Illegal care? Treating undocumented immigrants in Texas

The Texas attorney general says it's against the law to provide routine care to foreign workers. Physicians and hospitals say that's not ethical, and not good medicine.

By Amy Snow Landa, AMNews staff. Oct. 1, 2001.

Physicians in Texas county hospitals and clinics have treated low-income residents for years without concern for whether their patients can prove they are U.S. citizens or legal residents.

In a city like Houston, where an estimated one-quarter of indigent patients are undocumented immigrants, denying them publicly funded health care services would mean turning away a lot of patients in need of care -- a scenario that holds little appeal for physicians.

"When you read the Hippocratic oath, it doesn't say anything about [a patient's] citizenship," explains Jeff Starke, MD, chief of pediatrics at Ben Taub General Hospital, Houston's largest public hospital. "It says I'm supposed to help people who come to me for help."

The idea is to treat people before their conditions become acute and require emergency care, he says, which is why Houston's public health care system -- the Harris County Hospital District -- offers preventive and primary care to needy inhabitants regardless of their legal status. Most of the nation's local public health care systems have similar policies.

But in Texas, Dr. Starke's sense of medical ethics and the county hospital districts' longstanding practice have collided with a recent legal opinion issued by Texas Attorney General John Cornyn.

In it, Cornyn wrote that provisions of the 1996 federal welfare reform law prohibit Ben Taub and other safety-net hospitals and clinics in the state from providing most nonemergency health care services to undocumented immigrants. The only exceptions are for immunizations, diagnosis and treatment for communicable diseases, and services for abused children. [...]