Burden Grows for Southwest Hospitals
By MICHAEL JANOFSKY
PHOENIX, April 11 — Felipe Gomez and a few friends were goofing around, burning ants with gasoline, when the can caught fire and left Felipe, 12, with burns over 25 percent of his body. He was admitted to Maricopa Medical Center on March 25 and already his bill exceeds $55,000, not including costs for skin graft surgery on Wednesday and daily physician costs. Hospital officials say the weeks of additional surgery and care he needs will put his final bill well above $250,000.
But Maricopa Medical does not expect to see a penny of it.
Felipe, who lives in Sonora, Mexico, is an illegal immigrant, one of thousands from Mexico and other countries who find their way into American hospitals every year for care they can neither get at home nor pay for in the United States, where federal law requires hospitals to treat emergency needs no matter where the patient lives.
For years, these patients have strained hospitals and health clinics near the border, driving some out of business and forcing many to reduce their services. The American Hospital Association estimated that in 2000, the 24 southernmost counties from Texas to California accrued $832 million in unpaid medical care, a quarter of which was directly attributable to illegal immigrants.
Now, the financial pressures are spreading north into larger cities, pushing the overall unpaid bills well into the billions of dollars and straining a health care system already stretched thin by rising numbers of uninsured citizens, inadequate Medicaid payments, ballooning federal and state deficits and federal laws that allow United States border agents to wave through anyone who claims to need emergency care.
"The problem is moving well beyond the border states," said Molly Collins, a policy analyst for the American Hospital Association in Washington. "We don't have hard data, but it's certainly what we're hearing from hospitals and state associations. This is a much broader issue."
Gov. Janet Napolitano of Arizona, a Democrat elected last year, blamed the federal government for not giving hospitals enough money to pay for care they are obligated to provide. Bills moving through Congress would relieve some of the pressure by allocating as much as $1.45 billion a year for five years to hospitals in states where treatment demands from illegal immigrants are the greatest. But as Senator Jon Kyl, an Arizona Republican and a co-sponsor of one bill, conceded, "This is a very tough budget year," making prospects of passage uncertain.
All the while, officials at hospitals throughout the Southwest say they are treating more illegal immigrants every year. Dr. Michael Christopher, medical director for the emergency department at St. Joseph's Hospital and Medical Center, a large private nonprofit facility in Phoenix, said Web sites widely known in Mexico explain the American emergency room laws and some even include maps leading to his hospital.
While many big-city hospitals are suffering to some degree, providing uncompensated care to illegal immigrants, perhaps none is facing such imminent danger as Maricopa Medical, one of the state's largest hospitals, a 540-bed county-owned facility here that handles about 77,000 emergency room visits a year and has the only burn center in the Southwest.
With uncompensated care losses in some years approaching $100 million, about 10 percent attributable to illegal immigrants, the hospital is losing doctors and nurses, delaying improvements and squeezing four patients into rooms built for two. A study for the Maricopa County Board of Supervisors found that in 2001, the five biggest health care providers in the county amassed $318 million in uncompensated care, 23 percent of it by Maricopa Medical.
"This hospital was conceived in the 50's, designed in the 60's, built in the 70's and became obsolete by the 80's," said Mark Hillard, Maricopa's chief executive, describing the hospital's myriad structural problems.
The hospital's finances have grown so desperate that Maricopa County, which includes Phoenix, is asking the state for permission to ask voters to increase county property taxes to generate as much as $50 million a year to keep the hospital open. If the state approves, which is expected, a ballot initiative would go before voters in November. Passage then is not so certain. Even with a state budget deficit approaching $1 billion, Arizonans typically resist tax increases no matter the need.
"We have a lot of support, but it's not an easy sell," said Don Stapley, a Maricopa supervisor. "If voters say no, we would start to shut the system down. That would create a social disaster for the entire community."
It is widely expected that closing Maricopa Medical would send thousands of patients, including those from local jails, to other hospitals that are also feeling a financial pinch from illegal immigrants.
Dr. Paul E. Stander, medical director at Good Samaritan Regional Medical Center, a private nonprofit hospital with 600 beds not far from Maricopa Medical, said his hospital now treated up to 15 illegal immigrants a day, compared with "just a few a month" five years ago. Their unpaid bills total as much as $5 million a year.
As a result, he said, the wait for intensive care beds can last several days, some emergency room patients can wait as long as 24 hours to see a doctor, and plans to upgrade equipment have been delayed.
The mounting pressures are causing hospital officials to re-evaluate the services they provide beyond emergency treatment. For example, he said, doctors would stabilize a patient with symptoms of gallstones, but not necessarily remove them.
"It's an uneasy situation for most of us to be in," Dr. Stander said. "As health care professionals, we usually desire to do whatever we can. But it's clear we cannot be the provider of choice for all of northern Mexico. It's an impossible burden for us to take on."
"And all the trends," he added, "would imply that things are going to get worse."
