Cover Story

Counting the costs

Immigration reform may wait, but the tab is running for border-state hospitals-and others-that must provide services to illegal immigrants

Issue: "Stealth care," Sept. 16, 2006

TUCSON - Arizona hospitals are still paying for a horrific accident last month when a white Chevy Suburban carrying 20 Mexican and Salvadoran nationals rolled several times Aug. 7 after its 20-year-old driver tried to outmaneuver U.S. Border Patrol agents. He attempted a sharp, high-speed turn to avoid spike strips on Martinez Lake Road about 30 miles north of Yuma, Ariz., in a failed attempt to drive around a border checkpoint.

Federal agents from the Yuma sector initially spotted the SUV near daybreak trying to run past the checkpoint on a dirt road. After the vehicle came to a rest, the Yuma County Sheriff's Department spokesman described the passengers as stacked like "cord wood" inside the crushed vehicle. Five passengers were pronounced dead on the scene. Six others died at hospitals, including the fetus of a pregnant 17-year-old who also died.

The crash may have been a tragic end to an ill-fated attempt to smuggle illegal immigrants. But it was only the beginning of the story for area hospitals tasked to save lives and nurse survivors back to health. All survivors were initially transported to Yuma Regional Medical Center; six were then medivaced to Banner Good Samaritan Medical Center in Phoenix. Nearly a month later, Good Samaritan was still treating three patients from the rollover plus a newborn in the hospital's neonatal ICU whom doctors delivered by Caesarean section from a female survivor.

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The costs in both tragedy and medical care are staggering. Good Samaritan spokesman Craig Fischer said final costs "are speculative" at this point but "will likely be substantial-into the hundreds of thousands of dollars for the most serious patients." The Yuma hospital said initial treatment it performed on 16 survivors did have a dollar number: $139,345.25. With the dead buried and the survivors stabilized, one question remains: Who will pay the bill? Hospitals across the country already know the answer: They will.

Despite passage of a law three years ago to compensate medical facilities that care for illegals, few are ever reimbursed. And despite agitation from pro-immigration and anti-immigration groups vowing to make reform legislation a key issue in this year's mid-term elections, congressional leaders announced last week that they will backburner immigration reform-and the mounting costs associated with a fast-growing population of illegals-until after the election.

Federal law now requires hospitals to provide emergency care to anyone who shows up in the emergency room, regardless of the patient's citizenship status or ability to pay. For migrants this means a kind of free health insurance program that leads many-of both legal and illegal status-to use emergency rooms not just for emergencies, but also for primary care.

Nobody really knows how much hospitals are paying to care for foreign nationals who show up in emergency rooms across the country. The federal government can't even be certain how many illegal immigrants are in the country, though most estimates put the number around 11 million people who either crossed into the United States illegally or who overstayed legitimate visas. Most hospitals have only recently begun to account for the cost of providing care to a foreign national population that, because of their legal status, can't get health insurance. It's an underground community, which makes recordkeeping difficult.

But the anecdotal evidence and limited studies suggest that hospitals pay many millions to care for illegals. The most comprehensive study undertaken, already six years old, found that in 2000 emergency medical care of non-payers in the 24 California, Arizona, New Mexico, and Texas counties along the Mexican border cost $190 million.

Unrecouped costs like that take a large toll. Sixty hospitals in California closed their doors from 1993 to 2003 because, according to the Journal of American Physicians and Surgeons, nearly half the hospitals' patient charges were never paid. Those hospitals that don't shut down may face cutbacks in services to paying customers or face leaving the trauma business altogether. In July 2003 Tucson's 355-bed University Medical Center (UMC) became southern Arizona's sole Level One trauma center after all other hospitals in the region dropped emergency care or closed down entirely.

"The foreign nationals-not just illegals-cost UMC about $5 million to care for [this year]," said Kevin Burns, UMC's chief financial officer. "That's cost, not what we could have charged. That's roughly five new hospital beds we could pay for in a year. That $5 million a year over a few years would pay for our needed emergency room expansion." Instead, he said, wait times at UMC have reached 10 hours, partly because of high demand and overuse of the hospital's emergency room.

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