Bill Excludes Mexican Doctors From O.C.

Orange County is excluded from a state bill that would allow Mexican doctors and dentists to treat California’s poor, prompting protests from local health-care advocates who say the doctors could help eradicate back-room clinics run by untrained practitioners.

Sponsors of the controversial legislation said it is designed to bring health care to areas that have a large number of Medi-Cal patients--mostly Latinos--but few Spanish-speaking health professionals.

The measure, passed by the Assembly last month and under consideration in the state Senate, has divided Latino health-care advocates and has come under fire from California medical associations, putting the proposed three-year pilot program in jeopardy.

Critics insist that Mexican practitioners should be held to the same standards as American doctors, while supporters argue that loosening the licensing requirements will make health care more accessible to those most in need.

Both sides plan to meet in Sacramento on Tuesday to discuss their differences.

If approved by the Senate and signed by the governor, the measure would permit 70 doctors and 50 dentists from Mexico to practice in nonprofit clinics in the state.

Arnoldo Torres, executive director of the California Hispanic Health Care Assn. and the bill’s sponsor, said it would effectively shut down underground clinics in the state. Spanish-speaking patients would finally have doctors who are culturally and linguistically compatible, he said.

Latino health officials in Orange County agree, which is why they question the decision to exclude the county from the program. It was Orange County, they argue, where an 18-month-old Anaheim girl died in 1999 and a 13-month-old Santa Ana boy died in 1998 after they were treated at illegal clinics.

“We were never consulted, and nobody’s told us why we’re not a part,” said Isabel Becerra, director of health and policy development for the Coalition of Orange County Community Clinics.

Los Angeles, Ventura, San Bernardino, San Diego and Imperial counties are among the areas covered by the legislation. Orange and Riverside counties are not included.

Orange County was excluded, in part, because the sponsors wanted to target medically underserved and rural counties that are popular among new immigrants.

Some of the state’s Latino advocates said Orange County’s reputation for conservatism and as the birthplace of initiatives against illegal immigration may have been taken into account.

Torres said adding Orange and Riverside counties will be one of the topics discussed Tuesday.

In Orange County and elsewhere in Southern California, immigrants are sometimes attracted to illegal clinics and pharmacies because the unlicensed and untrained providers speak Spanish. They also sell prescription drugs that are popular and legal in Mexico but illegal in the U.S.

Officials at the Coalition of Orange County Community Clinics--a consortium of 19 clinics that treated 133,000 patients last year--believe they have made progress in educating immigrants about the dangerous illegal clinics.

Executive Director Marty Earlabaugh Gordon said about 60% of the clinics’ patients are Latino and about 20% of the patients are uninsured. The rest qualify for limited coverage from state and federal programs for office visits, she said.

“The bill’s intent is good. About 50% of our patients are Spanish speakers. We could use some of those doctors, but each clinic would have to assess how many doctors or dentists it would need, if we were ever included,” she said.

Latinos account for up to 30% of Orange County’s population--as many as 875,000 people--according to 2000 census figures. Statewide, Latinos also make up about 30% of the population, but only 5% of the state’s physicians are Latino.

America Bracho, head of Latino Health Access in Orange County, offered qualified support for the bill, introduced by Assemblyman Marco Firebaugh (D-Los Angeles), but cautioned that “it still needs a lot of details to be worked out, like the differences in medications given to patients here and in Mexico.”

“I believe they could answer a major need this community isn’t getting. But the fact that you’re a Mexican doctor doesn’t assure that you can be a better doctor to Latino patients. These people still have to be competent,” said Bracho, a Venezuela native.

Latino health-care advocates are divided over the measure.

Dr. Hector Flores, spokesman for the California Latino Medical Assn. who has a family practice in East Los Angeles, said the bill establishes a two-tier care system.

Under the bill, Mexican physicians would be required to pass parts two and three of the state’s medical examination but would be exempt from the science-oriented part one.

They also would complete a six-month residency, rather than the year required of U.S. doctors.

“Are we saying that two-thirds compliance is good for poor people but not everybody else?” said Flores, a Veracruz, Mexico, native who is a graduate of UC Davis’ medical school.

Flores also expressed concern that U.S. medical schools may use the pilot program as an excuse to stop recruiting minority students.

Instead, Flores favors using U.S. students attending medical schools in Mexico and other countries for the pilot program. “Many of these students are already culturally and linguistically sensitive, and they also speak English. They would make a better pool of candidates,” he said.

The legislation would require that Mexican physicians and dentists be fluent in English and take the exam in English. Mexican practitioners would also be issued “temporary and limited” licenses to practice in California.

The Medical Board of California, which regulates physicians, opposes key proposals of the measure, including the less rigorous medical exam and reduced residency requirement.

Board officials also asked whether doctors with temporary and limited licenses would be considered fully qualified to practice medicine, and if they could buy malpractice insurance or obtain federal certification to administer and prescribe controlled drugs.

California Medical Assn. officials also are concerned about what they feel is a provision “to lower standards for [Mexican] physicians.”

Torres, of the California Hispanic Health Care Assn. and a major force behind the legislation, is unmoved by the criticism.

“I completely dismiss what the medical board thinks. Their agenda is not about people. It’s about their profession,” he said.

Torres said Mexican physicians should be exempt from part one of the exam “because they’ve already passed it in Mexico.”

A six-month residency would be adequate because many doctors in Mexico undergo residency training of two years or more, he said.