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

Alberta Health Services is investigating after an un‐ documented woman says she was denied an emer‐ gency C-section at an Ed‐ monton 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 per‐ son without medical insur‐ ance, Estrada said she ex‐ pected 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 Mis‐ ericordia Community Hospi‐ tal, where she had the C-sec‐ tion 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 com‐ pletely different would have happened," she told CBC News, speaking in Spanish.

Watch| Undocumented woman says she was told she has to pay upfront for emergency C-section:

Advocates and health ex‐ perts say nobody should be denied emergency medical care because of their immi‐ gration status.

AHS's website states, "you will not be denied emergency medical care in Alberta even if you do not have medical in‐ surance."

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 even‐ tually bring her 12-year-old son to Canada.

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

Worried about her preg‐ nancy and immigration status, she said she con‐ tacted Diana Ramirez, a com‐ munity organizer with the Al‐ berta Workers' Association for Research and Education (AWARE).

Ramirez helped her dur‐ ing the pregnancy and Estra‐ da said the Multicultural Health Brokers Cooperative, which serves immigrants and refugees, connected her to a family doctor she saw regu‐ larly.

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, ar‐ rived at the Royal Alex's labour and delivery unit around 4:30 p.m. that day.

Estrada said the nursing staff first brought up pay‐ ment 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.

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 discus‐ sion and AWARE provided CBC News with the record‐ ings.

In one recording, a nurse can be heard saying in En‐ glish 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 hospi‐ tal's response

Ramirez said she was shocked by Estrada's story since she had helped multi‐ ple women in the past in sim‐ ilar situations without inci‐ dent.

"I don't think anybody should be withholding care, especially in an emergency situation," she said.

Jason Foster, an associate professor at Athabasca Uni‐ versity and AWARE board chair, and Chris Gallaway, the executive director of the nonprofit Friends of Medicare, are also criticizing the hospi‐ tal'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 sim‐ ply unacceptable."

Jenna Hennebry, a full professor at Wilfrid Laurier University (WLU) and expert on migrant worker rights, said denying access to repro‐ ductive 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 hu‐ man rights," she said.

Hennebry is also the codirector of the International Migration Research Centre at the Balsillie School of Inter‐ national Affairs and WLU.

Ramirez said AWARE plans to help Estrada file two com‐ plaints: 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 abil‐ ity to pay," he told CBC News in an email.

He said patients from out‐ side Canada are billed in cer‐ tain cases, almost always af‐ ter care has been provided.

A spokesperson from Covenant Health, the provider that operates the Misericordia hospital, said it works with patients and fam‐ ilies to establish payment plans when there is no insur‐ ance to cover costs, in ad‐ vance where possible.

Covenant Health's spokesperson said it is com‐ mitted to ensuring all patien‐ ts requiring emergency med‐ ical 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.