They fly in from Caribbean islands and South America to Miami International Airport, some coming just to seek care at Jackson Memorial Hospital before returning to their native lands.
They pay for the airfare, but they won't pay for the healthcare at Jackson, Dade County's public hospital. They are illegal aliens who know they can get such high-tech services as oncology and obstetrics for free.
Most illegal aliens come to Florida seeking a job or protection from religious or political persecution, and wind up at Jackson's emergency department. But many travel to the United States just for expensive healthcare services they can't get in their countries, said Ronald Ruppel, Jackson's chief financial officer.
Those medical jet-setters account for only about 3% to 5% of the illegal aliens treated at 1,376-bed Jackson. But they are part of a larger problem. Care for illegal aliens who live and work in Dade County accounted for $42 million of the $214 million in net unreimbursed costs at Jackson in 1993, Mr. Ruppel said.
"They pay sales taxes, property taxes through rents. We can't turn them away from inpatient care," he said.
Mr. Ruppel said the hospital doesn't report aliens to the federal Immigration and Naturalization Service because it would discourage them from receiving less-costly preventive care.
"We are better off treating people at early stages of illness than waiting for when they are really sick," he said. "If there was a threat (of deportation), they wouldn't come here."
Over the last three years, Jackson has admitted 26,000 patients classified as illegal aliens, Mr. Ruppel said.
Those patients represented about 14% of Jackson's total admissions of 180,000 from 1991 to 1993, he said. Illegal aliens also accounted for 200,000, or 11%, of Jackson's 1.8 million emergency department and clinic visits during that three-year period, he said.
The dollar impact of illegal immigrants is staggering. Jackson's net unreimbursed costs from 1991 to 1993 totaled $103 million for illegal aliens. In 1993, Jackson spent $42 million, up from $29 million in 1991.
The state estimates there are 345,000 illegal aliens living in Florida, about 229,000 of them in Dade County.
Other hospitals in southern Florida, such as 146-bed Pan American Hospital-which serves the Hispanic neighborhood of Miami called Little Havana-also treat illegal aliens. But Jackson treats the most, said a spokeswoman from the South Florida Hospital Association.
One woman from the Bahamas has delivered five babies at Jackson, two of whom were premature and required neonatal intensive-care services, Mr. Ruppel said. The unpaid cost for those two babies was $250,000. Some 12,000 babies, or 17% of Jackson's total, are delivered to women who are in this country illegally, Mr. Ruppel said.
"Cancer is another common problem (for which illegal aliens seek care at Jackson)," Mr. Ruppel said. "People have relatives here who are aware of our technology. They come here for chemotherapy, live here with relatives and leave when they are finished."
Mr. Ruppel said Jackson typically spends $35,000 to $40,000 per case for cancer patients.
"We and the taxpayers of Dade County are bearing a heavy burden because of a lack of (federal) government support," Mr. Ruppel said.
Two years ago, voters approved a half-cent sales tax increase to help fund indigent care at Jackson. Last year, the tax generated $90 million for the hospital, he said.
But that isn't enough, Mr. Ruppel said. Of Jackson's total budget of $678 million in 1993, $214 million in costs, or 32%, went unreimbursed, he said. The national average for hospitals is 12%, according to the American Hospital Association.
In April, Jackson joined the state of Florida in a $1.5 billion lawsuit against the federal government that seeks, in part, to collect unpaid costs of healthcare for illegal aliens (April 18, p. 22).
"We have a real argument with the federal government about an immigration policy that's created a recurring nightmare for state and local governments," said Florida Gov. Lawton Chiles in announcing the lawsuit.
Mr. Chiles, a Democrat who's seeking re-election in November, said the federal government should pay its share for refusing to protect Florida's borders.
For Jackson, as its unreimbursed costs increase, Mr. Ruppel said, it can only respond by cutting its expenses.
"We do things that limit access. We don't replace staff, we don't purchase supplies we need, we don't keep equipment up with technology," he said. "We don't know how bad it will get. A lot depends on the problems in the Caribbean. We do know this. If we don't treat them, nobody will."