To Treat or Not to Treat:To Treat or Not to Treat:The Legal Confusion and The Legal Confusion and Inconsistency in Treating Inconsistency in Treating

Illegal ImmigrantsIllegal Immigrants

Laura RedmondLaura RedmondNursing 500, Section 901Nursing 500, Section 901

Drexel UniversityDrexel University

““Give me your tired, your poorGive me your tired, your poor

Your huddled masses yearning to breathe free,Your huddled masses yearning to breathe free,

The wretched refuse of your teeming shore,The wretched refuse of your teeming shore,

Send these, the homeless, tempest-tost to me,Send these, the homeless, tempest-tost to me,

I lift my lamp beside the golden door!”I lift my lamp beside the golden door!”- Emma Lazarus (1886)- Emma Lazarus (1886)

Brief Overview of Immigration LawBrief Overview of Immigration Law Quota SystemQuota System 1965 Hart-Celler Act1965 Hart-Celler Act More aggressive legislation followedMore aggressive legislation followed

1994 California Proposition 187 (State)1994 California Proposition 187 (State) 1996 Illegal Immigrant Reform and Responsibility Act 1996 Illegal Immigrant Reform and Responsibility Act

(Federal)(Federal) Focus changed to limiting public services, especially health Focus changed to limiting public services, especially health

care and schoolscare and schools Ultimately overturned, but emerging agenda notedUltimately overturned, but emerging agenda noted

Immigration legislation has greatly increased in Immigration legislation has greatly increased in recent years with focus on exclusion of services recent years with focus on exclusion of services for undocumented immigrantsfor undocumented immigrants

Should We Ration Health Care?Should We Ration Health Care?

Should We Ration Health care?Should We Ration Health care?

Increased financial strain on facilities due to rise Increased financial strain on facilities due to rise in number of uninsuredin number of uninsured

Many people blame illegal immigrants however, Many people blame illegal immigrants however, economic evidence and cost estimates of economic evidence and cost estimates of providing health care varies.providing health care varies.

These numbers provide the basis for most These numbers provide the basis for most political discussions on rationingpolitical discussions on rationing

Access to Health CareAccess to Health Care

Emergency Medical Treatment and Active Emergency Medical Treatment and Active Labor Act (EMTALA)-2003Labor Act (EMTALA)-2003

To offset the institutional and provider costs of To offset the institutional and provider costs of EMTALA, a reimbursement policy was EMTALA, a reimbursement policy was proposed under the Medicare Modernization proposed under the Medicare Modernization Act (MMA)- 2003Act (MMA)- 2003 Required reporting of illegal immigrants seeking careRequired reporting of illegal immigrants seeking care Opposed by many health care and professional organizations, Opposed by many health care and professional organizations,

immigrant rights groups, and hospitals immigrant rights groups, and hospitals

Health care blackmailHealth care blackmail Mandatory reporting put providers at risk to become Mandatory reporting put providers at risk to become

unwitting agents for the BCISunwitting agents for the BCIS

Risked violating the patient-provider trust Risked violating the patient-provider trust relationshiprelationship If perceived as immigration agents, undocumented If perceived as immigration agents, undocumented

immigrants may avoid seeking medical care due to fear and immigrants may avoid seeking medical care due to fear and suspicion potentially leading to a health care crisis for the suspicion potentially leading to a health care crisis for the individual and public overall.individual and public overall.

Presented a legal conundrum:Presented a legal conundrum: In following the guidelines for the MMA reimbursement, In following the guidelines for the MMA reimbursement,

providers risked violating HIPAA- legislation enacted to providers risked violating HIPAA- legislation enacted to protect the privacy and confidentiality of patient informationprotect the privacy and confidentiality of patient information

Access to Health CareAccess to Health Care

Can We Protect the Public Health?Can We Protect the Public Health?

