating their own terrorism by going after workers.”

After the Iowa raid, the federal interpreter said many of the immigrants did not understand the charges to which they pleaded guilty. But federal officials said the judges in the cases believed that the guilty pleas had been made freely and voluntarily.

Pregnant Immigrant jailed in Nashville, shackled during labor

August 4, 2008

Pregnant woman's jailing questioned

Immigration policy says pregnancy is grounds for release

By JANELL ROSS
Staff Writer

The decision to jail a nine-months pregnant woman for days is raising questions about how the Davidson County Sheriff's Office handles the immigrant enforcement it volunteered to do.

Juana Villegas, 33, an immigrant with no criminal record, was arrested July 3 on a traffic violation charge, held in the Davidson County jail and shackled to her hospital bed before and after delivering her baby on July 7, she said.

Villegas was separated from her newborn son for two days and not allowed to bring a breast pump or cream for lactating mothers back to jail.

The sheriff's office has maintained its actions were consistent with its policies.

But what happened to Villegas — who said she told officers in booking she was due to deliver in days — conflicts with federal immigration policy as well as Tennessee Department of Correction and international jailing practices. Last week, the matter drew a visit to Villegas' home from the Atlanta-based Mexican consulate.

"I don't know that much about the law or any policy," said Villegas, a mother of four children born in the U.S. "But this … it does not seem right. It does not seem safe."

At issue is when Villegas should have been released.

When a person is arrested on state charges — such as driving without a license as Villegas was — officers have the option to write them a ticket or make an arrest. The Berry Hill officer involved in Villegas' case opted for arrest out of what his report indicates was concern that "prosecution would be jeopardized."

A magistrate granted Villegas bail. The amount was unavailable Friday.

But the Davidson County Sheriff's Office voluntarily participates in a program called 287g, which allows trained Davidson County sheriff's deputies to screen foreign-born inmates and pass information along to U.S. Immigration and Customs Enforcement.

The day of her arrest, ICE placed a hold on Villegas, a native of Mexico who first arrived in the U.S. in the 1990s. The hold keeps immigrants in jail past any local sentence ordered.

Davidson County Sheriff's Office spokesman Rick Gentry said Friday it was Villegas' failure to post bail that delayed her release.

Her attorney says that's not true, because local bail bondsmen won't post bail on inmates who face U.S. Immigration and Customs Enforcement involvement.

"This is simply a cheap attempt by the sheriff to evade his responsibility for the unconscionable way his jail treats pregnant women in labor," said Elliott Ozment, Villegas' attorney. "I think the real question here is why was this woman held for days in ICE's name even though ICE has said this is not what they want."

Pregnant women freed

Since 2007, ICE has required its officers making arrests to identify "at the earliest opportunity," people arrested on noncriminal immigration violations who "may be sole caregivers or who have other humanitarian concerns," said Temple Black, an agency spokesman.

A formal policy was developed for work-site raids. But the general practice is applied whenever individuals are detained in immigration violations, he said.

Those who are to be evaluated for immediate humanitarian release include those with "serious medical conditions … pregnant women, nursing mothers," the disabled and others, according to the first paragraph of the policy.

These evaluations are to be made the day of an arrest.

Neither Davidson County nor ICE responded to a request for comment about exactly when the federal agency was told that Villegas was pregnant or had just delivered a baby, but the timeline of events suggests ICE didn't know the situation until well into her jail time.

Hours after she was sentenced to time served on her traffic violation and turned over to ICE agents to deal with her immigration status, she was released. Black said it was on humanitarian grounds.

Notice about her pregnancy should have been given when deputies made contact with ICE and provided information that led to the hold, said Joan Friedland, the National Immigration Law Center's immigration policy director.

If ICE knew about the pregnancy, the hold likely wouldn't have been placed, Villegas could have posted bail and she wouldn't have gone into labor in jail, Friedland said.

Davidson County sheriff's deputies are aware of the humanitarian release policy and the jail does comply with all ICE standards, Gentry said in an e-mail.

Policy requires shackles

The Davidson County Sheriff's Office has also maintained that its officers followed procedure in the hospital. It is the agency's policy to shackle and restrain medium-security inmates during transport or while in a hospital bed.

Villegas, who arrived at the hospital shackled at her wrists and ankles, was considered a medium security inmate because of the ICE hold. In addition, according to the sheriff's office, she was either deported or left voluntarily in the late 1990s and then returned to the country without authorization.

Ozment said the exact terms of Villegas' departure are unclear.

Flight risk questioned

Restraints are considered unnecessary and dangerous during any stage of labor, according to Sheila Dauer, director of the women's rights program at Amnesty International USA.

"These kinds of restraints — belly chains, leg irons — are really a violation of international standards of treatment," Dauer said. "It's a minority of women in prison who have a history of violence to start with, and it's highly unlikely they're going to attempt to escape while in labor, which is a pretty painful process."

Amnesty recommends instead posting a guard outside the door.

