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Sridhar Natarajan/MEDILL

Juan Ramirez has been admitted in a temporary-care facility since October 2008, and according to doctors, will continue to be there for much longer.


Undocumented immigrants pose tricky questions for health care industry

by Sridhar Natarajan
Feb 17, 2011



Sridhar Natarajan/ MEDILL

Comparitive illegal immigration statistics


Doctors fear community health care funding cuts

In a move that could potentially cripple services offered by community health centers, the House of Representatives was expected to  vote Thursday on Continuing Resolutions, one of which calls for a spending cut of close to $2 billion dollars in community health care funding.

The cut would result in nearly 150,000 people losing access to affordable health care in Illinois, according to the
National Association of Community Health Centers.

These facilities, known as Federally Qualified Health Centers, are community-based organizations that cater to underserved communities and the uninsured, including undocumented immigrants.

According to 2007 U.S. Census data, a little more than 20 percent of the 43 million uninsured in the country are undocumented immigrants.

Dr. Michelle Gitler, a physician at Schwab Rehabilitation Hospital, says  blocking access to basic health care will have negative consequences in the long run.

“If we don’t cover more people with primary care, they are going to use the emergency care more often,” she said.

The long-term treatment costs would be more than what is required to offer basic health care to everyone, with or without documents, Gitler said.

The focus needs to be on measures to deter illegal immigration, said Ira Mehlman of the Federation for American Immigration Reform.

“What you want to do is ensure health care facilities are not made available to illegal aliens,” he said, “instead of putting in place cuts that affect everyone.”


Inside Room 307 at the Schwab Rehabilitation Hospital, not a lot has changed in two-and-a-half years.

A television set perched high up on the wall is tuned to a Spanish station. A few feet away, Juan Ramirez lies on the same bed he has occupied since October 2008, and he is most probably unaware of the mid-afternoon show playing at the moment.

Ramirez is unlike any patient at Schwab. No one knows anything of his past and in his vegetative state, there is no way he can offer them a clue.

A minor police record that contains no fingerprint match and the absence of a paper trail leads hospital officials to believe that he is an undocumented immigrant.

The only thing doctors are certain of is that he will probably spend the rest of his life in the same room.

When news reports recently told the story of another patient, a Mexican national, being deported from his bed at Christ Hospital via air ambulance, it angered many in the Mexican community.

Dr. Michelle Gitler, however, was drawn to the story for another reason.

Gitler has been the treating physician for Ramirez for most of the time since he was admitted with a severe brain injury to Mount Sinai Hospital, the sister-institution to Schwab, since Aug., 27, 2008.

Just like the case at Christ, Ramirez, too, would have been sent back to his home country or turned over to family if the hospital had its way. But Schwab’s efforts ran into a dead end.

“He doesn’t even need therapy anymore,” Gitler said. “He is practically living here.”

The reason someone like Ramirez, without any documentation to prove legal status, has access to health care is because of the Emergency Medical Treatment and Active Labor Act that was passed by Congress 25 years ago.

It requires hospitals to take in any emergency case, without performing what Gitler calls a “wallet biopsy.”

While no one contests the legislation, it is the post-emergency care, particularly in cases like Ramirez’s , that worries health care facilities.

There is no public aid that will pay for undocumented immigrants who find themselves in hospitals for any amount of time; or even indefinitely like Ramirez.

“It’s not good for business,” Gitler says, matter of factly.

Some other hospitals in the area like the John Stroger Hospital have contracts with nursing homes, where they send patients like Ramirez and pay for their care.

Either way, it is the hospital’s responsibility to provide care, according to Donna Joslin, the state-appointed public guardian for Ramirez.

Joslin says there are fewer than 10 patients in the Chicago area who are both wards of the state and in a similar state of limbo at an area hospital.

However, there could be more like them who haven’t come to the attention of state authorities, Joslin said. Recently, one of her wards was sent back to Poland after they traced the patient’s roots.

But Gitler and her team have not been that fortunate.

While Ramirez’s case might be rare, Gitler says the hospital frequently encounters undocumented immigrants.

“A lot of families are reluctant to give their address,” she says. “They don’t want the police to come and arrest them.”

A new bill proposed earlier this week in Arizona was the first of its kind that would require hospitals to verify documents of patients before admitting them for non-emergency cases.

Gitler says that physicians and health care agencies have received loose threats from the government to report people without legal documents, even in Illinois.

“I am not going to do that,” she says. “That is ridiculous.”

It’s exactly the kind of statement that angers people like Ira Mehlman at the Federation for American Immigration Reform.

The organization advocates for stricter measures to regulate immigration.

Mehlman said, “There is hypocrisy on part of the medical establishment: When insurance companies ask for patient information, they jump through hoops like obedient poodles. But when it comes to tax-payer money, then they become very apprehensive suddenly.”

He says facilities like Schwab, which may house patients indefinitely, are not necessarily bearing the burden.

“It’s not like the hospital eats the costs,” Mehlman said. “They pass it on to their patients and ultimately the tax-paying public.”

But even experts acknowledge there is no easy solution.

Yolanda Suarez-Balcazar, who deals with issues of community health care at the University of Illinois, Chicago, says that although the issues are complex, fully enforcing the immigration laws is not the solution.

“There are many factors that go into immigration,” Suarez-Balcazar said. “They come here and do jobs that no one else wants to do.”

When it comes to addressing health care questions for them, she says, it is hard to pinpoint where the money must come from.

But she does say there are some things that are not negotiable. “Everyone must have access to health care,” she said. “You are playing with the lives of people.”

But this debate has no meaning inside the third-floor room at Schwab.

Gitler walks across the room, stands by Ramirez’s side and asks her long-time patient the usual question — how his day has been.

As always, there is no answer.