By MICHAEL JANOFSKY
PHOENIX, April 11 — Felipe Gomez and a few friends were goofing around, burning ants with gasoline, when the can caught fire and left Felipe, 12, with burns over 25 percent of his body. He was admitted to Maricopa Medical Center on March 25 and already his bill exceeds $55,000, not including costs for skin graft surgery on Wednesday and daily physician costs. Hospital officials say the weeks of additional surgery and care he needs will put his final bill well above $250,000.
But Maricopa Medical does not expect to see a penny of it.
Felipe, who lives in Sonora, Mexico, is an illegal immigrant, one of thousands from Mexico and other countries who find their way into American hospitals every year for care they can neither get at home nor pay for in the United States, where federal law requires hospitals to treat emergency needs no matter where the patient lives.
For years, these patients have strained hospitals and health clinics near the border, driving some out of business and forcing many to reduce their services. The American Hospital Association estimated that in 2000, the 24 southernmost counties from Texas to California accrued $832 million in unpaid medical care, a quarter of which was directly attributable to illegal immigrants.
Now, the financial pressures are spreading north into larger cities, pushing the overall unpaid bills well into the billions of dollars and straining a health care system already stretched thin by rising numbers of uninsured citizens, inadequate Medicaid payments, ballooning federal and state deficits and federal laws that allow United States border agents to wave through anyone who claims to need emergency care.
"The problem is moving well beyond the border states," said Molly Collins, a policy analyst for the American Hospital Association in Washington. "We don't have hard data, but it's certainly what we're hearing from hospitals and state associations. This is a much broader issue."
Gov. Janet Napolitano of Arizona, a Democrat elected last year, blamed the federal government for not giving hospitals enough money to pay for care they are obligated to provide. Bills moving through Congress would relieve some of the pressure by allocating as much as $1.45 billion a year for five years to hospitals in states where treatment demands from illegal immigrants are the greatest. But as Senator Jon Kyl, an Arizona Republican and a co-sponsor of one bill, conceded, "This is a very tough budget year," making prospects of passage uncertain.
All the while, officials at hospitals throughout the Southwest say they are treating more illegal immigrants every year. Dr. Michael Christopher, medical director for the emergency department at St. Joseph's Hospital and Medical Center, a large private nonprofit facility in Phoenix, said Web sites widely known in Mexico explain the American emergency room laws and some even include maps leading to his hospital.
While many big-city hospitals are suffering to some degree, providing uncompensated care to illegal immigrants, perhaps none is facing such imminent danger as Maricopa Medical, one of the state's largest hospitals, a 540-bed county-owned facility here that handles about 77,000 emergency room visits a year and has the only burn center in the Southwest.
With uncompensated care losses in some years approaching $100 million, about 10 percent attributable to illegal immigrants, the hospital is losing doctors and nurses, delaying improvements and squeezing four patients into rooms built for two. A study for the Maricopa County Board of Supervisors found that in 2001, the five biggest health care providers in the county amassed $318 million in uncompensated care, 23 percent of it by Maricopa Medical.
"This hospital was conceived in the 50's, designed in the 60's, built in the 70's and became obsolete by the 80's," said Mark Hillard, Maricopa's chief executive, describing the hospital's myriad structural problems.
The hospital's finances have grown so desperate that Maricopa County, which includes Phoenix, is asking the state for permission to ask voters to increase county property taxes to generate as much as $50 million a year to keep the hospital open. If the state approves, which is expected, a ballot initiative would go before voters in November. Passage then is not so certain. Even with a state budget deficit approaching $1 billion, Arizonans typically resist tax increases no matter the need.
"We have a lot of support, but it's not an easy sell," said Don Stapley, a Maricopa supervisor. "If voters say no, we would start to shut the system down. That would create a social disaster for the entire community."
It is widely expected that closing Maricopa Medical would send thousands of patients, including those from local jails, to other hospitals that are also feeling a financial pinch from illegal immigrants.
Dr. Paul E. Stander, medical director at Good Samaritan Regional Medical Center, a private nonprofit hospital with 600 beds not far from Maricopa Medical, said his hospital now treated up to 15 illegal immigrants a day, compared with "just a few a month" five years ago. Their unpaid bills total as much as $5 million a year.
As a result, he said, the wait for intensive care beds can last several days, some emergency room patients can wait as long as 24 hours to see a doctor, and plans to upgrade equipment have been delayed.
The mounting pressures are causing hospital officials to re-evaluate the services they provide beyond emergency treatment. For example, he said, doctors would stabilize a patient with symptoms of gallstones, but not necessarily remove them.
"It's an uneasy situation for most of us to be in," Dr. Stander said. "As health care professionals, we usually desire to do whatever we can. But it's clear we cannot be the provider of choice for all of northern Mexico. It's an impossible burden for us to take on."
"And all the trends," he added, "would imply that things are going to get worse."
