Bill Would Open Door to Doctors From Mexico

A bill in the state Legislature that would allow Mexican physicians and dentists to cross the border and treat California’s poor is pitting advocates of expanded care against leading medical associations that claim it threatens to damage the quality of that care.

The bill would rewrite California licensing requirements so that approximately 70 doctors and 50 dentists from Mexico could practice at nonprofit clinics in a three-year experiment.

It was introduced by Assemblyman Marco Firebaugh (D-Los Angeles) and was sponsored by the California Hispanic Health Care Assn. Although the Assembly has approved the measure, it faces an uphill struggle in the Senate.

If approved, the bill would allow the Mexican doctors to work in areas that have had difficulty attracting health professionals because they have high numbers of patients covered by Medi-Cal, the government program that pays for health care for the poor. Doctors often resist accepting patients who are covered by Medi-Cal because that system pays far less than private insurers.

The debate over the bill pits two compelling interests against each other: the need to expand health care to poor, largely Spanish-speaking patients, and the desire to see that the care for those patients is not less thorough than it is for others.

By treating more patients with Medi-Cal, the Mexican doctors would bring more revenue to the clinics. The clinics would pay the doctors’ salaries at rates commensurate with the clinics’ regularly licensed doctors.

According to its supporters, the bill (AB 1045) is intended not only to help tackle a statewide medical care shortage, but also to target the health needs of poor and uninsured Latinos in California.

“Our universities don’t do enough to prepare our doctors to care for an increasingly diverse population,” said Firebaugh.

Only 5% of the state’s physicians are Latino, although Latinos represent more than 30% of the population. And in Los Angeles County alone, about half of the households headed by Mexican immigrants do not have health insurance, according to a year-old study by the Center for the Study of Latino Health and Culture.

David Quackenbush, an analyst from the California Hispanic Health Care Assn., said language and cultural barriers between Latino patients and non-Spanish-speaking health professionals can result in Latinos getting substandard medical treatment or choosing to forgo visits to doctors.

The association is a 20-year-old Sacramento-based coalition of 12 nonprofit clinics across the state that specialize in serving uninsured Californians.

If the bill becomes law, one firm likely to receive Mexican physicians and dentists is Del Norte Clinic in Olivehurst, an agricultural hamlet north of Sacramento.

Today, at its 11 clinics in Northern California, only five of its 50 doctors speak Spanish; none of the 12 dentists speaks the language.

“We have to have a translator come into the room. Many times it’s a record clerk or a receptionist who knows little medical terminology,” said Bill Denny, director of Del Norte Clinic.

In some cases, patients do not feel as free to discuss intimate personal health issues “with a third party in the room as they would be one to one,” Denny added.

The California Dental Assn. opposes the bill. It says changing the licensing rules for the Mexican dentists could downgrade the quality of care that some patients receive.

“The problem we have with the bill at this point is that it allows foreign-trained dentists to practice without any way to evaluate their training, because schools vary so much,” said Dr. Jack Broussard of Pasadena, president of the dental association.

The California Medical Assn. has not taken a position on the bill, but it has formed a subcommittee to track the measure.

“The shortage of culturally sensitive health care is a difficult problem to fix without completely sacrificing the quality of care in this state,” said Robert McElderry, associate director of government relations for the medical group.

Firebaugh carried a similar bill last year, but the licensing features were stripped from the measure. Instead, what resulted was the creation of a 30-member task force to study cultural impediments to health care facing poor people.

Kathleen Hamilton--director of the state Department of Consumer Affairs, which licenses physicians and dentists, and a co-chairperson of the task force--said Firebaugh’s new bill is premature and attempts an end run around the task force.

“One of the things that is troubling about this year’s legislation is that it was sponsored by a member of the task force,” said Hamilton, referring to Arnoldo Torres, executive director of the California Hispanic Health Care Assn.

Although the two sides disagree on the solution, supporters and opponents of the legislation agree on one important point: There are not enough physicians, dentists and clinics available to poor people.