Hospital weighs charity care for illegal immigrants

Nonemergency services for illegal immigrants debated

08:24 PM CDT on Saturday, September 15, 2007
By JEFF MOSIER / The Dallas Morning News
jmosier@dallasnews.com

A poor illegal immigrant who goes to the John Peter Smith Hospital emergency room in Fort Worth gets the same care at the same price as any other indigent resident.


COURTNEY PERRY/DMN
The Rev. Sergio Diaz is working to expand health care services available for illegal immigrants in Tarrant County. But the same person who goes to a JPS clinic for nonemergency treatment is often faced with a hefty bill. Unlike other large urban public hospital systems in Texas, JPS excludes illegal immigrants from its charity program that provides preventive healthcare.

Trying to balance politics, medicine and money, the Tarrant County Hospital Board of Managers will debate and possibly decide Tuesday whether to spend millions to provide free or low-cost nonemergency medical care to thousands of illegal immigrants.

The Rev. Sergio Diaz of Iglesia San Miguel, an Episcopal church in Fort Worth, said he has been fighting for this issue because of the damage caused by inadequate health care. He said members of his church – many of them illegal immigrants – can't get preventive health care and that some have died from complications from treatable diseases such as diabetes.

"This touches my heart because most of my people are immigrants," said Mr. Diaz, a member of Allied Communities of Tarrant. "I've seen a lot of people suffering."

Health care has become a major part of the national debate about illegal immigration, and the costs even led Dallas County officials to send bills to Mexico and other countries demanding payment for some of its expenses at Parkland Memorial Hospital.

Also Online
09/15/07: Hispanics shift hospitals' resources
The debate has also been simmering for more than a year in Tarrant County, where Allied Communities of Tarrant, a coalition of churches and social-justice activists, has pushed for the expansion of charity care. At the same time, a local conservative group favoring a crackdown on illegal immigration has been urging the board to retain the existing policy.

Dennis Killy, a member of the Tarrant Alliance for Responsible Government, said expanding cheap health care to illegal immigrants is an insult to citizens and to those who came to the United States legally. It simply rewards those who ignore federal law, he said.

"Where does it end?" Mr. Killy said. "When do we stop paying our tax money for something we're getting nothing for?"

Mr. Killy said he believes a significant majority of board members support his group's position and would not change the JPS policy. Officials with Allied Communities of Tarrant said they think it's going to be a closer vote.

Three board members, Erma C. Johnson Hadley, Dan Serna and Ronnie W. Coulson, all declined to comment on how they might vote.

"It's my obligation to leave my mind open," Mr. Serna said.

Mrs. Johnson Hadley, board chairwoman, said this is a difficult decision that generates strong opinions and mixed emotions among many people. She said she met with Sen. John Cornyn and told him that this is something that needs to be addressed in Washington.

"We feel somewhat put out that we're having to deal with a federal issue," she said.


Differing figures

People supporting a tougher stance on illegal immigration see this as a critical financial issue. They worry that a change in policy will cost taxpayers dearly.

The cost of this possible expansion, however, depends on who's adding the numbers.

The hospital district hired Phase 2 Consulting of Austin to conduct a study, which was released in July.

Estimating the number of illegal immigrants in Tarrant County at 107,000, the study calculated that expanding the charity program would cost the hospital district an additional $41.3 million right now. That number would increase to $114.4 million by 2017, according to the study.

Allied Communities of Tarrant conducted its own study in February that came to a dramatically different conclusion. Quoting 18th-century literary figure Samuel Johnson and a passage from the Bible's book of Leviticus in the introduction, the alternative study estimated the cost to be between $2 million and $4.2 million added to the hospital district's $600 million-plus budget.

Parkland officials estimated their cost for nonemergency care for illegal immigrants was $22.4 million in the past year – about halfway between the two Tarrant County estimates.

Patricia Gaffney, a member of Allied Communities of Tarrant who helped research and write the report, challenged some of the basic assumptions of the Phase 2 study. She said that study projects a 56 percent increase in Tarrant County's illegal immigrant population in the next decade even though federal reports show that illegal immigration is decreasing.

Ms. Gaffney also said the Phase 2 study overestimates the number of illegal immigrants who would use the service. Many are wary of government programs because of their immigration status, she said.

Mr. Killy said he is more likely to believe an independent, third-party report than one created by a group advocating for one side of the issue.

Dave McElwee, another member of Tarrant Alliance for Responsible Government, said that aside from the immediate cost, he also worries about the message that expanded health care would send.

"I think there ought to be programs for the indigent but not for those in the country illegally," he said. "All this does is act as a magnet for other illegals."


No extra funds now

If the board votes Tuesday to expand health care, it's not clear how quickly such a change would be implemented, JPS senior vice president Robert Earley said. He said the board and Tarrant County Commissioners have already approved the 2007-08 budget, and no funds are set aside for additional health care costs for illegal immigrants.

