New Rules Curb Free Health Care for Foreigners

Los Angeles County health officials on Monday issued regulations aimed at barring most foreign visitors from obtaining free medical care at county hospitals and clinics, a practice that doctors estimate has drained millions of dollars from publicly financed health programs for poor California residents.

Exceptions will be made only for foreign visitors suffering serious medical emergencies which, “if not immediately diagnosed and treated, could lead to serious physical or mental disability or death,” according to the regulations being distributed this week to the staffs of the county’s six public hospitals and 46 health centers.

Even in emergency cases, county lawyers are working on a means for Los Angeles County to obtain payment from the foreign patients’ home countries if the patients fail to pay, according to Irene Riley, a health department finance official.

The announcement of the new regulations follows a Times investigation into abuses by foreign visitors of free state and county health programs for the poor and uninsured. The county Board of Supervisors responded to the newspaper’s findings by ordering county health officials to find a way to deter these non-resident patients.

The new regulations apply to legal foreign visitors entering the United States on short-term visas for business or pleasure. They also cover foreign nationals entering from countries without visa requirements, such as Canada and certain Caribbean nations. Besides tourists and business travelers, these visitors include foreign exchange students, certain agricultural workers and their dependents.

The regulations do not affect illegal immigrants, who, under federal and state law, are entitled to state Medi-Cal coverage for emergency and pregnancy-related treatment, and they frequently obtain routine treatment through the county indigent care program.

Even if the visiting foreigners can pay for their care, the new regulations bar them from obtaining non-emergency medical treatment at county facilities, Riley said.

“We don’t want them to take up a place in line,” Riley said, noting that waiting times, even for emergencies, are already long at the perpetually overcrowded county facilities.

County officials hope the new regulations and a system less “friendly” to non-resident foreign patients will deter use. On Monday, signs were being posted in English and Spanish in all county health facilities.

Headlined: “Foreign Visitors and Certain Other Nonimmigrant Persons,” the notices read: “Foreign visitors who entered the United States with visas or under the Visa Waiver Pilot Program, and certain other nonimmigrants are not eligible to receive NONEMERGENCY health services at this county facility.”

“What we are trying to get at are the ones that are coming to this country deliberately for the purpose of seeking care,” Riley said.

Initial reaction from county doctors Monday was skeptical, however.

“I’m not sure this is really going to deter the group that is the main problem--the ones who are being told by doctors in their own country: ‘You can’t get treatment here. Go to America,’ ” said Dr. Irwin Ziment, chief of medicine at Los Angeles County-Olive View Medical Center in Sylmar. “These patients are genuinely sick. They’ve all made that big journey. And they are just going to hang around until they become a serious emergency,” thus qualifying for care.

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Although many non-resident foreign patients are here in such desperation, the Times investigation turned up examples of patients who appeared to be seeking care in California’s public hospitals because they were aware that they could obtain sophisticated treatment for free. Doctors described patients who arrived in luxury cars and wearing expensive jewelry, only to claim poverty when confronted with the hospital bill.

At the very least, county officials said they expect the new policy to deter plastic surgery and expensive organ transplant procedures for foreign visitors.