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Is It A Crime To Help Illegal Immigrants Get Healthcare?

According to some state legislators, the answer is yes. Lawmakers in South Carolina are pushing legislation that would “make it illegal to transport immigrants anywhere, including a hospital” reports the New York Times. Fox News Phoenix reports that in Arizona, a bill has been introduced to “require hospitals, when admitting nonemergency cases, to confirm that a person seeking care is a U.S. citizen or in the country legally. In emergency cases where the patient isn’t here legally, the hospital would be required to call immigration authorities after the treatment is done. Hospitals in non-emergency situations would also be required to contact federal immigration authorities, but they would have more apparent discretion about whether to treat illegal immigrants.”

Such ill-advised efforts by states to criminalize health care for undocumented persons has led the American College of Physicians, the nation’s second largest physician organization, to speak out against “Any law that might require physicians to share confidential information, such as citizenship status to the authorities, that was gained through the patient–physician relationship conflicts with the ethical and professional duties of physicians.” ACP made this statement in a new position paper on immigrants’ access to health care released yesterday at its annual scientific meeting in San Diego, California.

Moreover, ACP argues that, “Access to health care for immigrants is a national issue and needs to be addressed with a national policy. Individual state laws will not be adequate to address this national problem and will result in a patchwork solution.” A national policy on immigrants’ access to health care should include the following elements, says ACP:

- Taxpayers should not be required to subsidize health insurance coverage for persons who are not legal residents of the United States and people should not be prevented from paying out-of-pocket for health insurance based on immigration status.

- The same access to health coverage and government-subsidized health care for U.S.-born children of parents who lack legal residency should be the same as any other U.S. citizen.

- Acknowledgement of the public health risks associated with undocumented persons not receiving medical care because of concerns about criminal or civil prosecution or deportation.

- Immigration policy should include increased access to comprehensive primary and preventive care, and vaccinations and screening for prevalent infectious diseases. This will make better use of public health dollars by improving the health status of this population and alleviating the need for costly emergency care.

- Federal government support for safety-net health care facilities and offsets for costs of uncompensated care provided by these facilities.

- Acknowledgment that physicians and other health care professionals have an ethical and professional obligation to care for the sick. Immigration policy should not interfere with the ethical obligation to provide care for all.

- Policies that do not foster discrimination against a class or category of patients in the provision of health care.

ACP concluded with a “call to action” for a national policy that recognizes the need for the country to control whom it admits within its borders and to differentiate its treatment of those who comply with the law in establishing legal residency from those who do not, while recognizing that hospitals and physicians have an ethical obligation to provide care for residents lacking legal documentation.

Some readers of this blog might question why ACP is wading into the complex, controversial, and polarizing debate over immigrants’ access to health care. (ACP’s paper addresses only questions relating to immigrants’ access to health care, not broader immigration policy.) But in my opinion, ACP should be praised for confronting an issue that affects health care for tens of millions of persons in the United States, documented and undocumented alike. As ACP President Fred Ralston, MD, MACP remarked at yesterday’s press event, “Access to health care for immigrants is crucial to the overall population of the U.S. We all have a vested interest in ensuring that all residents have access to necessary care.”

If physicians don’t speak up for their patients, even those who lack legal residency, who will? Not federal and state politicians, that’s for sure.

Today’s question: What is your reaction to ACP’s call for a national policy on access to care for immigrants that is in accord with physicians’ ethical obligation to care for the sick?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*


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3 Responses to “Is It A Crime To Help Illegal Immigrants Get Healthcare?”

  1. I agree that ACP should be praised for what passes these days as a brave stand. We need to stop demonizing and start dealing with these issues with a more rational, comprehensive, national approach.

  2. Michael Wong says:

    Interesting question. The practical implications are that before anyone administers medical care to a patient, they’d have to ask whether that patient is an illegal immigrant. So, that if someone is lying bleeding in the street, we’d have to ask “are you an illegal immigrant?” If the answer is no or we were not satisfied, then we’d have to walk on!? Or, if one of these legislators is unconscious and it was not clear what they were an illegal immigrant, they’d be denied care. Yes, indeed, an interesting question!

  3. israel martinez says:

    I feel sad about goverment decicions in almost every aspect about illigal inmmigrants, i can feel the fear and the impotence of illigal inmmigrants, i can see the sorrow of my friends and family when they are trying to get opportunities, sometimes they have to fight harder to get food to their homes, to survive in this f… county of freedom, now i cant do anything to help them?, but say what i feel, things must change, illigals are persons no criminals!

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

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As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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