we've been having heated - but not yet angry - discussions

  1. regarding the provision of medical services to undocumented residents - illegal aliens. As students, we've had the opportunity this semester to have clinical experiences that include being with community nurses as they make well-baby visits to the new parents. Seems as if we've all noticed a vast percentage have been to undocumented families.

    We're a divided bunch. Some of us can't afford insurance while in school and yet see these families recieving services that they can't get. We've discussed the morals of providing health care to all/any who are in need. The ever-present problems of limited budgeting. Today it was mentioned about the helicopter crash this weekend in Texas. An undocumented mother and her ill child were being flown somewhere for treatment when the helicopter went down. Pilot, mother, baby died. The nurse was critically injured.

    A long-time L&D nurse at one of the local hospitals commented when I asked her what her thoughts were (she has some interesting experiences as a Peace Corp nurse in South America, a more global view of nursing than is usually seen here in the midwest) "Well, I've never had to do a drug test on an Hispanic mother, I've never had to call in family services for suspected abuse. I have done these many, many times for 'our own white trailer trash' American residents." She'd rather see the young families have a chance at a healthy start.

    It's a puzzlement to me. I'm not sure how I feel about this. Much of my concern is linked to budget. I just see a greater and greater drain on an extremely overtaxed system already. If we have to limit our services - should not our own citizens recieve the first services available?


    arghhhhhhhhhhhhh - these ethical discussions make my head spin sometimes. I think I know what I believe and then someone makes a good point and I have to reconsider what I have already concluded to be true.

    I feel like Eeyore.... think, think, think, think, think
    •  
  2. 170 Comments

  3. by   unknown99
    Documented or not, people deserve the right to good health care. To me , there should be no ethical dilema. We as healthcare providers do just that, we PROVIDE CARE!!! It doesn't matter who a person is, what race they are, or if they are documented or not. I wholeheartedly believe that the day a healthcare professional question if they should be providing care or not based on the fact that the people are documented or not, then that should be the day that the healthcare provider step down as such!!!
    Was it the fault of the undocumented mother that the helicopter crashed? ABSOLUTELY NOT! It was an ACCIDENT! This mother only wanted what any other mother would want, and that was for her child to have the healthcare that was needed!!!
    Your L&D nurse is 100% correct in her assessment of Hispanic mothers. They are here with their families just trying to have a better life. We have a large population of Hispanics where I live. Never once have I seen one abuse their child, or get arrested for drugs. It is a daily occurence for the caucasians.
    Personally, I am appalled that any health care provider would even question whether or not care should be provided to ANYONE! The day that happens should be the day that healthcare provider quit healthcare.
    Last edit by unknown99 on Mar 24, '04
  4. by   nurseunderwater
    Quote from sagarcia210
    We as healthcare providers do just that, we PROVIDE CARE!!! It doesn't matter who a person is, what race they are, or if they are documented or not. I wholeheartedly believe that the day a healthcare professional question if they should be providing care or not based on the fact that the people are documented or not, then that should be the day that the healthcare provider step down as such!!!

    well said sagarcia, well said.

    ps: it's pooh who does all the think, think, thinking....he's the ultimate taoist archetype
  5. by   IowaCindy
    is that aid should be provided. Period.

    But the reality of healthcare as I understand it and read about is that money will become (if this hasn't already happened) determining factor in who gets services, how much service is available in any one geographical area. I've read that clinics are closing in Arizona because of the burden of the cares to the undocumented residents.

    There will be many struggles for access to funding in the coming years. An aging population will require greater services, aging schools will need money to rebuild and update. on and on and on.....it won't stop, the needs.

    I think the greater answer will lie in a societal change in thinking? One of my elder brothers is strongly urging me to become more politically active. "Take that nursing background, Sis, and go change the world."

    Ha. Hard to do if I can't remember the difference between Pooh and Eeyore.
  6. by   hogan4736
    Arizona taxpayers payed out 30 million dollars to hospitals for care delivered to mostly (arguably) illegal immigrant health care (from emergency room visits only)...

    Is this a problem?
    YES

    Are there more hidden costs (than just ER visits) from giving health care to illegal aliens?
    YES

    Will I take care of this undocumented patient as I would anyone else?

    Of course!

    Can I have an opinion while being a good nurse?

    OF COURSE...

    The two are mutually exclusive

    sean
    Last edit by hogan4736 on Mar 24, '04
  7. by   c.wicks
    No tienen seguro....pagan generalmente con efectivo.
  8. by   TinyNurse
    well said sargarcia!! I don't work on a copter, but wow, patient care IS patient care whether or not documented in the US. I would care for an illegal baby just as i would a legal one, as I"m SURE the other ER nurses here would do.
    xo Jen
  9. by   gwenith
    To be honest the biggest drain on health care at present is the legal system and it is definitely a "non-essential service"

    We were and low litigious society until recently when a change in how the legal fratenity dealt with lawsuits caused a sudden rise in litigation with the concurrent rise in medical insurance passed on as rising cost to the consumer.

