UTMB to cut immigrant cancer care

[no name 1]

The move could shift the burden to Harris County medical facilities

By ALEXIS GRANT

Copyright 2007 Houston Chronicle

The University of Texas Medical Branch in Galveston may soon close its doors to poor illegal immigrants who need cancer care, a move that could increase the patient load in Harris County.

The medical school, unable to meet the demand for cancer care by indigent patients with limited state funds, is considering a policy that would require patients to prove they're here legally to qualify for financial assistance. That would save the hospital system money but contradict its mission of providing care for the poor.

"Everyday, very difficult decisions have to be made because there are too few resources for the demand," said Karen Sexton, vice president and CEO of hospitals and clinics at the medical branch.

The policy decision, which has been under consideration for months by the medical branch's Cancer Patients Acceptance Committee, is expected to be made by January and any changes would be effective immediately, Sexton said.

If cancer patients are turned away in Galveston, they'll likely find their way to hospitals in Houston, health care officials said.

"The Harris County Hospital District and probably to some degree M.D. Anderson can't help but be affected by this," said Dr. Ronald Walters, associate vice president for medical operations at The University of Texas M.D. Anderson Cancer Center. "It should worry the taxpayers of at least Harris County."

All hospitals, both public and private, are required to treat emergency-room patients, regardless of whether they're insured or qualify for Medicaid. That requirement is straining hospitals across the country, and some have closed because of financial losses from treating the uninsured.

It's also unusual for hospitals, particularly public ones, to turn away patients who need non-emergency care, although they're not required by law to treat them. But some facilities, including one in Fort Worth, now deny indigent patients who can't prove they're here legally as a cost-cutting measure.

Demand vs. dollars

The issue is part of a larger debate over immigration, particularly whether illegal immigrants should have access to taxpayer-funded services, including education.

"When you stop providing care for one service, it becomes a slippery slope," said Lovell Jones, co-founder of the Houston-based Intercultural Cancer Center, a policy group. Turning away illegal patients presents opportunities for racial profiling, he said, and Hispanics are likely to be hit hardest.

Others argue state residents should have priority when it comes to taxpayer-supported services.

"Every dollar the state of Texas or Harris County and the city of Houston spends on health care for people who aren't supposed to be in the country is a dollar they can't spend on citizens and legal immigrants," said Steven Camarota, director of research for the Center for Immigration Studies, a Washington, D.C.-based group that advocates tighter immigration controls.

Sexton, who acknowledged the issue raises ethical questions, said the medical branch's $1.4 billion annual budget included about $12 million this year to treat indigent cancer patients, but it wasn't enough.

Citizenship is not considered by the Harris County Hospital District — and it shouldn't be since it receives state funding for indigent care, said King Hillier, vice president of public policy and government relations of the district, which operates Ben Taub General, Houston's largest public hospital.

"We do not question citizenship status," he told the Galveston County Daily News. "If they live in Harris County and can prove residency, then they are paying taxes. If they're paying rent, then their landlord is paying property taxes to the hospital district."

'A gut-wrenching decision'

The University of Texas M.D. Anderson Cancer Center, which also is state-funded, sometimes turns away poor, undocumented immigrants who need care, but its policy is to help those patients as often as possible, said Walters, who helps decide who gets care and who doesn't. "It is always a gut-wrenching decision," he said.

About 21 percent of the uninsured population in Texas are illegal immigrants, according to a study released last month by Camarota's group, the Center for Immigration Studies.

Another report, published last week in the Archives of Internal Medicine, challenged the perception illegal immigrants are disproportionately burdening the health care system. They're 50 percent less likely than U.S.-born Latinos to use emergency rooms in California, according to the report. Experts said they likely fear being reported to authorities.

The Associated Press contributed to this story.

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[Ban Hammer 14,171]

[SqdnGuns 21]

GOOD!! Take care of the poor who are here LEGALLY.

[Mr. Big Dog 10,747]

"Every dollar the state of Texas or Harris County and the city of Houston spends on health care for people who aren't supposed to be in the country is a dollar they can't spend on citizens and legal immigrants,"

It's a valid point, isn't it?

