The hypocrite’s oath: Latino immigrants and health access in the Hamptons

Like many New Yorkers did this summer, I boarded a Hampton Jitney from the east side of Manhattan in late August and made my way to the finger tips of Long Island.  Instead of landing on the beach, however, I found myself in the crowded office of a small community-based organization bursting with children and parents, canned goods and clothing swaps, and the bilingual chatter of Latino immigrants seeking help for any number of different problems.  I was with a colleague, and we were there to meet a client.  Here is her story:

In late July, Laura was rushed to the emergency room of a local Hamptons hospital due to severe stomach pains.  She is only a teenager, undocumented, uninsured, and uncomfortable speaking anything but Spanish to discuss complicated health matters.  After some ten hours spent unattended on a hospital gurney, Laura was finally seen by a surgeon the following morning.  No one explained to her, in a language she could understand, why her stomach was on fire or why she was about to receive an operation.  Turns out it was appendicitis.

Laura was admitted to the hospital for 24 hours after her surgery and then summarily discharged, even though she was still in pain.  No one talked to her about a discharge plan or explained self-care strategies to use in the wake of her operation.  All she knew, through the help of family members advocating on her behalf, was that there was still a drainage tube in her body, and she would have to go to her surgeon’s private office to have it removed.

At this private office, Laura was told that she would have to pay $1500 upfront to extricate the tube, and if she didn’t pay it they couldn’t do the procedure for her.  The emergency room of the hospital where she was originally treated, and to which she returned after this extortionate demand, also refused to remove the tube, insisting again that she go to the surgeon’s private office.  Her fear mounting, Laura turned to her primary care physician and the local community group for help.  Together they advocated with the hospital and the surgeon to have the fee for the tube removal reduced to $300.

Sitting in the surgeon’s waiting for the second time, Laura and her family were subjected to a verbal assault by the physician who initially treated her.  She was the reason he and his assistant had to get up in the middle of the night to come to the ER and operate, he shouted.  She was ungrateful for the fact that he wasn’t getting paid for the services he was providing to her.  Oh, and he also wanted to know—in front of all of the other patients in the waiting room—was she in the country legally or illegally? Only after his anger was vented did the surgeon remove the drainage tube from Laura’s body, but as a parting gift, he also reneged on their payment arrangement and billed her $5000.

As a civil rights-oriented health care lawyer in New York City, I thought I knew what racial and ethnic disparities in health care looked like, and how they manifested themselves.  But Laura’s case surprised even me.  Here we had potential violations of federal and state discharge planning laws, language access regulations, patient dumping statutes and financial assistance laws, not to mention flagrant disregard for the medical profession’s codes of conduct and a whiff of fraud and consumer protection violations.

What is more, hers is potentially not the only story of its kind.  In our interview, Laura’s sister mentioned another family member who had been turned away from the emergency room of the same Hamptons-area hospital.  The director of the community-based group where we were conducting the interview also knew of a similar case.  To her, the mistreatment was targeted toward a specific patient population.  As an Irish-Catholic nun, she noted, she had little problem accessing high-quality, respectful care from the same surgeon who treated Laura.  However, the same was not true for the low-income Latino/a residents of the community whom she served.

Since meeting with Laura, I have wondered how cases like her come into being.  What are the factors that allow doctors—people who have pledged to do no harm—to exhibit openly hate and bias, to take actions that actually threaten the lives and well-being of some category of their patients?  What are the dynamics that make it acceptable for immigrant patients seeking relief from pain and illness to be turned away from their local houses of healing?  How does this happen in a place known to be the summer playground of New York’s financial and cultural elite?  Do the Haves not have enough?

As has been mentioned previously on this blog, this has been a long, hot summer of hate and injustice against Latinos and immigrants, and I can’t help but think that the vitriol spewed into our airwaves is creating a space—a social sanction—for overt acts of harm.  After all, Long Island is the place that anti-immigrant provocateur Steve Levy calls home, and whose blistering comments against the undocumented are only the most public example of the kind of anger that led to Marcelo Lucero’s brutal murder two years ago this fall.  Levy and others like him have also complained that Mexican “anchor babies” are the reasons hospitals on Long Island are in financial distress.  It should come as little surprise to us, then, that some physicians at these very hospitals have adopted a hostile attitude toward those patients that they see as a threat.

As a health care advocate, I have to be attuned to these broader dynamics around race and immigration, for they are directly impacting the clients I serve.  And, as racial justice activists, we all have to be vigilant of the many manifestations of hate – not only in the extreme examples of violent crimes and assaults, but also the quiet, painful attacks that take place in our schools, workplaces and hospitals.