COLUMN ONE : Medicine Bordering on Crisis : Poor visitors unable to pay for treatment are packing clinics and hospitals near Mexico. Widespread poverty and a shortage of doctors on the U.S. side add to the strain.

The parking lot of Thomason Hospital says a lot about medical care in the region near the border.

Many of the license plates are from Mexico, just as many of the people in the packed emergency room of the public hospital are Mexican nationals. Those who live in Juarez, on the Mexican side of the Texas border, are likely to give the address of an aunt or a brother or cousin who lives in El Paso. That’s the way it works here.

The reason is both prudence and money. The best care along the border with Mexico is on the American side. The cheapest care is at Thomason, which writes off about $50 million a year in unpaid bills. The emergency room has become the family doctor for thousands who need medical help but happen to live in another country that is a few minutes’ drive away.

That is only one small aspect of the predicament along the 2,000-mile boundary where the United States meets Mexico. Doctors and health officials near the border paint a picture of health care like no other place in the United States.

Five of the six poorest metropolitan areas in the country are strung out along the U.S.-Mexican border. Their economies resemble those of inner-city slums, with staggering poverty and unemployment rates. Problems such as extreme poverty, inadequate sanitation, exploding population, Third World clinics on the Mexican side and a lack of either insurance or doctors on the American side have combined to produce a system in sad need of repair. And the evidence points to a crisis that is only getting worse.

For instance:

* At Holy Cross Hospital in Nogales, Ariz., a third of the emergency admissions are Mexican nationals who cannot afford to pay for their treatment. Almost all of them come from the sister city of Nogales, Mexico, whose population is 10 times that of the Arizona border town of 25,000.

* More than half of 400 El Paso farm workers tested for tuberculosis last year turned up positive. Health officials blamed cramped buses and unsanitary living conditions for the alarmingly high incidence of TB, an infectious disease caused by airborne bacteria.

* The Mexican-U.S. border is now seen as an ideal setting for an outbreak of cholera, which has taken an estimated 4,000 lives in 14 Latin American countries during the past year. At least one cholera case was confirmed recently in Brownsville, the southernmost city in Texas. A woman had contracted the disease from eating contaminated shrimp while on a trip to Tampico, Mexico.

* Also in Brownsville, during the last three years 28 women have given birth to babies without brains. The occurrence of this rare congenital defect, known as anencephaly, is six times the national average in Brownsville. Authorities have not identified a cause, but some in the community suspect toxic emissions from factories below the border in Matamoros.

Problems are compounded on the U.S. side of the border by the fact that many people have no medical insurance. In Hidalgo County, in the Lower Rio Grande Valley, the number of people living at or below the poverty line hovers around 40%--compared to 13.5% nationwide--and unemployment is 18%, compared to 7.8% nationwide. Figures for other counties along the border, especially in Texas, are similar.

In a switch on the usual pattern, some of these uninsured people often resort to far cheaper, albeit less modern, treatment on the Mexican side, particularly for things such as dental work. And many U.S. residents go to Mexico to fill their prescriptions at much cheaper prices, though quality control on drugs is considerably more lax.

Lack of Insurance

Employment is no guarantee of medical insurance, said Dr. Charles Wilson, the Hidalgo County health director. A General Accounting Office report, released last September, bears that out. The report said that in 1989, 33% of all Latinos--and 37% of the nation’s Mexican-Americans--had no coverage, largely because their employers did not provide it and their wages were so low they could not buy a policy.

The results of that lack of insurance can be seen every day in hospitals along the border, where patients wait until a medical problem that might have been easily treated has become acute. The examples take on various forms: Pregnant women who have received no prenatal care often suffer from severe complications, and many babies are born underweight.

Childbirth itself is an issue. Many pregnant Mexican women show up at hospital emergency rooms on the U.S. side at the last minute--so far along in labor that they cannot be turned away. The children they bear are American citizens, eligible for immediate medical and nutritional aid, as well as other, long-term benefits.

A proposed constitutional amendment introduced last fall by Rep. Elton Gallegly (R-Simi Valley) would deny U.S. citizenship to American-born children of illegal immigrants. This would revise the 14th Amendment, which guarantees citizenship to everyone born in the United States.

“It’s a drain on the system,” said Dr. Wayne Wilson, a McAllen obstetrician. He said non-paying “drop-ins” account for roughly 10% of his deliveries. “I don’t see why the U.S. government, doctors and hospitals on this side of the border have to take care of these people. I don’t think the Founding Fathers had this in mind when they wrote the Constitution.”

The GAO study of border counties also described ailments that might have been prevented. It said that 60% of diabetes-caused blindness could have been prevented with proper treatment, as could 51% of the kidney failures and 67% of all disease-related amputations.