[Caladan 19]

Makes sense, unfortunately. (Though bolding a sound bite doesn't make it true.) I don't think that documentation should be required for emergency care, but cancer treatments are expensive, and if they can't keep up with demand, residency is as decent a place to start as any.

[Empress of Groovy 373]

It's a tough situation, as cancer treatment is indeed expensive and often long term. But it makes me sad and angry to think of seriously ill people being turned away. Cancer is tough to deal with at the best of times. I wonder why this is being presented as a financial issue rather than an ethical one. It doesn't seem civilized to say to a cancer patient, "Sorry, amigo, you'll just have to wait until that tumor gets big enough to constitute an emergency, then come on back!"

I can't imagine that anyone who has been affected by cancer (self or friend/family member) would say, "Right on!" when reading this. Seeking treatment for a debilitating illness isn't the same as visiting the ER for the sniffles just because you can.

[Caladan 19]

Sniffles and other illnesses are contagious, though. If the hospital has limited resources to spend on indigent patients, from a public health perspective, it makes more sense to treat the contagious ones.

[Empress of Groovy 373]

Sniffles and other illnesses are contagious, though. If the hospital has limited resources to spend on indigent patients, from a public health perspective, it makes more sense to treat the contagious ones.

I was just using "the sniffles" as an example of a nonemergency ailment. I live in AZ and visit the border area frequently. There's a lot of attention given to the drain on hospitals and clinics, which is certainly an issue. Residents complain that undocumented people visit the ER when they have a cold because by law, they have to be seen.

I do know that resources are limited. I guess my issue was with what seemed like mindless support of turning away people sick with cancer without considering the human aspect. I just think of people I've known who have had cancer. They were so sick and in so much pain, and the image of someone being told that no help is available makes me want to cry.

Yeah, bleeding heart, I know. My political views are all over the place (OK, I'm a lefty who likes guns), but I have strong feelings about providing health care to all. I think that health care is a moral issue that is too often treated like a commodity. And of course it's important from a public health standpoint to ensure that people with contagious diseases are treated and/or quarantined regardless of status or ability to pay.

[Fandango 1,440]

Sniffles and other illnesses are contagious, though. If the hospital has limited resources to spend on indigent patients, from a public health perspective, it makes more sense to treat the contagious ones.

I was just using "the sniffles" as an example of a nonemergency ailment. I live in AZ and visit the border area frequently. There's a lot of attention given to the drain on hospitals and clinics, which is certainly an issue. Residents complain that undocumented people visit the ER when they have a cold because by law, they have to be seen.

I do know that resources are limited. I guess my issue was with what seemed like mindless support of turning away people sick with cancer without considering the human aspect. I just think of people I've known who have had cancer. They were so sick and in so much pain, and the image of someone being told that no help is available makes me want to cry.

Yeah, bleeding heart, I know. My political views are all over the place (OK, I'm a lefty who likes guns), but I have strong feelings about providing health care to all. I think that health care is a moral issue that is too often treated like a commodity. And of course it's important from a public health standpoint to ensure that people with contagious diseases are treated and/or quarantined regardless of status or ability to pay.

But if there's limited resources, then what?

Every dollar spent on an illegal is one less that can be spent on a citizen or LPR...

Who gets turned away? Sure, in a perfect world, we fix everyone...hell, in a perfect world, there'd be no cancer at all...but that's not what we're living in.

[Empress of Groovy 373]

My reply was really more in response to replies dismissive of the predicament of being undocumented and needing cancer treatment. You'd think that the article was about the government deciding to withhold ice cream from unruly kids.

[Caladan 19]

Sniffles and other illnesses are contagious, though. If the hospital has limited resources to spend on indigent patients, from a public health perspective, it makes more sense to treat the contagious ones.

I was just using "the sniffles" as an example of a nonemergency ailment. I live in AZ and visit the border area frequently. There's a lot of attention given to the drain on hospitals and clinics, which is certainly an issue. Residents complain that undocumented people visit the ER when they have a cold because by law, they have to be seen.

I do know that resources are limited. I guess my issue was with what seemed like mindless support of turning away people sick with cancer without considering the human aspect. I just think of people I've known who have had cancer. They were so sick and in so much pain, and the image of someone being told that no help is available makes me want to cry.

