Posted on November 1, 2007

11 of 18 in Burn Unit Undocumented

Cheryl Clark and Leslie Berestein, Union-Tribune (San Diego), October 31, 2007

“These are the most expensive kinds of cases, but we don’t look at these patients and say, oh, because they aren’t legal residents, we’ll stop providing care or stop changing their bandages,” said Dr. Thomas McAfee, UCSD’s physician-in-chief. “It’s part of our ethic to continue to provide this care no matter what.”

According to the Mexican Consulate in San Diego, the burn victims are from central and southern Mexico, and include one woman. Four are in critical condition. All were rescued north of Tecate last week, said consulate spokesman Alberto Lozano, and it is suspected they had crossed the border illegally before coming face to face with the Harris fire.


Those in critical condition may include a married couple from Guerrero, according to the consulate. The others are a 20-year-old man from Guerrero and a man from Chiapas.

With some facing a long rehabilitation, hospital officials said they realize many U.S. taxpayers don’t believe UCSD should provide such expensive hospital care to illegal immigrants. But, by law, that care must be provided “to anyone who comes regardless of their ability to pay.”


Last year, San Diego County hospitals provided $619 million in uncompensated care, and an estimated 10 percent to 17 percent of that paid for treatment for undocumented immigrants, according to the Hospital Association of San Diego and Imperial Counties.

Burn care requires ventilators, multiple surgeries, round-the-clock intensive care and grafts from human cadaveric skin. McAfee said grafts can be grown from patients’ own skin to minimize tissue rejection at $500,000 per patient.

Last year, the average cost of treating a burn patient at UCSD was $45,000 for an average 15-day stay.


Esmeralda Siu of the Coalición Pro Defensa del Migrante, a network of migrant shelters and other services in Baja California, said rules prevent the United States from sending Mexican nationals home before they can travel safely.


Mark Krikorian, executive director of the Center for Immigration Studies, a group that advocates immigration restrictions, said that in the case of the 11 border burn victims, it might make sense to request assistance from the Mexican government or arrange long-term care in their home country.


The bottom line, hospital officials say, is that these patients need care.

“UCSD is faced with a real dilemma,” said Michael Bardin, a spokesman for Scripps hospitals. “Many of these burn patients will require care long term, and you can’t discharge them to the street. You have to have some place for them to go regardless of whether they are legal or not.”

Several sources of federal and state funding can help hospitals recoup some of that money, but they don’t come anywhere near a significant reimbursement, said Steve Escoboza, association president.

For example, the federal government provides $250 million per year for payments to eligible providers for emergency health care to undocumented immigrants. In 2005, San Diego County received only $1.4 million of that money.

A special Medi-Cal fund can reimburse costs of care for certain patients who can document strict criteria of U.S. residency, even if they are not in this country legally. But that fund pays for only a few days of care, or until the patient is stabilized.

Patients with severe burns may require months or years of physical therapy, medication and other forms of care. Sometimes these patients must be transferred out of the hospital to a caring family environment.


A spokesman for the Border Patrol said the agency is held financially responsible for the medical bills of patients in the agency’s custody. But it appears that the rescued border crossers are not in its custody.

UCSD officials said no Border Patrol agents are stationed at the hospital.

Immigration officials do not have the sort of formal relationship with hospitals that they do with prisons, said Lauren Mack of U.S. Immigration and Customs Enforcement. Agents routinely scout prisons and jails for deportable individuals.


Mack said the arresting agency, such as the Border Patrol, is typically responsible for maintaining jurisdiction over an individual it wants to guard.

Still, Mack said, even if the hospitalized fire victims are not in immigration custody, anyone in the country illegally is deportable.

Damon Foreman, an agent in the Border Patrol’s San Diego sector, said the protocol with injured individuals who are to be deported is that “a doctor has to classify them as fit for travel or for incarceration.”


“We are not sending agents to hospitals and going to everyone’s sick bed and finding out who is here illegally or not,” Foreman said. “The Border Patrol doesn’t do that. These people are there for help.”