Thread: Parkland will treat all moms-to-be

Parkland will treat all moms-to-be

http://www.dallasnews.com/sharedcont...s.d9b9669.html
Note! There is a video, for this article, on the Dallas Morning News Website, which I have not watched.

01:32 AM CDT on Monday, June 12, 2006
By SHERRY JACOBSON / The Dallas Morning News
LARA SOLT/DMN

Patients like Maribel Angon (right), with Elizabeth Estrada, 6 months, and Maria Govea, with Joe Morales, 7 months, cram into the Vickery Health Center for medical attention. Maria Gamez whimpered quietly and admitted feeling "a small pain" two hours into hard labor at Parkland Memorial Hospital. But she did not want a spinal infusion of painkiller, called an epidural, to make her discomfort disappear.

"Hispanic women are just wonderful; they birth wonderfully," Tori Agustsdottir, the nurse-midwife, confided as she stepped out of the room. "The perception of pain is very cultural. These women don't want epidurals. But American women are quick to take the medication."

Ms. Gamez is typical of Parkland's current generation of maternity patients. She is Hispanic and an immigrant and had nowhere else to go when she became pregnant last year.

Since Parkland opened in 1895, it has served Dallas' indigent population, which often includes uninsured minority and immigrant residents.

A recent patient survey indicated that 70 percent of the women who gave birth at Parkland in the first three months of 2006 were illegal immigrants, hospital officials said.

These Hispanic women had been having their babies at Parkland without much attention until the recent debate over illegal immigration. Critics have questioned the ease with which illegal immigrants are delivering their babies at U.S. hospitals – at taxpayers' expense.

Parents, doctors fight for space in neonatal nurseries
Parkland "is supposed to be taking care of those people who are citizens of the United States and who are living there legally," said U.S. Rep. Michael Burgess, who toured the Dallas hospital recently and noted the high percentage of "first-generation Americans" among its newborns.

At Parkland, birthing babies has become a moneymaking venture.

In 2004, the hospital spent $70.7 million delivering 15,938 babies but ended the year with a $7.9 million surplus in obstetrics.

The positive bottom line resulted from a hefty infusion of Medicaid funds, about $34.5 million, to cover the delivery costs for the undocumented women. Dallas County taxpayers also kicked in $31.3 million, or about 40 percent of the total obstetrics costs, and the federal government paid an additional $9.5 million to make up for the hospital's high percentage of patients on Medicaid, the state-federal insurance program for the poor.

From Parkland's view, these Hispanic women are but the latest wave of low-income, uninsured patients served by the charity hospital. The emerging immigration debate presents a major dilemma for the hospital's professional staff, which staunchly defends its commitment to caring for such needy residents.

"We were tasked with taking care of the indigent sick of Dallas County ... that included the immigrant population, both legal and illegal," said Dr. Ron Anderson, Parkland's president and chief executive officer, who notes that all immigrants pay Parkland's property taxes as homeowners or as part of their rent.

While Parkland's tax rate has not increased in the last six years, Dr. Burgess, a Flower Mound Republican who trained as an obstetrician at Parkland in the 1970s, warned that "your property taxes are sky-high because you're paying for people who don't have medical insurance."

Still, the congressman doesn't expect the hospital to turn away illegal immigrants who are pregnant.

Guaranteed care

The average patient in Parkland's maternity wards is a 25-year-old, married, Hispanic woman giving birth to her second child, according to a recent hospital analysis. Another Parkland survey suggested that she also is an illegal immigrant.

Under a 1986 federal law, called the Emergency Medical Treatment and Active Labor Act, pregnant women cannot be turned away by a hospital if they are in need of emergency help, such as being in labor. Hospitals that deny care to such patients face a $50,000 fine and termination from the Medicare program.

But Parkland takes it a step further by offering these women prenatal care, which improves their chances of delivering healthy babies and at a lower cost to the hospital.

"Doctors and nurses are in the healing business and not the immigration business," Dr. Anderson said. "You're left with a human being in front of you who's going to deliver a baby and who needs your help."

In recent years, Parkland has placed a premium on qualifying such patients for special Medicaid coverage. Around the 37th week of a 40-week pregnancy, uninsured patients must share their identification papers with Parkland counselors, said Bethanne Keating, the hospital's financial counseling manager.

But the hospital staff stops short of asking the women whether they are illegal immigrants. In fact, the patients are assured that none of their documents will be shared with immigration officials.

