On a blistering day in May, US Border Patrol agents in southern California's Imperial County found a man collapsed in the desert. The 39-year-old had successfully sneaked across the border from Mexico, only to succumb to heat stroke. The agents called an ambulance to take him to nearby El Centro Regional Medical Center, where he spent two days in intensive care and several more in recuperation. The agents didn't come back for him, so he left with relatives bound for Los Angeles -- leaving the hospital with his unpaid bill for $26,890.
No one at El Centro Regional was surprised. The public hospital is losing more than $1 million a year treating undocumented immigrants, many of whom were injured trying to cross the border -- people who've broken bones jumping from the 20-foot border fence in Calexico, nearly drowned trying to swim the All-American Canal, or become dehydrated in the Imperial Valley desert.
Neighboring Pioneers Memorial Hospital lost more than $500,000 on similar cases last year, not to mention unpaid ambulance service and physicians' fees. The two hospitals have to cover 150,000 people in a county that already has some of the highest unemployment and poverty rates in the country. "We're struggling to treat needy people, and the cost is bearing down on people least able to afford it," says Ted Fox, CEO of El Centro Regional.
Other border counties in California, Arizona, New Mexico, and Texas are similarly deluged with a rising tide of illegal immigrants, and likewise left unaided with the burden of caring for those that need medical attention. That burden has increased drastically since 1994, when the Immigration and Naturalization Service launched Operation Gatekeeper, a massive crackdown on illegal border crossings at urban checkpoints. In California, with the once-porous crossing at San Diego now much tightened, would-be immigrants have shifted east, to borderlands straddling mountains, deserts, and rivers; the rugged terrain, in turn, has sent them pouring into US emergency rooms.
Human-rights groups have protested the deaths and injuries caused by Operation Gatekeeper, but another issue has gone virtually unnoticed: Who pays for the immigrants' hospital care, ambulance service, autopsies, and burials? Federal law mandates that hospitals treat anyone who needs emergency care, including illegal immigrants; but the federal government only pays for the medical care of illegal immigrants who are in INS custody. When no arrest is made, hospitals and local governments are left to cover any medical costs. Those unpaid bills add up to billions every year, a fiscal crisis that has already helped drive at least one hospital out of business and several health care workers to abandon border areas.
Since Operation Gatekeeper started, the number of illegal immigrants captured in San Diego has dropped by 60 percent, while rising sevenfold in the rugged El Centro sector. "It's like poking your finger in a balloon," says Fox. "If you displace air in one place, it's going to bulge out somewhere else." The Border Patrol doesn't track the number of people injured in illegal crossings, and only started tallying deaths in 1996. That year, nine people died trying to get into Imperial County; last year, the figure was 63.
Those who arrive sick or hurt are often found by Border Patrol agents, who give first aid and call 911. According to El Centro INS agent Manuel Figueroa, agents don't question or detain injured suspects. This policy has sparked controversy in cash-strapped communities, since the INS would have to pay the medical bills if its agents had taken someone into "custody" -- which, according to the INS officers we spoke to, simply means finding out whether the injured person is a non-US citizen in the country illegally.
The INS maintains that its policy is about compassion, not shirking payment. "If we come across someone in immediate need of medical assistance, we don't check their immigration status; we get them medical care. Our first concern is [whether] they are going to make it," says INS spokesperson Sharon Gavin.
Medical providers say they don't want the Border Patrol to start handcuffing the sick; they just need to be reimbursed. "Somebody has to pay for these people," says Calexico Fire Chief Carlos Escalante, who oversees the only public ambulance service in Imperial County. "It's our job to take care of them, and we'll do that as long as the supplies last. (But) one day we'll be out of business, and then who's gonna take care of them?"
At the same time that federal government policies are putting more demands on border hospitals, government support for them is dwindling. Federal Medicaid and Medicare reimbursements to El Centro Regional have been slashed by more than $3 million over the past three years, and next year the hospital faces a cutback of almost further $2 million.
San Diego County's Scripps Memorial Hospital was forced to close just last spring because it was losing $5 million a year, due in large part to unreimbursed care. A general surgeon and two anesthesiologists have recently left El Centro Regional because they were suffering financially. Physicians' charges are broken down separately from general hospital costs, and when patients can't pay, the doctors aren't paid. Now El Centro Regional has only two general surgeons to share emergency calls.
Fox says the hospital sometimes works with the Mexican Consulate to return patients to Mexico when they are discharged, but there's no hope of getting the Mexican government to pay bills left by its citizens. The Mexican government pays for medical care for aliens in its country, and likewise believes the US should pay for the treatment of aliens here, says Rita Vargas, Mexico's consul general in El Centro.
Imperial County has helped form a coalition of 24 border counties lobbying for federal aid to offset the losses hospitals suffer in fulfilling their obligation to treat illegal immigrants. As a result, bills are now pending before the House and Senate that would allocate $800 million over four years to states and counties to reimburse medical-care costs for undocumented immigrants. But those funds would be divided among 17 states, and would cover only a fraction of what hospitals spend annually treating illegal immigrants -- a figure Congress estimated at $2.8 billion two years ago. And in fact, says a spokesperson for Rep. Brian Bilbray, R-CA, who introduced the House bill, the legislation may not even come to a vote this session.
From Ted Fox's viewpoint, the prospects for hospitals like El Centro Regional look grim. "We're not trying to profit from people's illnesses down here. We're the safety net," he says. "There's nothing below us but the abyss of no care. And we can't keep this up much longer."