Costly case raises issues of immigration, health care

Don Emmanuel, now 2, needed extensive care in the months after his birth. Doctors say his heart problems have improved markedly.
Don Emmanuel, now 2, needed extensive care in the months after his birth. Doctors say his heart problems have improved markedly. (Photos By Susan Biddle For The Washington Post)
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By Eliza Barclay
Kaiser Health News
Tuesday, January 5, 2010

For Jeanne d'Arc Kayembe, the trip to Washington in May 2007 was meant to be a month-long respite from an abusive boyfriend and a chance to visit relatives before going home to the Democratic Republic of the Congo to have her first child.

But searing abdominal pains sent Kayembe, who was six months pregnant, to Shady Grove Adventist Hospital. After relieving her pain, a doctor told her to stay in bed and not return to Kinshasa until after she had delivered her baby.

The Shady Grove emergency room was the entry point for Kayembe, who spoke almost no English and had little money, to a foreign medical system that was, by turns, both frightening and surprisingly welcoming.

Kayembe gave birth at Shady Grove to a very sick son, Don Emmanuel, who eventually got more than $1 million worth of care, mostly at Children's National Medical Center. U.S. taxpayers and the hospitals footed the bill.

In some ways, Kayembe and her son are at the white-hot intersection of immigration and health care. But Kayembe's case doesn't fit neatly into those political and policy battles, which often focus on undocumented immigrants. An employee of Congo's telecommunications agency, she came to the U.S. legally, on a tourist visa. And because her son was born here, he became a U.S. citizen and thus was entitled to Medicaid, like any poor child.

To Mark Krikorian, executive director of the Center for Immigration Studies, a Washington think tank that supports tighter immigration controls, Kayembe's case suggests that rules for entering the United States ought to be toughened. He questions the wisdom of admitting a woman who was six months pregnant and from a country with a primitive health system. (Visa applicants are not asked whether they are pregnant.)

"The basic question when you're looking at the intersection of health care and immigration is the selection of whom to admit," he said. "Once you admit somebody, the game is up." Lawmakers, he said, "need to be a little more demanding in this area."

But Adam Gurvitch, a consultant to the National Immigration Law Center, which advocates for the rights of low-income immigrants, disagreed. He said that U.S. officials already have a screening process for visas that is highly subjective and rejects many more applicants from poor countries than from Western Europe or Japan. He added that "we would never accept such prohibitions for Americans" wanting to go overseas.

As the debate ensues, legal and undocumented immigrants continue to show up in emergency rooms, where hospitals are required by federal law to treat and stabilize them. In Kayembe's case, medical staff helped in crucial ways that went far beyond health issues.

Alone -- and crushed

After Kayembe's first visit to Shady Grove, she followed the doctor's advice, staying at the Germantown home of her nephew, 23. Much of the time she was alone. When Kayembe, then 39, gave birth in August 2007, she was crushed to learn that her son had two heart defects and suffered from congenital developmental issues.

"I was happy when the baby was born, but then the happy left when the nurse told me he had a heart problem," Kayembe said in an interview. "I said, 'Why, my God?' and I cried all day."

The baby remained in the intensive care unit at Shady Grove for two weeks, but he needed specialized care, including a cardiac catheterization to repair a ventricular problem and a hole in his heart. Doctors decided the surgery should take place at Children's after the baby grew a bit stronger.

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