Medical lawyer Madeleine P. Cosner published this 2005 article in a professional journal. She wrote that illegal immigrants are having serious hidden negative impacts on public health, on our institutions, and our budget, and she proposes a program, complete with acronym, to regain control of illegal immigration.
Illegal Aliens and American Medicine
By Madeleine Pelner Cosman, Ph.D.
Journal of the American Physicians and Surgeons
Volume 10, Number 1 - Spring 2005
The Seen and the Unseen
The influx of illegal aliens has serious hidden medical consequences. We judge reality primarily by what we see. But what we do not see can be more dangerous, more expensive, and more deadly than what is seen.
What is unseen is their free medical care that has degraded and closed some of America's finest emergency medical facilities, and caused hospital bankruptcies: 84 California hospitals are closing their doors. 'Anchor babies' born to illegal aliens instantly qualify as citizens for welfare benefits and have caused enormous rises in Medicaid costs and stipends under Supplemental Security Income and Disability Income.
By default, we grant health passes to illegal aliens. Yet many illegal aliens harbor fatal diseases that American medicine fought and vanquished long ago, such as drug-resistant tuberculosis, malaria, leprosy, plague, polio, dengue, and Chagas disease.
What is seen is the political statistic that 43 million lives are at risk in America because of lack of medical insurance. What is unseen is that medical insurance does not equal medical care. Uninsured people receive medical care in hospital emergency departments (EDs) under the coercive Emergency Medical Treatment and Active Labor Act of 1985 (EMTALA), which obligates hospitals to treat the uninsured but does not pay for that care. Also unseen is the percentage of the uninsured who are illegal aliens. No one knows how many illegal aliens reside in America. If there are 10 million, they constitute nearly 25 percent of the uninsured. The percentage could be even higher.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires every ED to treat anyone who enters with an 'emergency' - including cough, headache, hangnail, cardiac arrest, herniated lumbar disc, drug addiction, alcohol overdose, gunshot wound, automobile trauma, human immunodeficiency virus (HIV)-positive infection, mental problem, or personality disorder.... Any patient coming to a hospital ED requesting 'emergency' care must be screened and treated until ready for discharge, or stabilized for transfer - whether or not insured, 'documented,' or able to pay. A woman in labor must remain to deliver her child.
EMTALA is an unfunded federal mandate. Government imposes viciously stiff fines and penalties on any physician and any hospital refusing to treat any patient that a zealous prosecutor deems an emergency patient, even though the hospital or physician screened and declared the patient's illness or injury non-emergency.
High-technology EDs have degenerated into free medical offices. Between 1993 and 2003, 60 California hospitals closed because half their services became unpaid. Another 24 California hospitals verge on closure. Even ambulances from Mexico come to American EDs with indigents because the drivers know that EMTALA requires accepting patients who come.
Los Angeles County Trauma Care Network, built in 1983, was one of America's finest emergency medical response organizations. EMTALA contributed to the Trauma Care Network's loss of focus and loss of money.
In Los Angeles, 95 percent of outstanding homicide warrants are for illegal aliens, as are 66 percent of fugitive felony warrants. The notorious 18 Street Gang has 20,000 members, of whom 60 to 80 percent are illegal aliens, according to the California Department of Justice and the Los Angeles Police Department, respectively.
Illegal aliens move freely in crime sanctuary cities. In Los Angeles, San Diego, Stockton, New York, Chicago, Miami, Austin, and Houston, no hospital, physician, city employee, or police officer is permitted to report immigration violators to the Department of Homeland Security's Bureau of Immigration and Customs Enforcement. The Los Angeles Police Department prohibits police officers from 'initiating police action where the objective is to discover the alien status of a person.'
As many as 10,000 illegals cross the 1,940-mile-long border with Mexico each day. About 33 percent are caught. Many try again, immediately. Authorities estimate about 3,500 illegal aliens daily become permanent U.S. residents - at least 3 million annually. EMTALA rewards them with extensive, expensive medical services, free of charge, if they claim an emergency need for care.
American hospitals welcome 'anchor babies.' Illegal alien women come to the hospital in labor and drop their little anchors, each of whom pulls its illegal alien mother, father, and siblings into permanent residency simply by being born within our borders.
Anchor babies instantly qualify for public welfare aid. Between 300,000 and 350,000 anchor babies annually become citizens because of the Fourteenth Amendment to the U.S. Constitution: 'All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and the State wherein they reside.'
