Dec. 3, 2007, 11:14PM
Illegal residents turned away in Tarrant
Hospital district does what UTMB is considering


By ALEXIS GRANT
Copyright 2007 Houston Chronicle

The idea of turning away sick illegal immigrants who go to the University of Texas Medical Branch in Galveston for cancer treatment may be controversial, but the policy already is in place in at least one hospital district in Texas.

JPS Health Network in Fort Worth, Tarrant County's hospital district, has for several years told patients who live in the country illegally to find non-emergency care elsewhere. That rule also applies to U.S. citizens who live outside Tarrant County.

Galveston's hospital district may soon join those ranks when it comes to cancer care because it is unable to meet demand with limited state funds. The medical school's Cancer Patients Acceptance Committee has for months considered restricting the district's $12 million annual budget for indigent cancer patients to people who can prove they're in the country legally. A decision is expected to be made by January.

Harris County health officials say if the new policy goes into place the Harris County Hospital District, which does not use legal status as criteria for patient selection, likely will have to pick up the slack.

In Fort Worth, patients who don't have insurance or qualify for Medicaid and aren't legal residents are referred to the federally qualified health center there, said Robert Earley, senior vice president of JPS Health Network. "It's such a politically charged issue," Earley said. "As a public hospital, people are going to say you need to be certain that you're there for every single person. But yet funded by tax dollars, you run into a political issue from a base of people that are paying that say, 'Wait a second, I don't want my money used in that way.' "

Opponents of the policy point out that people who pay rent in the city contribute to the tax base because their landlord pays taxes, he said.

The hospital still provides emergency care to anyone who comes through its doors — as required by law — and their urgent care, prenatal care and school-based clinics also are available to everyone.

The district hired a consulting company earlier this year to figure out how much money they'd spend if they didn't follow that policy. Phase 2 Consulting, which is based in Austin, estimated about 107,000 illegal immigrants live in Tarrant County, and about a quarter of those would look to JPS Health Network's charity program for preventive care if that was allowed. Treating those patients would cost about $41 million a year, the group estimated.

$100 million cost
Harris County spends about $100 million annually on the care of illegal immigrants, including emergency care and childbirth, said David Lopez, president and CEO of the Harris County Hospital District.

To qualify for non-emergency care at Harris County's two hospitals, Ben Taub General and Lyndon B. Johnson General, patients who don't have insurance must show proof of income and prove they live in the county. They do not need to prove they're living here legally.

"If you start asking about citizenship, there are some individuals who have to be seen who may defer being seen by a physician because they're afraid of being deported," Lopez said.

He told the story of a young woman who visited one of the county's hospitals about a year ago and admitted she was in the U.S. illegally. The staff diagnosed her with typhus, a contagious disease that could have spread to others had she not been treated, Lopez said.


Conflicting opinions
The issue of whether to use taxpayer money to provide preventive health care to illegal immigrants has long been debated in Texas. In 2001, then-Attorney General John Cornyn issued a legal opinion that said federal law prohibited public hospitals from using tax dollars to provide non-emergency care to people lacking legal status.

But Attorney General Greg Abbott issued a very different legal opinion in 2004. It said hospitals can make their own decision about whether to use state funds for that purpose, which is why policies today differ by hospital district.

Some health officials say covering preventive care for people who can't afford it makes fiscal sense because it cuts down on emergency room visits, which often are more costly. And while hospitals have the choice to treat patients in non-emergencies, they are obligated to treat anyone who shows up in the emergency room.


Need for reform
"There's an element here where you could say in the short run (that cutting preventive services) might save some money, but in the long run I'm not sure that it would," said Steven Wallace, associate director of UCLA's Center for Health Policy Research.

Many emphasized that this is just one problem in a system most agree needs reform.

"This kind of goes hand-in-hand with the larger problem of the increased number of uninsured Americans and the strain that causes on the indigent care system," said Daniel Montez, chief executive of the Denver Harbor Clinic, a community health clinic in Houston that serves the uninsured.

http://www.chron.com/disp/story.mpl/metropolitan/5349442.html