Doctors, clinicians voice concerns about Prop. 187
Medical workers foresee financial, ethical problems
By Ben Gilmore
Tina Harris, who makes sure children at Culver City's Montessori Elementary School get their immunizations, is outraged. "Children shouldn't have to suffer," Harris said. "They shouldn't pay the price they're totally innocent."
Harris is one of many in the health care field who are objecting to Proposition 187 the controversial "Save Our State"initiative that aims to refuse illegal immigrants some state-supported services, such as non-emergency public health care like immunization shots to children.
Many doctors and clinicians are voicing concerns about the proposal, claiming its implementation will create practical and financial problems, health hazards and serious ethical dilemmas for the medical community.
Proposition 187 leaves federal law to define "emergency" vs. "non-emergency," critics said. Some doctors said they feel the proposal is poorly written, since federal law is extremely unclear as to which situations are "emergencies."
"The only situation which federal law defines as emergency is a woman in labor. Otherwise, it's pretty much up to the doctors," said Marshall Morgan, chief of emergency medicine at the UCLA Medical Center. "The proposal is so badly written that it's impossible to tell what will happen. It's extraordinarily ambiguous."
Should Proposition 187 pass, health care workers at publicly funded facilities would be required to report suspected illegal immigrants to the Immigration and Naturalization Service.
"It's ludicrous," Morgan said. "What are we supposed to do? Check everybody with brown skin? It's ridiculous."
Other logistical concerns about Proposition 187 have arisen. Currently the Los Angeles County Department of Health runs 39 community health centers and six comprehensive health centers.
The Venice Family Clinic, a private clinic that provides free comprehensive medical care to low-income individuals, typifies the kind of facility that will take the heat, said clinic Medical Director Susan Fleishman.
"There's no question that our demand will go up. Some people are going to have no other option," Fleishman said. If the initiative is passed, the clinic will continue providing free care to low-income persons regardless of citizenship, Fleishman explained. But, she added, the clinic will have to sacrifice public funds which make up 25 percent of its current funding to do so.
The combination of skyrocketing demand and decreased funds would create a grim financial situation for free private clinics in Los Angeles County, which number at least 23, Fleishman said.
"It's the same all over L.A. It's hard to keep up financially as it is, and it'll get worse. We already see over 20,000 people a day," Fleishman said. "We're going to have to do a lot of fundraising."
Another problem, which some doctors fear will expand if Proposition 187 goes into effect, is the spread of infectious diseases.
Currently the Los Angeles County health department offers free immunizations that cover infections including measles, influenza, polio and hepatitis B, regardless of background or citizenship.
Proposition 187 would deny these immunizations to illegal immigrants, creating what many doctors said would be a serious health hazard and resulting in a violation of ethics.
"History has shown that if vaccination rates go down, infection rates go up," said Andrew Kaplan, a UCLA Medical Center doctor who specializes in pediatric infectious diseases.
Kaplan, Morgan and Fleishman all cited a 1990 Southern California measles epidemic to show the consequences of lowered vaccination rates. In 1990, 12,586 cases of measles were reported in California, compared with 61 the next year, according to the immunization branch of the California Department of Health Services.
"For one reason or another, people didn't get immunized, out of carelessness or other reasons," Kaplan said. "An epidemic broke out in L.A. and Orange County, affecting mostly college students and preschoolers."
Brad Ackerson, a fellow in Pediatric Infectious Diseases at the UCLA Medical School, said he thinks the initiative may cause similar epidemics of disease.
"(Proposition) 187 creates a potential for increasing the spread of contagious preventable disease. People may be contagious and unimmunized and be reluctant to seek medical treatment," he explained.
Denying a segment of the population immunizations may also be financially draining, since vaccinating all children is cheaper than treating those who would contract disease if they were unimmunized, some critics claimed. Vaccination saves an average of $9 for every dollar spent, according to a California Department of Health Services.
Epidemics and monetary issues aside, the idea of allowing a child to contract a serious preventable disease is ethically repugnant to many doctors, Morgan said.
"I can remember when people lived in fear of polio every summer," Morgan recalled. "We have an obligation to not harm people, and to treat them against diseases no matter what. It's a disaster any way you look at it."