This is the second time this issue has come up for Tarrant County. For part of 2004, the board opened up all its programs to illegal immigrants. JPS officials were uncertain about whether a new state law allowed or mandated them to provide nonemergency charity services to illegal immigrants. Mr. Early said a ruling by the Texas attorney general and statements of intent from the sponsor clarified that the law didn't require the expansion.

At the time, JPS officials said the expanded program cost them up to $4 million for six months. Mr. Earley said the participation was probably limited three years ago because the program wasn't actively promoted by the hospital district and there were questions about how long it would last.

The board voted in August 2004 to make immigration status a factor for the JPS charity nonemergency care.

Officials with Allied Communities of Tarrant and the Texas Hospital Association also said most urban public hospitals in the state don't limit health care service because of immigration status, but neither had conducted a comprehensive study.

Dr. Ron Anderson, chief executive of Parkland Memorial Hospital, which does not exempt illegal immigrants from its charity programs, said the decision by JPS did not affect his system.

But he said that it makes sense to get all low-income residents preventive health care in neighborhood clinics. When he came to Parkland in 1982, the system had no clinics and about 182,000 emergency-room visits annually.

Since then, the system opened neighborhood clinics countywide, and the emergency-room visits fell to 145,000 even though the population has nearly doubled.

"The truth is, if you don't provide this care in the clinic, you'll provide this service in the emergency room," Dr. Anderson said.


AT WHAT PRICE?
Two studies were created this year estimating the cost of expanding nonemergency health care to illegal immigrants in the John Peter Smith Hospital system. One was created by Allied Communities of Tarrant, which supports the expansion, and the other by Phase 2 Consulting on behalf of JPS.

ACT study
Current cost $2 million to $4.2 million
Estimated number of illegal immigrants 96,800
Percentage of illegal immigrants projected to use the new service 27 percent

Phase 2 study
Current cost $41.3 million
Estimated number of illegal immigrants 107,000
Percentage of illegal immigrants projected to use the new service 7 percent

Regional Roundup Fort Worth

August 28, 2007

Woman, 32, accused
of prostituting girl, 14


A 32-year-old woman remained in custody Monday after being arrested on an accusation of prostituting a 14-year-old girl. Fort Worth police on Saturday arrested Debra Castillo on an accusation of compelling prostitution. Witness told police a woman driving a gray Toyota 4Runner and approaching men asking them if they wanted to have sex with a girl for $50. Police responded and also arrested Jorge Martinez, 32, on an accusation of sexual assault of a child. It was unclear what his relationship was between the girl and Ms. Castillo, police said. Both Ms. Castillo and Mr. Martinez [illegal alien] were transferred to the Mansfield Correctional Facility where they were each held in lieu of $10,000 bond Monday.

From staff reports

Suspects in Kaufman teen's death entered U.S. illegally

Suspects in Kaufman teen's death entered U.S. illegally

12:52 PM CDT on Friday, August 10, 2007
Associated Press

PORTLAND, Ore. – Two cousins accused of killing a Texas teenager during her visit to Oregon acknowledged entering the country illegally from Mexico, a federal Immigration and Customs Enforcement official said.

One of the men, Alejandro Rivera Gamboa, 24, went unnoticed by immigration officials even though he was arrested four times on drunken driving charges since 2000, The Oregonian newspaper reported.

He and 23-year-old Gilberto Arellano Gamboa were arrested this week in the death of 15-year-old Dani Countryman of Kaufman, Texas, whose body was found late last month in an apartment southeast of Portland.

Oregon law prohibits local police from actively searching out illegal immigrants, but the rules change when foreigners land in jail. If local authorities find reason to believe the person is deportable, they may notify Immigration and Customs Enforcement.

At the same time, immigration officials search local jails and flag inmates who may be in the country illegally.

"We can't cover every jail in the United States," said Lorie Dankers, an immigration spokeswoman, noting that her agency also relies on local law enforcement officials to notify the immigration agency when they get inmates with questionable residency status.

In Rivera Gamboa's case, immigration officials have no record of contact after arrests, according to the Clackamas County Sheriff's Office, in 2000, 2003, and twice in 2006.

After their arrests in the murder case, the cousins told a federal immigration officer they have been in the United States illegally for about six months, Dankers said. According to state records, Rivera Gamboa obtained an Oregon identification card in April 2006.

In Clackamas County, where hundreds of jail inmates are released early each month because of overcrowding, illegal immigrants could be booked and released before immigration authorities ever get a chance to speak with them. It is unclear how much time Rivera Gamboa spent in the Clackamas County Jail, but a misdemeanor charge of drunken driving likely wouldn't have kept him there long.

Lt. Mike Alexander, Clackamas County jail operations manager, said local law enforcement officials are also limited in how much they can pursue federal immigration questions.

"If (inmates) choose not to tell us, we don't have any protocols that allow us to go forward," Alexander said.

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