Immigrants have problems navigating the Immigrants have problems navigating the complex U.S. health care systemcomplex U.S. health care system Language barriersLanguage barriers Cultural unfamiliarityCultural unfamiliarity

If care becomes influenced by immigration If care becomes influenced by immigration status, we add fear of discovery and deportationstatus, we add fear of discovery and deportation May provide inaccurate medical histories, incorrect contact May provide inaccurate medical histories, incorrect contact

information, or avoid system altogetherinformation, or avoid system altogether May lead to medical mismanagement and disease controlMay lead to medical mismanagement and disease control

Greatest fear with increased immigration is Greatest fear with increased immigration is communicable diseasecommunicable disease Return of previously eradicated diseasesReturn of previously eradicated diseases

TbTb MalariaMalaria LeprosyLeprosy PolioPolio

The World Health Organization postulates that The World Health Organization postulates that air travel alone has accounted for the increases air travel alone has accounted for the increases in disease incidence and fear a pandemic is only in disease incidence and fear a pandemic is only a plane ride awaya plane ride away

Can We Protect the Public Health?Can We Protect the Public Health?

Legal QuandariesLegal Quandaries

Which obligation should U.S. health care Which obligation should U.S. health care providers uphold- law-abiding citizen or ethical providers uphold- law-abiding citizen or ethical professional?professional?

Are practitioners that treat illegal immigrants at Are practitioners that treat illegal immigrants at risk for malpractice claims?risk for malpractice claims?

Would providers be exempt from lawsuits filed Would providers be exempt from lawsuits filed on behalf of undocumented immigrants?on behalf of undocumented immigrants?

Will workers and institutions need more liability Will workers and institutions need more liability and malpractice insurance?and malpractice insurance?

Would it be enough to protect from federal Would it be enough to protect from federal prosecution?prosecution?

Would prolonged treatment time constitute harboring Would prolonged treatment time constitute harboring and be punishable with fines or jail?and be punishable with fines or jail?

Time tables, multiple legislative bills, and legal Time tables, multiple legislative bills, and legal clarification is obscure at best and providers risk clarification is obscure at best and providers risk violation, whether intentional or not.violation, whether intentional or not.

Legal QuandariesLegal Quandaries

Provision of Care Provision of Care Undocumented immigrant health care planUndocumented immigrant health care plan

Funded by illegal immigrant paymentsFunded by illegal immigrant payments Specifically developed for those interested in attaining Specifically developed for those interested in attaining

naturalized statusnaturalized status Using funded clinics safe from the BCIS would decompress Using funded clinics safe from the BCIS would decompress

tertiary care centers and improve overall illegal immigrant tertiary care centers and improve overall illegal immigrant healthhealth

Little Hoover Commission (2002)Little Hoover Commission (2002) National Immigration Forum survey (2005)National Immigration Forum survey (2005)

Interventional CareInterventional Care Internet-based treatment and telemedicineInternet-based treatment and telemedicine Tailored-telephone technologyTailored-telephone technology Culturally specific, yet anonymous Culturally specific, yet anonymous Assumes access to cost-efficient technologyAssumes access to cost-efficient technology Upholds both civil and ethical obligationsUpholds both civil and ethical obligations

Use of Nurse navigators Use of Nurse navigators Specifically trained in illegal immigrant issuesSpecifically trained in illegal immigrant issues Assists patients in navigating the complex health care systemAssists patients in navigating the complex health care system Serve as a resource for providing and securing careServe as a resource for providing and securing care

Provision of CareProvision of Care

Use of safety net community and faith-based Use of safety net community and faith-based preventative medical centers preventative medical centers Culturally sensitiveCulturally sensitive Perceived safe placesPerceived safe places May contribute to better treatment and follow-up careMay contribute to better treatment and follow-up care Decreases use of emergency department for preventative and Decreases use of emergency department for preventative and

primary careprimary care

Bilingual /multi-lingual careBilingual /multi-lingual care Reduces barriersReduces barriers Provider educational opportunity and ability to develop Provider educational opportunity and ability to develop

innovative and culturally-specific interventions innovative and culturally-specific interventions

Provision of CareProvision of Care

So What Do We Do Now?So What Do We Do Now?

As health care providers, we must develop strategies to As health care providers, we must develop strategies to care for the undocumented immigrant population and care for the undocumented immigrant population and not succumb to health care blackmailnot succumb to health care blackmail

Political activism and involvement is the key to Political activism and involvement is the key to legislative change and understandinglegislative change and understanding

We must continue to uphold our ethical and We must continue to uphold our ethical and professional obligation to “care” first and ensure the professional obligation to “care” first and ensure the preservation of the individual and public healthpreservation of the individual and public health

THANK YOU!THANK YOU!