- The Washington Times - Tuesday, September 24, 2002

Part Two of Five

SELLS, Ariz. The Tohono O'odham Nation here, the second largest Indian reservation in the United States, is facing a medical crisis.
Every month, more than 50,000 illegal aliens cross the reservation, which is located in the harsh desert regions of southern Arizona and shares 76 miles of the international border with Mexico. The illegal aliens are pushed to the remote regions of southern Arizona by a U.S. border enforcement strategy aimed at taking control of established ports of entry.
The hundreds of illegal immigrants who have been injured or have fallen victim to dehydration or heat stroke on the reservation have overloaded its only hospital. The medical costs of illegal aliens seeking to enter the country have also affected dozens of other hospitals along the U.S.-Mexico border, at a cost to taxpayers of millions of dollars a year.
"We are a small rural hospital funded by Congress to take care of our Native American population," said Darrell W. Rumley, director of the Sells Indian Hospital, which serves the nation's 25,500 members. "We are the only hospital between Tucson and Yuma, serving an area about the size of Connecticut.
"But we are required by law to treat those who present themselves for care, including the illegal aliens who show up on their own and those being brought here by the federal government. Over the last few years, their numbers have been going up in a big way," he said. "We're doing what we can to survive."
Mr. Rumley's situation is not unique.
Dozens of hospitals in the 28 counties along the U.S.-Mexico border in Texas, New Mexico, Arizona and California have either closed their doors or face bankruptcy because of losses caused by "uncompensated care" given to illegal immigrants.
The losses began to mount in 1994 after the U.S. Border Patrol initiated a new enforcement strategy to control the flow of illegal immigrants at urban ports of entry in California. That plan has since been expanded to Arizona and Texas and has resulted in what the General Accounting Office said in a recent report was a "shifting of the illegal alien traffic" to other, more remote areas of the border.
Under federal law, hospitals with emergency-room facilities are required to treat anyone who shows up for care, including illegal immigrants, although the government has been silent on who pays the bill for the illegal immigrants swamping hospitals all along the border.
"We need help," Mr. Rumley said.


School overcrowding
A similar crisis exists in public education, where illegal immigration has had a major effect on elementary and secondary school enrollments, particularly among the four border states.
Schools, like hospitals, are prohibited under federal law from denying immigrant students access to a free public education. As a result, the annual cost to taxpayers to provide that education is estimated in the billions of dollars.
A report last month by the Federation for American Immigration Reform (FAIR) said that rising immigration numbers were to blame for school overcrowding, adding that if the flow of immigrants were not cut, they would account for 96 percent of the future increase in the school-age population over the next 50 years.
The report said the numbers included a massive flow of illegal aliens into U.S. schools and predicted that the quality of education would not improve if the government did not stop illegal immigration.
In 1982, the U.S. Supreme Court, in a 5-4 decision, said children of illegal immigrants have a constitutional right to a free public education. The high court prohibited schools from adopting policies or taking actions that would deny illegal aliens access to education based on their immigration status.
The ruling, in a case known as Plyler vs. Doe, overturned a Texas law that at the time allowed school districts to bar illegal immigrants or require them to pay tuition.
"By denying these children a basic education," the court said, "we deny them the ability to live within the structure of our civic institutions, and foreclose any realistic possibility that they will contribute in even the smallest way to the progress of our nation.
"It is difficult to understand precisely what the state hopes to achieve by promoting the perpetuation of a subclass of illiterates within our boundaries, surely adding to the problems and costs of unemployment, welfare and crime," the majority opinion said.
The court said school officials could not require children to prove they were in the country legally by asking for documents such as citizenship papers, but could require proof the child of illegal aliens lived within school district attendance zones, as they might for any other child.
But the high court warned the schools to be "careful of unintentional attempts to document students' legal status," which could lead to the "chilling" of their rights. The court said schools could not inquire about a student's immigration status, make inquiries that could expose the students' legal status and could not require the students to supply a Social Security number.
The court also prohibited any communication with the U.S. Immigration and Naturalization Service concerning a student's immigration status and said the schools should not cooperate with the INS in any manner that "jeopardizes immigrant students and their right of access."
The Urban Institute and others have estimated that 15 percent of all kindergarten through high school children in California are illegal immigrants, who cost the taxpayers $1.6 billion annually. Elected officials and education and immigration experts do not have specific numbers for New Mexico, Arizona and Texas, but believe that between 10 percent and 15 percent of the total enrollment in those states are illegal aliens.
The high cost of educating illegal immigrants is one reason California voters passed Proposition 187 in 1994, which called for the state's schools not to admit illegal aliens. The courts, so far, have blocked implementation of Proposition 187 and schools in that state still provide a free public education for school-age children regardless of their immigration status.
"Every child is an individual of great worth," said Lowell Billings, assistant superintendent of the Chula Vista, Calif., Elementary School District. "We're not the immigration cops and that is not a function of our public school system."
Mr. Billings, who takes over as superintendent on Oct. 1, said Chula Vista officials make "every effort" to find out if the 25,000 children attending the district's 39 schools actually live in the city, including a proof of residency and home visits, but that the law requires him to educate those children who show up for class.
"I would be a bald-faced liar if I told you that 100 percent of the children enrolled in the district's schools are legal residents," Mr. Billings said. "But we are not the INS. Our job is education and we are focused on teaching and learning."
The predominantly Hispanic school district, located just three miles north of the U.S.-Mexico border, has built six schools since 1998 and is adding 600 to 800 students a year.


