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No ID, no health care?

August 2, 2011

I was struck by this New York Times article  written by a doctor that serves low income people in San Francisco. Dr. Sanjay Basu tells the story of an illegal immigrant named Carlos who furiously pedaled his red huffy bike for three miles across town to reach a mobile van offering health care.

He would pant while locking his bike to the bumper, then wipe sweat off his upper lip and compose himself, extending a firm handshake to our nurse. I saw him so often with his helmet on that it was not until our third visit that I realized he was nearly bald.

What I had noticed, though, was a growth the size of a golf ball emerging above his left clavicle that had begun to press on his airway, causing him to wheeze. “I come here as fast as I can,” he would say every time, apologizing for how long it took to ascend San Francisco’s hills.

The van was too small to offer Carlos the biopsy he needed to see if that lump was cancerous. Because he had no identification, no doctor’s office would take him. The emergency room was no help either, because Carlos wasn’t sick enough.

The hospital eventually gave him an appointment for a biopsy; it was scheduled in five months and three weeks. Carlos kept the yellow appointment slip in the front pocket of his overalls. He would bike with it; his sweat stained the paper until the edges wore thin.

But Carlos never made it to his appointment. Dr. Sanjay Basu says Carlos stopped showing up at the medical van. And then Basu discovered that the red huffy Carlos rode had been sold at auction for $32.  Did the lump in his chest turn out to be cancer that eventually killed him? Basu never finds out. But he does note-

At the age of 50, Carlos already had surpassed by an entire year the average life expectancy of a migrant laborer in the United States.

Is this true? If you’re an illegal immigrant with no identification, you can’t get health care? Emergency rooms are required to take patients regardless of their immigration status. What about doctors? I put some calls out to get a sense of the situation in Rhode Island.

Nick Tsiongas, former president of the Rhode Island Medical Society and an active member of the state’s health care advocacy community, says he hasn’t heard of doctors refusing care to patients because they don’t have identification, but he wouldn’t be surprised if it happens.

Rhode Island Hospital  says it doesn’t keep track of people who come to its ambulatory care center because they’ve been turned away from private doctors. Of course, Rhode Island’s community health centers treat everyone regardless of their immigration status and don’t keep track of who is or isn’t in the country legally.

The Department of Health says it

…does not have any written requirements about private physicians having to accept patients with[out] valid identification. Physicians have a right to know who they are treating in their office.

Like most data about illegal immigration, this topic seems hard to track. Undocumented often means invisible. I’ll post more information if it comes in.

But perhaps identification/immigration status isn’t the main issue. Legal immigrant or not, without insurance, it’s hard to get specialty care.

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