December 7, 2007
BY PATRICIA ANSTETT
FREE PRESS MEDICAL WRITER
Dumitru Nistorescu, a Romanian worker who came to Detroit seven years ago to begin a new life, is alone in his Rochester hospital room, paralyzed and unable to breathe on his own.
He is miles from the underground network of friends he kept as an undocumented immigrant, living undetected on a passport that expired two years ago.
So far, Crittenton Hospital Medical Center has paid $540,000 for his care since he was admitted Aug. 13 following a massive stroke. For more than three months, no one would take him. Not nursing homes. Not his home country.
But today, or at the latest Saturday, Nistorescu, 53, is to go home, adding a $65,000 expense for an air ambulance from Pontiac to Bucharest.
Hospitals all over the United States, as well as doctors and clinics serving immigrant communities, are familiar with the problems of caring for -- and paying for -- the medical treatment of undocumented immigrants.
"All the time they come here," said Adnan Hammad, PhD, director of community health for the Arab Community Center for Economic and Social Services, which runs a large clinic in Dearborn. Many come in with serious health problems, even advanced cancer, and can't understand why ACCESS can't pay for their operations, Hammad said.
He said he coaxes physician friends to take some of the patients and charge them reduced rates. He works with hospitals to care for the others.
Medicare has a $1-billion budget for emergency care for undocumented immigrants through 2008. But the bulk of the funding goes to states such as California, Texas and Arizona, which have larger percentages of immigrants than Michigan, hospital officials say.
Hospitals absorb expenses
Crittenton applied three months ago for those funds for Nistorescu and never heard from Medicare, Marilyn Messina, director of quality outcomes for Crittenton, said Thursday. Medicare's media relations office did not return a call for comment Thursday.
Crittenton also will attempt to get some money from the Romanian government and Nistorescu's family -- his father, who is 71, a daughter and an ex-wife -- who live in the Black Sea town of Tulcea, Messina said.
"When all else fails, we just absorb the expense," she said.
Federal law requires hospitals to accept all patients needing emergency care.
"Henry Ford sees this population," said Joy Berent, senior corporate counsel at Henry Ford Health System in Detroit. "We provide the care knowing there will be no subsidies."
Another problem is that undocumented immigrants don't want to cooperate with hospitals trying to get reimbursement by providing information for federal forms, fearing it will cause them problems, she said.
Eventually, the costs, considered charity care, are passed on to consumers and companies as a business expense via higher insurance premiums, said Brian Peters, senior corporate vice president at the Michigan Health and Hospital Association. The Lansing organization represents 146 nonprofit hospitals.
"It's a hidden tax we all pay," he said.
Social worker helps with return
Nistorescu's return to Romania was facilitated by Catherine Kroll, a licensed clinical social worker at Crittenton, who called each workday for three months trying to find a place that would take the stone worker. Stroke patients such as him typically are transferred to nursing homes, but none of the nearly 60 she contacted would take an uninsured patient, she said.
Her first call to local immigration officials yielded only a referral to the U.S. Department of Homeland Security.
Neither agency "even was interested in taking down his name," Kroll said.
A Homeland Security official told her to call the Romanian Consulate in Chicago.
Kroll did, and this week she and Doina Boblea at the consulate overcame the final two hurdles: The Emergency Hospital of Bucharest-Floreascu agreed to accept Nistorescu as a patient, and the Romanian government signed the paperwork to oversee his transfer.
Friend offers details of life
Silvia Popovici of Detroit, a friend of Nistorescu, helped Kroll piece together his past. Kroll found out that Nistorescu was living in the United States on a passport that expired in 2005, owned two cars and had a valid Michigan driver's license.
Nistorescu came to Detroit in 2000 on a Greyhound bus from New York City, Popovici said in a telephone interview Thursday. He stayed in a room at her mother's house in Detroit.
He never learned English. "He went around with the rest of us," said Popovici, who also is Romanian.
He was kind, trustworthy and a skilled carpenter and handyman who loved to fish, she said. He taught her to cook and her son how to drive, she said. He had been an artist and had elegant handwriting.
Nistorescu had the stroke while traveling with Popovici's son to see a friend in Oakland County. The son took him to Crittenton.
While there, Nistorescu was befriended by the staff. His physician, Dr. Namdeo Kale, visited him every day.
A Romanian friend Nistorescu had worked with visited him once, Kroll said. Popovici also visited him on several occasions, including for Nistorescu's birthday Oct. 30.
On their visits, they held hands, but "right now, Dumitru doesn't know who I am," she said. "It's better to know he's going home. If something happens to him, he can be buried with the Christian rituals" of his homeland, she said.
Contact PATRICIA ANSTETT at 313-222-5021 or panstett@freepress.com.
http://www.freep.com/apps/pbcs.dll/article?AID=2007712070388
The only real security in life is to be very good at what you do.