Many Parkland patients have acknowledged that they came to Dallas from Mexico or other parts of Latin America, hospital officials said. Some of the patients offer foreign passports and expired tourist visas as proof of those journeys. Others describe how they walked across the border and ended up in Dallas County.

"They know that they're illegal, but we never use that word or the word undocumented," Ms. Keating said. "Some come as refugees and are eligible for other types of benefits."

Parkland's annual birth rate, which has hovered around 16,000 in recent years, could go up or down depending on the outcome of the immigration fight.

If young immigrants flock to the U.S. before the border security improves, the hospital's birth rate could increase. If immigrants stopped moving to Dallas or were forced to leave, Parkland's birth numbers probably would go down.

"We can't predict what will happen, but so far, there's been no effect on the number of patients we're seeing," said John Gates, the hospital's chief financial officer.

Lining up for help

Newly pregnant women – most of them Hispanic – continue to show up daily at the hospital's nine prenatal clinics throughout Dallas County.

On a recent morning at the Vickery Health Center in northeast Dallas, a steady stream of women, most of them noticeably pregnant, moved through a crowded waiting room. Two babies were crying as their mothers tried to keep track of the other children who were brought along for the visit. Every chair in the room was filled by 10 a.m.

The bustling operation sits in the heart of the low-income Vickery Meadow community, where immigrant and refugee families have crowded into small, rundown apartments. Outside the clinic, a group of day laborers stood under a light post, waiting for rides to their temporary jobs.

Gloria Corona, 31, was back at the prenatal clinic for the first time in four years, convinced that she was pregnant with her third child but wanting to find out for sure. Her boys, 4 and 5 years old, were born at Parkland.

Speaking through a translator, Mrs. Corona expressed gratitude for the Parkland staff having taught her to stay away from alcohol, to eat vegetables and fruits and to drink lots of water during her pregnancies.

She also was grateful that Parkland charged her nothing for the first two deliveries. In her native Mexico, she would have had to pay $200 for a hospital delivery, the equivalent of four to six weeks' pay there, because she had no health insurance, she said.

A cheaper alternative in Mexico would have been a birthing center, which uses less-skilled staff but still costs about $50.

"The care they give here is a lot more personal for me and the baby," said the immaculately dressed woman.

As its patient load has increased, however, Parkland's free maternity care has effectively ended, Mrs. Corona said. The hospital has begun asking all women to pay something toward their bills – at least $10 per prenatal visit and an additional $100 toward the eventual delivery costs.

Mrs. Corona said she wanted to pay something but the amount would depend on whether her husband was working. "I want to pay for the baby," she said, "because they give me the good care here."

The women who rely on the Vickery Prenatal Clinic are mainly Hispanic, although there are black women and the occasional Eastern European refugee. Of the eight patients interviewed randomly that day, three were from Collin County, which does not have a tax-supported hospital to provide obstetrics care.

Back at home, several women were more willing to tell their stories about how they ended up at Parkland.

Far from home

In Richardson, Yolanda Perez shares a spotless three-bedroom apartment, decorated with stuffed bears, with her husband, their two young daughters and her husband's sister.

The adults came to Dallas almost three years ago, she said, after paying a guide $1,700 apiece to smuggle them into the U.S. They crossed the border into Arizona and were driven to Dallas, where they hoped to find jobs that would give them a better life.

Ms. Perez worked for a year as a maid at a Frisco hotel until her pregnancy got in the way. Her husband found construction jobs, although the couple sometimes has had to borrow from friends and family to pay the monthly $850 rent.

But her experience at Parkland has been good, she said.

"They treated me well," she said, following the recent birth of her second daughter, Lizbeth. "They were nice. They gave me everything I asked for."

Things have worked out well for the family in Dallas, she added. Her husband has found better jobs than he could in Mexico, where he mainly cleared land and wasn't earning enough to feed a family.

Her only problem, she said, crying softly, was the heartbreak of living so far from her family. While she appreciated that she and her husband could afford more things by coming to the U.S., they cannot go home to Mexico and visit relatives. Their children will not know their grandparents, aunts and uncles south of the border.

"It seems much better here," Ms. Perez conceded, with a forced smile. "In Mexico, you don't know any better."

'Better here'

Beatriz Aviles, 20, told a more complicated story about her travel from Mexico to Dallas, where she shares a large apartment with her boyfriend's extended family.

