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USC Immigration

The United States is a country of immigrants. Even so, the debate over immigration has never been so intense. After the terrorist attacks of September 11, 2001, concerns about securing borders and screening immigrants have dramatically escalated. The in-depth coverage from the University of Southern California looks at how both people and policy have been impacted. The USC News21 Fellows and Faculty also wish to thank California Connected (KCET) and Christina Wu for extra footage used in our stories, Lee Warner for Editing Assistance and Scott Shulman for Camera Assistance.

Immigrants and Healthcare: Prescription for Emergency?

As overwhelmed L.A. emergency rooms disappear, anti-immigration groups have seized upon the perception that illegal immigrants are to blame. Are they right?
By Karl-Erik Stromsta, August 2, 2006

When Carol Meyer’s daughter broke her arm and had to be lugged to the emergency room, the veteran paramedic figured getting the limb reset would be a snap.

After all, as acting director of the Los Angeles County Emergency Medical Services (EMS) Agency – not to mention a personal friend of the on-call orthopedic surgeon – she had all the right connections. More importantly, she held the golden ticket that has become a rara avis in the American healthcare system: an up-to-date insurance card.

Not good enough.

Eight hours after arriving in the helter-skelter emergency room, Meyer’s daughter finally received treatment. By then the injury had gotten so bad she qualified for a slot in the Intensive Care Unit.

“I just don’t think the public really understands how severe the problem is until you’ve actually waited in an emergency room for eight hours with an injured child, like I did,” Meyer said.

In the world of emergency healthcare – a world synonymous with heart attacks and gunshot wounds – the word “crisis” should never be applied lightly. Yet that might be the only word left to describe the state of emergency healthcare in Los Angeles, where ERs are choking on patients.

In the past decade, more than 20 Los Angeles emergency rooms have been shuttered, with more slated for the chopping block later this year. Ambulance diversion – when an ambulance is turned away because an emergency room is at capacity – has become de rigueur. Just six emergency rooms now exist for every one million California residents, the lowest ratio in the nation.

Excuses for the medical mess abound: nursing shortages; private doctors refusing new patients; a rapidly aging population. And in Los Angeles, ground zero for the immigration debate, perhaps it was inevitable that immigrants themselves would come under fire.

In recent years, anti-immigration groups have seized upon the perception that illegal immigrants consume scarce healthcare resources.

“People are frustrated when they go to overwhelmed ER facilities and find them full of illegal immigrants – in many cases people who don’t even speak English,” said Jack Martin, a spokesperson for the Federation for American Immigration Reform (FAIR), a group advocating tougher immigration laws.

“The quality of service suffers, and it strikes them as being unfair,” he said.

Officials estimate that illegal immigrants seeking emergency and follow-up care cost Los Angeles County $340 million in 2003 – or $1,000 per taxpayer.

But Carol Meyers said the illegal immigrant argument is overblown.

“You often hear that the illegal situation is what’s causing our ER problems, but I don’t believe it,” she said. “I think they’re a piece of it, but not a large piece.”

According to a new study conducted by the University of California and the Mexican government, illegal immigrants are just half as likely as U.S.-born whites to use emergency rooms, despite the often grueling physical conditions of their jobs.

“These people need to be receiving more medical care, not less,” said David Stout, community outreach director for the ‘Justice for Immigrants’ campaign.

Nevertheless, the presence of illegal immigrants in Los Angeles emergency rooms is undeniable, as is their inability to pay for most major procedures. Since most employers that hire them don’t provide health insurance, they often avoid medical treatment until an illness or an injury has become acute, at which point they are left with few other choices.

As a result, emergency rooms are often overrun with illegal immigrants and others lacking health insurance. More problematically, they come in with a variety of non-emergency ailments, including headaches, throat infections, mental disorders and HIV – ailments that could be treated at primary-care clinics with less cost to taxpayers.

Under the Emergency Medical Treatment and Labor Act of 1986, all emergency rooms that accept federal money are required to offer care to everyone, regardless of their immigration status or ability to square the bill. Unfortunately, the EMTALA remains an unfunded federal mandate, meaning hospitals receive no repayment from the government no matter how deeply into their own pockets they must dig.

“Why put the burden on doctors?” asked Carl Coen, president of the Eisner Pediatric and Family Medical Center in downtown Los Angeles. More than 90 percent of the Eisner clinic’s patients are Hispanic, and more than half speak only Spanish.

“(We) need to deal with closing the borders, but once people are here our mission is to take care of the community and take care of people.”

Carol Meyers said the current economic grippe plaguing hospitals and clinics is unsustainable.

“It’s important for a community to know that its ER never closes its doors,” she said. “But if you don’t pay your light bill, the lights are shut off. If you don’t pay your phone bill, your telephone is shut off. And if we don’t reimburse our hospitals and doctors, they’re not going to be there for us.”

One frightening result of overstretched emergency rooms is the potential for a natural disaster or a terrorist attack to completely overwhelm area hospitals.

“Our hospitals need to have a surge capacity during disasters,” Meyer said. “But when you’re busy every night of the week, maintaining surge capacity becomes difficult. We are really going to be in trouble in a major disaster with numerous injuries, or a pandemic flu.”

David Stout of Justice for Immigrants said that blaming illegal immigrants for the ills of the healthcare system misses the real source of the problem: the skyrocketing cost of health insurance.

“Most of the time anti-immigration groups are just using scare tactics, trying to hijack the healthcare issue,” Stout said. “Many normal Americans are using emergency rooms like doctors’ offices too.”

Carol Meyer said the bottom line is that everyone living in the United States needs access to healthcare – even if it means an eight-hour wait to get a broken arm fixed.

“We have a lot on our plates as a society – our streets, crime, business problems,” she said. “But one thing we all have in common is the need to be healthy and have our lives. We have nothing without our lives.”

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