Physicians Oppose Ban on Care

Doctors who treat undocumented women in public clinics in Ventura County say they will continue to give them prenatal care regardless of new federal welfare reform guidelines banning those benefits.

Although the guidelines were scheduled to go into effect Jan. 1, court challenges have indefinitely postponed their implementation in California.

But many doctors say even if the ban eventually takes effect, it won’t make any difference. They will still offer care to those women in need.

“It will become a civil disobedience issue for most people,” predicted Dr. Brian Prestwich, a family physician who works at the Las Islas Clinic in south Oxnard. “No matter what the state decides, our commitment is to the well-being of the patients of this county. We will continue to see all pregnant patients as long as we can, including those without funding or citizenship.”

Most of his colleagues at Las Islas agree. So do top administrators at Ventura County Medical Center.

Their concern is not only a humanitarian one. Indeed, many doctors say the county’s primary motivation is economic: Activists have noted that every $1 invested in prenatal care has been shown to save $3 in subsequent costs in pregnancy and birth complications.

“It’s been well-documented that adequate prenatal care pays off in the long run with healthier babies, and less funds spent,” said Dr. Richard Ashby, medical director at the Ventura County Medical Center. “Most counties . . . are almost forced into addressing this issue this way.”

Denise Martin, president of a nonprofit organization representing health delivery systems in 17 counties in California, said many counties--including San Francisco, San Mateo and Contra Costa--will also continue to give care to undocumented women.

“This is a very tough issue,” she said. “But if someone came into a physician’s office and needed prenatal care, it would be very difficult to turn that patient away when the life of the mother or the baby could be jeopardized.”

She said health care providers--whether in the public or private sector--do not want to have to act as Immigration and Naturalization Service agents.

Simi Valley activist Stephen R. Frank, who led thecounty’s campaign for a 1994 ballot measure denying public services to illegal immigrants, said if doctors continue to treat those women it will be a violation of the intent of the law.

“These women are here illegally,” Frank said. “They should go back to their native lands to receive the care they need.”

Frank said free prenatal care is an economic incentive for illegal immigrants to have their babies here.

“I ask: How many of these women became pregnant after they arrived for the purpose of creating an American citizen?” he said. “They are creating the sympathy to keep them here.”

Public health care services for illegal immigrants are currently limited to emergency medical care and treatment of expectant mothers.

When the new guidelines are implemented, illegal immigrants will be eligible only for emergency medical care.

According to state officials, about 70,000 undocumented women are now receiving state-subsidized prenatal care, costing California an estimated $83.7 million in 1996-97.

In Ventura County, there are about 812 undocumented pregnant women eligible for the restricted medical coverage, said Helen Reburn, chief deputy director of the county’s social services agency. But the cost of providing health services to those women was not immediately available.

No one knows how many of Las Islas’ patients are undocumented. Doctors say they don’t ask. And they do not want that to become part of their job.

“It’s not a medical decision, it’s a social decision, it’s a moral decision,” said Dr. Kenny Finger, a family care doctor at Las Islas. “I hope it doesn’t ever have to come to that.”

Some doctors at Las Islas estimate that as many as one-third of their patients may be illegal immigrants.

In a small office at the clinic, Dr. Sheryl Dickstein gave a 17-year-old girl a prenatal checkup. They had never discussed her immigration status. She came to the United States five years ago and is in the third trimester of her pregnancy. She is not a U.S. citizen.

The girl said she would still come to the clinic even with the new guidelines. But she said she was scared because it would cost so much money.

Not all women would seek care during their pregnancies, Dickstein and other doctors said. And the doctors said many of these women are high-risk cases, who will get sick without early medical counseling and treatment.

“If this happens, it is the county hospital who will inherit the sick babies and mommies,” Prestwich said. “So it is worth it to provide prenatal care, whether or not they are reimbursed.”

Despite the legal challenges to the new welfare reform guidelines, Gov. Pete Wilson’s office remains confident that the state will prevail in its efforts to implement them. It is just a matter of time, they said.

“Ultimately this law will be upheld,” said Lisa Kalustian, a spokeswoman for the governor. “We have federal law behind us that makes this absolutely appropriate, and absolutely legal.

“We need to stop directing limited resources to people who have broken the laws of this country, and expand services to those who are here legally, and should have first priority. The California taxpayer should not be footing the bill.”

But, in the end, taxpayers will still be forced to pick up the bill and it may be even more costly, other officials say.

“The result may be that women will still have deliveries here in the emergency room without any prenatal care,” Reburn said. “And the cost of any emergency medical care is more costly than by normal delivery.”