The costs of illegal immigration
The cost of providing federally mandated health care and education to illegal immigrants has been estimated at more than $5 billion a year, although Congress lacks any accurate assessment of the actual costs borne by the states.
Those expenses do not include other mandated costs, including funds required by the states, cities and counties to prosecute illegal aliens who commit crimes. One study in 2001 said the 28 border counties spend $125 million a year to process and prosecute illegal aliens.
It also costs more than $500 million annually to incarcerate illegal immigrants. Much of that financial burden is being borne by California, where one in every seven inmates is an illegal alien.
"Not much attention is being paid to the tremendous costs of mandates imposed on states and local governments that must provide care to a swelling number of noncitizens within their borders," said Sen. Jon Kyl, Arizona Republican. "Yet those costs ultimately take a human toll, too.
"Every tax dollar spent on emergency care or criminal justice for an illegal immigrant has to be paid by American taxpayers," Mr. Kyl said, noting that at the same time, indigent U.S. citizens "must abide by stricter limits, fewer choices and rising prices under their government health care coverage."
"We are a generous people, but more and more of my constituents are saying this is unfair," he said. "But we need a more commonsense approach to dealing with costs and problems of illegal immigration. A compassionate people must act to help those in need, but the needs of American citizens and taxpayers must also be considered."
Meanwhile, at the Tohono O'odham Nation, Mr. Rumley said the Sells Indian Hospital, with its seven emergency-room beds and a "highly dedicated staff," has been able to keep up with the rising number of illegal aliens, but he is not optimistic about the future.
"We already have begun discussions on what services we can cut back, and have deep concerns on how this flood of illegal aliens will [affect] the services we can offer our own community," Mr. Rumley said. "This community is very interested in health care and is knowledgeable about the services we provide.
"We can only squeeze so much out of our program before it impacts on them," he said.
Last year, 579 illegal immigrants were taken to the Sells Indian Hospital, compared with 90 in 1990. During the first four months of 2002, the hospital has treated 200 illegal aliens at an estimated and uncompensated cost of $500,000.
"The doctors here are doing a very good job with very limited resources," said Dr. Lois Steele, who supervises the hospital's medical staff. "It can be frustrating. There are times when you are overwhelmed, and you just have to make do with what you have."
"Darrell has done well in trying to keep us in the black," Dr. Steele said.


