Sunday, April 26, 2009

Mr. Marshall's E-Mails to Consulate in Haiti

This post consists of a series of e mails sent back and forth from OSF’s attorney Douglass Marshall and the American Consulate in Port-au-Prince, Haiti.

My comments follow individual e mails.

Quick Summary:

Mr. Marshall contacted the American Consulate in Haiti regarding Heurese Joseph. Heurese is a patient of mine in the Haitian Hearts program. And Mr. Marshall e mailed me that he phoned Cleveland Clinic Foundation (CCF) about Heurese’s legal status in the States.

Heurese had heart surgery at OSF in Peoria in 2002, but she had been refused further care at OSF when she became ill in 2008. Cleveland Clinic accepted Heurese for life saving heart surgery. Heurese was operated in Cleveland in December, 2008.

As you can see below, Mr. Marshall presumably sent his first e mail to the Consulate on April 1, 2009.

At the same time Mr. Marshall was e mailing the Consulate, Gertrude the Haitian Hearts Coordinator in Haiti, was feverishly working on obtaining a medical visa (B2 visa) for another Haitian Hearts patient, Katina Antoine.

Katina is a 14 year old girl who had heart surgery at OSF in Peoria in 2002. I examined Katina in November, 2008 and she needed repeat heart surgery also. She was quite ill. Just like Heurese, Katina was denied further medical care by OSF and needed heart surgery quickly.

After four months of "begging and pleading" Haitian Hearts was able to get Katina accepted into Cleveland Clinic for heart surgery.

Gertrude told me that she had an unusually hard time getting the B2 visa for Katina. She went to the Consulate on three separate occasions and Katina’s visa application was denied twice. This was intensely difficult to accomplish and a huge physical strain on Katina who was very weak.

After many e mails and letter revisions by Cleveland Clinic, Katina’s visa was granted on April 14, 2009.

Did Mr. Marshall’s contact with the American Consulate have anything to do with slowing the visa approval for Katina? Will Mr. Marshall’s meddling negatively influence visa applications for future Haitian Hearts patients that are accepted at US medical centers and need the visa for travel for life saving heart surgery?

Here is the string of e mails. We have no documentation what was said during Mr. Marshall’s phone calls to Cleveland Clinic.

From: Douglass Marshall []
Sent: Wednesday, April 01, 2009 1:32 PM
To: Port-au-Prince, NIV
Subject: B2 visa

I would like to find out who is listed as the financial support person and at what hospital Heurese Joseph was supposed to receive medical services. She lives in Port-au-Prince. I represent OSF Saint Francis Medical Center in Peoria, Illinois, and Ms. Joseph has requested medical services at OSF. However, OSF did not sign a support affidavit for her. Her physician is Dr. John Carroll, and we believe that the Cleveland Clinic is listed as the supporting hospital.

Can you provide me with any information? Thank you.

My Comment:

Why is OSF interested in this information on a person who has applied for charity assistance? Do they make these kinds of inquiries on all patients who apply for charity assistance? When OSF treats people who aren’t U.S. citizens—much less reviews applications for charity assistance--do they typically contact the Consulate in the person’s home countries making inquires about their visa status?

What is most revealing about this e-mail is that OSF acknowledges that they know the answer to the question they are asking: Cleveland Clinic is the supporting hospital. This information was provided to OSF on the Ms. Joseph’s charity application form. So why would they write the Consulate to ask a question they already had the answer to?

In my opinion, they are trying to sabotage not only Ms. Joseph’s ability to get medical care but also that of future Haitian Hearts’ patients.

E Mail Response from the American Consulate in Port-au-Prince, April 8, 2009:

Mr. Marshall,

Could you please explain to me how you, as an attorney, are involved? I mean that as a very sincere question and for my own education. This the first time an attorney has been in touch with my office for this type of request.

Have you indeed contacted Dr. John Carroll and Cleveland Clinic? If not, I would suggest that you do so, since you seem already to have elicited that information from someone, I suppose Ms. Joseph.

