October 12, 2008
For Immigrants, Checking to See if the Doctor Is In
By JOE BERGER
GREENWICH, Conn.

TWO years ago, Dr. Katrina S. Firlik, a neurosurgeon at Greenwich Hospital, was called in on a case she had never seen before — certainly not in moneyed Greenwich.

A 25-year-old landscaping worker who had slipped into the United States illegally just three months before had been admitted with an excruciating headache. It turned out to be a symptom of a strain of tuberculosis meningitis, which Dr. Firlik said was rarely seen in the United States. Within weeks, the disease, resistant to antibiotics, had invaded his spinal fluid, creating an inflammatory mass that stretched from his neck to his lower back and was compressing his spinal cord. The man could no longer stand and was losing bladder control.

Dr. Firlik spent much of a Sunday digging out the mass, and the patient was hospitalized for another six weeks until the infection disappeared, finally leaving in a wheelchair, though he did eventually walk. The bill for his hospitalization alone totaled $200,000, some of which would have been covered by a limited provision for emergency care under the federal Medicaid program, but certainly not all. And Dr. Firlik said that she and other doctors who treated him essentially did so free.

Although the case was unusual in its costs, Greenwich Hospital, like many other hospitals in the New York area, is increasingly finding itself providing uncompensated medical care to poor, uninsured and often illegal immigrants.

The number of illegal immigrants seeking emergency care at Greenwich has sharply increased since 2005 after the closing of United Hospital in the nearby Village of Port Chester, a community across the border in New York that has a high proportion of poor and working-class immigrants. In the year after United’s closing, Greenwich’s maternity load soared to 2,300 from 1,400.

Hospitals across New York State, New Jersey and Connecticut all report struggling with the costs of delivering emergency care and sometimes more to illegal immigrants and other uninsured patients, and many see it as their obligation.

“We take care of a lot of immigrants here and we’re proud of it because these people are going to be the future of our country,â€