    We too have a lot of illegal aliens who slip through the cracks or even come over from thier own country to have the operation here on someone's borrowed medicare card but they are not putting the strain on the sytem that the lawyers are.
  10. by   leslie :-D
    Quote from c.wicks
    No tienen seguro....pagan generalmente con efectivo.
    well said.
  11. by   flashpoint
    I don't disagree that everyone deserves appropriate health care and that all patients should be treated equally, but I have to agree with questioning allocation of resources. It is frustrating to see people who are not citizens and who do not have jobs receiving free care while many people with insurance avoid going to the doctor because they don't have the $15 for the copay.
  12. by   zenman
    Sounds like a good argument for national health care! I've also been to Mexico on medical mission trips. These people never complain and are glad to get any help. Then you come home and someone complains that you didn't fill their water pitcher fast enough!
  13. by   kmchugh
    Quote from sagarcia210
    Documented or not, people deserve the right to good health care. To me , there should be no ethical dilema. We as healthcare providers do just that, we PROVIDE CARE!!! It doesn't matter who a person is, what race they are, or if they are documented or not. I wholeheartedly believe that the day a healthcare professional question if they should be providing care or not based on the fact that the people are documented or not, then that should be the day that the healthcare provider step down as such!!!
    Was it the fault of the undocumented mother that the helicopter crashed? ABSOLUTELY NOT! It was an ACCIDENT! This mother only wanted what any other mother would want, and that was for her child to have the healthcare that was needed!!!
    Your L&D nurse is 100% correct in her assessment of Hispanic mothers. They are here with their families just trying to have a better life. We have a large population of Hispanics where I live. Never once have I seen one abuse their child, or get arrested for drugs. It is a daily occurence for the caucasians.
    Personally, I am appalled that any health care provider would even question whether or not care should be provided to ANYONE! The day that happens should be the day that healthcare provider quit healthcare.
    Nice. I have reflected on this question quite a bit. I don't happen to agree with you. In your mind, my disagreement means I should quit being a nurse. And if I don't want to quit, the healthcare police should take away my license.

    First, as to the "right" to healthcare: If you mean that healthcare should be available to all, regardless of race, creed, sexual orientation, or any other "discriminator," I would agree. If you want to say that all manner of healthcare should be available to all, regardless of ability to pay, my response would be absolutely not. The minute you say this, I will respond by giving you some very good reasons that I need a new HUMMER. But, I can't afford one, so by the same reasoning you use to justify healthcare, I will justify why you (the taxpayer) should buy my new HUMMER. I'd like that with an AM/FM/satellite radio/CD player, please. Bottom line, any thing that must be provided to any group of people at the expense of another group of people cannot be a right.

    Does that mean I think the first thing any ER should check for is the ability to pay for care? No, and under the law as it currently exists, no one can be turned away from a hospital based on ability to pay. However, consider some other facts. The cost of healthcare in the US is skyrocketing, in part because many of us are forced to pay for the care (via increases in our own billing) given to those who cannot pay. Also consider, under the law as it exists, illegal aliens (I refuse to use the softer, but less accurate term "undocumented") can demand care at amost any healthcare facility. The facility must give that care, but is not allowed to report the alien to authorities as illegal. It becomes a safe, free ride, at all of our expense. Consider the following scenario:

    My wife was a nurse in a major burn center. Burn units are notoriously expensive. If you had a health insurance policy that capped your coverage at about $250,000 (fairly common cap), and were severely burned, you could reach your cap within a couple of weeks in a burn unit. And burn units are not "money makers" for hospitals. Generally, if fully paid for the care of a burned patient, the hospital does little more than break even. My wife cared for a number of illegal aliens at this hospital (a not for profit, Catholic facility), and the hospital was forced to eat the cost of caring for these patients. She often found that the families of these patients were the most demanding, most complaining, quickest to curse a nurse of any patient she cared for. They demanded that you not only cared for the patient, but that you fed them while they were there. Suppose you, as a nurse, reported this family to the INS, so that when the patient was stable, recovering, and could safely be moved, they could be taken back to whereever they were from, would any legal action be taken? Yes, against YOU for a violation of the patient's privacy. Insanity. The illegal alien gets the free ride, care better than our own citizens. There are many things very wrong with this scenario.

    As to your contention that illegal aliens don't commit child abuse, don't get involved in illegal drug activities, etc, nonsense. If you (or the OP's L&D nurse) have never seen it, it's because you haven't looked. I have worked ER, and have seen the children of illegals brought in after hideous abuse. Not worse than other groups, but illegals are not immune.

    My FIL is in law enforcement, and works narcotics. Every day, EVERY DAY, a state trooper in the state where he works pulls over a vehicle of illegal aliens transporting illegal drugs. The point is that illegals are, as a group, no better or worse than any other group in the US. There is, however, one significant difference: As a group, every member of the group called "illegal aliens" is, by definition, a criminal. Simply by being here, they are violating US law.

    Does that mean we should deny them treatment? No, but neither should they have better treatment, or more priviledges than what I, as a patient who will pay, should get. And, if they must seek treatment, fine. But there must also be an allowance to report them as illegals, so they can be deported when stable. Sound harsh? Why? Is it any more harsh than the requirement we all have to report suspected child abusers? Whatever arguments you give for not reporting illegal aliens can be extended to not reporting suspected child abuse.

    Remember, there is another side to the argument. Just because I don't happen to agree with you does not mean you are somehow a better nurse, or that you belong in healthcare, and I don't. I still give very good care, and the immigration status of the patient is moot. But there needs to be some limitation.

    Kevin McHugh, CRNA
  14. by   kmchugh
    Quote from zenman
    Sounds like a good argument for national health care!
    I'm sorry, but this makes no sense! Because you haven't had the opportunity to hear someone complain, we should raise our taxes to support them?

    I don't complain much, can I have my HUMMER now?

    KM

close