Visa records are subject to confidentiality regulations. I will seek guidance and I would be very interested in any further information you can give me about how your hospital became involved.

Nancy McCarthy
NIV Chief

My Comment:

Understandably, the Consulate official is confused and states that she has never received this type of a request before. She makes the sensible suggestion that OSF contact me and also points out that he already has the information he is requesting. She tells him nicely that visa records are confidential.

The following is an e mail from the Consulate to Cleveland Clinic and cc’d to me:

Dear (I left out the CC employee name),

I have received an inquiry about a patient to whom we issued a visa on your request, Heuruse Joseph, dob 08-08-1978.

The visa was issued on Nov 24, 2008 and she was to have arrived for urgent heart surgery on Dec. 27. Your information informed us that a stay of two months was required and the visa was so annotated. She actually entered the US on Nov 27, 2008. Did she in fact ever receive treatment through your program?

I have just received an inquiry from another hospital, in Peoria, stating that as of now she is applying to them for medical services.

Any light you can shed on the current situation would be appreciated.

Nancy McCarthy
NIV Chief

My Comment:

As one can see, the Consulate is confused and is now e mailing CCF and even wonders if Heurese was operated at Cleveland.

CCF asked me to respond to the Consulate official. Here is my response:

Dear Ms. McCarthy,

Heurese Joseph had major heart surgery at Cleveland Clinic in December, 2008.

Heurese is being followed by me with blood tests and physical exams. The results of an upcoming echocardiogram will be reviewed by her heart surgeon at Cleveland Clinic to determine her immediate and long term care.

Heurese has applied to OSF's Charity Assistance Program in Peoria for an outpatient echocardiogram. She is waiting to hear from OSF.

Her I-94 document is valid until May 26, 2009.

Thank you very much.


John A. Carroll, M.D

Here is the Consulate response to me on April 9, 2009:

Thanks for your reply. Could you please get in touch with the hospital in Peoria to clarify with them what is needed? They have written me directly for information.


Nancy McCarthy

However, OSF's Doug Marshall pressed forward with his inquiry about Heurese and her visa status:

From: Douglass Marshall []
Sent: Monday, April 20, 2009 7:29 PM
To: McCarthy, Nancy H
Subject: B2 Visa

Ms. McCarthy,

Thank you for replying. My firm is General Counsel to OSF Healthcare System, located in Peoria, Illinois. OSF owns and operates Saint Francis Medical Center. I am working with OSF to resolve the issue of Ms. Joseph's status in the United States, and Dr. Carroll's request for services to be rendered to Ms. Joseph by OSF.

For many years, Dr. John Carroll brought Haitian children to OSF through the Haitian Hearts Program in Central Illinois. OSF sponsored these children and cared for them. However, in approximately 2002, OSF stopped sponsoring Haitian children through this program. (OSF's employees still go to Haiti and provide free medical and healthcare services to children through another Central Illinois program called, Friends of the Children of Haiti. In addition, OSF treats children, not from just Haiti, but from all over the world).

In December, 2002, OSF contacted Consul General Roger Daley to make him aware that OSF was no longer sponsoring Dr. Carroll's patients. OSF received a reply on December 6, 2002 from Bisola Ojikutu, Vice-Consul, that the Consulate was surprised to learn that OSF was no longer sponsoring Dr. Carroll's patients. The Vice-Consul stated that medical visas would no longer be issued under OSF's name for Dr. Carroll's patients. Also involved in these discussion were Julia Stanley and William Rowland at the Embassy.

It is my understanding that in order to have a Non-Immigrant Medical B2 Visa approved, there has to be a letter from a sponsoring hospital, who will treat the patient. Even though OSF no longer sponsors his patients, Dr. Carroll continues to ask OSF to treat patients that are in the United States, presumably sponsored by some other hospital. Ms. Joseph is the most recent request by Dr. Carroll for services from OSF. OSF is pleased that Dr. Carroll is able to continue his treatment of Haitian children through sponsorship by other hospitals. However, such requests of OSF seem not to comply with the B2 Visa requirements. OSF would like your position on this matter.