Yeah, bleeding heart, I know. My political views are all over the place (OK, I'm a lefty who likes guns), but I have strong feelings about providing health care to all. I think that health care is a moral issue that is too often treated like a commodity. And of course it's important from a public health standpoint to ensure that people with contagious diseases are treated and/or quarantined regardless of status or ability to pay.

But if there's limited resources, then what?

Every dollar spent on an illegal is one less that can be spent on a citizen or LPR...

Who gets turned away? Sure, in a perfect world, we fix everyone...hell, in a perfect world, there'd be no cancer at all...but that's not what we're living in.

I don't think it's really illegal vs. legal, or shouldn't be in the case of infectious disease. It's not like illegals who can't pay are going to go home to Mexico's hospitals to be treated, and it's not like germs are going to check for papers before infecting others. Plus, there's a decent case to be made that early treatment and prevention are more cost effective than emergency care.

[kerewin21 2]

The problem you come up with is just as Caladan says. I'm a physician and I've seen people come in extremely ill with things that could have been easily taken care of had they come in months or years prior. But they don't because they can't afford it and sometimes because they're here illegally. I have a patient who is dying of invasive cervical cancer. Never went to a doctor because she is here illegally. Now we're spending millions on emergency treatment for her because she's so ill we can't send her away. If she had come in a few years ago and gotten a pap smear, this would probably never have happened.

Sometimes refusing care is penny wise and pound foolish.

The case of treatment for people who already have cancer is I think a bit more complicated; but if they stay here (rather than returning home for treatement, which people almost never do) and don't get earlier treatment, they're more likely to get very serious complications (IE, spreading of the cancer to areas that will require ICU stays or emergency surgeries, heart attacks, strokes, etc). Then by law (and I would argue by conscience) we have to take care of them. Maybe if we'd taken care of them earlier we would have saved a lot of money.

Just a thought. And BTW, the majority of uninsured patients I take care of are US citizens and legal immigrants.

[Boiler 47,203]

You do not need to be uninsured to be unable to afford Cancer Treatment.

Finite resource, near unlimited demand, on any moral basis how do you tell somebody who is here legally that they can not have treatment because that limited resources is going to someone here illegally?

[Boiler 47,203]

Just thought of something else, Visitors are strogly recommended to have Travel Insurance including Medical and Emergency Travel Insurance.

I used to work in the Insurance Industry, I had a few Medical Repatriations, seem to remember that by Air Ambulance from US to UK was about $30,000. And that would be an extreme case, usually most could be patched up to travel on a normal Commercial flight.

So whatever is needed to get to medical stability plus the airfare would be that max you would need to incur even if you took the most sympathetic view.

[peejay 327]

The problem you come up with is just as Caladan says. I'm a physician and I've seen people come in extremely ill with things that could have been easily taken care of had they come in months or years prior. But they don't because they can't afford it and sometimes because they're here illegally. I have a patient who is dying of invasive cervical cancer. Never went to a doctor because she is here illegally. Now we're spending millions on emergency treatment for her because she's so ill we can't send her away. If she had come in a few years ago and gotten a pap smear, this would probably never have happened.

Sometimes refusing care is penny wise and pound foolish.

The case of treatment for people who already have cancer is I think a bit more complicated; but if they stay here (rather than returning home for treatement, which people almost never do) and don't get earlier treatment, they're more likely to get very serious complications (IE, spreading of the cancer to areas that will require ICU stays or emergency surgeries, heart attacks, strokes, etc). Then by law (and I would argue by conscience) we have to take care of them. Maybe if we'd taken care of them earlier we would have saved a lot of money.

Just a thought. And BTW, the majority of uninsured patients I take care of are US citizens and legal immigrants.

I understand your position because of your oath as a physician. But if our government would do its sworn duty there wouldn't be millions of illegal aliens and the myriad of societal problems they incur on us.

If they weren't here, we could also save a lot of money. They are here because they are cheap and disposable labor that employers can use while dumping the costs on society and extra profits in their own pockets. It burdens the many while enriching the few.

They should not be here nor do they have a right to be here for whatever reason. I realize it is a chicken or the egg dilemma. Provide for them because they are here or cut them off to make them leave.

Unfortunately providing non-emergency services to illegal aliens only encourages them to stay.