She met Cesar Chamu in Mexico more than two years ago, and he brought her to Dallas, where he had been doing landscape work since 2000. They paid a "coyote," or guide, $3,000 to get them across the Rio Grande by boat.

Although her advanced pregnancy made her unsteady on her feet, the young woman said she has tried to care for the two children who live in the large apartment and helped cook meals under the watchful eye of Mr. Chamu's mother and elderly aunt.

"Dallas is nice," she said, although it was not clear how often Ms. Aviles was able to leave the apartment. She hasn't worked since she arrived in Texas in 2004.

Her pregnancy was uncomplicated but a bit frightening, she admitted. She was prone to waking her boyfriend in the middle of the night to complain about the kicking baby.

She ended up at Parkland because the couple had no health insurance and could not afford to go elsewhere. His landscaping job pays about $200 a week, just enough to cover basic living expenses and the couple's share of the $700-a-month rent.

Although they went to great lengths to sneak into Dallas, Ms. Aviles was born at Parkland in 1986, according to the birth certificate she recently obtained.

She is a U.S. citizen but could not prove it until she crossed the border from Mexico, where her mother had taken her shortly after her birth in the Dallas hospital. Her grandmother raised her.

On March 7, her daughter, Esmeralda, was born at Parkland after 10 hours of labor. The couple paid $100 toward the cost of the birth and was given a car seat for the ride home.

Their plans for the future include marriage, more babies and, hopefully, U.S. citizenship for Mr. Chamu, who wants to open his own landscaping business.

"My life is better here," Ms. Aviles said as she juggled the baby in her arms.

Staff writers Emily Ramshaw and Margarita Martín-Hidalgo contributed to this story.

E-mail sjacobson@dallasnews.com


Parkland's obstetrics costs in 2004

Patients 18,351
Days hospitalized 55,964
Total cost $70,715,271
PAYMENTS
Medicaid $34,476,973
Dallas County taxes $31,339,519
Additional federal funds $9,514,523
Other revenue $2,086,130
Commercial insurance $823,608
Parkland employee health coverage $348,040
Self-pay $141,408
Tobacco funds $104,059
Medicare $90,444
Losses due to payment delays $235,217
Surplus funds $7,982,138
Hospital's total budget $802,106,000
County taxpayers' contribution $322,109,000

SOURCE: Parkland Health and Hospital System



There is a companion discussion about the first article in this series at
http://www.alipac.us/modules.php?nam...asc&highlight=

It would be cheaper to fly them all home and let them have lil anchors in mexico. Then mexico could deal with the freeloaders.

"Hispanic women are just wonderful; they birth wonderfully," Tori Agustsdottir, the nurse-midwife, confided as she stepped out of the room. "The perception of pain is very cultural. These women don't want epidurals. But American women are quick to take the medication."

What exactly does this statement have to do with the issue of illegals getting free health care.

As its patient load has increased, however, Parkland's free maternity care has effectively ended, Mrs. Corona said. The hospital has begun asking all women to pay something toward their bills – at least $10 per prenatal visit and an additional $100 toward the eventual delivery costs.

For all of you who have not had children lately, this is a joke. I had my son 2 years ago and the hospital bill (just the hospital, not doctor fees) was over $13,000.

El Presidente Vicente Bush has turned being a jackass and an absolute unmitigated idiot into a fine art. He expresses concerns about the high cost of healthcare and it's negative impact on American's and the economy being a major contributor to the budget deficit. Yet he backs a travesty of a senate bill that would add billions to healthcare costs and further reduce the quantity and quality of healthcare for Americans as he has diverted millions of dollars from medicaid/medicare to cover illegal aliens health care. I am willing to bet all those illegal alien parasites have already complained to the ACLU, LaRaza, Mecha and all the other "we hate gringo" organizations about those maternity fees. The government will direct the hospital to stop the practice and will tell the American taxpayer to bend over and take it even more as they have been doing. The lives and welfare of American citizens have absolutely no value or meaning to this administration.

On March 7, her daughter, Esmeralda, was born at Parkland after 10 hours of labor. The couple paid $100 toward the cost of the birth and was given a car seat for the ride home.

Their plans for the future include marriage, more babies and, hopefully, U.S. citizenship for Mr. Chamu, who wants to open his own landscaping business.

"My life is better here," Ms. Aviles said as she juggled the baby in her arms.

Wow! I should have gone there to have my babies. $100 is a bargin! And now Ms. Aviles wants more and more babies. Look out Parkland Hospital. Awl, more little anchor babies.