The number of undocumented migrants ending up in San Diego hospitals after falls from the border wall has spiked in recent years, but U.S. Customs and Border Protection (CBP) is avoiding skyrocketing medical costs by releasing injured people from federal custody, according to a KPBS review of CBP and hospital records.
This trend comes on the heels of a new California law that expanded the state’s MediCal program to cover medical costs of undocumented immigrants. CBP is on the hook for all hospital expenses if the migrants remain in federal custody, but since 2021 MediCal has covered most of the costs of migrants CBP releases from custody.
Doctors at UC San Diego Medical Center began noticing that CBP agents were keeping fewer migrants in their custody earlier this year, said Doctor Jay Doucet, the hospital’s head of trauma.
“They used to pay much more often,” Doucet said. “But then we noticed this year that they’re not paying nearly as much. It’s mostly [MediCal] paying for it now.”
In 2019, CBP paid the medical expenses of roughly 75% of the patients their agents brought into UC San Diego. That percentage increased to 80% in 2020 but then dropped to 50% in 2021. So far this year, the CBP payment rate at the hospital is down to 15%, although that percentage could go up as payments are processed.
CBP’s own data from the San Diego region shows a similar trend.
In the 2019-2020 fiscal year, CBP paid the hospital bills of 3,133 people in San Diego, according to the agency’s records. That number dropped to 1,334 people in 2020-2021, and to 556 for the first 10 months of the current fiscal year, the records show.
More casualties
This decrease in the number of people CBP pays for comes amid record increases in both the number of apprehensions along the southern border and the number of migrants hospitalized after falling from the 30-foot-tall border wall in the San Diego region.
The UC San Diego Medical Center has received so many border fall patients this year that the hospital had to dedicate an entire ward just for them, Doucet said.
“In fact, we’re seeing some of the highest numbers on a monthly or daily basis that we’ve ever seen,” he said.
UCSD had 49 migrant patients in 2019. That number more than doubled to 99 in 2020 and then shot up to a record of 270 in 2021. By the end of July this year, the hospital had already had 201.
Nobody tracks the whereabouts of migrants that CBP decided not to keep in custody at the hospital, even though they were caught crossing the border illegally.
“Once they leave the hospital, we can’t really help them anymore,” Doucet said. “We have no follow-up with these patients, we don’t know what the long-term outcomes are, we don’t know who many find work, how many stay in the U.S. or how many leave. We have none of that data.”
CBP agents give hospitalized migrants a notice to appear in immigration court, but they do not give them electronic monitoring equipment like they do with others they apprehend, a CBP spokesperson said.
“They are given the same documentation that they would receive from a station/processing center with the information letting them know they need to report to ICE and immigration court with address changes,” the spokesperson said. “In short, there is no difference in the processing, disposition determination and serving of paperwork with the exception that they will not have Alternate to Detention technology placed on them by ICE at the hospital.”
The spokesperson declined to answer any follow up questions – including why the agency is not keeping patients in custody as often as it did in prior years.
Doucet has his own theory.
“You can see why,” he said. “I mean, if you see the average charge, it’s very expensive. For their budget, it’s great if they just get rid of the patient and leave the patient in the hospital.”
The average cost per patient in fiscal year 2020-2021 was $5,548, more than three times what it was two years ago.
Hidden impact
The majority of the patients — around 80% — are Mexican nationals, according to Carlos Gonzalez Gutierrez, the Mexican Consul General in San Diego.
His office provides legal and financial aid to injured Mexican nationals. He blames the injuries on the fact that the 17-foot-tall border wall in San Diego was replaced by a 30-foot wall during the Trump administration.
“There are still many people who are not aware of what an impact it has that the wall was raised up to 30 feet,” he said.
Injuries range from broken legs, fractured spines, head trauma and even death, he said.
Gonzalez is frustrated that the public does not seem to be outraged by this.
“To me, for example, it was pretty impactful that during the first 12 days of August, eight Mexican nationals died trying to cross the border in an undocumented way,” he said. "Eight people in 12 days. And we did not see any story in the media.”
In August, the Mexican Consulate helped reunite a mother from Veracruz with her adult son who was in a coma after he suffered severe head trauma from a fall off the wall in June.
“There was a two-week period where I didn’t hear anything from him,” the mother, Guillermina, said. “I was sure I would never see him again.”
The man regained consciousness but with severely limited cognitive function. Consulate staff told Guillermina that even though her son is in his early 20s, he has the mental function of a small child and will need 24-hour care for the foreseeable future.
Guillermina asked that her son's name and her full name not be published due to their circumstances.
Criticism from both sides
CBP’s handling of this issue has drawn condemnation in both liberal and conservative circles.
Liberal activists say the wall was specifically designed to cause serious injuries and death — that’s the strategy behind deterrence.
“Death has always been part of the calculus,” said Pedro Rios, an activist with San Diego-based American Friends Service Committee. “There is the expectation that people would fall, that they would be injured and that they would die.”
Rios said the fact that CBP is leaving more migrants at the hospital is an example of the federal government shirking its responsibility.
“They aren’t taking the responsibility of ensuring that people who are injured are being taken care of,” he said. “And they are not footing the bill. In fact, they are leaving the rest of San Diego County, the rest of California to pay for the injuries that are caused by the border wall.”
Meanwhile, conservative critics say the CBP’s practice of releasing migrants from custody —especially after they were caught illegally climbing the fence — is a sign of the Biden Administration’s lax border enforcement policies.
They view it as an example of the so-called “catch and release” practice — in which Border Patrol agents detain migrants who crossed the border illegally, give them a notice to appear in immigration court on a certain date and then release them.
“In essence, they’re saying we’re going to release you into the country and we’re just not going to worry about you anymore,” said Hans von Spakvosky, senior fellow at the Heritage Foundation, a conservative think tank.
The problem with that strategy is undocumented migrants do not always show up to court.
Data from the Executive Office for Immigration Review, the agency that oversees immigration courts, shows that about 25% of migrants were given deportation orders in absentia during Fiscal Year 2018, the latest year available. The in-absentia rate drops to 11% for asylum cases and increases to 33% for migrants who are released.
Von Spakovksy said this is just the latest example of the federal government leaving state taxpayers with the medical expenses of undocumented immigrants.
“There are numerous studies that have been done on the costs of this kind of illegal immigration and all of those studies show that the vast majority of these costs are paid by local governments, not the federal government,” von Spakovsky said. “And healthcare costs are one of the big factors.”
