Updated: Sunday, Oct. 31, 1999 at 23:53 CST

Searching for affordable medical treatment is often a painful task for undocumented immigrants in Tarrant County

By Michelle Melendez
Star-Telegram Staff Writer

One in a yearlong series of stories about undocumented immigrants in North Texas.

Maria lives with sharp stomach pain. At times, it doubles her over and makes her vomit.

The pain became so unbearable in August that a friend took her to John Peter Smith Hospital in Fort Worth. An emergency room doctor determined that she might have an ulcer or a problem with her gallbladder that could be fatal without surgery.

The 'Undocumented Immigrant' Fallacy


Each year the Border Patrol is making more than a million apprehensions of persons who flagrantly violate our nation's laws by unlawfully crossing U.S. borders to work and to receive public assistance, usually with the aid of fraudulent documents. Such entry is a misdemeanor, and if repeated becomes punishable as a felony.


But because she is an undocumented immigrant without insurance, Maria would have to pay the entire cost upfront to schedule an operation. The doctor prescribed painkillers, antibiotics and a steady diet of Mylanta and Tagamet.

"A dog is worth more than me in this country," said Maria, 43, who came to the United States illegally in 1992 to join her husband, who is a naturalized citizen. She, like other undocumented immigrants who were interviewed, spoke on the condition that her last name not be used.

Since 1997, JPS -- Tarrant County's publicly funded health-care system -- has denied discounted care to many undocumented immigrants who are poor and uninsured. Instead of paying $5 or $10 to see a doctor, they are charged a $28 hospital fee, plus doctor fees. For a hospital admission, they pay full price instead of $50.

JPS officials said the policy was changed to comply with new welfare laws enacted by Congress. Yet, county hospitals in Dallas, Austin, El Paso, Houston, San Antonio and other cities continue to provide care without regard to immigration status, according to state and hospital officials.

"I think Tarrant County is alone on this," said Anne Dunkelberg, senior policy analyst for the Center for Public Policy Priorities, an Austin group that focuses on poverty issues.

Except in emergencies, JPS asks for proof of legal residency or full payment in advance before a low-income, uninsured individual can see a doctor, hospital officials said. Other exceptions include prenatal care, immunizations and tests for communicable diseases.

"Prior to [1997], JPS had a sliding-scale discount, and undocumented people could qualify. Now they have to show proof of legal residency," said Kay Melugin, senior manager of patient registration.

JPS Chief Financial Officer Don Wooters said the hospital's primary responsibility is treating Tarrant County's poor.

"When we take care of anybody else, we are inhibiting our ability to serve our primary population," he said.

JPS officials said a provision of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 requires that states enact laws to allow "unqualified aliens" to receive state or local benefits.

A Texas health official and officials at other hospitals said there is no mandate to cut off immigrant care.

"In our rules, there is no citizenship requirement," said Bonnie Majers, director of indigent health care for the Texas Department of Health, which administers the state's indigent program for 138 county hospitals.

Majers said some hospital districts have asked the Department of Health whether they should continue serving undocumented immigrants with indigent funding. The state has not given them an answer, she said.

"If people live here, pay taxes here, they can apply for our indigent health-care program," said Patti Daniel, director of admissions for Parkland Health and Hospital System in Dallas.

Dunkelberg said she is unaware of any state enacting a law to approve state benefits for undocumented individuals. It is widely believed that the federal requirement is unconstitutional, she said.

"If a county or local government has taken that position, it is not because they are under federal pressure," Dunkelberg said. "There are no sanctions and no enforcement."

Josh Bernstein, a policy analyst for the National Immigration Law Center, said California, which has the nation's largest population of undocumented immigrants, continues to provide health care to them.

"To not do so is very penny- wise and pound-foolish," he said. "People who have a hard time paying for basic care end up in emergency care."

Outside of JPS, options for indigent care in Fort Worth are limited.

The University of North Texas Health Science Center family practice clinics charge sliding-scale fees based on income for basic care such as annual exams.

Most hospitals require full payment in advance, unless a person qualifies for charity care.

Osteopathic Medical Center of Texas and its family clinics charge full price but provide a 20 percent discount to individuals paying cash.

Officials at All Saints Hospital said undocumented immigrants can qualify for charity care if they meet poverty guidelines. The hospital budgeted $5.3 million for charity care this year.

Some immigrants tap an unofficial network of volunteer doctors who see poor patients for free. But their resources are limited.

"There's a lot of people in different groups making an effort to help people who are disadvantaged. But it's not coordinated," said Leverett Golden, a Bedford family doctor who volunteers one day a month to see patients at Cornerstone Community Center northeast of downtown Fort Worth.

A friend referred Maria to see Golden, but he was unable to help her any more than the emergency room doctor.

Dr. Craig Whiting of UNT's Northside Family Practice Clinic in Fort Worth said he sees two or three patients a month who are in situations similar to Maria's. It is difficult for many patients to obtain follow-up treatment for problems related to pap smears, mammograms and colon exams, he said.

Some people save money for operations. Others return to Mexico to obtain medical care at a lower cost. But many persevere until they are so sick that they must turn to an emergency room, he said.

"We do see a fair number of undocumented people because we can offer people a low-cost alternative," Whiting said. "But it's an outpatient clinic. There's only so much we can do."

Paperwork sometimes discourages undocumented immigrants from seeing a doctor. At the UNT Northside clinic, for example, immigrants can furnish letters from their employers to establish their incomes. But some are afraid to cooperate, said Irene Marquez, who screens patients at the clinic.

"I tell them we don't give out any information" to the U.S. Immigration and Naturalization Service, she said. "We just want it to see if they qualify for a discount."

In May, the INS issued a bulletin that seeking health-care benefits would not affect immigration applications.

Whiting said cost is a bigger factor than fear in keeping some undocumented immigrants from getting the care they need. Without regular preventive care, they often end up in emergency rooms, where they are treated first and billed afterward.

Since Maria's emergency room visit in August, her prescriptions have run out. To comfort herself, she wraps herself in warm sheets from the dryer at the laundry where she worked until recently.

She is trying to hang on until she can get her green card, which would establish legal residency. With that document, she and her three children could qualify for indigent care at JPS. Two of her children also have serious medical problems. She buys her daughter's epilepsy medicine at a flea market. And she took her son to Mexico in 1997 so he could receive treatment for a stomach ailment.

Her husband applied for legal residency for his family. But the application was denied because the $14,000 a year he earns making plastic bags at Film Pack in Crowley is less than the amount required for approval. A family of four must earn $24,000 a year so they won't become a "public charge," according to immigration laws.

"We came from Mexico because we were living in poverty," Maria said. "We thought things were going to be better here. But at times, we suffer here more."