Case Study: Immigration

Tito Valdez came to the United States of America from Honduras in 1984. When he arrived he was 19 years old. He came here illegally by sneaking across the border from Tijuana to San Diego. He paid $750.00 to Coyotes who brought him across. His family in Honduras was living in abject poverty; they lived in what is called a “villa,” which is a collection of cardboard and corrugated steel shelters. The shelters have dirt floors and there is no running water or electricity. The land that they live on is government land and they do not pay anything to live there. His mother and father have six children and Tito is the oldest. There was no honorable work for Tito in Honduras. There was work available, but it involved being a member of a gang, or in other illegal activities. In addition, Honduras was experiencing political turmoil as one corrupt government changed to another. There was violence and oppression everywhere. Tito and his family raised the $750.00 to pay the Coyotes by selling things they had, going into all their savings, and asking relatives for donations and loans. Everyone’s hope was that Tito could find employment in the US to make enough to be able to help the family in Honduras. Tito did not have many specific skills, but he was willing to work from sunup until sundown to do whatever was asked of him. His family was religious and they had taught him the value of work and honesty. With all his heart he wanted to help his family. He knew that, in some ways, he was their only hope and he did not want to let them down.


In Los Angeles he found work as a mason’s helper (a mason is an expert in stone-work like brick, tile, granite, etc.). He made $300.00 per week working between 10-12 hours per day six days a week. He found a 3-bedroom apartment with 7 other illegal immigrants. His part of the rent was $125.00 per month. He carefully budgeted the rest of his expenses and was able to send around $700.00 per month to his family. For them it was the difference between life and death. The family was able to buy food, necessary clothing, and some basic health care for the younger children.


In time, Tito learned the mason’s trade well. His boss gave him more responsibility and noticed that Tito always showed up for work and was always on time. His boss allowed him to drive the company truck to supervise different job sites. He received a wage increase to $500.00 per week. All of the money he received was in cash and there were no deductions from his pay. He increased the amount he sent to Honduras to $1,000 per month and the family related to him that for the first time in years they did not feel they were living on the edge of extinction.


At night Tito went to free classes at the junior college to learn English. He progressed rapidly and even though his English was not great, he could understand and communicate with others. After three years passed, his boss gave him even more responsibility and increased his wages so that he was making around $3,000 per month. He eventually purchased a used truck, got an apartment of his choosing with four others, and was able to increase the amount he sent to Honduras. Tito missed his family, but life in the United States gave him opportunities and freedom that he could not have experienced in his native country. One evening Tito received a call from his younger brother Isidro. Isidro was 20 now and he also wanted to come to the United States. He eventually came and Tito was thrilled to have his “hermanito” (little brother) with him. Isidro started to work for Tito at the masonry job and was doing well. One day, on the job, there was an accident in which Isidro was involved. He received massive injuries and it was determined that he had spinal-cord trauma. Tito did not know what to do and feared taking him to the emergency room for fear that they both would be deported. Finally, other co-workers convinced Tito to immediately take Isidro to the ER or he might have permanent damage or possibly even die.


When they arrived at the ER, they immediately took Isidro in to stabilize him and get a full assessment. One of Tito’s co-workers, who was a U.S. citizen, did not like that fact that Tito, in his view, was using the system. While Tito and Isidro were at the hospital he called the press and alerted them to the fact that Isidro was receiving expensive medical care at taxpayer expense. Before long, there were reporters and others gathered at the hospital protesting the use of taxpayer money to help Isidro.


Once the physicians stabilized Isidro, they informed the hospital administration that to fully take care of Isidro would involve weeks and maybe months of in-patient care in addition to physical therapy and perhaps other surgeries. In all, the doctors said, it would probably cost the hospital between 50-75 thousand dollars. The hospital was under legal obligation to take care of his emergent needs pursuant to IMTALA regulations, but not the long-term obligations. They knew that Isidro was an illegal alien and had no insurance. Certain doctors were pleading with the administration to start care for Isidro or they feared that there would be permanent disability.


What should the hospital do?