Doctors, clinicians voice concerns about Prop. 187
Medical workers foresee financial, ethical problems
By Ben Gilmore
Tina Harris, who makes sure children at Culver City’s Montessori
Elementary School get their immunizations, is outraged. "Children
shouldn’t have to suffer," Harris said. "They shouldn’t pay the
price  they’re totally innocent."
Harris is one of many in the health care field who are objecting
to Proposition 187 Â the controversial "Save Our
State"initiative that aims to refuse illegal immigrants some
state-supported services, such as non-emergency public health care
like immunization shots to children.
Many doctors and clinicians are voicing concerns about the
proposal, claiming its implementation will create practical and
financial problems, health hazards and serious ethical dilemmas for
the medical community.
Proposition 187 leaves federal law to define "emergency" vs.
"non-emergency," critics said. Some doctors said they feel the
proposal is poorly written, since federal law is extremely unclear
as to which situations are "emergencies."
"The only situation which federal law defines as emergency is a
woman in labor. Otherwise, it’s pretty much up to the doctors,"
said Marshall Morgan, chief of emergency medicine at the UCLA
Medical Center. "The proposal is so badly written that it’s
impossible to tell what will happen. It’s extraordinarily
ambiguous."
Should Proposition 187 pass, health care workers at publicly
funded facilities would be required to report suspected illegal
immigrants to the Immigration and Naturalization Service.
"It’s ludicrous," Morgan said. "What are we supposed to do?
Check everybody with brown skin? It’s ridiculous."
Other logistical concerns about Proposition 187 have arisen.
Currently the Los Angeles County Department of Health runs 39
community health centers and six comprehensive health centers.
The Venice Family Clinic, a private clinic that provides free
comprehensive medical care to low-income individuals, typifies the
kind of facility that will take the heat, said clinic Medical
Director Susan Fleishman.
"There’s no question that our demand will go up. Some people are
going to have no other option," Fleishman said. If the initiative
is passed, the clinic will continue providing free care to
low-income persons regardless of citizenship, Fleishman explained.
But, she added, the clinic will have to sacrifice public funds
 which make up 25 percent of its current funding  to do
so.
The combination of skyrocketing demand and decreased funds would
create a grim financial situation for free private clinics in Los
Angeles County, which number at least 23, Fleishman said.
"It’s the same all over L.A. It’s hard to keep up financially as
it is, and it’ll get worse. We already see over 20,000 people a
day," Fleishman said. "We’re going to have to do a lot of
fundraising."
Another problem, which some doctors fear will expand if
Proposition 187 goes into effect, is the spread of infectious
diseases.
Currently the Los Angeles County health department offers free
immunizations that cover infections including measles, influenza,
polio and hepatitis B, regardless of background or citizenship.
Proposition 187 would deny these immunizations to illegal
immigrants, creating what many doctors said would be a serious
health hazard and resulting in a violation of ethics.
"History has shown that if vaccination rates go down, infection
rates go up," said Andrew Kaplan, a UCLA Medical Center doctor who
specializes in pediatric infectious diseases.
Kaplan, Morgan and Fleishman all cited a 1990 Southern
California measles epidemic to show the consequences of lowered
vaccination rates. In 1990, 12,586 cases of measles were reported
in California, compared with 61 the next year, according to the
immunization branch of the California Department of Health
Services.
"For one reason or another, people didn’t get immunized, out of
carelessness or other reasons," Kaplan said. "An epidemic broke out
in L.A. and Orange County, affecting mostly college students and
preschoolers."
Brad Ackerson, a fellow in Pediatric Infectious Diseases at the
UCLA Medical School, said he thinks the initiative may cause
similar epidemics of disease.
"(Proposition) 187 creates a potential for increasing the spread
of contagious preventable disease. People may be contagious and
unimmunized and be reluctant to seek medical treatment," he
explained.
Denying a segment of the population immunizations may also be
financially draining, since vaccinating all children is cheaper
than treating those who would contract disease if they were
unimmunized, some critics claimed. Vaccination saves an average of
$9 for every dollar spent, according to a California Department of
Health Services.
Epidemics and monetary issues aside, the idea of allowing a
child to contract a serious preventable disease is ethically
repugnant to many doctors, Morgan said.
"I can remember when people lived in fear of polio every
summer," Morgan recalled. "We have an obligation to not harm
people, and to treat them against diseases no matter what. It’s a
disaster any way you look at it."