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  1. #1
    Senior Member AlturaCt's Avatar
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    Silver Spring(Wash DC) Hospital Struggles to Serve

    This is not news to border states. However this is happening all across the country now.


    Immigrants Swell Uninsured Ranks At Holy Cross

    Some weeks it seems as if the whole world, with its many troubles, has walked through the doors of Holy Cross Hospital.

    Daily, the second-floor women's clinic fills to overflowing with patients from countries in Central America, Africa and Asia. Some have never had care during previous pregnancies -- and never had a child born alive. "We ask, 'Do you know why?' " says director Nancy Nagel. "And they say, 'I just lost the baby.' "

    Elsewhere, from the emergency room to the primary medicine clinic, doctors and nurses confront conditions and diseases they did not see a decade ago -- malaria, infectious diarrhea, parasites such as tapeworm. Even many common ailments can be more challenging, because they often require translation from a panoply of foreign tongues and cultures.

    Serving the underserved is integral to Holy Cross's mission, and the Silver Spring hospital has long shouldered much of the care for poor, uninsured residents of Montgomery County. But as that population has expanded rapidly with the continued arrival of immigrants, legal and illegal, it has become a much more difficult and expensive proposition.

    And now a generous mission is reaching its limit. After yet another sharp increase in the prenatal program it runs for the county, Holy Cross has drawn a line. Starting today, for the first time since it opened in 1963, Maryland's biggest community hospital will restrict how many uninsured obstetrics patients it will accept."It has taxed the system enormously," said physician Imad Mufarrij, a native of Lebanon who can converse with patients in five languages.

    Barely half an hour from the congressional chambers where the nation's immigration policies have been rancorously debated, there is little dissent over what is right to do. It is why Holy Cross opened its primary health clinic two years ago, agreeing to cover what in 2005 was a $460,000 operating deficit. And why it spends almost half a million dollars annually on interpretation services and ethnic-specific programs for patients and Spanish classes for employees.

    From 2000 to 2005, the cost of the institution's yearly charity care more than doubled to $9 million; the care is significantly but not entirely for immigrants. A third of the total now goes to the low-income women, a veritable United Nations, who are seen through Holy Cross's Maternity Partnership with the county.

    President and chief executive Kevin Sexton has no qualms: "As much as I am interested in public policy and public issues, I basically suspend that at the door of a health care facility and believe that everyone needs care."

    The pressures on Holy Cross mirror those at other facilities in the region, though they fall far short of the intense demands that providers face in towns and cities along the U.S.-Mexican border. Washington Hospital Center regularly translates documents and physician-patient communication into nearly a dozen languages, including Turkish and Tagolog. Inova Health Systems estimates that it spends at least $10 million on such services, outreach programs and charity care for uninsured immigrants in Northern Virginia. In Fairfax County, more than one in seven births are to immigrants, according to one estimate.

    Critics cite the burden they say newly arrived immigrants place on health care as one rationale for restricting their numbers. Last year, the federal government set aside $1 billion to cover emergency room care for illegal immigrants through 2009. The full medical bill to U.S. hospitals, clinics and taxpayers probably exceeds $6 billion annually, calculates Steven Camarota of the Center for Immigration Studies, a research group that seeks "fewer immigrants but a warmer welcome for those admitted."

    Still, Camarota thinks proposals to deny access to treatment misdirect the debate. "Either you select immigrants who are self-sufficient and don't need help from the government, or you shut up about the cost," he said. "There's no middle ground."

    The head of Holy Cross's primary care clinic agrees with the latter point. At her clinic, the uninsured patients are not asked how long they have been in the United States or whether they came lawfully.

    "The fact is," director Elise Riley said, "people are here. They're going to end up on our doorstep one way or another."

    A morning spent in the busy maternity clinic is an experience in multiculturalism and multilingualism -- and their possible complications. Many mornings, 60 or more women are seen. The phone at the front desk rings nonstop for inquiries and appointments.

    "Sir, I cannot understand you," Melina Martinez tells an Asian caller with limited English. "Did your wife have a C-section? If her C-section looks okay, she doesn't have to come back for two weeks."

    There is a pause while Martinez tries to grasp the man's response. "Does she have staples in? Staples, like you use for paper." At this point, the health unit coordinator is earnestly making stapling motions in the air. "You have to check, sir. Check her incision. Check her belly."

    At the front desk, a patient from Cameroon schedules her next gynecology visit. A Salvadoran woman waits. She needs to monitor her blood-sugar levels for gestational diabetes but seems confused on the instructions she has been given.

    "Escribo?" a nurse asks, offering to write them down in Spanish.

    Some patients have had so little education in their homelands that the staff may teach them reading along with prenatal nutrition, occasionally receiving handmade tortillas or tamales as thank-you gifts. In fact, illiteracy was a factor taken into consideration when Holy Cross redesigned the clinic as part of a facility-wide expansion and renovation. Women now have their blood drawn as they come in, rather than being sent to a lab elsewhere in the hospital. Before, bilingual signs directed them down corridors, but many Central American immigrants had gotten lost because they could read neither English nor Spanish.

