On September 3, 2015 I met with Teresa Small, Tucson Sector spokeswoman for the U.S. Customs and Border Protection’s Office of Field Operations, to ask about the procedures of transferring patient care between Mexican and U.S. healthcare providers at the port of entry in Nogales. Her colleague, Edith Serrano, joined us. Here are the excerpts of our interview.
IJ: What are the procedures for transferring patients from a Mexican ambulance operated by the Cruz Roja or other entities to a U.S. ambulance, often sent by the Nogales Fire Department?
Ms. Small: “Throughout the ports in Arizona it is typically going to be like this. The hospital in Mexico makes the arrangements with the U.S. hospital to transfer the patient. Once this is completed, the U.S. hospital faxes the port the detailed information regarding the severity of the medical situation and any other pertinent information to review. This gives us, Customs and Border Protection, time to review the situation and information of the person arriving into the U.S. to determine if the patient will be authorized to be transported. Once this is established, CBP allows the paramedics to transfer the patient from the Mexican ambulance to the U.S. ambulance and obtains biometric information if possible."
IJ: What type of documentation is required? What type of documentation is required of Mexican doctors and other healthcare providers who want to cross into the U.S., accompanying patients? What about patient's family members?
Ms. Small: “If they are a U.S. citizen, they are required to present their valid Western Hemisphere Travel Initiative document, such as U.S. Passport, U.S. Passport Card, Enhanced Driver’s License, or Trusted Traveler card (examples would be the Global Entry or SENTRI documents). If they are a U.S. citizen, we cannot deny their entry into the U.S. Now, if the patient is an alien, seeking to lawfully enter the United States, they must establish their admissibility to the satisfaction of the Customs and Border Protection officer. This is done as part of the inspection process. CBP typically encounters Mexican nationals, at least in these border areas, to either have a DSP-150 document, which is also known as our Border Crossing Card, or lawful permanent resident document, which many refer to as the Green Card."
“The process for Mexican healthcare providers and family members who want to accompany the patient is the same.”
IJ: What are the procedures for transferring patients from a U.S. ambulance to Mexican Cruz Roja or other ambulance at the port of entry?
Ms. Small: “They take them into vehicle secondary. Just because somebody has come onto our port, doesn’t mean that they’ve been admitted into the United States. If the person is in an ambulance, they’ll be transported to the vehicle secondary where there is more space and they are able to place the patient from one ambulance into the other."
Ms. Serrano: “I think it depends on the port. At DeConcini they will use one of our outbound lanes. […] They will call over the radio to stop all incoming traffic, the ambulance comes in against traffic and backs up to Lane 1, they open the gates and they transfer the patient right there. […] That’s when we go and look at the documents and make sure that everything is intact. Then they make the transfer and off they go."
IJ: Are there any situations when Cruz Roja or other Mexican ambulances are allowed to cross the border and take patients directly to the Holy Cross hospital? If so, what are those situations? Who escorts the ambulance?
Ms. Small: “This isn’t typically what occurs. Because they would be considered working in the U.S., if they were to come over in that form of capacity. So unless they had some special visa to be able to do that, it’s not going to occur."
IJ: I know that previously, perhaps decades ago, Cruz Roja used to be able to take patients to the U.S. hospitals...
Ms. Small: “And that was decades ago, like you said. From what I was reading, I came across something that was in the early 90s. It probably ended in the early 90s. Since our merger this is not the process that is done any longer."
IJ: Are there any exceptions for critical emergency situations, when the patient is unresponsive or has a life-threatening illness or injury? Can U.S. ambulances take them? Earlier in July a 9-year-old Mexican girl was struck by lightning in northern Sonora and taken across the border to Tucson for treatment.
Ms. Small: “The process is still going to be the same. We will ask for documentation. If they don’t have some form of documentation, if it is that form of severity that you’re talking about, we may consider a parole. But it’s not automatic. […] It’s going to be a case by case situation. Typically, if they have no documents, depending on the severity of the medical situation, we may provide a parole for that person to enter the U.S. to receive the medical attention. The parole would be provided at the port. […] The decision of the port director is not based on meeting the person, though. They are provided with the paperwork pertaining to the situation and they make the determination if the person is going to be paroled or not."
Ms. Serrano: “It’s case by case. Sometimes they come from as far as Hermosillo, so by that point they’ve already connected to us. […] This gives us time to do some research to see if [the patient] had any issues in the past. Again, case by case. Obviously, the more time we have in advance, we are able to make those inquiries. So it depends. It really depends. Ultimately it is the decision of the port director to allow that."
IJ: What are the procedures for letting Mexican firefighters come into the U.S. to provide mutual aid when the binational plan is activated in emergency situations? What type of documentation is required from the firefighters?
Ms Small: “In general, when those situations occur, we are given a list of those potential firefighters that are going to come over. So we are able to make sure that there’s nothing derogatory in their background."
“In essence, when we deal with these situations, we know that it can be a life-threatening situation, so we do everything possible to expedite where we can. But of course the coordination between the hospitals is huge. If they are able to get that in place, it makes our job just that much easier. We are not there to try to impede the patient care. We want to get them help as well. But it really depends on the situation.”