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Facing charity's end

Posted: December 24, 2006 - 7:12am  |  Updated: December 24, 2006 - 7:14am
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Reyna Vazquez, left, helps her daughter Maria Vazquez, 6, with a counting exercise before dinner at their home.  Savannah Morning News

Christmas is a time of hope.

Perhaps for no one more so this season than Reyna Vazquez, 21, a stay-at-home mom on Savannah's south side.

Her daughter - Maria, 6, a sprite of a child who loves pink and who flashes a gap-toothed smile - wants a Cinderella dress and a Jasmine costume for Christmas.

Consider that done.

Vazquez's wish for herself, though, is getting harder to fulfill in Georgia.

She needs dialysis three times a week to stay alive. But she's an undocumented immigrant from Vera Cruz, Mexico.

Recent federal and state crackdowns on access to public funds for health care mean Vazquez and others in her situation are less likely to get steady medical attention here.

Administrators at Memorial Health University Medical Center say the laws not only hurt undocumented immigrants with chronic health conditions, but they also have unintended consequences for hospitals, including higher costs and more crowding in the emergency room plus an emotional toll on health-care workers.

Smuggled to Savannah

Vazquez smuggled herself and her daughter into the United States when she was 16. She was still nursing then 1-year-old Maria, who fell ill and feverish in the desert during the weeklong journey by car across the border in Arizona and then to Savannah.

Maria's father, an undocumented immigrant himself, had sent for the pair and arranged for their passage. Vazquez worked briefly as a hotel housekeeper, but the job didn't work out. Neither did the relationship that brought her here. She left Maria's dad because of his drug and alcohol addictions.

She then fashioned a life with her new partner, a bricklayer named Luis Galarza-Chavarria, 43. His family treats her little girl as their own. An extended network of neighborhood friends, all from Mexico, collectively takes care of each other with baby-sitting, cooking and cleaning.

But none of them can provide dialysis.

Vazquez was diagnosed two years ago with glomerular nephritis. The auto-immune disease of unknown origin quickly progressed to irreversible kidney failure. The only treatments are thrice weekly dialysis, or a kidney transplant.

As a young mother with a disabling condition, she previously qualified for emergency Medicaid benefits parceled out in three-month chunks. But Georgia this year adopted Senate Bill 529, which became the Georgia Security and Immigration Compliance Act. It requires health-care providers to verify a patient's legal immigration status before such patients can qualify for Medicaid, which is a joint state and federal health-care assistance program for the poor and disabled. Similarly, on July 1, the federal government began requiring that those applying for Medicaid must verify that they are U.S. citizens.

Tough choices

Since mid-November, Memorial Health has paid for Vazquez's dialysis, which costs about ,000 a week. Officials there have told her that she'll no longer get that care after this week.

There are several reasons for cutting her off, said Mary Ann Bowman Beil, vice president for corporate ethics and compliance.

First, Memorial is not licensed to provide the outpatient dialysis care she requires. Providers have ignored that rule thus far out of compassion, Beil said.

Memorial could pay for Vazquez's care at a private outpatient facility, but doing so means spending limited resources that cannot be spent on others in need.

Memorial estimates it has spent about million since July on undocumented immigrants. An estimated 300,000 of these illegals live in Georgia, according to the U.S. Census Bureau.

"We want to care for every person who comes through the door," Beil said. "In the same breath, people in this community really do expect us to steward the resources of the federal government to meet this community's needs, and that's where you see the ethical dilemma. We do want to do it all for everyone. But there isn't enough to do it all for everyone."

That's exactly the concern of state Sen. Eric Johnson, R-Savannah, who supported the new law.

"Georgia taxpayers cannot afford to treat our own needy citizens," he wrote in an e-mail. "It is sad, but we have to say 'no' to those who enter our country illegally. ... If, for example, we continue to provide non-emergency care for illegal immigrants, we would be forced to reduce even more services to the poor."

But the new laws aren't necessarily a fiscal fix. Health-care officials worry that hospitals could end up spending more on cases like that of Vazquez.

That's because critically ill patients who show up at the emergency rooms legally cannot be turned away, regardless of their legal status.

Moreover, the law could stretch ERs to the breaking point.

"It's widely known ERs are understaffed, underfunded and overburdened," said Isaiah Delamar, Atlanta-based acting regional counsel for the Mexican American Legal Defense Fund, which is considering a legal challenge to the new Georgia statute.

"What's going to happen if more undocumented persons seek emergency care? If already the emergency wait is five hours, it could be nine.

"That hurts everybody, citizens and non-citizens alike. There's an ER crisis, and this is only going to add to the crisis."

Meanwhile the effect on health-care workers is worrisome, too.

"It breaks their hearts," said Amy Hughes, vice president of government affairs at Memorial. "Care is provided based on what the patient needs. We don't ever want to be put in the position of having to be the determiner of who rations care."

But that's exactly the position Memorial finds itself in.

The cost of emergency

Vazquez will fall critically ill in a matter of days without dialysis, said Dr. Michael J. Wilkowski, a nephrologist with Medical Associates of Savannah.

The process mechanically cleanses the blood but provides only about 10 to 20 percent of normal kidney function. If she went about two weeks without dialysis, toxins would build up in her body. Fluid in the lungs could cause respiratory distress or death.

The emergency care she inevitably will seek is expensive.