Handcuffs are used while transporting pregnant state prison inmates, and one leg is cuffed to the bed after delivery, said Dorinda Carter, Tennessee Department of Correction spokeswoman. No restraints are used during labor and delivery, Carter said.

"For them to say this is the standard way that we do things, well that's an indictment of their so-called standards," said Ozment, "and I think the sheriff ought to be called to account for that."

What you can to for Efren to show immediate support TODAY!!!

E-MAIL, FAX AND PHONE CAMPAIGN FOR EFRÉN PAREDES, JR.
TO THE GOVERNOR OF THE STATE OF MICHIGAN



Send e-mails, faxes, and make phone calls to the Governor's office.

Fill Out Governor's Online Opinion Form
If you would like to fill out the Governor's online opinion form you can do so by entering the following link into your web browser:

http://www.michigan.gov/gov/0,1607,7-168-21995-65331--,00.html

In the box labeled "Issue" please insert "Efren Paredes, Jr. Commutation Request." Underneath that box click the option "For" and then copy and paste the sample letter that appears below into the "Message"section.

Leave Phone Message for Governor
If you would like to leave a telephone message for the Governor you can do so by calling one of the available phone numbers: 517-373-3400 or 517-335-7858 (Constituent Services).
If you choose to call either of the listed phone numbers you are urged to tell them you are calling to express your support for the "pending commutation request of Efrén Paredes, Jr. #203116." Please leave your contact information as well and ask that your support for the commutation go on record.

Send Fax Message to Governor
If you would like to copy and paste the message and send it as a fax you can do so by faxing it to the Governor's fax number which is: 517-335-6863.


Use the below sample letter you can copy and paste into e-mails or faxes you would like to send the Governor to express your support. The only modification you need to make is to the information at the end of the letter that reflects who it is addressed from. The letter is only intended to assist you frame a letter of your own. You can use the entire letter or only use parts of it. The decision is yours.

Dear Honorable Gov. Granholm:

I write to express my support for the pending commutation request that was submitted to your office on behalf of Efren Paredes, Jr. on 2/28/08. The request was submitted by The Injustice Must End (TIME) Committee to Free Efren Paredes, Jr.

Religious leaders, community leaders, and other respected and knowledgeable people across the state strongly support this request. Support for Efren's release is vast and includes citizens across the nation, as well as members of the international community.

This urgent appeal for clemency seeks the release of Efren Paredes, Jr., a Latino former high school honor student, who has been imprisoned nearly two decades for a 1989 crime that occurred in Berrien County. He has been incarcerated since age 15 and will turn 35-years-old on April 4, 2008.

If Efren had been sentenced as a juvenile he would have been released over 14 years ago at the latest, and as early as 18 years ago. The three individuals who pleaded guilty in the same case Efren was charged with have all served their prison sentences and been released. They were all older than Efren and admittedly guilty. Efren is the only person charged who remains in prison.

Efren has exhausted all his court appeals. His only hope for release now is by seeking a commutation from your office. If Efren is not granted a commutation he will die in prison never having experienced a single day of freedom in society in his adult life.

The prosecuting attorney from the time Efren's case was in the Berrien County court, is now a judge in the same county. The assistant prosecuting attorney who represented Berrien County, is still in that same position. Their influence, coupled with their many years of service in that county is deeply entrenched and part of the reason Efren has not received any relief sought in the county.

Society will benefit much from Efren's release. It is my prayer that you grant Efren's commutation request and provide him the opportunity to experience freedom for the first time in his adult life.

Sincerely,

Your Name
Address
City, State, Zip Code
E-mail Address

Burger King Signed with the CIW!!!

to join the CIW listserve e-mail: https://lists.mayfirst.org/cgi-bin/mailman/listinfo/announce

From:
http://www.ciw-online.org/BK_CIW_joint_release.html

WASHINGTON – May 23, 2008 - The Coalition of Immokalee Workers (CIW) and Burger King Corp. (NYSE:BKC) today announced plans to work together to improve wages and working conditions for the farmworkers who harvest tomatoes for the BURGER KING® system in Florida.

BKC has agreed to pay an additional net penny per pound for Florida tomatoes to increase wages for the Florida farm workers who harvest tomatoes. To encourage grower participation in this increased wage program, BKC will also fund incremental payroll taxes and administrative costs incurred by the growers as a result of their farmworkers' increased wages, or a total of 1.5 cents per pound of tomatoes.

BKC also joins other fast-food industry leaders and the CIW in calling for an industry-wide net penny per pound surcharge to increase wages for Florida tomato harvesters.

Together, BKC and the CIW have also established zero tolerance guidelines for certain unlawful activities that require immediate termination of any grower from the BURGER KING® supply chain. The BKC/CIW collaboration additionally provides for farmworker participation in the monitoring of growers' compliance with the company's vendor code of conduct.

