Thread: FL: It's tricky to treat many immigrants, hospitals say

It's tricky to treat many immigrants, hospitals say
By JENNIFER BOOTH REED
jreed@news-press.com
Originally posted on December 30, 2007


The boy and his parents appeared at the Family Health Centers office in Fort Myers unannounced, carrying a note from a private pediatrician:

"Please take care of this patient. He has chronic liver failure."

Dr. Jorge Quinonez, a pediatrician and Family Health Centers' medical director, works with uninsured immigrant families. Their treatment can be difficult on both ends — for them, finding doctors who will see them; for the American medical system, finding a way to manage the often uncompensated cost of their care. This was the most dramatic case Quinonez had ever seen.

Quinonez persuaded All Childrens Hospital in St. Petersburg to admit the child. When doctors there realized the extent of his illness, they sent him back. Dialysis would cost $50,000 a year, and the boy needed that, as well as immediate placement on the kidney transplant list.

Quinonez's practice doesn't offer that kind of specialized care. He told the members of the family to go home to Mexico for treatment. They did, and Quinonez has heard since the boy is doing well.

In this case, both sides achieved their aims. The boy got his medical care and the American health system avoided the cost of caring for him.

That's not typical.

Immigration poses challenges for the health care system, which often can't get compensated for cost of care. A 2003 Florida Hospital Association survey of 39 hospitals found the medical centers gave away $40.2 million in charity care for illegal immigrants. That didn't take into account the noncitizens who are here legally but who are uninsured and underemployed and are likely to land in emergency rooms.

The United States has about 36 million immigrants, a third of whom are estimated to be here illegally, according to the U.S. Census Bureau. How to pay for their medical care is part of a broader debate on immigration policy and on what to do about the country's out-of-control health care costs.

In many ways, the immigrants' stories are no different than those of uninsured citizens, who have medical doors shut on them and debt collectors chasing for impossible-to-pay medical bills when they get care. But the challenges of being a noncitizen and uninsured — and the challenges of caring for them — are even greater than they are for uninsured Americans.

Consider:

• Medicaid will pay for emergency treatment for noncitizens, but the payments stop when the condition is no longer considered an emergency — even if the patient requires prolonged hospital care. Hospitals are not permitted to bill patients for the difference. At Lee Memorial Health System, it costs about $1,700 a day to stay in the hospital. Hospital officials say they end up writing off the extended stay.

• Noncitizens are not eligible for regular Medicaid or subsidized health insurance plans for children.

• Uninsured people of all stripes end up in emergency rooms for care, but immigrants do so at higher rates, according to the Florida Hospital Association. The emergency room is the costliest way to deliver medical care, and it's also the place forbidden by federal law from turning anyone away. At Lee Memorial, the average ER visit cost is $325.

• Hospital social workers must turn into sleuths trying to track the identities of immigrant patients who come into the trauma center unconscious — a challenge if they're illegal, lacking identification and their friends and family are fearful of speaking with anyone in a perceived position of authority.

• These same social workers sometimes struggle to find follow-up care for patients, who may need home health, rehabilitation or family members to care for them after discharge from the hospital. Frequently, they come across workers who share housing with other workers, but not spouses or relatives who could offer such care.

• Immigrants are flooding delivery rooms to give birth to children, who are automatically U.S. citizens. In 2005 and 2006 alone, Lee County saw a total of about 2,100 babies born to illegal-immigrant mothers, state birth records show.

These children, in turn, often qualify for Medicaid or other subsidized health plans. The Center for Immigration Studies report found in Florida 18 percent of immigrant-headed households had at least one family member who qualified for Medicaid as opposed to 11 percent of native households.

The issue, suggested Steven Camarota, author of the Center for Immigration Studies report, is American immigration policy opens the door to undereducated, low-wage workers who will need American support ranging from Medicaid to food assistance. Forty-seven percent of immigrants are uninsured or on Medicaid compared with 26 percent for native born.

"The problem here for Florida and the country mainly stems from the education level," Camarota said.

His solution: Either change the policy and admit better-educated, self-sufficient people or accept the fact these newcomers need social supports.

But until that happens, both sides continue to struggle.

"The majority of these families cannot afford to go to the dentist and even the doctor," said Rae Nicely, the executive director of Lehigh Community Services.

She sends them to the few places she knows will see them — Family Health Centers, the Salvation Army, the Health Department.

But the services aren't enough, especially for those families who don't have transportation.

"It's a real issue," she said.

www.news-press.com

The issue, suggested Steven Camarota, author of the Center for Immigration Studies report, is American immigration policy opens the door to undereducated, low-wage workers who will need American support ranging from Medicaid to food assistance. Forty-seven percent of immigrants are uninsured or on Medicaid compared with 26 percent for native born.

"The problem here for Florida and the country mainly stems from the education level," Camarota said.

His solution: Either change the policy and admit better-educated, self-sufficient people or accept the fact these newcomers need social supports.

DING! DING! DING! We have a winner!! This is exactly WHY Americans are fed up with illegal aliens. Our legal immigration policy should be to admit SELF-SUPPORTING immigrants, not uneducated illiterates who are not capable of supporting themselves and their many children!

We do NOT accept newcomers who need social supports aka illegal aliens!

