Baby’s Death Puts Focus on Immigrants’ Health Access

Despite the growing availability of low-cost medical care for many children, some immigrants continue to seek care from unlicensed practitioners because of economic and cultural barriers, which played a role in the death of an Orange County toddler this week, officials said.

County officials were especially concerned because the 18-month-old girl, who died after receiving an injection in the back room of a Tustin gift shop, had been born in Anaheim and probably was eligible for Medi-Cal benefits or the new Healthy Families program for children of the working poor.

“Any time you have a child who dies because they didn’t have access to appropriate care, that is a major problem that needs to be addressed,” said Len Foster, acting director of public health for the county. “It has to strengthen our resolve to address this issue.”

Foster and others said “the needless tragedy,” the second death within a year of a Latino toddler after unlicensed medical treatment, could serve as a catalyst to spark change throughout the county. Several officials said the community must do a better job of educating and improving medical access for immigrant families.

Selene Segura Rios died late Monday after being injected with what her parents were told was penicillin at the back-room clinic in Tustin, police and her father said. Alberto Ramirez Segura, who lacked medical insurance, said he took his daughter to the store because it was after 6 p.m. and their doctor was unavailable.

Police arrested Monica Bernabe, 23, the night-time manager of Los Hermanos Gift Shop in Tustin, but said she would be released late Thursday. Police said prosecutors concluded there was not enough evidence to bring criminal charges.

Bernabe could not be reached for comment.

Lt. Mike Shanahan said police are continuing their investigation and want to speak with the “absentee” owners of the store, Oscar Eduardo King of Chula Vista, and his sister, Laura Escalante. King did not return phone calls Thursday but earlier said he had turned the business over to his sister.

Shanahan said the response to a police request for information about the business on McFadden Avenue has been disappointing. “We need people who have been using that clinic to come forward and talk to us,” he said.

Alberto Segura, who lived within blocks of Anaheim Memorial Hospital, said his child’s illness didn’t appear to call for costly emergency room care. The irony of living so close to the hospital where Selene died, and where she could have been taken for treatment in the first place, was not lost on him.

“We didn’t think she was seriously ill. We never thought she was dying,” he said. “But I’m a construction worker, and my family doesn’t have insurance. I couldn’t afford to take her to a hospital for treatment. I don’t know what to think right now. We did the best we could.”

Steering immigrant families away from convenient but unlicensed medical care is difficult because of economic pressures, language problems, fear of deportation and the comfort level in dealing with healers, said health care professionals.

Some pointed out that because community clinics are closed at night and on weekends, immigrant families frequently must confront the impossible position the Seguras faced.

“People don’t have choices,” said John Castro, who runs a law center for immigrants in Anaheim. “People need to have a 24-hour clinic that would give them an option between choosing an unlicensed clinic and going to an emergency room where care can cost more than $1,000.”

The county doesn’t offer direct services except for those with a few communicable diseases. Unlike Los Angeles County, there is no Orange County hospital for indigents.

“If someone has a cold, they have to go elsewhere,” said Sara Murrieta, Latino public health liaison and co-chair of the Santa Ana Safe Medicine Coalition.

Federal, state and local government officials acknowledge that the immigrant community is often fearful of seeking services to which they or their native-born children are entitled and are sometimes confused by lengthy forms.

A General Accounting Office report to the U.S. Senate last year said many immigrant families “hesitate to enroll in Medicaid because they are concerned that it will negatively affect their immigration status.”

But even legal residents fear that if they receive benefits, “they will be labeled a ‘public charge’ and will have difficulties with the Immigration and Naturalization Service when seeking citizenship, visa renewal or reentry” into the country, the GAO said.

Many in the immigrant community prefer to use the services provided by healers--called curanberos--because that is how they got care in their local villages, said several health care workers.

“People come to America and look for these curanberos, and they find them through friends,” said Iliana Cross, who works at the Huntington Beach Community Clinic. “Word goes around and you will find them in places you least expect them, like a flower shop for example.”

County leaders have no immediate plan for intensifying efforts to educate the immigrant community. They said any program would wait until April, when dozens of health care groups will hold the first-ever communitywide planning session to address medical needs.

A previous effort to inform immigrant families about the danger of using unlicensed health care was confined to Santa Ana and run by the Santa Ana Safe Medicine Coalition. The group was organized last fall after the death of 13-month-old Christopher Martinez, who was treated by an unlicensed practitioner at a storefront clinic in Santa Ana.

The coalition planned public service advertisements on radio and television to publicize the availability of low-cost or free medical services but has been unable to raise the necessary money.

Instead, their outreach was limited to handing out fliers and speaking at community events, including a local fiesta and a women’s conference at Rancho Santiago Community College.

“We haven’t been able to get any funding,” said Dr. Mary Watson, director of Free Health Plan, which operates two free clinics in Santa Ana. “Our target is parents and grandparents of kids, and people who use physicians who aren’t physicians; people who are fooled or duped into using these services.”

Foster said his agency can’t do the job alone.

“It has to be something that we as a community have to come together to address, from the churches, to the school systems to the parent groups, everyone,” he said.

The county does staff the 45 to 50 hospitals and clinics here with personnel who can approve patients for Medi-Cal or other public benefits, said Bob Griffith, chief deputy director of the county Social Services Agency.

That does little, however, to reach people who are avoiding such mainstream facilities in the first place. Latinos said Los Hermanos is well-known and well-regarded in the community, a reputation illustrated by the distance the Seguras traveled from Anaheim to the Tustin store.

Los Hermanos is not the only shop to offer pharmaceuticals and medical care at cut-rate prices, Castro and others said. The shops’ popularity makes it tougher for health care professionals to persuade immigrants to avoid unlicensed medical services.

“Part of educating people who are new to the country is to let them know what constitutes good medicine and what isn’t,” Watson said.

Murrieta, the county health care agency’s Latino liaison, said more work needs to be done to publicize the free clinics and benefits available to American-born children of immigrants, regardless of their parents’ residency status.

County officials said thousands of children of undocumented parents receive medical benefits through Medi-Cal and the Healthy Families program. The status of the parents is not an issue, they said.

Children ages 6 to 19 in a family of four can be eligible for Medi-Cal when the family income is less than $16,500. With younger children, the income ceiling is higher.

Limited Medi-Cal benefits--covering prenatal care and delivery--are available to pregnant women regardless of residency status.

Healthy Families, which has a premium of $4 to $27 a month, is available to a family of four with income as high as $32,900 a year.

“People have to be told,” Murrieta said. “We are going to try to get to the Spanish-language newspapers and to ESL classes at community colleges.”

Times staff writers Robert Ourlian and H.G. Reza contributed to this report.