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care and the other half serves as an “asylum” for profoundly disabled Guatemalans. Although it is the only public rehabilitation hospital in the country, it dedicates just 32 beds to rehabilitation and does not offer the specialized brain injury treatment that Mr. Jiménez needed. The Guatemalan foreign ministry said that it knew of 53 repatriations by American hospitals in the last five years. During a visit by The Times to the National Hospital in June, the most recent arrival was an 18-year-old, Diana Paola Miguel, transported there by the University Medical Center in Tucson nine days after a van accident crushed her pelvis, which the Arizona hospital repaired. Supine on a gurney, she Ms. Paola was too tremblingly upset to talk. Dr. Von Ahn said he believed that American hospitals were dumping patients that should be their responsibility. “It’s the same as the classic fall on the stairs, right?” he said. “You go to my home, you fall on my stairs and then you sue me. I am responsible.” Shortly after Mr. Jiménez arrived, the Guatemalan hospital contacted his common-law wife, Fabiana Domingo Laureano, who lived in the city of Antigua with their two young sons, and asked her to come get him. Ms. Domingo, who was 27 at the time, was shocked to learn that her husband was back and terrified by the request. Then as now, she was eking out a living, selling traditional woven clothing in a marketplace while sharing a spare, concrete room with her sons in her parents’ humble home. “I was already living from hand to mouth,” she said in an interview in Antigua, where her sons now supplement her income by selling cigarettes after school. “How could I possibly have given him what he needs?” The couple met as teenagers in the highland village of Soloma. In the mid-1990s, Mr. Jiménez migrated with his wife’s family to Antigua, a volcano-ringed colonial city where tourism sustains the local economy. While she sold clothing, Mr. Jiménez worked as a bus driver’s assistant. Together, they earned about $6 a day, which was not enough to support their family, so Mr. Jiménez, with his wife’s brother, Francisco Gaspar, decided to follow a well-traveled path to the north. That is when he changed his name from Gervacio Gaspar to Luis Jiménez, which is how he is now known, even by his family After pledging to pay a coyote, or smuggler, about $2,000 each to ferry them into the United States, they crossed into California under cover of darkness and made their way to Encinitas, where Mr. Jiménez’s older brother lived, Mr. Gaspar said After the two men failed to find regular work, Mr. Gaspar began suffering panic attacks and returned to Guatemala; Mr. Jiménez decided to try his luck in Florida. “Lamentably,” Mr. Gaspar said, “luck eluded him.” After the hospital contacted Ms. Domingo, Telemundo, the Spanish-language network, called Ms. Domingo and offered to take her to Guatemala City. Shortly thereafter, the network showed her reunion with her husband. “You are Maria by chance?” Mr. Jiménez said to his wife as the television cameras rolled. “Fabiana,” she replied. Their two sons stood by her side, wide-eyed. A few weeks later, Dr. Von Ahn said, the hospital discharged Mr. Jiménez “because we needed the bed,” transferring him to another public hospital, San Juan de Dios. That is where Mr. Jiménez’s brother, Enrique Lucas Gervacio, found him when he made his way down from the mountains by bus. “He was lying in the hallway on a stretcher, covered in his own excrement,” Mr. Lucas said. “So we cleaned him up and we brought him home.” In Favor of Jiménez In May, 2004, a Florida appeals court overruled Judge Fennelly. The Fourth District Court of Appeal found that the Florida state judge had overstepped his bounds because deportation is the prerogative of the federal government. The court also declared that no evidence supported the hospital’s assertion that Mr. Jiménez would receive appropriate care in Guatemala; the discharge plan, the ruling said, was not detailed enough to satisfy federal requirements or the hospital’s own rules. The appeals court voided the judge’s order although, given that Mr. Jiménez was already back in Guatemala, that action came too late for him. It might affect others, though. The decision has become what is known legally as a case of first impression on the issue of hospital repatriations. John DeLeon, a lawyer who advises the consulates of Mexico, Honduras and Guatemala in Miami, said he now referred to it when he received calls from hospitals looking to discharge seriously injured or ill immigrants. “I now write I call my Montejo Gaspar letter,” he said. “It’s a letter that says, ‘Listen, don’t take action to dump this individual because you’ll be risking legal action. The law is now that hospitals can’t dump immigrant patients without securing appropriate after-care. If somebody has a serious illness and needs continuing care, a hospital can’t simply discharge them onto the street, much less put them on a plane.’ ” Mr. DeLeon said that he was “bombarded by such cases,” adding that he was investigating another medical repatriation by Martin Memorial, which took place two weeks ago “behind the back of the Mexican government.” Martin Memorial confirmed that on July 16 they flew Neptali Díaz, a severely brain-injured patient to Mexico. A court order authorized Mr. Diaz’s transfer to an unspecified Mexican hospital, ending the man’s 859-day, $2 million stay at Martin Memorial. After the ruling in Mr. Jiménez’s favor, Martin Memorial did not appeal. But the case did not go away. The appeals court ruling set the stage for a personal injury lawsuit, taken on by Searcy, Denney, Scarola, Barnhart & Shipley in West Palm Beach. With that established firm behind him, Mr. Gaspar initiated a false imprisonment action claiming that his cousin was essentially kidnapped by the hospital and smuggled out of the country in a kind of medical rendition. Since then, appeals judges have again ruled in Mr. Jiménez’s favor, stating the hospital can be sued for punitive damages as well as for the cost of his medical care. This infuriates Ms. Plato Nicosia, the hospital administrator, who said it was Mr. Jiménez’s family who owes the hospital money and not vice versa. “Should they win, we would like them to take those damages and pay his hospital bill,” she said. Jack Scarola, representing Mr. Jiménez’s guardian, said that he empathized with the hospital’s “significant economic burden” but said that it was the “quid pro quo” of accepting Medicare and Medicaid funds to help finance the hospital’s services. (About 45 percent of Martin Memorial’s net operating revenues came from Medicare and Medicaid last year, based on state data.) Also,” he continued, “they chose the wrong way to deal with it. The right way would have been through the Legislature. There is no program in place to appropriately distribute care to undocumented persons who are catastrophically injured, and there should be. But you don’t stick a brain-injured immigrant on a private plane and spirit him out of the country in the predawn hours.” Weighing Quality of Life The journey to Jolomcú is an arduous one, as Mr. Jiménez’s new legal team discovered when several members — a lawyer, a paralegal, a priest and a bioethicist — first traveled there to meet him. After a five-hour drive north from Guatemala City to Huehuetenango and then a winding trip, filled with hairpin turns on cliff-hugging roads up and over the Cuchumatán Mountains, they arrived at the provincial city of Soloma. From there, the road to Mr. Jiménez’s hamlet only goes so far, and the trip must be completed on foot, up and down a rutted dirt path through goat-strewn meadows. The Americans arrived at the top panting. There, awaiting them, in an idyllically situated one-room brick house, was Mr. Jiménez, a broad grin lighting up his face. “The first striking thing was his disposition: He was very, very happy,” said the Rev. Frank O’Loughlin, who pastored migrant workers in South Florida for decades. “Then, the second thing, he was well cared for. What I did was I got down over him and hugged him but also smelled. And there were no bedsores. Nothing was malodorous.” As they drove back to Huehuetenango, Marnie R. Poncy, a nurse-lawyer who runs a bioethics law project in Palm Beach County, offered her view: “I said, ‘His quality of life is better than it would be in an American nursing home.’ ” “But I hazarded a guess that his longevity of existence was probably severely curtailed,” she said. Still, the team reached a conclusion that surprised them: “There was no real compelling reason to think of bringing him back to Florida,” Father O’Loughlin said. “We needed to focus on getting help to him or him to help in Guatemala.” Help has been slow in arriving. When The Times took the trek to visit him in late June, Mr. Jiménez had not budged from his hilltop home since returning there and no medical professional had visited him, either. With his mother too frail to move him into his wheelchair, his life had shrunken to the confines of his bed, across from his mother’s. During the visit, Mr. Jiménez, wearing a nubby Adidas hat and a ski jacket, sat wrapped in a Guatemalan blanket; his mother, who wore a traditional woven skirt, with a floral scarf braided through her long gray hair, stood by his side. She patted his head; he reached out to pick lint from her sweater. A few days prior, he had suffered a particularly violent seizure. “He was almost dead,” his mother, Mrs. Gervacio, said in Kanjobal, which was translated into Spanish by a school principal serving as interpreter. “For many years, I am caring for him like he is a baby, changing his diaper, washing him. But this is worse. I am worried to leave him alone at all.” She is right to worry, said physicians consulted for this article. Patients suffering seizure disorders run the risk of injuring themselves — and of increasing their brain damage. Still, Mrs. Gervacio does leave from time to time, she said, to go to Mass, shutting the door behind her and hoping for the best. “It scares me a lot when you leave, Mama!” Mr. Jiménez blurted out, revealing that he was intently following the conversation that at first took place as if he were not there. Given that Mr. Jiménez’s mother’s health is failing, the family worries about the future, too. And Mr. Jiménez shares their concern. “The day my mother is no longer, what’s going to happen to me?” he said. “This is what I have on my mind.” Mr. Jiménez, whose memory is patchy, said he remembered nothing about his time in the United States — not Indiantown, not his job as a gardener, not the accident and not the hospital. He does, remember the dreams that propelled his migration, and he expressed them eloquently: “I headed north like a peasant with a heavy bundle on his back, bent over, determined to better himself,” he said. “Other people had things so I thought, ‘Why not me?’ But now I regret it. Maybe God was punishing me for my illusions.”