John Chidsey, chief executive officer of Burger King Corp., said, "We are pleased to now be working together with the CIW to further the common goal of improving Florida tomato farmworkers' wages, working conditions and lives. The CIW has been at the forefront of efforts to improve farm labor conditions, exposing abuses and driving socially responsible purchasing and work practices in the Florida tomato fields. We apologize for any negative statements about the CIW or its motives previously attributed to BKC or its employees and now realize that those statements were wrong. Today we turn a new page in our relationship and begin a new chapter of real progress for Florida farmworkers.

"For more than 50 years, BKC has been a proud purchaser and supporter of the Florida tomato industry. However, if the Florida tomato industry is to be sustainable long-term, it must become more socially responsible. We, along with other industry leaders, recognize that the Florida tomato harvesters are in need of better wages, working conditions and respect for the hard work they do. And we look forward to working with the CIW in the pursuit of these necessary improvements. We also encourage other purchasers and growers of Florida tomatoes to engage in dialogue with the CIW in support of driving industry-wide socially responsible change."

Lucas Benitez of the CIW added, "The events of the past months have been trying. But we are prepared to move forward, together now with Burger King, toward a future of full respect for the human rights of workers in the Florida tomato fields. Today we are one step closer to building a world where we, as farmworkers, can enjoy a fair wage and humane working conditions in exchange for the hard and essential work we do everyday. We are not there yet, but we are getting there, and this agreement should send a strong message to the rest of the restaurant and supermarket industry: Now is the time to join Yum! Brands, McDonalds, and Burger King in righting the wrongs that have been allowed to linger in Florida’s fields for far too long."

U.S. Senator Richard Durbin (IL-D): “I applaud Burger King for announcing today that it will be providing an extra penny per pound to the tomato pickers of Immokalee, Florida and establishing a zero-tolerance policy for worker abuses in the region. Today's announcement is a major step forward in improving the wages and working conditions of the Immokalee workers. I call on other purchasers of the region's tomatoes and the Florida Tomato Growers Exchange to join Burger King and do the right thing for these workers.”

U.S. Senator Bernie Sanders (VT-I): “I have been to Immokalee and seen first-hand the conditions for farm workers there, perhaps the most exploited workers in America. I am very pleased that Burger King has agreed to help the tomato pickers who have worked for too long for too little. I know that this has been a long and hard road for Burger King, and I believe the American people will appreciate what they are doing. I hope now that other corporations will join Burger King, McDonalds and Yum Brands in doing the right thing.”

The CIW has ended its campaign against BKC and its franchisees and will work with the company to further foster improvements and sustainable changes throughout the Florida tomato industry. The CIW and BKC will also work together toward development of an industry-wide vendor code of conduct and increased worker wages through encouragement of full buyer and grower participation.

Teenage farm worker dies of heat exhaustion

On May 14, the official temperature was 95 degrees; it was even hotter inside the wine grape vineyard owned by West Coast Grape Farming, east of Stockton, where Maria and her fiancé, Florentino Bautista, worked. Maria had been working for nine hours.

At 3:40 p.m. Maria became dizzy. She didn’t know where she was and didn’t recognize Florentino. Maria passed out. Florentino helplessly held her in his arms.

There was no water for the workers from 6 a.m. to 10:30 a.m. When water arrived, it was a 10-minute walk from where Maria was working, too far to access. There was no shade or training for foremen and workers about what to do if someone became ill from the heat—as required by law.

The foreman came over and stood four or five feet away, staring at the couple for about five minutes. He said, "Oh, that’s what happens to people, but don’t worry. If you apply some rubbing alcohol to her, it will go away." It didn’t.

After a number of delays Maria was taken to a clinic. On the in Lodi, the foreman called on the driver’s cell phone and spoke to Florentino. “If you take her to a clinic,” the foreman said, “don’t say she was working [for the contractor]. Say she became sick because she was jogging to get exercise. Since she’s underage, it will create big problems for us.”

They arrived at the clinic at 5:15 p.m., more than an hour and a half after Maria was stricken. She was so sick an ambulance took her to the hospital. Doctors said her temperature upon arrival was 108.4 degrees, far beyond what the human body can take.

Maria’s heart stopped six times in the next two days before she passed away on Friday.

Doctors said if emergency medical help had been summoned or she had been taken to the hospital sooner, she might have survived.

It is hard for Maria’s family and her fiancé, Florentino, to accept her death, knowing it could have been prevented.

Florentino, said, “There should be justice for what happened. It wasn’t just. It wasn’t fair what they did.”

***

This is not the first time farm workers have needlessly died from the heat. Ten have died over the last four years.

Three farm workers perished from the heat in summer 2005, when Governor Schwarzenegger issued the regulation to prevent such deaths.

In 2007, 36% of employers inspected by Cal-OSHA were not following the heat regulation, according to a story in the Sacramento Bee. Associated Press just reported that Jimenez's employer, Merced Farm Labor, had been issued three citations in 2006 for exposing workers to heat stroke, failing to train workers on heat stress prevention and not installing toilets at the work site. To date the $2,250 it owes in fines has not been paid, according to the article.