Immigration advocates are concerned that the implementation of the Affordable Health Care act will bring with it an increase in "medical repatriation," the practice of hospitals flying undocumented immigrants to their native countries, often while they are unconscious, the Associated Press reported on Tuesday.

"It really is a Catch-22 for us," said Dr. Mark Purtle, vice president of Medical Affairs for Iowa Health System. "This is the area that the federal government, the state, everybody says we're not paying for the undocumented."

Implementation of the ACA, the AP reported, will mean hospitals will get less funding for the treatment of uninsured patients, which civic groups said will enhance a practice that already targets a defenseless population.

"[Undocumented immigrants] don't have advocates, and they don't have people who will speak on their behalf," said immigration attorney John De Leon.

In a phone interview, one Mexican national, Jose Rodríguez-Saldana, told the AP that an Iowa hospital told his family in 2008 that he should be sent home because he was unlikely to survive injuries stemming from an auto accident.

"They wanted to disconnect me so I could die," said Rodríguez-Saldana, who is now paralyzed on the left side of his body from hip and spine damage. "They said I couldn't survive, that I wouldn't live."

While hopsitals are required to provide emergency care for patients regardless of their citizenship status or ability to pay, the AP reported, the American Hospital Association does not monitor the repatriation of immigrant patients, nor does it have a policy in place regarding the issue.

"The problem is it's all taking place in this unregulated sort of a black hole, and there is no tracking," said Lori Nessel, director of the Center for Social Justice at Seton Hall Law School.

In a December 2012 report, (PDF) Nessel's organization and New York Lawyers for the Public Interest, identified at least 600 instances of immigrants being removed from care without their consent since 2008. The two groups said the actual number of cases is significantly under-reported.

"When hospitals engage in forced or coerced medical repatriations of ill or injured immigrants directly from their hospital beds, such actions are tantamount to deportation," the report said. "However, because the hospitals circumvent immigration proceedings and there is no governmental involvement or oversight, the repatriated immigrants are denied the right to due process that is guaranteed by international human rights law."

Even if patients consent to being relocated after treatment, the report said, they lose the ability to re-enter the U.S. for three or 10 years, depending on how long they were in the country before being hospitalized.

A spokesperson for U.S. Immigration and Customs Enforcement told the AP that the agency "plays no role" in a medical provider's decision to repatriate a patient. Those discharges are not considered "removals, deportations or voluntary departures" under the Immigration and Nationality Act.

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