Doctors around the state say
a growing fervor over illegal immigration may scare illegal immigrants away
from seeking health care and create a public health threat.
A recent case in Alamance County -- in which
medical records may have been used to help prosecute a library worker who was
in the country illegally -- has prompted many to speak out about what they see
as an unprecedented breach of trust between doctor and patient.
"Whether you're legal or illegal, it's
always been assumed that your medical information is private and can't be used
against you," said Dr. Christopher Snyder III of Concord, president of the
N.C. Academy of Family Physicians. "The doctor-patient relationship is
sacred, and I'm not sure that has really been challenged until now. We're in
uncharted territory."
Snyder was among several doctors who said
that if patients become afraid to seek care, infectious diseases could spread,
infant mortality could rise, and emergency costs could increase.
Immigrants have high rates of infectious
diseases such as tuberculosis, once a scourge that killed thousands, and often
do not have health insurance. Public health clinics, along with some private
ones, provide basic care that doctors say is key to
maintaining the health of the broader community, offering prenatal care,
immunizations and screening, and treatment for contagious diseases.
Pam Silberman,
president of the N.C. Institute of Medicine, which studies health care issues,
said it is not in the public interest to build more obstacles to immigrant health
care.
"If they cough on somebody and they have
tuberculosis," Silberman said, "that
doesn't stop with them."
Strict federal laws prohibit the release of
medical records in most cases. But records can be released on the order of a
judge, which is what happened in the case of the library worker.
Alamance County Health Director Barry Bass
said that during a recent State Bureau of Investigation inquiry into his health
department, a judge ordered him to release the records of about five patients,
one of whom was library worker Marxavi Angel
Martinez. Martinez, who had been brought to North Carolina by her parents when
she was a toddler, now faces federal felony charges for using the Social
Security number of a dead person.
New trend feared
Chris Hoke, a
lawyer with the state Division of Public Health, said judges frequently order
the release of medical records in criminal and civil cases, but he said he does
not know of any previous cases where public health records were used to help
prosecute people for being in the country illegally.
Some doctors worry that it could become a
trend.
There is growing sentiment among anti-illegal
immigration groups that taxpayer-funded health care constitutes a public
benefit that illegal immigrants should not receive, even though federal law
requires that public health care be provided regardless of immigration status.
"Why are we giving away free health
care?" asked Ron Woodard, an anti-illegal immigration activist from Cary.
"If people have enough money to send home, which is what many of them are
doing, then they've got money to pay some of their medical bills."
Woodard said he still favors providing
emergency care and public health care for children. Otherwise, he said, all
services should be denied -- including immunizations -- and the money used for
the care of legal residents.
Alamance is among several counties across the
country that have adopted that philosophy and have
begun asking whether they should provide health services to illegal immigrants.
Beaufort County, in Eastern North Carolina, has considered cutting some public
health programs that are used by illegal immigrants, such as prenatal care for
poor women.
Those efforts haven't gone far because most
public health programs receive state and federal funding and must be provided
under state law.
Lynette Tolson,
director of the N.C. Association of Local Health Directors, said no public
health departments in North Carolina have cut off care based on immigration
status. But she said some health directors feel under siege.
"The doors are open at local health
departments," Tolson said. "But health
directors have to defend the essential public health services practically every
day."
Challenge foreseen
Peter Morris, medical director for Wake
County Human Services, said he now fears that he could be forced to turn over
patients' medical records for use in immigration cases. And he said he is
concerned that public pressure eventually will push Wake County to question the
services it provides to illegal immigrants. He said that if public outrage is
strong enough, federal and state laws requiring care for illegal immigrants
might be challenged.
If that happens, Morris said, years of work
to build trust in the state's growing Hispanic population could be destroyed.
"Any person who lives in our community
presents a potential public health risk," Morris said. "To scare them
away could mean that a public health risk goes undetected until it has affected
more of us than it should have."
HEALTH CARE ACCESS
Health advocates note that access to health
care is important not only to prevent the spread of infectious diseases; it
also keeps health care costs down.
A Pew Hispanic Center study released last
week shows that Hispanics are less likely than other minorities and whites to
have a regular health care provider.
"When people don't get the information
or treatment that would allow them to manage illnesses at an early stage or
avoid a disease altogether, the costs of health care escalate and the burden of
expensive late-stage medicine often falls to publicly funded health
services," the report concluded. "An important strategy to reduce
chronic illness, and the costs associated with it, is through prevention via
regular monitoring and educational initiatives."
Among findings:
* 73 percent of Latino adults report having a
usual place where they seek medical help or advice, while 27 percent have no
usual health care provider. As in the general population, males, the young and
the less educated are less likely to have a usual health care provider.
* 30 percent of Latinos born outside of the
United States lack a usual place for health care, compared with 22 percent of
U.S.-born Latinos.
* 32 percent of Latinos who mainly speak
Spanish lack a regular health care provider, compared with 22 percent of
Latinos who mainly speak English.
* 49 percent of Latinos who have lived in the
United States for less than five years lack a usual health care provider,
compared with 21 percent of those who have lived in the United States for 15
years or more.