Thank you for your attention to this matter.

My Comment:

Why is OSF interested in resolving “the issue of Ms. Joseph’s status in the United States”? Why do they have any interest in this? And, in fact, who is it an “issue” for? It certainly isn’t an issue for the Catholic Church. On March 19, 2009, Cardinal Francis George of Chicago, President of the U.S. Conference of Catholic Bishops sent a letter to President Obama asking him to grant Haitians currently in the United States Temporary Protected Status. TPS would allow Haitian citizens who are already here to continue their stay. TPS is granted for citizens from countries that have experienced recent extreme hardship. Haiti would seem to definitely qualify.

So while the U.S. Bishops are requesting that Haitians be permitted to stay in the country, OSF is questioning the consulate on the visa status of a Haitian. Again, why?

Heurese Joseph is here legally on a B-2 visa. She did indeed have very successful heart surgery at Cleveland Clinic. She is residing in central Illinois and needs a follow up echocardiogram. She could go back to Cleveland to receive this test, but since she is here and OSF has a charity assistance program, she applied for an echo. All OSF had to say was no. Ms. Joseph never received any kind of answer from OSF. The only action the application prompted was a flurry of e-mails and phone calls from OSF to the consulate and Cleveland Clinic. They haven’t once evidenced any care or concern about Ms. Joseph’s medical concerns, though they are very concerned about her visa status.

Since OSF discontinued their involvement with Haitian Hearts and stopped caring for Haitian Hearts patients, I have never requested a visa for a patient and listed OSF as the treating hospital. I do continue to ask OSF if they will accept patients, WHO ARE TRAPPED IN HAITI WITH NO REAL MEDICAL CARE, especially those like Ms. Joseph and Katina Antoine who have been their patients before and whom they might presumably feel some kind of moral obligation. Though they have continued to say no (or more typically they don’t answer at all), I will continue to ask in the hopes that they change their mind. And even though Mr. Marshall intends the reader to believe that I request OSF’s help with patients that are in the States, this is false. Medical centers in the States that have accepted Haitian Hearts patients follow up with my patients and obtain echocardiograms and other post op testing as a matter of principal. Heurese is the first Haitian Hearts patient of mine in the United States that has filled out the OSF Charity Assistance application. (By the way, she never did hear from OSF about the echocardiogram she requested.)

My requests of them to provide medical care to Haitian patients obviously upsets OSF and is one of the reasons for their e-mails to the consulate. Though OSF might like it to be the case, there is no violation of a B-2 visa by my asking OSF for charity assistance. In fact, to maintain their tax exempt status, they are legally required to provide a certain amount of charity care. They can decline the request, but in my opinion, there is no good reason for them to contact the consulate other than to attempt to sabotage the ability of Ms. Joseph and future Haitian Hearts patients to receive medical care in the United States.

Mr. Marshall also leaves out the important fact that Haitian Hearts donated over 1.1 million dollars to OSF-Children’s Hospital of Illinois for the care of Haitian Hearts patients. His word “sponsorship” makes it sound as if the work for my Haitian kids was done pro bono. It was not.

To obtain passports, medical letters, and visas for one child can take up to three years in Haiti. The roads are not great, there has been much violence in the last several years, and communication with the families in Haiti can be very difficult. If Mr. Marshall tried to find one medical center and one visa for one child for heart surgery in the United States, he would immediately see the complexity of the situation. And if the child does not leave Haiti for heart surgery, it usually means death for that child.

OSF and Mr. Marshall need to understand this and understand that creating confusion at the level of the Consulate in Haiti and at Cleveland Clinic may indeed be life threatening for Haitian children that need heart surgery in the future.

