Montejo V. Martin Memorial Medical Center Case Analysis

A Case Analysis of Montejo v. Martin Memorial Medical Center, Inc.

After a car accident in February of the year 2000, left Luis Jimenez with severe brain damage and physical injuries, conflicts of his medical care led to an eight-year legal battle between Martin Memorial Medical Center and Montejo Gaspar Montejo, his appointed guardian. Due to federal regulations, Martin Memorial Hospital was required to provide critical care to Luis Jimenez who was an illegal immigrant. EMTALA requires hospitals to provide an appropriate medical screening and necessary treatment to anyone who comes into the emergency room. Treatment must be provided regardless of a patient’s ability to pay or citizenship (Canedy, 2002). Hospitals are typically reimbursed

by Medicaid for providing emergency care. The goal is to provide treatment, stabilize the patient, and then to discharge.
Jimenez remained in the hospital for four months, then he was transferred to a skilled nursing facility in June. Due to his limited mental capacity, Montejo was appointed as Jimenez’s guardian. In January of 2001, Jimenez was readmitted to Martin Memorial Hospital for emergency care. Once he was stabilized, Martin Memorial Medical Center was unable to find a medical facility that would accept him. Apart from emergency care, undocumented immigrants do not qualify for insurance reimbursement. Due to lack of insurance, most long-term care facilities will refuse to accept these patients. Jimenez remained at Martin Memorial Medical Center accumulating thousands of dollars in uncompensated care expenses.
Unfortunately, the hospital failed to meet an agreement with Jimenez’s guardian regarding the patient’s placement. In addition, they received no support or direction from the government. The increasing financial strain caused by the situation, lead to a legal battle between Martin Memorial Hospital and the patient’s guardian. In November 2001, Montejo filed a guardianship plan which stated Jimenez would require around the clock care at a hospital or skilled nursing facility due to his medical state for at least twelve months. Martin Memorial Medical Center intervened. Montejo retorted that Martin Memorial could not be listed as an “interested party” according to the guardian proceedings statute. However, the hospital could prove they were an “interested party”. Martin Memorial was providing all of Mr. Jimenez’s medical care. Montejo was unable to pay for the medical services, and the bills continued to accumulate. Except for $80,000 received from emergency Medicaid, Martin Memorial had little hope of recouping medical expenses. The approval of the proposed guardianship plan would continue to cause a financial strain on Martin Memorial due to unreimbursed care. Since Martin Memorial could prove they were affected by the outcome of the proceeding, under Florida Statutes, they were indeed an “interested party” (Klein, 2015).
Martin Memorial further proceeded their claim stating that as Jimenez’s guardian, Montejo was responsible for ensuring Jimenez received care in a facility that was appropriate for his long-term care needs. Jimenez had been stabilized by the hospital and no longer required acute care. The hospital had improved his condition to the best of their ability, and did not have the resources to provide him with further therapeutic care. In addition, Martin Memorial had received out to all rehabilitation facilities in their area. Admission was denied because Mr. Jimenez did not have insurance, he did not qualify under federal programs, nor could his guardian afford to pay for his services. To continue progressing, Jimenez needed to be admitted to a long-term rehabilitation facility. By allowing him to remain in the hospital, Montejo failed to provide him with the rehabilitation services he required (Findlaw, 2017).
Martin Memorial presented a fair argument. By filing the guardianship plan, Mr. Montejo was placing Martin Memorial in a position to provide continuous care to Mr. Jimenez knowing they would not receive reimbursement for his care. It is not the hospital’s responsibility to finance a patient’s medical needs. That responsibility belongs to the patient or the patient’s guardian. Based on the evidence provided, Martin Memorial requested permission to transport Mr. Jimenez to an accepting rehabilitation center in Guatemala.
On June 27, 2003, the court ruled in Martin Memorial’s favor.

The hospital was granted permission to transport Mr. Jimenez to Guatemala at their own expense. Martin Memorial was required to provide “a suitable escort with the necessary medical support for the Ward’s trip back to Guatemala” (Findlaw, 2017, p. 1). Montejo filed an appeal on July 9, 2003 as well as a motion to stay. Martin Memorial was given until 10 am on July 10th to respond to the motion to stay. The hospital took advantage of the response time and transported Mr. Jimenez back to Guatemala before they had to file a response. This act shows Martin Memorial’s desperation to remove the patient from their facility. After its desperate act, Martin Memorial claims that the appeal is moot because Mr. Jimenez’s return was preempted by federal immigration law (Klein,

2015).
Mr.

Montejo was able to use this statement to his advantage in another case. He provided evidence to argue that Martin Memorial did not provide enough evidence to support a proper discharge because the patient was not sent to an appropriate rehabilitation center. Because Martin Memorial receives federal reimbursements, under 42 C.F.R. section 482.43 (d) they are only allowed to discharge patients if they find an accepting facility that would meet the patient’s medical needs (Klein, 2015). It was determined by the hospital’s discharge committee that Mr. Jimenez required post-hospital care at a brain injury rehabilitation center. The hospital did not have documentation stating the accepting facility provided proper rehabilitation. Dr. Miguel Graces testified that no such facilities existed in Guatemala. In addition, the trial court’s subject matter jurisdiction was questioned because federal immigration law preempts deportation (Klein, 2015). Consequently, on May 5, 2004 the court order authorizing the transport of Mr. Jimenez was reversed.

The reverse of this order, led to another lawsuit filed by Montejo in September 2004 claiming false imprisonment. The case was initially dismissed due to Martin Memorial stating at that time they had a valid order to transport Mr. Jimenez which laid grounds for immunity. However, the dismissal was challenged. The question was if immunity from a false imprisonment claim could be granted if the court did not have jurisdiction. Under Florida law,

any order issued outside of subject matter jurisdiction is void (Findlaw, 2017).
Florida law requires the following elements to support a false imprisonment claim “1) the unlawful detention and deprivation of liberty of a person 2) against that person's will 3) without legal authority or “color of authority” and 4) which is unreasonable and unwarranted under the circumstances” (Findlaw, 2017, p. 2). Martin Memorial argues that the confinement of Mr. Jimenez was performed under a court order which is “protected by the absolute immunity related to judicial proceedings” (Findlaw, 2017, p. 2). However, the court did not agree. On August 23, 2006, the court filed in favor of Montejo. The false imprisonment claim was allowed to proceed.
The court had decided in favor of Montejo for three elements of false imprisonment. However, in order to win his case, the fourth element still had to be proven. The court had to determine whether or not Martin Memorial’s actions, in the case of Mr. Jimenez, were unwarranted and unreasonable. On July 27, 2009, the jury ruled unanimously that Martin Memorial did not act unreasonably. Although later overturned, the hospital transported Mr. Jimenez back to Guatemala under a court order.
The court decided in Martin Memorial’s favor. However, in actuality, no one really wins. Medical deportation remains an issue. Although there have been meetings, Congress still hasn’t fully addressed the issue. No guidelines have been instituted. Hospitals still remain on their own to solve their problems. Healthcare costs continue to rise as hospitals increase their rates in order to recoup unreimbursed medical services. In addition, American’s with insurance continue to pay higher copays, deductibles, and premiums to cover the increasing healthcare cost.