His solution: Either change the policy and admit better-educated, self-sufficient people or accept the fact these newcomers need social supports.

Not to be sour grapes--but can you really trust anyone these days to be reputable? We already have a lot of educated people coming in from other countries--legally and illegally--and my hunch is that many of them will jump on the gravy train, too, if at all possible. There are some in this category who are holding down legitimate jobs and covered by a group health plan. There are also unscrupulous entrepreneurs, shysters and con artists in this category who secretly view the US as ripe for the taking.

Please take care of this patient. He has chronic liver failure."

Dr. Jorge Quinonez, a pediatrician and Family Health Centers' medical director, works with uninsured immigrant families. Their treatment can be difficult on both ends — for them, finding doctors who will see them; for the American medical system, finding a way to manage the often uncompensated cost of their care. This was the most dramatic case Quinonez had ever seen.

Quinonez persuaded All Childrens Hospital in St. Petersburg to admit the child. When doctors there realized the extent of his illness, they sent him back. Dialysis would cost $50,000 a year, and the boy needed that, as well as immediate placement on the kidney transplant list.

This article is incorrect in some manner--either in the diagnosis or the treatment.
Liver failure is treated with medication and/or a liver transplant--dialysis and a kidney transplant is not a treatment for liver failure.
Dialysis and/or a kidney transplant is the treatment for renal failure.

A reporter error or is the patient made up?

"The liberty of a democracy is not safe if the people tolerate the growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism - ownership of government by an individual, by a group, or any controlling private power."
Franklin D. Roosevelt

An Immigration Illness

Cure for stressed hospitals: comprehensive reform


12:00 AM CST on Sunday, December 30, 2007

The state-funded University of Texas Medical Branch in Galveston might soon have to curtail some potentially life-saving services, such as cancer treatment, because it can't cope financially with an overload of illegal-immigrant patients. Similarly at Parkland Hospital in Dallas and numerous other county-funded medical facilities, budgets are at the breaking point, largely because of demand from illegal immigrants and other uninsured patients.

The federal government is supposed to pick up much of the tab, as it should, since illegal immigration is Washington's problem. But Texas' share of federal funds for immigrants' hospital care, $47 million last year, covered only a fraction of the expenses. State and county taxpayers wind up paying the rest.

Doctors are in an increasingly precarious position. They must honor their oath to heal the sick as best they can without discrimination. Yet public hospitals are taxpayer funded, and when too much money goes to care for people with no legal right to be in this country, doctors and hospital administrators feel pressure to draw the line.

They've tried to curtail non-emergency care for illegal immigrants but have quickly faced threats from advocacy groups that they'll start sending them directly to emergency rooms, where by law no one can be turned away. Doctors are being turned into de facto immigration-enforcement agents, which clearly is not their job.

Dr. Ron Anderson, president and chief executive at Parkland, says that the costs faced by county hospitals "are catastrophic" but that it's unfair to put doctors in a position of deciding who should receive care based on immigration status. "I don't want physicians, nurses and social workers trying to sort a patient as legitimate or illegitimate. ... We need to have the policy defined at the border and at the workplace. I don't want it in my E.R."

Our diagnosis: UTMB and Parkland exhibit symptoms of chronic immigration-stress syndrome. We've already seen epidemic proportions of it in our schools. This condition develops when public services reach the breaking point due to a persistent lack of attention to immigration reform by our leadership in Washington.

Left untreated, immigration-stress syndrome can lead to severe complications, including convulsions of anger by taxpayers. Home remedies, such as those attempted in Farmers Branch and Irving, tend only to treat the symptoms.

The best medicine we've found is a big horse pill known as comprehensive immigration reform. Efforts by Congress to pass it earlier this year failed, and now the problem is spreading.

It sickens us that next year's elections will delay a comprehensive reform measure at least until 2009. But voters have an opportunity to play the doctor and should take advantage of the elections to surgically shorten the careers of politicians who fail to make a priority of immigration reform Â* all of it, from enforcing our borders and cracking down on employers who hire illegal immigrants, to establishing a guest worker program and a pathway to legalization.

The patient's health depends on it. STRESS INDICATORS


• 72 percent of Dallas' immigrants are from Mexico. The national average is 28 percent.


• 82 percent of births at Parkland Hospital are Hispanic, and 40 percent of their parents are illegal immigrants.


• Unreimbursed state Medicaid expenditures for illegal immigrants in 2000: $18.1 million; in 2005: $38.7 million. That's an increase of 114.3 percent.


SOURCES: Texas comptroller's office; data compiled by DFW International from various studies

www.dallasnews.com

the solution is easy; we need a cure for comprehensive imigration reform and that is Comprehensive Imigration Law Enforcement Reform or CILER.

"The majority of these families cannot afford to go to the dentist and even the doctor,"

But they always seem to be able to afford to have 14 kids, brand new SUVs, cell phones, iPods, color TVs, etc.

Originally Posted by reptile09

"The majority of these families cannot afford to go to the dentist and even the doctor,"

But they always seem to be able to afford to have 14 kids, brand new SUVs, cell phones, iPods, color TVs, etc.

I agree
cannot afford my foot
Ive read News story after story of free clincs and medical care all over the country
No wonder they cant afford it
Its been given to them and now they dont want that taken away !!!