Undocumented woman says she was denied emergency C-section at Edmonton hospital

April 9, 2024 Canuck

Alberta Health Services is investigating after an undocumented woman says she was denied an emergency C-section at an Edmonton hospital last month.

Perla Estrada, 35, said a doctor told her to go to the hospital on March 25 after an ultrasound revealed she had low amniotic fluid and needed a C-section.

She said at the Royal Alexandra Hospital, she was told she had to pay $5,000 upfront for the procedure and that no doctor there would see her unless she did so.

As an undocumented person without medical insurance, Estrada said she expected to pay for the cost of her hospital care after the birth, but she did not have enough money to pay the amount upfront.

She later went to the Misericordia Community Hospital, where she had the C-section and gave birth to her daughter Violet.

“If I didn’t have a friend that helped me and took me to the other hospital, more likely I would have just come home, and something completely different would have happened,” she told CBC News, speaking in Spanish.

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Undocumented woman says was told to pay upfront for emergency C-section

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Perla Estrada, a Mexican citizen, says she was told by staff at the Royal Alexandra Hospital in Edmonton that she could not get an emergency C-section unless she paid $5,000 upfront. Alberta Health Services says it’s concerned by the case and is investigating.

Advocates and health experts say nobody should be denied emergency medical care because of their immigration status.

AHS’s website states, “you will not be denied emergency medical care in Alberta even if you do not have medical insurance.”

Spokesperson Kerry Williamson said AHS is “very concerned about this case” and is contacting the patient to discuss the details.

From Mexico to Canada

Estrada said she came to Canada from La Paz, Mexico in October 2022 on a tourist visa.

She said she had met an employer online who told her she would receive a work permit once she came to Canada but the offer did not materialize.

Estrada said her plan was to obtain a work permit, save money in Canada and eventually bring her 12-year-old son to Canada.

She said she met a Canadian man last year and they were planning to get married but they broke up after she became pregnant in July.

A woman in red speaks. — Diana Ramirez, a community organizer with the Alberta Workers’ Association for Research and Education, said she was shocked by what happened to Estrada since she had helped multiple women in the past in similar situations without incident. (Emilio Avalos/CBC)

Worried about her pregnancy and immigration status, she said she contacted Diana Ramirez, a community organizer with the Alberta Workers’ Association for Research and Education (AWARE).

Ramirez helped her during the pregnancy and Estrada said the Multicultural Health Brokers Cooperative, which serves immigrants and refugees, connected her to a family doctor she saw regularly.

On March 25, about a week before her due date, Estrada said she went to an ultrasound appointment, where a doctor told her she had low amniotic fluid and should go to the hospital for a C-section.

She and a friend, who also happened to be in her third trimester of pregnancy, arrived at the Royal Alex’s labour and delivery unit around 4:30 p.m. that day.

Estrada said the nursing staff first brought up payment after she had waited for several hours, and hours later, a nurse told her she was not going to be seen by a doctor until she paid.

At that point, Ramirez said, Estrada called her, in tears.

“She just mentioned really quickly that they weren’t going to attend to her unless she paid the cash up front,” Ramirez said.

A mother in a blue sweatshirt holding her baby. — Estrada says she gave birth to her daughter Violet after being told she had to pay upfront for a C-section at a different hospital. (Emilio Avalos/CBC)

Estrada said her friend then called her sister, who arrived at the hospital around 11 p.m. with another friend.

A different nurse, who spoke Spanish, talked with the group. One of Estrada’s friends recorded their discussion and AWARE provided CBC News with the recordings.

In one recording, a nurse can be heard saying in English that Estrada had to pay upfront, then later, in Spanish, that she should try another hospital.

In another recording, the same nurse mentioned that the rule about the cost was something “the department” had decided.

Estrada said a friend drove her to the Misericordia, where she was seen right away.

She had the C-section surgery there and Violet was born in the early morning of March 26.

Experts criticize hospital’s response

Ramirez said she was shocked by Estrada’s story since she had helped multiple women in the past in similar situations without incident.

“I don’t think anybody should be withholding care, especially in an emergency situation,” she said.

Jason Foster, an associate professor at Athabasca University and AWARE board chair, and Chris Gallaway, the executive director of the non-profit Friends of Medicare, are also criticizing the hospital’s response.

Both were quoted in a new release sent Friday by the non-profit advocacy group Migrante Alberta.

Foster said in the release that Estrada should have been billed after receiving care at the Royal Alex.

Gallaway said, also in the news release, that delays or barriers to accessing care in a health emergency “are simply unacceptable.”

Jenna Hennebry, a full professor at Wilfrid Laurier University (WLU) and expert on migrant worker rights, said denying access to reproductive health care goes against international law.

“It really is not something that should be done in this country and it is something that’s a clear violation of human rights,” she said.

Hennebry is also the co-director of the International Migration Research Centre at the Balsillie School of International Affairs and WLU.

Ramirez said AWARE plans to help Estrada file two complaints: one with Alberta Health Services and one with the Human Rights Tribunal of Alberta.

AHS investigating

Williamson said AHS could not speak about a specific patient but is investigating what happened.

“All patients should be able to access emergency care, regardless of their ability to pay,” he told CBC News in an email.

He said patients from outside Canada are billed in certain cases, almost always after care has been provided.

An aerial view of a large, tan building with many windows. It says "Royal Alexandra Hospital" near the top. There are cars parked outside. — An aerial view of Royal Alexandra Hospital in Edmonton is seen by drone on Oct. 4, 2021. (David Bajer/CBC)

A spokesperson from Covenant Health, the provider that operates the Misericordia hospital, said it works with patients and families to establish payment plans when there is no insurance to cover costs, in advance where possible.

Covenant Health’s spokesperson said it is committed to ensuring all patients requiring emergency medical attention receive the care they need, regardless of their ability to pay.

Ramirez said a director from AHS called Estrada on Friday night, mentioned a thorough investigation would be done and apologized.

Estrada said she has not received bills yet for her overnight stay at the Royal Alex or her treatment at the Misericordia but plans to pay them off over time.

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