Case Number 1:
An uninsured man presents to the Emergency Department of a hospital with a fracture of both of the bones of his forearm. The strange part of the case is that he's not in that much pain despite having, according to his story, fallen earlier in the day suffering the fracture acutely. My partner is on call, and sees the patient in the ED, and determines appropriate care for this fracture involves internal fixation of the bones with plates and screws.
When he performs the surgery he notices that the hematoma (blood) around the fracture shows significant organization, consistent with a much older fracture, 7-10 days. He successfully fixes the fracture, and the next day the patient is discharged from the hospital. My partner tries to arrange follow-up for the Spanish speaking gentleman, only to be told through a translator that the patient plans to follow-up with his own physicians - in the Dominican Republic.
Case Number 2:
An elderly uninsured woman shows up in the Emergency Department with a broken hip and shoulder. Here the story is much clearer. This Spanish-speaking woman explains that 7 or 8 days ago she fell - in the Dominican Republic - and then flew north to come to our ED for free care for her fractures.
You read that right. Both of these patients were in the DR when they were injured and spent money for a plane ticket - round trip in at least one case - pin order to present in the United States for free care in American hospitals. This happens regularly. Less than a year ago we had a man present to the ED after being shot - in Puerto Rico. He got himself on a plane and came north for his care. His free (to him) care.