"It's crazy, it's crazy," Hughes said. "Then she'll have to be admitted as an inpatient for what should be an outpatient procedure. It just doesn't make any sense at all."

Hospital and state officials alike might be banking on shifting their burdens to other providers or other states.

"You're hoping the leaf blows in the other yard," said Peter Doliber, a nationally recognized expert in indigent care finances who worked at Memorial for nearly a decade as director of community benefits.

Those leaves are plentiful.

More than 100 undocumented people in Georgia undergo dialysis treatments or have had transplants that no longer are covered by Medicaid, said Chris Starr of the National Kidney Foundation of Georgia.

And kidney failure isn't the only chronic condition where care up front saves money later. Untreated diabetes can lead to dire complications, as can a host of other diseases. Hughes worries specifically about immigrant women who fail to get mammograms.

"I worry that cancer is going to go undetected," she said. "That bothers me."

The sponsor of the Georgia immigration law refutes the cost argument.

"I reject the idea that the cost will go up," said state Sen. Chip Rogers, R-Woodstock. "The entire purpose of (the law) is to make Georgia less attractive for illegal activity. If there are fewer (undocumented immigrant) people here, by definition that makes medical cost go down."

Johnson finds fault with the leniency of ER admissions.

"The federal government desperately needs to change the law that requires hospitals to treat anybody who walks into an ER," he wrote. "That is breaking the bank and allows a 'back door' around any health-care reform."

Doliber says there's no easy answer.

"At some point you have to say: Who pays?" he said. "You have a 21-year-old girl who's dying, and she has a 6-year-old kid. How do you turn your back? I don't blame the hospital. I think it's a poorly constructed law. There's a lot more we need to do for the uninsured, whether they're legal or not. It's a broken system."

What's best

Vazquez makes a compliant patient.

One recent evening, she stood in her kitchen, pulling cooked beef with deft fingers.

It was warm in the house - both with cooking and friendship. Vazquez and two neighbors moved through their tasks as though choreographed, no one needing to ask what to do next.

On the stove, a generous soup pot held pulled chicken for tostadas de tinga, a dish traditionally rich with chipotle chilies, adobo sauce and onions. In a smaller dish was Vazquez's bland version. She has cut out spicy foods in an effort to reduce sodium and potassium. When one's kidneys are not healthy, those minerals build up as toxins.

She has keep her weight down on her 4 foot 10 inch frame, also to avoid taxing her system. She consumes only a liter of fluid a day, and she said she is always thirsty.

At the far end of the table, Maria's pencil hovered over a photocopied homework assignment. Pretty in a pink sweater trimmed in faux fur, her silky black hair in a pony tail, she counted a set of stars.


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vlad_the_inhaler 12/24/06 - 05:58 pm

But I don't pay taxes so that ILLEGAL ALIENS can get free access to health care in my country. You want to move here? Fine. Do so legally.

Mary Landers' use of the phrase "undocumented immigrant" is woefully incorrect. "Immigrant" refers to someone who has gone through or is going through the legal procedure of immigration. Crossing a nation's border without signing the guest book, as it were, is not a legal procedure. It is a flagrant violation of the laws of the nation these people want to be a part of. Vasquez is a criminal who crossed the border ILLEGALLY, thereby invading this country and bringing her daughter along on her ILLEGAL adventure.

What sort of parent breaks the law with her child in tow?

Vasquez's story, as well as the millions of other illegal aliens' stories may be heart wrenching for those whose hearts overpower their minds, but it boils down to the same situation -- they are here against the law. They are parasites in the system, using up public funds to take care of themselves in this country when they aren't even supposed to be here. They work off the books, not paying taxes, usurp public funds that should go to help legal, tax-paying citizens who need and are entitled to public assistance, and then they send their illegally obtained paychecks back to enhance the economy of a foreign nation.

Their presence in this country is a siphon sucking some of the lifeblood of our sensitive economy and sending it back to their hypocritical, corrupt government. In Mexico, people are required to have voter ID cards with their photos. In Mexico, if an American is caught attempting to cross the border illegally, they are thrown into a Mexican prison. No extradition. No "catch and release" policies.

This situation has gotten out of hand. I refuse to feel sorry for anyone who disregards the laws of the land for their own selfish gain. If she needs dialysis, then she should go back home where she belongs and try to get her treatments there instead of stealing the services from taxpaying American citizens.

Shame on Landers for writing this bilge. And shame on her for not reporting this invading criminal to the appropriate authorities. As sad as Vasquez's story is, I am not moved to do anything but campaign for a Constitutional Amendment stripping non-citizens of the civil rights that legal American citizens possess.

These people are invaders and must be treated as so. No other country in the world tolerates this type of crime and we shouldn't either.

It is almost treasonous that people in this country are aiding and abetting invaders with no right to be in this country.

What's next? A story about how some poor crackhead mother can't afford Christmas presents for her twelve illegitimate kids because her crack habit costs her too much money?

SONA 12/24/06 - 10:52 pm
Illegals like them are

breaking the back of our medical system. All of you with insurance are paying for these poor saps sucking off of our system of charity. Some areas of the Southern border have hospitals on the verge of collapse due to the volume of illegals they serve. In many places in the US health care is a right, not in the US. We have a long way to go before we raise taxes high enough to cover such costs. Look at any system that supports such charity like in Canada or the UK and the systems are broken and the quality is less than stellar, well unless you have money. Send her home and let the government of Mexico care for her needs, not the US taxpayers.

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