Hospitals in crisis
The revised border enforcement strategy has forced hundreds of thousands of illegal immigrants to cross into the United States at remote desert areas, where the often harsh terrain and weather send thousands to rural hospitals. The shifting of illegal aliens to those remote areas has placed several hospitals and health care facilities in jeopardy.
The Southeast Medical Center in Douglas, Ariz., is on the verge of bankruptcy because of uncompensated care to undocumented aliens; the Cochise County, Ariz., Health Department, inundated with immigration issues, spends as much as 30 percent of its annual $9 million budget on undocumented aliens; and the University Medical Center in Tucson faces up to $10 million this year "in uncompensated care to foreign nationals."
Also, Good Samaritan Regional Medical Center in Tucson has lost $1 million because of its treatment of illegal immigrants in the first quarter of fiscal 2002; and the Regional Medical Center Hospital and Pioneers Memorial Hospital, both in El Centro, Calif., lost more than $1.5 million last year in their treatment of illegal immigrants.
Scripps Memorial Hospital in San Diego was forced to close after losing more than $5 million a year in unreimbursed medical care, much of it for illegal immigrants.
Many of the problems, however, are not confined to the border areas.
A Medicaid emergency services program in North Carolina averages 221 new cases every month involving immigrants, many of them illegal, at a cost of about $32 million, and a Chicago hospital spent $650,000 this year for organ and stem-cell transplants for three illegal-alien children.
The Emergency Medical Treatment and Active Labor Act mandates that hospitals with emergency-room services treat anyone who presents themselves for care, including illegal aliens.
The act does not say who is responsible for paying the bills. The Border Patrol pays only for the treatment of immigrants already in custody and identified as illegal aliens. Because the vast majority of illegal immigrants are transported for medical care before they are arrested, the hospitals are responsible for the bill.
The Border Patrol argues that when it discovers people in need of medical attention their first concern is to get them to a hospital with no regard to their immigration status.
Hospital administrators and health care providers believe that immediate medical attention is important, but they want to be reimbursed for their mounting and often debilitating financial losses.
James J. Dickson, head of the Copper Queen Community Hospital in Bisbee, Ariz., has referred to the rising financial burden facing hospitals that treat illegal immigrants as "a tragic and contentious situation."
In testimony earlier this year before a House Government Reform subcommittee, Mr. Dickson said uncompensated costs attributed to "Border Patrol apprehensions" and "compassionate entry trauma" had risen more than 400 percent during the past four years.
Rep. Jim Kolbe, Arizona Republican, and Rep. Ed Pastor, Arizona Democrat, are trying to win support for a bill to ease the situation. Introduced last year, the bill called for the Department of Health and Human Services to set up a five-year pilot program for reimbursements to hospitals and other health care outlets for emergency treatment given to illegal immigrants.
The bill has since stalled and no hearing has been scheduled.
Mr. Kyl, ranking member of the Senate subcommittee on immigration, believes taxpayers in the four border states pay a disproportionate share of the expenses for treating illegal immigrants. He has introduced legislation that would provide $200 million per year in reimbursements to the border states, reimbursing not only the states and localities, but also the hospitals, doctors and other health care providers.
The bill, however, has languished in committee. No hearings are scheduled and the Bush administration has shown little interest in it.
"It is the responsibility of the federal government to control illegal immigration. When it does not, states that happen to be in the pathway of most illegal immigrants should not be left picking up the tab," Mr. Kyl said.
Mr. Rumley agrees.
"We are overwhelmed and we need help," he said. "While I try to be compassionate in my job, the impact of illegal immigration on our community has been devastating. We are billing the people, billing the government and getting nowhere."
He added: "Is there a responsible authority out there?"

Part Three:Mexican police join drug lords in border trade

Part One:New strategies to slow the flood of illegal immigrants.


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