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Immigration See other Immigration Articles Title: 11 of 18 in burn unit undocumented: UCSD cases put focus on who pays for care The fact that 11 of the 18 wildfire victims lying in UCSD Medical Center's burn unit are illegal immigrants with no apparent health coverage highlights the daunting financial challenge hospitals face in providing long-term, intensive care for all those who need it. “These are the most expensive kinds of cases, but we don't look at these patients and say, oh, because they aren't legal residents, we'll stop providing care or stop changing their bandages,” said Dr. Thomas McAfee, UCSD's physician-in-chief. “It's part of our ethic to continue to provide this care no matter what.” According to the Mexican Consulate in San Diego, the burn victims are from central and southern Mexico, and include one woman. Four are in critical condition. All were rescued north of Tecate last week, said consulate spokesman Alberto Lozano, and it is suspected they had crossed the border illegally before coming face to face with the Harris fire. Four other people, two men and two women, were found dead Thursday in a ravine off state Route 94. Their badly burned bodies remain unidentified, although authorities suspect they crossed illegally before they died. Those in critical condition may include a married couple from Guerrero, according to the consulate. The others are a 20-year-old man from Guerrero and a man from Chiapas. With some facing a long rehabilitation, hospital officials said they realize many U.S. taxpayers don't believe UCSD should provide such expensive hospital care to illegal immigrants. But, by law, that care must be provided “to anyone who comes regardless of their ability to pay.” Last year, San Diego County hospitals provided $619 million in uncompensated care, and an estimated 10 percent to 17 percent of that paid for treatment for undocumented immigrants, according to the Hospital Association of San Diego and Imperial Counties. Burn care requires ventilators, multiple surgeries, round-the-clock intensive care and grafts from human cadaveric skin. McAfee said grafts can be grown from patients' own skin to minimize tissue rejection at $500,000 per patient. Last year, the average cost of treating a burn patient at UCSD was $45,000 for an average 15-day stay. When patients need long-term nursing care, said UCSD spokeswoman Leslie Franz, “we make arrangements on a case-by-case basis. This could mean anything from them continuing to receive care from us, or we might transition them to another facility in that person's home state or another country, if we can expedite that.” However, appropriate care in a person's native country is not always available. Esmeralda Siu of the Coalición Pro Defensa del Migrante, a network of migrant shelters and other services in Baja California, said rules prevent the United States from sending Mexican nationals home before they can travel safely. “By law, they can't deport them if they are injured,” said Siu, who is based in Tijuana. “They have to be stabilized, and that they accept leaving, and that they are well to travel.” Mark Krikorian, executive director of the Center for Immigration Studies, a group that advocates immigration restrictions, said that in the case of the 11 border burn victims, it might make sense to request assistance from the Mexican government or arrange long-term care in their home country. “An illegal immigrant who is in Chicago and goes to the ER, it's hard to say the Mexican government should pay for it,” Krikorian said. “I think there is a plausible case to make for people who were sneaking across the border at the time of the injury, and clearly don't have any business to be there. We should tap the Mexican government to say, 'We need to share the burden here.' ” The bottom line, hospital officials say, is that these patients need care. “UCSD is faced with a real dilemma,” said Michael Bardin, a spokesman for Scripps hospitals. “Many of these burn patients will require care long term, and you can't discharge them to the street. You have to have some place for them to go regardless of whether they are legal or not.” Several sources of federal and state funding can help hospitals recoup some of that money, but they don't come anywhere near a significant reimbursement, said Steve Escoboza, association president. For example, the federal government provides $250 million per year for payments to eligible providers for emergency health care to undocumented immigrants. In 2005, San Diego County received only $1.4 million of that money. A special Medi-Cal fund can reimburse costs of care for certain patients who can document strict criteria of U.S. residency, even if they are not in this country legally. But that fund pays for only a few days of care, or until the patient is stabilized. Patients with severe burns may require months or years of physical therapy, medication and other forms of care. Sometimes these patients must be transferred out of the hospital to a caring family environment. McAfee said that in many cases, Mexican patients who come to U.S. hospitals may have insurance through a Mexican family member. “If the patient is eligible for that, we will sometimes transfer the patient back to Mexico.” Many times, however, the patient remains at UCSD, cared for with funding supplemented by other government sources such as Medicare, or payments from other patients covered by private insurance. “We are all bearing the cost,” McAfee said. “That's the only way a hospital can break even at the end of the year.” The Mexican consulate is willing to provide assistance to Mexican nationals who are fire victims, spokesman Lozano said. A woman who lost her home in the firestorm and wanted to return to her hometown in Mexico was provided airfare, he said. The consulate has not received any request for financial assistance for those hospitalized, Lozano said. A spokesman for the Border Patrol said the agency is held financially responsible for the medical bills of patients in the agency's custody. But it appears that the rescued border crossers are not in its custody. UCSD officials said no Border Patrol agents are stationed at the hospital. Immigration officials do not have the sort of formal relationship with hospitals that they do with prisons, said Lauren Mack of U.S. Immigration and Customs Enforcement. Agents routinely scout prisons and jails for deportable individuals. “We don't get calls from the hospital to pick them up,” she said. Mack said the arresting agency, such as the Border Patrol, is typically responsible for maintaining jurisdiction over an individual it wants to guard. Still, Mack said, even if the hospitalized fire victims are not in immigration custody, anyone in the country illegally is deportable. Damon Foreman, an agent in the Border Patrol's San Diego sector, said the protocol with injured individuals who are to be deported is that “a doctor has to classify them as fit for travel or for incarceration.” Foreman and other agents said that the priority during the firestorm was to save lives, and immigration checks came second. “We are not sending agents to hospitals and going to everyone's sick bed and finding out who is here illegally or not,” Foreman said. “The Border Patrol doesn't do that. These people are there for help.” Siu, in Tijuana, said the undocumented fire victims in the burn unit deserve to be treated the same as any injured victim of the firestorm. “They have to treat them,” she said. “It is an emergency.” Poster Comment: When the dollar hits the fan, you will no longer read stories like this. Instead you will read about the rioting illegal aliens who do not like their 50% pay cut and 25% unemployment rate.
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