To Treat Or Not To Treat

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  • To Treat Or Not To Treat

    1. 1. To Treat or Not to Treat: The Legal Confusion and Inconsistency in Treating Illegal Immigrants Laura Redmond Nursing 500, Section 901 Drexel University
    2. 2. <ul><li>“ Give me your tired, your poor </li></ul><ul><li>Your huddled masses yearning to breathe free, </li></ul><ul><li>The wretched refuse of your teeming shore, </li></ul><ul><li>Send these, the homeless, tempest-tost to me, </li></ul><ul><li>I lift my lamp beside the golden door!” </li></ul><ul><li>- Emma Lazarus (1886) </li></ul>
    3. 3. Brief Overview of Immigration Law <ul><li>Quota System </li></ul><ul><li>1965 Hart-Celler Act </li></ul><ul><li>More aggressive legislation followed </li></ul><ul><ul><li>1994 California Proposition 187 (State) </li></ul></ul><ul><ul><li>1996 Illegal Immigrant Reform and Responsibility Act (Federal) </li></ul></ul><ul><ul><li>Focus changed to limiting public services, especially health care and schools </li></ul></ul><ul><ul><li>Ultimately overturned, but emerging agenda noted </li></ul></ul><ul><li>Immigration legislation has greatly increased in recent years with focus on exclusion of services for undocumented immigrants </li></ul>
    4. 4. Should We Ration Health Care?
    5. 5. Should We Ration Health care? <ul><li>Increased financial strain on facilities due to rise in number of uninsured </li></ul><ul><li>Many people blame illegal immigrants however, economic evidence and cost estimates of providing health care varies. </li></ul><ul><li>These numbers provide the basis for most political discussions on rationing </li></ul>
    6. 6. Access to Health Care <ul><li>Emergency Medical Treatment and Active Labor Act (EMTALA)-2003 </li></ul><ul><li>To offset the institutional and provider costs of EMTALA, a reimbursement policy was proposed under the Medicare Modernization Act (MMA)- 2003 </li></ul><ul><ul><li>Required reporting of illegal immigrants seeking care </li></ul></ul><ul><ul><li>Opposed by many health care and professional organizations, immigrant rights groups, and hospitals </li></ul></ul>
    7. 7. <ul><li>Health care blackmail </li></ul><ul><ul><li>Mandatory reporting put providers at risk to become unwitting agents for the BCIS </li></ul></ul><ul><li>Risked violating the patient-provider trust relationship </li></ul><ul><ul><li>If perceived as immigration agents, undocumented immigrants may avoid seeking medical care due to fear and suspicion potentially leading to a health care crisis for the individual and public overall. </li></ul></ul><ul><li>Presented a legal conundrum: </li></ul><ul><ul><li>In following the guidelines for the MMA reimbursement, providers risked violating HIPAA- legislation enacted to protect the privacy and confidentiality of patient information </li></ul></ul>Access to Health Care
    8. 8. Can We Protect the Public Health? <ul><li>Immigrants have problems navigating the complex U.S. health care system </li></ul><ul><ul><li>Language barriers </li></ul></ul><ul><ul><li>Cultural unfamiliarity </li></ul></ul><ul><li>If care becomes influenced by immigration status, we add fear of discovery and deportation </li></ul><ul><ul><li>May provide inaccurate medical histories, incorrect contact information, or avoid system altogether </li></ul></ul><ul><ul><li>May lead to medical mismanagement and disease control </li></ul></ul>
    9. 9. <ul><li>Greatest fear with increased immigration is communicable disease </li></ul><ul><ul><li>Return of previously eradicated diseases </li></ul></ul><ul><ul><ul><li>Tb </li></ul></ul></ul><ul><ul><ul><li>Malaria </li></ul></ul></ul><ul><ul><ul><li>Leprosy </li></ul></ul></ul><ul><ul><ul><li>Polio </li></ul></ul></ul><ul><li>The World Health Organization postulates that air travel alone has accounted for the increases in disease incidence and fear a pandemic is only a plane ride away </li></ul>Can We Protect the Public Health?
    10. 11. Legal Quandaries <ul><li>Which obligation should U.S. health care providers uphold- law-abiding citizen or ethical professional? </li></ul><ul><li>Are practitioners that treat illegal immigrants at risk for malpractice claims? </li></ul><ul><li>Would providers be exempt from lawsuits filed on behalf of undocumented immigrants? </li></ul><ul><li>Will workers and institutions need more liability and malpractice insurance? </li></ul>
    11. 12. <ul><li>Would it be enough to protect from federal prosecution? </li></ul><ul><li>Would prolonged treatment time constitute harboring and be punishable with fines or jail? </li></ul><ul><li>Time tables, multiple legislative bills, and legal clarification is obscure at best and providers risk violation, whether intentional or not. </li></ul>Legal Quandaries
    12. 14. Provision of Care <ul><li>Undocumented immigrant health care plan </li></ul><ul><ul><li>Funded by illegal immigrant payments </li></ul></ul><ul><ul><li>Specifically developed for those interested in attaining naturalized status </li></ul></ul><ul><ul><li>Using funded clinics safe from the BCIS would decompress tertiary care centers and improve overall illegal immigrant health </li></ul></ul><ul><ul><li>Little Hoover Commission (2002) </li></ul></ul><ul><ul><li>National Immigration Forum survey (2005) </li></ul></ul>
    13. 15. <ul><li>Interventional Care </li></ul><ul><ul><li>Internet-based treatment and telemedicine </li></ul></ul><ul><ul><li>Tailored-telephone technology </li></ul></ul><ul><ul><li>Culturally specific, yet anonymous </li></ul></ul><ul><ul><li>Assumes access to cost-efficient technology </li></ul></ul><ul><ul><li>Upholds both civil and ethical obligations </li></ul></ul><ul><li>Use of Nurse navigators </li></ul><ul><ul><li>Specifically trained in illegal immigrant issues </li></ul></ul><ul><ul><li>Assists patients in navigating the complex health care system </li></ul></ul><ul><ul><li>Serve as a resource for providing and securing care </li></ul></ul>Provision of Care
    14. 16. <ul><li>Use of safety net community and faith-based preventative medical centers </li></ul><ul><ul><li>Culturally sensitive </li></ul></ul><ul><ul><li>Perceived safe places </li></ul></ul><ul><ul><li>May contribute to better treatment and follow-up care </li></ul></ul><ul><ul><li>Decreases use of emergency department for preventative and primary care </li></ul></ul><ul><li>Bilingual /multi-lingual care </li></ul><ul><ul><li>Reduces barriers </li></ul></ul><ul><ul><li>Provider educational opportunity and ability to develop innovative and culturally-specific interventions </li></ul></ul>Provision of Care
    15. 17. So What Do We Do Now? <ul><li>As health care providers, we must develop strategies to care for the undocumented immigrant population and not succumb to health care blackmail </li></ul><ul><li>Political activism and involvement is the key to legislative change and understanding </li></ul><ul><li>We must continue to uphold our ethical and professional obligation to “care” first and ensure the preservation of the individual and public health </li></ul>
    16. 18. THANK YOU!

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