Public hospitals in Texas are gearing for a fight after the district attorney in Houston threatened to prosecute the Harris County Hospital District for providing preventive care to undocumented immigrants.
Harris County District Attorney Chuck Rosenthal told Modern Healthcare he was forced to initiate a criminal investigation in late July after receiving complaints from several county residents, including a group calling itself "Young Conservatives of Texas," which sent copies of its complaint to media outlets. In its letter, the group said it doesn't believe Texas taxpayers are obligated to provide free care to citizens of Mexico.
The criminal probe follows the release of an opinion by Texas Attorney General John Cornyn in July, which states that a provision of federal welfare reform legislation, called the Personal Responsibility and Work Opportunity Act of 1996, bars the use of public funds to provide free care to illegal immigrants. Exceptions are allowed for emergency care and testing and treatment for communicable diseases (July 16, p. 6).
The Harris County Hospital District is the third-busiest public healthcare system in the country, with more than 800,000 outpatient visits annually, according to the American Hospital Association. District spokeswoman Dinah Massei said about 25% of the public system's patients are undocumented aliens.
Cornyn's opinion toppled a hornet's nest, since many publicly funded hospitals around the country routinely provide primary care to undocumented immigrants. In some cases, public hospitals say they believe state laws obligate them to provide care to anyone, regardless of citizenship.
Defenders say it's not only humane but also sound policy, since preventive measures such as prenatal care can curtail costly life-threatening events, such as premature births, which hospitals would be required to treat.
"To somehow expect that we turn our doctors and nurses into INS agents is the most bizarre thing I've ever heard. It's mean-spirited," said Ron Anderson, M.D., president and chief executive officer of Parkland Hospital and Health System in Dallas.
Anderson said public hospitals viewed the 5-year-old law as "a way for the federal government to shift responsibility (for care) to local and state governments. We never thought this was illegal and someone would prosecute it."
A Houston lawyer representing the hospital district, Rusty Hardin, said Cornyn "flat-out misread the statute."
"Nowhere does the statute state that it's a crime to provide (preventive care)," Hardin said. "This is simply a pronouncement to immigrants that they have no federal entitlement or right to these benefits." Hardin said what states or counties do with their own money "is up to them."
Still, not all local governments have made the same interpretation. In Fort Worth, Texas, for example, Tarrant County's JPS Health Network curtailed preventive services to undocumented immigrants in 1997 because of the law.
Although the 1996 law allows states to pass legislation overriding the provision, it's unclear how many have done so, said Lynne Fagnani, vice president for finance and reimbursement at the National Association of Public Hospitals and Health Systems, which represents 110 facilities that treat predominantly uninsured and low-income patients. She called Cornyn's opinion "completely counter to the mission of our hospitals, which is to treat anyone regardless of financial status and any other status."
Safety-net hospitals are supporting a bill introduced in July by U.S. Rep. Gene Green (D-Texas) that would exempt primary care from the act. However, Anderson said the bill offers only a partial fix, since it might not clear a legal path to provide specialty care, such as treatment for hypertension. He said it might be necessary for Texas Gov. Rick Perry to call a special legislative session to address the matter.
Meanwhile, Rosenthal said he wasn't sure how long his investigation would take, or which individuals face potential charges. Hospital officials declined to comment, citing legal reasons.
Rosenthal said every Hispanic publication in Texas, as well as some outside the state, has accused him of harsh treatment of illegal immigrants. "If you're asking whether I'm relishing the idea of putting somebody from the hospital district in jail or under indictment, I'm not," Rosenthal said. He added, "I don't get to pick and choose the laws that I uphold."