Tuesday, August 19, 2008

Illegal immigrant crackdown may threaten America's health, some doctors say

By KRISTIN COLLINS | Raleigh News and Observer/GNS
Posted on the Chicago Sun Times.

Doctors 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, N.C. -- 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 North Carolina 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 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 North Carolina 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.

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.

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 North Carolina 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.

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