California travesty

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Dr. Gene Rogers had a pretty good idea of what was coming when he saw his supervisor and a county security officer arrive at his office door. His supervisor was holding paperwork; the security guard was holding an empty box.

Dr. Gene Rogers knew what they had come to do, and why they were doing it. As the medical director for Sacramento County's Indigent Services program for the better part of the past decade, Dr. Rogers has waged a long fight against the central California county's practice of providing non-emergency medical care to illegal immigrants — a policy he says violates federal law and results in the poorest American citizens being denied the care they deserve.

That fight cost Dr. Rogers his job. In a two-sentence memo to Dr. Rogers, the county's Health and Human Services director, Lynn Frank, informed him that he was fired, but thanked him for his services. No reason for his termination was offered, but then he didn't really expect one. "Sacramento County knowingly violated state and federal laws, misappropriated taxpayer revenues and diverted funds designated for indigent citizens to pay for services delivered to illegal aliens," Dr. Rogers said. "And they did so even as they cut the budget."

Fired earlier this month, Dr. Rogers is the latest casualty on a frontline in the struggle over illegal immigration that's often overshadowed: the battle that has simmered throughout government agencies. Many government employees remain silent in the face of what's happening — fearful for their jobs and perhaps doubtful that they would make a difference. But Dr. Rogers, a Vietnam veteran, felt compelled to become a conscientious objector to the status quo.

The local cost of the medical treatment provided to illegal immigrants is small when contrasted to the billions of dollars the state and federal governments spend every year on the "undocumented," but the numbers have grown dramatically. According to county health officials, the hundreds of illegal immigrants who were being treated through the indigent program in the mid-1990s have now grown to thousands of people, with the annual cost to taxpayers swelling into the millions of dollars.

Ironically, when Dr. Rogers, 67, took the position of medical director for the indigent services program back in 1999, he arrived in the Central Valley with hardly a clue (let alone an opinion) about illegal immigration and its impact on social services. He had one goal: to provide the best care possible for those who need it most.

As the years went by, however, that egalitarian perspective began to be tinged with cynicism as he watched poor citizens get squeezed out of the system even as illegal immigrants gleefully manipulated it, all while bureaucrats facilitated the rampant violations of the very laws they were entrusted to enforce.

"I've seen cases and case histories of patients who essentially have come up from Mexico for the express purpose of being treated here, and then leaving to return home," Dr. Rogers said. "I've watched illegal immigrants brazenly demand free, non-emergency health care that was meant for our poorest citizens. I've heard them and their families complain. They feel entitled to it." Dr. Rogers filed a lawsuit in 2003 after county officials "stonewalled" him when he questioned why they were cutting budgets while still providing non-emergency medical treatment to people who have no legal right to be in the country.

The lawsuit is currently under appeal in federal court, but its impact was felt in the state capital, causing a nervous Latino Legislative Caucus in California last year to push through a bill by state Sen. Deborah Ortiz that explicitly allows counties to "opt" to provide non-emergency medical care to illegal immigrants. Sacramento County also responded, Dr. Rogers said, by seeking to alienate him from his prior relationships with county medical staff and by methodically preparing to fire him — with a little humiliation thrown in along the way. On one occasion, Dr. Rogers said, he was forced to sit through a staff meeting in which his supervisors asked case-management nurses one by one if they had any issues or problems with him. None said they did, but it was a humiliating experience.

"I am concerned that you continue to focus on patients' immigration status," Program Manager Nancy Gilberti said in a negative work review, "which is outside your and [the] program's purview." Mrs. Gilberti's remarks reflect a prevailing culture that has emerged in government: a culture that will not tolerate anyone who dares to draw a distinction between American citizens and illegal immigrants. It is a culture that now pervades police departments, public schools and universities, social services and health care.

But when someone like Dr. Rogers speaks up to question the impact on citizens of such allocation of funds for health services like those in Sacramento, the response is clear: Sit down and shut up — or else.

But considering that a young Dr. Rogers started his medical career trying to save the lives of horrifically wounded American soldiers in the jungles of Vietnam, Sacramento County's apparatchiks picked the wrong target this time. For Gene Rogers himself, his crusade is deeply rooted in those grim battlefields he found himself on more than 30 years ago. He watched young men fight and die, men who sacrificed all for the very distinction that citizenship brings to Americans.

It's a distinction that Sacramento County and so many others may choose to ignore, but for Dr. Rogers, that loyalty is a sacred trust he is determined to keep.

Mark Cromer is a senior writing fellow for Californians for Population Stabilization.