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STATE DEPARTMENT INSTRUCTS EMBASSIES TO BE 'JUDICIOUS' IN ISSUING
VISAS FOR MEDICAL TREATMENT
by Michael J. Gurfinkel, Esq.
The U.S. State Department recently sent a cable
to U.S. Embassies and Consulates around the world to be "judicious"
(use sound judgment) in issuing visas for medical treatment in
the United States and to "be alert" for medical travel that might
result in "unexpected high costs for US hospitals."
The cable advisory was issued by Secretary of State Colin Powell
in November 2001, in the wake of numerous complaints from U.S.
hospitals and American taxpayers that public and charity funds
were being drained by non-resident aliens who were granted visas
for medical check-ups, but ended up being hospitalized for several
weeks or months in the U.S. The hospital expenses of these patients
were eventually paid from public funds or from funds raised by
charitable organizations for local patients.
Consular officers were advised that when they interview medical
visa applicants, they should make sure that the applicants have
overcome "public charge" issues and have fully established their
eligibility for non-immigrant visas. This means that the applicant
must be able to establish that he or she has the funds to pay
for the check-up and other hospital expenses that may be incurred,
such as surgery and rehabilitation. The money can come from personal
funds or from sponsors, but it must be established that the funds
are available, and that the patient will not be relying on U.S.
taxpayers to foot the bill for their medical expenses.
Under the Emergency Medical Treatment and Active Labor Act (EMTALA)
enacted by the US Congress, hospitals are required to receive
and treat patients with emergency medical conditions, regardless
of the patient's ability to pay or lack of insurance coverage.
The treatment must continue until the patient's condition stabilizes.
A problem arises for hospitals when a US doctor provides a letter
to an overseas visa applicant, agreeing to "see the patient for
free". After receiving a visa, the applicant travels to the US
and sees the doctor. After a brief initial diagnosis, the doctor
immediately refers the patient to a hospital, which is obligated
under EMTALA to provide follow-up treatment, regardless of the
cost to taxpayers of such treatment.
In some cases, the cost of the follow-on treatment runs into hundreds
of thousands of dollars, exhausting funds that charities may have
raised for the treatment of indigent local patients. In one example
cited by the State Dept., a young leukemia patient's parents applied
for a medical visa for the child, and presented a letter from
a Maryland doctor, agreeing to "care for" the child at no cost.
The child was issued a visa and traveled to the United States,
where the Maryland doctor promptly referred the child to the Children's
National Medical Center in Washington.
The child's hospitalization expenses exceeded $650,000, which
represented nearly the entire sum raised by columnist Bob Levey
in the Washington Post's annual fund-raising campaign to support
charity care at the children's hospital for Washington-area residents.
So, a single alien on a medical visa used up all the funds intended
for local poor people.
The State Department also received similar complaints from New
York's public health system, where overseas patients with medical
visas sought treatment and incurred six-figure expenses, exhausting
much of the state's public health fund.
Because of these cases, the State Department instructed consular
officers to evaluate medical visa applicants closely, to ascertain
whether their medical condition may require more than an office
visit, and also to determine whether funds are available for the
follow-up treatment. Applicants are encouraged to locate a charity
and/or U.S. hospital willing to sponsor follow-up treatment (or
foot the bill for the treatment). If this is not available, applicants
will be required to submit a cost estimate for follow-up treatment
from the U.S. hospital, and present evidence of sufficient funds
to pay for the medical expenses.
While the State Dept. fully recognizes the humanitarian need for
medical visa applicants to get urgent medical treatment in the
United States, there is also a public outcry in the U.S. against
the rampant use by foreigners of public and charity funds intended
for indigent American patients. That is the primary reason the
U.S. government is now being more "judicious" in issuing medical
visas.
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