By the time Juan Ramirez was discovered on Aug. 27, 2008, the damage had already been done. Ramirez, 42, an immigrant living without a known address or family in Little Village, was lying unconscious between two parked cars in an alley on west 31st street, his skull cracked open, the circumstances of the injury unknown.
At Mount Sinai Hospital, surgeons performed a craniectomy, a procedure which removes a fragment of the patient’s skull to avoid compressing a swollen brain. The portion of Ramirez’s skull remains surgically implanted under the skin and fat of his abdomen to keep it alive. Although the surgery saved his life, many of his higher functions – eating, moving, communicating – could not be preserved, even with rehab and therapy after his transfer to Schwab Rehabilitation Hospital in Douglas Park two months later.
His activity is limited to tracking motion with his eyes and moving a sluggish left index finger. The staff is unable to accurately gauge his level of cognition.Typically, a patient in Ramirez’s position would leave intensive care, complete a rehab assignment and move to a nursing facility or live under the care of family, but the situation in which Ramirez now finds himself in is hardly typical.
For one, his name might not even be Juan Ramirez.All the hospital had to work from is his registration from La Cruzada homeless shelter, his last known address. But according to Cook County court records he had used the aliases Roberto Mejia and Roberto Garcia.
It is also assumed that Ramirez is 42, though he has no birth certificate or social security number. He also may not be Mexican, as every effort to contact possible relatives through embassies, consulates or private investigators has come up empty. He has no identity, no family and nowhere to go; all issues that greatly complicate his health care.
Even in his incapacitated state Ramirez requires 24-hour care, but without insurance, a privately-owned nursing home, the most logical destination, has no incentive to accept him. Caught up in the system
Without a future care plan or discharge date, Ramirez hangs in limbo. He hasn’t made substantial progress in rehab and his doctors prognoses are that he will remain in a similar disabled state for the rest of his life. He occupies a bed in the subacute unit at Schwab, spending the past year in a facility where the average patient stays no more than a month.
“It’s an inappropriate use of resources,” said Dr. Michelle Gitler, Ramirez’s attending physician. “This is not the right place for him.” Gitler says it is impractical to devote one of the unit’s 20 beds to a long-term care patient when another rehab patient could be benefiting from Schwab’s services.Gitler is a part of Ramirez’s support team actively lobbying to advance his case, working along with his state-appointed guardian, Donna Joslin, and Mount Sinai’s social work director, Cara Pacione.
“It’s a very frustrating situation because there’s a person who really needs care,” Pacione said. “It’s not in his best interest, healthwise, to be in a hospital, but there isn’t anywhere for him to go that’s appropriate.” Ramirez’s advocates are hindered because of his John Doe status and no public aid available, the hospital is left to foot his medical bills.
Efforts to contact familyWhile he was admitted to the hospital with few belongings, several signs suggest that Ramirez emigrated from Mexico. His forearms are covered with tattoos typically given in border towns –a scorpion, stars and crosses. His registration at La Cruzada states his nationality and his time in Chicago was spent in Little Village, the Midwest’s largest Mexican community.
For undocumented immigrants who are alone who become severely injured in the U.S., hospitals attempt to connect the person with his or her home country. Through a common practice of repatriation, the patient can be sent home safely.However, Mexican officials say Ramirez cannot be moved without either identifying his family or proving that he is a Mexican national. As soon as Ramirez was admitted to Schwab, staff members sought out relatives in Chicago’s Hispanic neighborhoods.
A private investigator followed the few leads available, narrowing the list to a few families in Albany Park and a sister in El Paso, Texas, that Ramirez had listed as an emergency contact, but no one could be reached.Thus far no one has come forward as a family member and the heavy financial burden of Ramirez’s care can only serve as a deterrent for potential relatives to willingly be identified.
Until he can be placed with a family, a possible return to Mexico is out of the question.Ioana Navarrete, chief of protection at the Mexican Consulate in Chicago, says the Mexican government requires a family to commit to a patient’s care for the patient to be discharged and returned home.
“We encounter this on a regular basis,” Navarrete said. “Not always cases as sad as Mr. Ramirez’s, but people who either want to return to their home country or they cannot afford the care here.”According to the consulate, 19 immigrants have opted to be sent from Chicago-area hospitals back to Mexico since 2007.
A call for health care reformAs the House and Senate push to broaden health care availability, experts say the concerns of undocumented immigrants go ignored. Ramirez’s case is only one example of the consequences brought up by restricting immigrant health care.
With about 12 million undocumented immigrants in the U.S., recent versions of the health care reform bill could provide insurance at additional costs or outlaw coverage entirely. The push to prevent immigrant health care benefits conflicts with the mission of many medical institutions to provide emergency services to all patients, regardless of their ability to pay, saving lives at all costs.
Horacio Esparza, director of the Progress Center for Independent Living in Forest Park, has been fighting for Latino health care rights in cases similar to Ramirez’s. “If they gave their lives, their health, in this country, if they acquire a disability, I think they should have an opportunity,” Esparza said. “I’m not saying a prize, but they deserve something else. I think they have the right to seek medical services.”
With the county-run Oak Forest Hospital having transferred the last of its undocumented immigrant patients to nursing homes in 2007, Esparza said Cook County has not provided a suitable alternative for new patients requiring long term care.“Nursing homes, they only care about money, so they’re not going to accept [the undocumented] there,” Esparza said. “I think the only thing that’s going to happen to Juan Ramirez is he’s going to stay there at Schwab, he doesn’t have that many options.”
An uncertain futureUntil a discharge plan can be developed, Ramirez continues to wait, his fate entirely out of his hands.
Nurses help Ramirez pass the time by having him watch Latino and sports channels on TV and listen to the radio. Jennifer Gimenez, a resident nurse who works closely with Ramirez, tries to make him feel at home. She wheels him around the hospital, whether to greet trick or treaters around Halloween or to visit the hospital’s priest.
“The staff, we keep him company, sometimes we put him at the nursing station and interact with him, we make sure that he is taken care of,” Gimenez said. “We love Juan. We’re really going to miss him if he leaves.”Members of Schwab’s staff continue to seek closure for Ramirez’s case.
Disability Resource Coordinator Ramon Canellada spends time him each week, working to see if Ramirez can communicate when spoken to in Spanish. He tries to interpret Ramirez’s finger movements, asking him questions about his identity or displaying pictures and maps of countries looking for a definitive response. Canellada holds out hope that Ramirez will eventually lead a life outside of a hospital setting.
“There has to be somebody in the world that cares about him, that knows him,” he said. “He needs every opportunity to integrate, every opportunity to live.”