“We do not wish for him to return,” he continued. “He will be a burden for me, and I do not have the time or resources to care for him. My mother has established a new family, and I do not wish for this matter to disrupt her life. If they want to send him back, they will have to negotiate with the Chinese government to see if the government will care for him.”

Into the Unknown

Hospitals say the federal government ignores the burden posed by these patients. In fact, Immigration and Customs Enforcement does not assume any responsibility for the health care of illegal immigrants unless they are in federal immigration detention, said a spokeswoman, Kelly Nantel, and it does not get involved in repatriations undertaken by hospitals.

For some hospitals, such repatriations are routine, for others a last resort. And, just as some forcibly repatriate patients, others do so only with consent — although consent is a murky concept when patients are told they have no alternative. While some hospitals pay for an immigrant’s repatriation and for their care in their homelands; others never make any inquiries into how deported patients have fared.

“We don’t do any follow-up,” said Sister McBride at St. Joseph’s in Phoenix.

Even patients at hospitals that never repatriate immigrants can find themselves embroiled in discharge plans of considerable complexity, as the case of Darwin Castro demonstrates.

One day last May, Mr. Castro, a 21-year-old illegal immigrant from Honduras, was getting a ride home from his construction job in Oklahoma City when the driver crashed into a tree. By the time he arrived at the Oklahoma University hospital, he was in shock from extreme blood loss and rushed into an operating room for surgery on a badly wounded liver. He also suffered a traumatic brain injury, facial and arm cuts and a broken hand.

Alerted by Honduran friends to the accident, Mr. Castro’s cousin, Wilmer Ubener Reaños, 25, called the hospital from New Orleans, where he too worked in construction. Mr. Reaños asked a bilingual colleague for help in communicating with the hospital. From that point forward, the colleague, David Ruiz, became the family liaison, and the hospital believed that David — listed in the records with no last name — was the patient’s cousin.

After six weeks, Mr. Castro was ready for discharge, said Allen Poston, the hospital spokesman. With a feeding tube and bladder catheter, Mr. Castro needed round-the-clock care but the hospital failed to find him a charity bed in a nursing home. Since it never repatriates patients, the only other option was to discharge Mr. Castro to his relative in New Orleans, Mr. Poston said.