DOS Urges Caution in Issuing NIVs for Medical Treatment

FM SECSTATE WASHDC
TO ALL DIPLOMATIC AND CONSULAR POSTS
SPECIAL EMBASSY PROGRAM
BELGRADE POUCH
DUSHANBE POUCH
LAHORE POUCH
PESHAWAR POUCH
JAKARTA POUCH
SURABAYA POUCH
NASSAU POUCH
NDJAMENA POUCH

UNCLAS STATE 199998


VISAS, INFORM CONSULS

E.O. 12958: N/A
TAGS: CVIS, CMGT
SUBJECT: NONIMMIGRANT VISAS FOR MEDICAL TREATMENT

1. SUMMARY: THIS CABLE ADVISES CONOFFS OF THE POTENTIAL
UNINTENDED CONSEQUENCES OF ISSUING VISAS TO FOREIGN
NATIONALS SEEKING MEDICAL TREATMENT IN THE UNITED STATES.
CONOFFS SHOULD DRAW ON THESE COMMENTS AS THEY REVIEW NIV
APPLICATIONS TO ENSURE THAT THE APPLICANTS HAVE OVERCOME
PUBLIC CHARGE ISSUES AND FULLY ESTABLISHED THEIR
ELIGIBILITY FOR NONIMMIGRANT STATUS. END SUMMARY.

2. VO/F/P RECENTLY MET WITH [A REPRESENTATIVE] OF CHILDREN'S
NATIONAL MEDICAL CENTER IN WASHINGTON, WHO EXPLAINED THAT
THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT
(EMTALA) REQUIRES HOSPITALS TO RECEIVE AND TREAT PATIENTS
WITH EMERGENCY MEDICAL CONDITIONS, REGARDLESS OF THE
PATIENTS ABILITY TO PAY OR LACK OF INSURANCE COVERAGE.
THE TREATMENT MUST CONTINUE UNTIL THE CONDITION STABILIZES.
A PROBLEM ARISES FOR HOSPITALS IN SOME CASES WHEN A U.S.
DOCTOR PROVIDES A LETTER TO AN OVERSEAS VISA APPLICANT
AGREEING TO SEE THE APPLICANT AT NO COST. AFTER RECEIVING
A VISA, THE APPLICANT TRAVELS TO THE U.S. AND MEETS THE
DOCTOR, WHO CONDUCTS AN INITIAL DIAGNOSIS AND REFERS THE
APPLICANT TO A HOSPITAL, WHICH IS OBLIGATED UNDER EMTALA TO
PROVIDE FOLLOW-ON TREATMENT. IN SOME CASES, THE COST OF
THE FOLLOW-ON TREATMENT CAN RUN INTO THE HUNDREDS OF
THOUSANDS OF DOLLARS, EXHAUSTING FUNDS THAT CHARITIES HAVE
RAISED FOR THE TREATMENT OF INDIGENT LOCAL PATIENTS.

3. [THE HOSPITAL REPRESENTATIVE} CITED SEVERAL EXAMPLES,
INCLUDING THE CASE OF A YOUNG LEUKEMIA PATIENT WHOSE PARENTS
APPLIED FOR A VISA FOR HIM AND PRESENTED A LETTER FROM A
MARYLAND DOCTOR AGREEING TO "CARE FOR" THE CHILD. THE CHILD
WAS ISSUED A VISA AND TRAVELED TO THE UNITED STATES, WHERE
THE MARYLAND DOCTOR PROMPTLY REFERRED HIM TO CHILDREN'S HOSPITAL.
THE CHILD'S TREATMENT IS EXPECTED TO COST USD 650,000. THIS
FIGURE REPRESENTS NEARLY THE ENTIRE SUM RAISED BY COLUMNIST BOB
LEVEY IN THE WASHINGTON POSTS ANNUAL FUND-RAISING CAMPAIGN
TO SUPPORT CHARITY CARE AT CHILDREN'S HOSPITAL FOR
WASHINGTON AREA RESIDENTS. DEPARTMENT HAS RECEIVED SIMILAR
REPORTS FROM NEW YORK CITY'S PUBLIC HEALTH SYSTEM. IN A
NUMBER OF CASES, TRAVELERS FROM SOME COUNTRIES RECEIVED
VISAS FOR TEMPORARY MEDICAL TREATMENT AND INCURRED SIX-
FIGURE MEDICAL BILLS AT PUBLIC HOSPITALS.

4. IN LIGHT OF EMTALA REQUIREMENTS, VO ASKS CONOFFS TO BE
JUDICIOUS IN GRANTING NONIMMIGRANT VISAS FOR U.S. MEDICAL
TREATMENT. PLEASE QUESTION APPLICANTS CLOSELY TO ASCERTAIN
WHETHER THEIR MEDICAL CONDITION MAY REQUIRE MORE THAN AN
OFFICE VISIT. IF SO, CONOFFS SHOULD PURSUE A LINE OF
QUESTIONING TO DETERMINE THE TYPE AND PROVIDER OF FOLLOW-ON
TREATMENT THAT WOULD BE NEEDED. IDEALLY, THE SPONSOR
HOSPITAL WOULD EXPLAIN IN WRITING UNDER WHAT CIRCUMSTANCES
AND AT WHAT COST IT WILL PROVIDE WHATEVER TREATMENT AND
HOSPITALIZATION MAY BE REQUIRED FOLLOWING THE ANTICIPATED
DIAGNOSIS.

5. DEPARTMENT RECOGNIZES THAT CONOFFS USUALLY LACK THE
EXPERTISE TO ASK DETAILED QUESTIONS REGARDING AN
APPLICANTS MEDICAL CONDITION. DEPARTMENT ALSO RECOGNIZES
THAT APPLICATIONS FOR MEDICAL VISAS RAISE HUMANITARIAN
CONCERNS AND CAN BRING CRITICISM TO OVERSEAS POSTS IF
HANDLED INSENSITIVELY. FOR THESE REASONS, EACH MEDICAL
VISA APPLICATION SHOULD BE GIVEN A SYMPATHETIC AND THOROUGH
HEARING.

6. DEPARTMENT NONETHELESS ADVISES CONOFFS TO BE ALERT FOR
MEDICAL TRAVEL WHICH MIGHT RESULT IN UNEXPECTED HIGH COSTS
FOR U.S. HOSPITALS. IF NECESSARY, THE APPLICANTS HOST-
COUNTRY DOCTOR MIGHT ADVISE WHETHER THE APPLICANTS
CONDITION APPEARS TO REQUIRE SURGERY OR HOSPITALIZATION.
IN THOSE CASES WHERE FOLLOW-ON TREATMENT WOULD SEEM LIKELY
(WHICH SEEMS PROBABLE FOR ALMOST ALL CASES), APPLICANTS
SHOULD BE ENCOURAGED TO LOCATE A CHARITY AND/OR U.S.
HOSPITAL WILLING TO SPONSOR ANY AND ALL FOLLOW-ON TREATMENT
FOR THE APPLICANT. IN THE ABSENCE OF A SPONSORING
HOSPITAL, APPLICANTS SHOULD BE DIRECTED TO REQUEST A COST
ESTIMATE FOR FOLLOW-ON TREATMENT FROM THE U.S. HOSPITAL AND
PRESENT EVIDENCE OF SUFFICIENT FUNDS TO PAY FOR THE
TREATMENT.

POWELL