Providing care for as many as 2 million illegal aliens who live in California is becoming an increasing burden on the state's hospitals.
For example, because of California Medical Center's location as the only hospital between the crossing of two major freeways and South Central Los Angeles, the medical center has become the "depository" for treatment of illegal aliens. Their "sheer numbers" result in significant charity care, said James T. Yoshioka, president and chief executive officer of the Los Angeles facility.
CMC treats about 3,000 people in its emergency room every month, "and the majority of those have no method of payment," he said.
"We are an inner-city hospital, and it's not like we can cost-shift onto the insurer side. Our population is mainly Medi-Cal (the state's Medicaid program) or no insurance, so we really face the ultimate dilemma in this issue," Mr. Yoshioka said.
Another difficulty is "we wind up doing primary care in the emergency room, because they have no other access to care. So at about 5 p.m., we have about 100 people there trying to get primary care," he continued. "It's a tremendous strain on personnel."
The hospital has taken the position that it's not going to distinguish between the documented and the undocumented. "But it's ultimately going to hurt us," Mr. Yoshioka said.
"The situation is at a boiling point. Something needs to be done. We can't let it percolate like this or the delivery system will be damaged."
CMC is a prime example of the illegal immigrant problem that has swamped the state's healthcare system. According to the California Department of Health Services, CMC's Medi-Cal claims for illegal immigrants in 1993 were $11.6 million.
California Gov. Pete Wilson has filed a lawsuit against the federal government seeking reimbursement of $370 million he says is owed to the state for the cost of healthcare services to illegal immigrants. That amount does not include the cost of providing care to illegal aliens who are not eligible for Medi-Cal. The California Association of Hospitals and Health Systems supports the suit.
Sharp Healthcare's Sharp Chula Vista Medical Center, near the Mexican border, "gets a fairly significant number of emergency patients. They jump the border fence, which is 17 feet high, and some break their hips or legs," said Marc Sandstrom, general counsel for Sharp, a five-hospital system based in San Diego.
"We treat them. We have no problem with that. But it's uncompensated. Our emergency doctors are concerned with the amount of time they spend treating" these patients, Mr. Sandstrom said.
Two Sharp physicians were sued by illegal aliens for improper care, even though the physicians never saw the patients again after providing emergency treatment. The suit was unsuccessful, "but we had to defend it," Mr. Sandstrom said.
An illegal alien with a severe heart condition was recently brought by ambulance to Sharp Chula Vista. He tried unsuccessfully to pass himself off as a Medi-Cal recipient, Mr. Sandstrom said.
The patient was treated for six weeks, during which time he was moved to the cardiac center at Sharp Memorial Hospital. He later died, although staff "did everything to stabilize him, and, $275,000 later, we have to absorb that bill," Mr. Sandstrom said.
Though Sharp Chula Vista may see only five to 10 illegal aliens a month in its emergency room, the hospital is also a birthing center. Most illegal immigrants "have not had prenatal care, so they come in as very troubled mothers and babies," which makes childbirth difficult for both, he said.
Sharp hospitals deliver 28% of the babies born in San Diego County each year, including the 6,400 born to undocumented aliens under Medi-Cal. "On top of that we have those who just appear in our emergency rooms," he said.
Sharp estimates its costs for treating illegal aliens will exceed $5 million this year. "It was half that amount four years ago, and we think it will be between $6 million and $7 million in two years," Mr. Sandstrom said. "The concern we have is that the number is growing, that it's not a stable number and that none of the healthcare reform bills deal with this."
Jan Spencley, an administrator at University of California San Diego Medical Center, notes that if an illegal alien gives birth in the hospital and has a medical problem such as diabetes, "they have a need for ongoing care that nobody wants to pay for." UCSD works with agencies in the community and treats the illegal aliens on an outpatient basis "until we feel comfortable with it."
Still, once stabilized, that patient may need further treatment. "The problem is finding ongoing care" or, for some patients, additional emergency treatment, Ms. Spencley said.