While most Americans on the border are eligible for public assistance, relatively few doctors are willing to accept Medicaid payments and the tangle of paperwork that goes with them.

People seeking medical assistance in Texas, which abuts more than half the U.S.-Mexico boundary, also must go through one of the most complicated sets of rules. Texas has perhaps 10 programs for Medicaid enrollment, each with its own criteria for eligibility.

Doctor Shortage

In a four-county area of the impoverished Lower Rio Grande Valley, an estimated 12,000 women are eligible for Medicaid maternity benefits, but only 50 doctors are willing to treat them under the state aid program--a patient-doctor ratio that Wilson, the Hidalgo County health director, called far too high.

McAllen Medical Center, a private hospital, receives the largest share of what is known as “disproportionate funds” from the state, to help compensate for care given to indigents from both sides of the border.

In one poor section of El Paso, there is only one pediatrician for a population of 170,000 people, and only 14 doctors in the entire city accept Medicaid, according to Pete Duarte, Thomason Hospital’s chief operating officer. Of the estimated 800 doctors in El Paso, only 30 have offices south of Interstate 10, the line of demarcation between poor and middle-class neighborhoods.

Doctors and health officials along the border predict that medical care will become even spottier and Third World diseases, such as tuberculosis, malaria and leprosy, will become even more prevalent within a decade if the downward spiral of care continues.

The border’s medical crisis comes at a time when rapid population growth has severely taxed the infrastructure of cities in the region. Lured by the possibility of jobs in U.S. plants that have been built on the Mexican side of the border to take advantage of relatively cheap labor, hundreds of thousands of impoverished Mexicans from the interior have made their way to border cities.

During the last century, the border population has ballooned from 36,000 people to more than 6 million, with most of those arriving in the last 20 years. Shantytowns, known as colonias, without sewers or running water have become a shameful part of the border landscape.

Dr. Laurance Nickey, the El Paso city-county health director, said the Mexican-American border is an ideal setting for an outbreak of cholera.

“I am very worried about cholera coming to our colonias, “ he said. “You’ve got poverty, undereducation, a lack of general hygiene, untreated sewage, improper disposal and no potable water. These are the criteria for cholera.”

Nickey sharply criticized the federal government’s lack of effort to shore up conditions on the border.

“If they can do something for Afghanistan, why can’t they do something for the people who live right along the border,” said Nickey. “I’ve got Third World conditions not only in this county, but a Third World country next to me. Why can’t we do something to help our southern neighbor help themselves?”

Officials Inattentive

F. Douglas Crutchfield, a professor of public health at San Diego State University, agreed that the federal governments of both nations have been lax in addressing border issues, save the economic pluses of the proposed free trade agreement. The accord is expected to prompt many U.S. businesses to set up operations along the border.

“It’s been very frustrating for us,” he said. “Trying to get resources is like pulling teeth. Neither federal government pays much attention to the border.”

One small exception to that comes in the form of a bill now making its way through the Congress. It would reimburse hospitals that can prove more than 15% of their trauma patients are undocumented immigrants. The bill, introduced by Rep. Bill Lowery (R-San Diego), has a $50-million spending cap.

Such a sum would be a relative drop in the bucket. In California alone, undocumented immigrants account for more than $40 million worth of uncompensated care. Uncompensated care in California amounts to about $2.5 billion a year.

The answers to the health care problems of the border region run a wide range, made somewhat tricky by the fact that two nations would be involved in the process. There is almost universal agreement that the first order of business must be hygiene engineering--putting in the water and sewer mains, cleaning up the rivers and stopping toxic-waste dumping. With that would come mass immunization drives on both sides of the border.

Other suggestions: a binational agreement on payment for trauma cases, cross-border insurance plans and arrangements allowing Mexican hospitals to refer patients to medical facilities in the United States, with the Mexican government footing the bill for Mexicans treated in Texas, and vice-versa.

There is talk of a need to simplify the Medicaid process so that more people are eligible, not only along the border but perhaps nationwide.

In El Paso and elsewhere near the border, advanced midwife training is being offered to cut down on hospital deliveries. Expectant mothers are being taught how to recognize complications early. Duarte, of Thomason Hospital, said there needs to be more long-range planning for the area.

“We’re just patching things as we go along,” he said. “That’s the kind of vision we have.”

A Poverty Stronghold

Mexicans crossing into the United States for medical help are putting further pressure on many border cities. Five of six poorest U.S. metropolitan areas are along the Mexican border. According to the U.S. census, they are Las Cruces, New Mexico; El Paso, Texas; Laredo, Texas; McAllen, Texas; Brownsville, Texas.