Limits to Neurosurgical Care for an Undocumented Immigrant in the United States
A Case Report
DOI:
https://doi.org/10.46570/utjms.vol9-2021-520Keywords:
Intracranial Arachnoid Cyst, Neurosurgery, Health Services Accessibility, Social Determinants of Health, Undocumented ImmigrantAbstract
Documentation status is a well-recognized social determinant of health in the immigrant population of the United Sates. Lack of financial means and fear of legal repercussions can delay medical attention, limit treatment options, and decrease patient follow-up. This is reinforced by current government policies that limit financial assistance in emergency situations and deny coverage of preventative or follow-up care. Here we report a case of an otherwise healthy 24-year-old undocumented immigrant who presented to a rural United States emergency room with new-onset seizure, blurry vision, and headache. The patient was admitted to the neurosurgical service where he was diagnosed and treated for a symptomatic arachnoid cyst. Here we review current healthcare legislation that restricts access to preventative and follow-up healthcare in the United States. This case highlights the ways in which the undocumented immigrant patient population remains negatively impacted by these policies, often leading to late presentation and limited neurosurgical treatment options.
References
Squires D, Anderson C. U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. Issue Brief (Commonw Fund). 2015 Oct;15:1-15. eng. Epub 2015/11/26. Cited in: Pubmed; PMID 26591905.
Feldman HM, Buysse CA, Hubner LM, Huffman LC, Loe IM. Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. J Dev Behav Pediatr. 2015 Apr;36(3):207-17. eng. Epub 2015/03/21. doi:10.1097/dbp.0000000000000151. Cited in: Pubmed; PMID 25793891.
Liebert S, Ameringer CF. The Health Care Safety Net and the Affordable Care Act: Implications for Hispanic Immigrants [https://doi.org/10.1111/puar.12147]. Public Administration Review. 2013 2013/11/01;73(6):810-820. doi:https://doi.org/10.1111/puar.12147.
Acosta DA, Aguilar-Gaxiola S. Academic health centers and care of undocumented immigrants in the United States: servant leaders or uncourageous followers? Acad Med. 2014 Apr;89(4):540-3. eng. Epub 2014/02/22. doi:10.1097/acm.0000000000000182. Cited in: Pubmed; PMID 24556781.
Costich JF. Legislating a Public Health Nightmare: The Anti-Immigrant Provisions of the “Contract with America” Congress. Kentucky Law Journal. 2002:1043-1070.
Singer AS, Nicole Prchal. Immigration Facts: Deferred Action for Childhood Arrivals (DACA). The Brookings Institute; 2013. Metropolitan Policy Program at Brookings.
Martinez O, Wu E, Sandfort T, Dodge B, Carballo-Dieguez A, Pinto R, Rhodes SD, Moya E, Chavez-Baray S. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health. 2015 Jun;17(3):947-70. eng. Epub 2014/01/01. doi:10.1007/s10903-013-9968-4. Cited in: Pubmed; PMID 24375382.
Zibulewsky J. The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. Proc (Bayl Univ Med Cent). 2001 Oct;14(4):339-46. eng. Epub 2005/12/22. doi:10.1080/08998280.2001.11927785. Cited in: Pubmed; PMID 16369643.
Kershenovich A, Toms SA. The Acetazolamide Challenge: A Tool for Surgical Decision Making and Predicting Surgical Outcome in Patients with Arachnoid Cysts. J Neurol Surg A Cent Eur Neurosurg. 2017 Jan;78(1):33-41. eng. Epub 2016/07/15. doi:10.1055/s-0036-1584815. Cited in: Pubmed; PMID 27415592.
Westermaier T, Schweitzer T, Ernestus RI. Arachnoid cysts. Adv Exp Med Biol. 2012;724:37-50. eng. Epub 2012/03/14. doi:10.1007/978-1-4614-0653-2_3. Cited in: Pubmed; PMID 22411232.
Dyck P, Gruskin P. Supratentorial arachnoid cysts in adults. A discussion of two cases from a pathophysiologic and surgical perspective. Arch Neurol. 1977 May;34(5):276-9. eng. Epub 1977/05/01. doi:10.1001/archneur.1977.00500170030004. Cited in: Pubmed; PMID 856125.
Smith RA, Smith WA. Arachnoid cysts of the middle cranial fossa. Surg Neurol. 1976 Apr;5(4):246-52. eng. Epub 1976/04/01. Cited in: Pubmed; PMID 1265637.
Hall S, Smedley A, Rae S, Mathad N, Waters R, Chakraborty A, Sparrow O, Tsitouras V. Clinical and radiological outcomes following surgical treatment for intra-cranial arachnoid cysts. Clinical neurology and neurosurgery. 2019 Feb;177:42-46. eng. Epub 2019/01/02. doi:10.1016/j.clineuro.2018.12.018. Cited in: Pubmed; PMID 30599313.
Shim KW, Lee YH, Park EK, Park YS, Choi JU, Kim DS. Treatment option for arachnoid cysts. Childs Nerv Syst. 2009 Nov;25(11):1459-66. eng. Epub 2009/06/19. doi:10.1007/s00381-009-0930-7. Cited in: Pubmed; PMID 19536550.
Riva-Cambrin J, Kestle JR, Holubkov R, Butler J, Kulkarni AV, Drake J, Whitehead WE, Wellons JC, 3rd, Shannon CN, Tamber MS, Limbrick DD, Jr., Rozzelle C, Browd SR, Simon TD. Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr. 2016 Apr;17(4):382-90. eng. Epub 2015/12/05. doi:10.3171/2015.6.Peds14670. Cited in: Pubmed; PMID 26636251.
Bresa L. Uninsured, illegal, and in need of long-term care; the repatriation of undocumented immigrants by U.S. hospitals. Seton Hall Law Rev. 2010;40(4):1663-96. eng. Epub 2011/02/02. Cited in: Pubmed; PMID 21280390.
Becerra DA, David K.; Ayón, Cecilia; and Castillo, Jason T. Fear vs. Facts: Examining the Economic Impact of Undocumented Immigrants in the U.S. The Journal of Sociology & Social Welfare. 2012;Vol. 39 (Iss. 4):Article 7.
Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies, and Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care. In: Services UDoHaHS-CfMM, editor. Federal Register2019. p. 51836-51884.
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Copyright (c) 2021 Myles Keener, Rebecca Sturges, Kathryn Becker, Connor Gifford, Christopher Alexander, Jason Schroeder, Saksith Smithason
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