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Uncompensated Care Cripples Hospitals
By Lisa Finn

By Lisa Finn

One night last year, a young man riding a bicycle cut across New York State Route 25 in Laurel and headed straight into the path of an oncoming vehicle. The driver of the car swerved, and the cyclist landed in the road, shoes scattered beside him. When asked if he needed help, the man shook his head vehemently and answered in Spanish. Then, he limped back to his battered bike and sped off without his shoes.

The police officer writing up the incident said many undocumented workers in such situations flee to avoid discovery.

But, broken and bleeding, some may be forced to seek help at area emergency rooms. The issue of uncompensated emergency care for illegal immigrants is one the nation is facing, as escalating costs cripple hospitals. Many financially strapped emergency rooms have been forced to shut down.

In 2005, the cost of those uncompensated services spiraled over $1 billion nationally. To that end, the federal government allocated $1 billion toward uncompensated health care in six states; New York was designated to receive $12.3 million.

Under the Emergency Medical Treatment and Labor Act, hospitals that maintain an emergency department must provide emergency medical services to anyone, regardless of ability to pay. And, even with federal aid, East End hospitals are struggling to carry the burden.

The impact of immigration on public health policy has taken an enormous toll. Even for legal immigrants, the cost is steep. According to a June, 2005 report by the Employee Benefit Research Institute, more than 11 million immigrants were uninsured in 2003. From 1998-2003, immigrants accounted for 86% of the growth in the uninsured, largely because of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which imposed a five-year ban on participation in health and other public programs by newly arrived legal immigrants.

In addition to the pricetag of health care, there are other costs imposed by illegal immigrants: According to the Federation for American Immigration Reform, because they undergo no medical screening before entering the country, illegal immigrants have sparked a resurgence of contagious diseases, such as tuberculosis.

Nora Perry, president of the Southampton Hospital Foundation, said the crisis “is one that’s very difficult to document.” But the uninsured do cause financial repercussions. In 2005, she said, Southampton Hospital tallied $6 million in uncompensated care.

“One of the big difficulties in dealing with this community of individuals is because they are fearful. Many of them don’t have primary care physicians,” she said. “They end up using emergency rooms almost as a primary care provider and become more ill than other people because they let it go for so long.”

Nancy Uzo, vice president of Foundation External Affairs at Peconic Bay Medical Center said the hospital “does about $5 million in charity care a year.” That number, she said, represents 6% of the hospital’s $80 million budget.

Uzo said the number has been consistent. Information on the hospital’s financial aid program can be found on its website. Patients can apply for assistance if they do not qualify for Medicaid. “It’s a payment plan,” she said. “We try to work with people.”

When talking about charity care, said Uzo, it’s important to remember that hospitals “don’t make a lot of money to start with.” HMOs are public companies with investors and stock, and negotiate with hospitals for discounts. Often hospitals might have to “fight for six months or more to get paid a discounted rate for the care.”

The hospital’s operating margins, said Uzo, “are usually 1% or less. Which means if we have revenues of $80 million, we’re lucky if we make half a million in net revenue in any given year. When you’ve got a $5 million charity care bill going out the door, you can see how it really cuts it close many years. This is true for most hospitals in New York State.”

Uzo said thankfully, because the hospital is not for profit, it can accept donations, which enables it to build programs.

“The charity care, while we understand it’s part of our mission, it is a burden on the hospital,” she said.

Paul J. Connor III, president and CEO of Eastern Long Island Hospital in Greenport, said despite increased numbers of immigrants in the area, he couldn’t attest that there has been any correlating financial impact. Connor did say that ELIH has shouldered debt because of uncompensated care, to the tune of $1.5 million. He reasoned that ELIH is not as affected as other hospitals, because it has no maternity ward.

Lack of primary care, agreed Connor, is a crucial issue. In fact the Suffolk County Department of Health did have a primary care facility operating out of ELIH, but the clinic, which he said “didn’t have large volumes” of patients, closed due to budget cuts.

Other county clinics, or East End Health Centers, still operate in Riverhead, Southampton, and East Hampton.

Many private physicians, said Connor, don’t accept Medicaid because they are paid such a small amount per visit. “It’s a failure of the system. There should be some sort of process, on a human level, to recognize the problem and address it on a primary care basis.”

Sister Margaret Smyth of the North Fork Spanish Apostolate in Riverhead agreed that statistics are scant, but she is constantly helping the uninsured work out payment plans.

Undocumented immigrants, she said, will usually only head to a hospital for serious illnesses. Fear of hospitals is ingrained in cultural upbringing. “Back home, nobody’s got money for the hospital,” she said.

Smyth said she is working toward answers: “We’re trying to develop good primary care so we can keep them away from the hospital.” To that end, Smyth is working with North Shore Hospital to have a mobile health van come out to the East End on Sundays, twice a month to start. The van will be available to the entire population and will travel to places across the East End such as St. John the Evangelist Roman Catholic Church in Riverhead, where Latinos congregate.

Just last Wednesday, Smyth said she oversaw TB testing for immigrants at St. John’s. “We want to discover things before they become critical,” she said.

Mary Ella Reutershan, a Greenport resident, who worked for years as a volunteer at the Riverhead Clinic, said the problem is a shortage of nurses. “There’s no affordable housing out here,” she said.

East End legislators agree. Last week, Legislators Edward Romaine and Jay Schneiderman announced a joint initiative to create The East End Health Care Task Force, designed to address issues East End residents have faced due to compromised delivery of health services. “No longer will these residents be denied proper services because they live too far,” said Romaine.

Currently, the county’s Department of Health Services employs 21 public health nurses, yet only three work out of the Riverhead office and are responsible for delivering health care to the entire East End, including both North and South Forks, Shelter Island, and the entire area east of William Floyd Parkway.

Perry said the fear experienced by immigrants is hard to grasp. “It’s very difficult,” she said. “Very sad.”