    The clinic's success with its patients is measurable. Despite their socioeconomics, Holy Cross's percentage of low-birth-weight infants is half the state average, contributing to healthier starts in life.

    Early in the venture with the county, Holy Cross officials committed to caring annually for 1,200 uninsured obstetrical patients sent by the county health department. Within two years, that cap was reached and exceeded. By fiscal 2005, admissions were 1,802.

    Then last fall, Gov. Robert L. Ehrlich Jr. (R) barred several thousand legal immigrants from receiving state Medicaid, and the clinic's numbers surged again -- to 2,131 women by this spring. Projections only indicated further increases.

    Too much, hospital officials decided. They set a future limit of 1,500. The partnership had never been intended to include only one hospital, they reminded the county, yet theirs was the sole institution that had stepped up. As a consequence, Holy Cross's share of deliveries to low-income women had soared, to 65 percent of the county Medicaid total, from less than half five years earlier.

    "Holy Cross has been bearing the brunt of that," agreed Montgomery Health Officer Ulder Tillman. "They've really become overwhelmed."

    The stress is felt on the hospital floors where handsome art decorates the hallways and newborns spend their first day or so. Despite the recently completed expansion, the most significant in the facility's history, the 21 new labor and delivery rooms and 68 private maternity suites are always occupied -- and intermittently overbooked, given the nearly 8,900 births a year, 24 a day.

    No distinction is made when mothers are placed in those quiet, spacious suites. A young illegal immigrant, barely able to write her name, may be next door to a high-powered business executive. Neither would necessarily ever know.

    "It is harder in every way, including financially, to choose this course, but it's the right way," stressed Sexton, the chief executive.

    Even with the looming deadline, only late this spring did two other hospitals with major obstetrics services agree to join the partnership. Washington Adventist and Shady Grove Adventist will start accepting up to 700 uninsured women between them for care this summer.

    How quickly they and Montgomery's other hospitals will act on a different pledge is uncertain. As a group, they agreed more than a year ago to open three additional primary care clinics to assist the Holy Cross primary clinic, which expects to double patient visits to 10,000 by 2010. "In terms of following through," Tillman conceded, "it is painfully slow." Little has moved forward to date.

    "We need more people in the trenches," obstetrician Mufarrij said simply during a rare break in delivering babies one afternoon. He was a prime proponent of the maternity collaboration with the county and remains so despite the fiscal and physical demands it has meant for facility and staff alike. The previous night, his colleagues had done seven Caesarean sections in the midst of other arrivals. Mufarrij's own record is 14 deliveries in a 24-hour shift.

    But as a doctor, he sees no other way. "Once these patients are here, you have only two options," he said. "Neglect them or give them quality care."


    http://www.washingtonpost.com/wp-dyn/co ... 01871.html[/quote]
    [b]Civilizations die from suicide, not by murder.
    - Arnold J. Toynbee

  2. #2
    Senior Member crazybird's Avatar
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    Many hospitals are going to be forced to go to "for profit" and it's going to destroy what is left for our citizens who can't afford alot of care. It's going to be pick between a child or an elderly person. It bothers me because an illegal can come in time and time again and get care have more babies and they get care ....but that heartattack could be that elderly persons first ,and maybe last visit.
    Join our efforts to Secure America's Borders and End Illegal Immigration by Joining ALIPAC's E-Mail Alerts network (CLICK HERE)

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    And yet article after article will try to say that illegals contribute enough to cover their costs.

    Common sense alone without even looking at facts and figures would tell you that is not the case. How can people not see that this country will collapse with the weight of illegals and that is just financially, not taking into account the toll it is taking on society.

  4. #4
    MW
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    Senior Member MW's Avatar
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    Last year, the federal government set aside $1 billion to cover emergency room care for illegal immigrants through 2009.
    I don't know about the rest of you, but I'm getting sick and tired of the government subsidizing illegal immigrants with our tax dollars! Futhermore, I've yet to figure out whom, between the illegals and the federal government, is the biggest criminal. The government aids them, as evidenced above, they encourage them, and in some cases even harbor them. I could probably provide a page of things our government does to encourage illegal immigrant activity, but I'll shut up for now.

    "The only thing necessary for the triumph of evil is for good men to do nothing" ** Edmund Burke**

    Support our FIGHT AGAINST illegal immigration & Amnesty by joining our E-mail Alerts athttps://eepurl.com/cktGTn

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    I don't know about the rest of you, but I'm getting sick and tired of the government subsidizing illegal immigrants with our tax dollars! Futhermore, I've yet to figure out whom, between the illegals and the federal government, is the biggest criminal. The government aids them, as evidenced above, they encourage them, and in some cases even harbor them. I could probably provide a page of things our government does to encourage illegal immigrant activity, but I'll shut up for now.
    Very sick and tired of the double standards. As for who's the biggest criminial, I'm pretty sure I could sum it up for ya but probably better to keep my ... fingers shut.

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