One last note at a very human, "non-legal" level, Bisolo the Consulate Official referred to by Mr. Marshall above, was shaking and had tears in her eyes when I spoke with her at the Consulate in Haiti in 2003. She told me that Paul Kramer, Executive Director of Children’s Hospital of Illinois, had called the Consulate and told her that OSF was withdrawing support for Haitian Hearts and so she could not grant any more B2 visas for Haitian Hearts patients. Bisolo is from Africa and she knew this would mean the deaths of more Haitian kids. And it has.

Next e mail is from the Consulate to OSF's Mr. Marshall:

"McCarthy, Nancy H"
04/23/2009 09:30 AM

Thanks for your reply. It is very informative. I did give Dr. Carroll your contact information and I hope that at this point the two of you have a had a chance to sort this specific case out. I certainly understand your position. I have made note that your hospital no longer has a collaborative relationship with Dr. Carroll and I let my officers know, as well.

Consular officers must look at the information presented and come to a conclusion that the applicant meets the requirements or not – that includes looking at the purpose of travel and how that purpose will be accomplished financially.

Visas of any category allow the holder to apply for entry at the port of entry, and at that time the DHS official gives them an approved length of stay. However, the length of stay and the category of admission are determined by DHS, not be the visa itself, so if this applicant was admitted as a B2 for a period of, say, six months, that decision was made by DHS and we don’t have any control over it.

Again, thanks for your response and rest assured that we will not expect to see OSF being presented as a sponsor for medical treatment.

Nancy McCarthy
NIV Chief

My Comment:

Her last sentence says it all. Bishop Jenky and Sisters of OSF, where are you?


Both the U.S. Consulate and Cleveland Clinic asked me to contact OSF to clear up their confusion. Here is an open e-mail to Mr. Marshall:

Dear Mr. Marshall,

You make it clear in your communications that no possibility existed for OSF to grant my request for charity consideration for an echocardiogram for Heurese Joseph. Given that, the only defensible response to my request would have been the simple, sufficient, "No".

As the Consular officer noted, you seem to have had all the information there was.

What pretense do you make for contacting the Consulate, or Cleveland Clinic? The inquiry was not part of a sincere consideration of my application for Heurese.

Given OSF’s, and your own, history with me, the singular treatment of Heurese can only be seen for what it is, i.e., harassment and intimidation. As OSF’s attorney, your responsibility is to guide OSF away from legally questionable actions, not participate in them.

Regarding other statements you make:

1. "We wanted to ensure that the Consulate personnel understood that OSF is no longer a sponsor of Haitian Hearts" What support can you offer for belief that the Consulate might have thought otherwise?

2. "However, such requests of OSF seem not to comply with the B2 Visa requirements." In what way? Does Heurese’s visa restrict her from obtaining services from other than Cleveland Clinic? Does Heurese’s visa restrict her to Cleveland?

3. You have not provided your communication with Cleveland Clinic. Which did you contact first, Cleveland Clinic, or the Consulate? Whichever was the first, you received the answer that Cleveland Clinic was the sponsor of Heurese’s visa. There is no innocent explanation for contacting the second institution.

4. If you intend for OSF to investigate all charity applicants immigration status, then Heurese Joseph’s passport would have provided sufficient proof of hers. Heurese was already in the U.S., we were not requesting OSF’s involvement in Heurese obtaining a visa.

5. "OSF's employees still go to Haiti and provide free medical and healthcare services to children …" What pertinence does this have to your communication with the Consulate as a representative of OSF? What do the private, volunteer efforts of OSF employees have to do with OSF? (And Haitian Hearts brought many kids from that organization for heart no one comes for heart surgery from that organization.)

6. An echocardiogram can hardly be considered treatment. It is a test. Heurese had surgery at Cleveland Clinic, as her visa application stated. There is no open-ended treatment being requested of OSF.

7. "OSF … is pleased that you have found hospitals that will sponsor Haitian Hearts patients" Your actions contradict your statement. Malicious interference does not demonstrate pleasure.

8. Why did OSF stop sponsoring children through Haitian Hearts? Sr. Judith Ann repeatedly assured me that OSF would never abandon any child.



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