ALLENTOWN, PA. (AP) — Junior Clase’s cluttered kitchen table paints a picture of his life in the United States. Scattered across it are bottles of deodorant and conditioner that he sends back to the Dominican Republic, a Spanish-language Bible and a plastic medical brace for his wife, Solibel Olaverria.
Olaverria began having intense headaches and vomiting five months after she joined her husband in the U.S. In the emergency room, she was diagnosed with a brain aneurysm; during surgery to stop it from rupturing, she suffered a stroke and was induced into a coma.
She left the couple’s Allentown row house in December 2022 and has yet to return. Clase worries she never will.
In February 2023, Clase said, hospital administrators suggested transporting his still-comatose wife to a facility back in the Dominican Republic – an option he refused.
“They told me that they could send her back to my country,” he said – even without his consent. “At that moment, she was missing a piece of her skull. … If they put her in an airplane or a helicopter, it was possible that she would die.”
Though the federal government is the only entity with the jurisdiction to remove people from the U.S., hospitals across the nation sometimes return uninsured noncitizen patients in need of long-term care to their countries of origin.
Advocates call this “medical deportation.” Hospitals and medical transport companies refer to it as “medical repatriation.” By either name, the practice exists in ethical and legal gray areas – without specific federal regulations, widespread public knowledge or a national tracking system.
Facing limited options for care, some immigrant patients and family members may voluntarily decide to continue treatment outside of the U.S. Other times, experts say, the process occurs without full consent.
Lori Nessel, a professor at Seton Hall University who supervised a 2012 report about medical repatriation, said the practice amounts to “private deportation.”
“They were essentially being deported,” she said, “but outside of the legal process for deportation, because there was no immigration court involved.”
While some foreign governments track these repatriations, data is inconsistent and doesn’t reflect whether patients wanted to return, felt they had no other option, or were forced to leave.
Over the past two decades, academics, advocates and reporters have struggled to put a number on the phenomenon, which involves a tangled network of hospitals, air transport companies, and consulates that work in different states and countries.
Since 2020, the Philadelphia-based Free Migration Project has tracked 19 cases of patients facing medical deportation, through referrals and a telephone hotline it runs. Six of those came in the first six months of 2025, from cities in Pennsylvania but also Florida, New Jersey, and New York, according to Adrianna Torres-García, deputy director of the organization.
“We’ve had a higher volume of cases in the same span of time than any other given year,” Torres-García said. “It’s also more complex cases.”
Experts believe medical deportation happens more than tracking efforts account for, and some worry cases could now increase, given that the practice sits at the intersection of health care and immigration – two systems undergoing drastic change in the second Trump administration.
Medical treatment access for immigrants is key, as federal law mandates that Medicare-participating hospitals must provide stabilizing care to anyone with an emergency condition, regardless of insurance, ability to pay, or immigration status. However, with recent changes in regulations, the funding for such care is at risk.
In effect, experts said, the changes will leave even more immigrants uninsured and provide less funding for emergency care if they need it.
Patients “get sent bills that they often can’t pay,” said Benjamin Sommers, a health policy researcher at Harvard University. “I think there’ll be more of that.”
In May 2023, following public protest and media coverage of Olaverria’s case, local advocates achieved a legislative victory in Philadelphia: a ban on non-consensual medical repatriation, requiring hospitals to obtain informed consent before transferring patients.
With the ongoing struggle, Clase continues to care for his wife while pondering their uncertain future in the U.S.
“The majority of my time,” he said, “I dedicate it to my wife.”