In 2003 in Stockton, California, 70 percent of the 2,300 babies born in San Joaquin General Hospital's maternity ward were anchor babies, and 45 percent of Stockton children under age six are Latino (up from 30 percent in 1993). In 1994, 74,987 anchor babies in California hospital maternity units cost $215 million and constituted 36 percent of all Medi-Cal births. Now they account for substantially more than half.
Illegal aliens have translators, advocates, and middlemen supplied by immigrants' civil rights groups or by Medicaid. MediCal in 2003 had 760,000 illegal aliens, up from 2002 when there were 470,000. Supplemental Security Income is a nonmeans- tested federal grant of money and food stamps. People qualify easily. Scams, frauds, and cheats are rampant.
Among the organizations directing illegal aliens into America's medical systems are the Ford Foundation-funded Mexican American Legal Defense and Education Fund; the National Immigration Law Center; the American Immigration Lawyers Association; the American Bar Association's Commission on Immigration Policy, Practice, and Pro Bono; the Immigrant Legal Resource Center; the National Council of George Soros's Open Society Institute; the Migration Policy Institute; the National Network for Immigration and Refugee Rights; and the Southern Poverty Law Center. And there are more.
Immigrants on SSI, including legal aliens, refugees, and illegals with fraudulent Social Security cards, numbered a mere 127,900 aliens (3.3 percent of recipients) in 1982. By 1992 the numbers expanded to 601,430 entitled (10.9 percent of recipients). In 2003, this figure was several million (about 25 percent of recipients). The National Immigration Law Center (NILC) proudly announced that it obtained expensive cancer treatments, prenatal care, and critical health services for immigrants by means of its litigation.
Many illegals who cross our borders have tuberculosis. That disease had largely disappeared from America, thanks to excellent hygiene and powerful modern drugs such as isoniazid and rifampin.
TB's swift, deadly return now is lethal for about 60 percent of those infected because of new Multi-Drug Resistant Tuberculosis (MDRTB). Until recently MDR-TB was endemic to Mexico.
TB was virtually absent in Virginia until in 2002, when it spiked a 17 percent increase, but Prince William County, just south of Washington, D.C., had a much larger rise of 188 percent. Public health officials blamed immigrants. In 2001 the Indiana School of Medicine studied an outbreak of MDR-TB, and traced it to Mexican illegal aliens. The Queens, New York, health department attributed 81 percent of new TB cases in 2001 to immigrants.
Chagas disease, also called American trypanosomiasis or 'kissing bug' disease is transmitted by the reduviid bug, which prefers to bite the lips and face. The protozoan parasite that it carries, infects 18 million people annually in Latin America and causes 50,000 deaths. This disease also infiltrates America's blood supply.
Leprosy, a scourge in Biblical days and in medieval Europe, so horribly destroys flesh and faces it was called the 'disease of the soul.'... Leprosy, Hansen's disease, was so rare in America that in 40 years only 900 people were afflicted. Suddenly, in the past three years America has more than 7,000 cases of leprosy. Leprosy now is endemic to northeastern states because illegal aliens and other immigrants brought leprosy from India, Brazil, the Caribbean, and Mexico.
Dengue fever is exceptionally rare in America, though common in Ecuador, Peru, Vietnam, Thailand, Bangladesh, Malaysia, and Mexico. Recently there was a virulent outbreak of dengue fever in Webb County, Texas, which borders Mexico.
Polio was eradicated from America, but now reappears in illegal immigrants, as do intestinal parasites. Malaria was obliterated, but now is re-emerging in Texas. Asians number 4 percent of Americans, but account for more than half of Hepatitis B cases.
CRAG: A Proposal to Prevent Medical Cataclysm
Tough medicine could end the cataclysm in American medicine. I suggest the acronym CRAG for four critical actions to reclaim America's EDs; to restore medicine's proud scientific excellence and profitability; and to protect Americans against bacterial, viral, parasitic, and fungal infectious diseases that illegal aliens carry across our borders.
Close America's borders. Prevent illegal entry with fences, high-tech security devices, and troops re-deployed from Germany and South Korea. Deport illegal aliens. Homeland Security's Immigration and Customs Enforcement has a division of Detention and Removal dedicated to deportation. It is hobbled by the powerful Executive Office for Immigration Review (EOIR), the Department of Justice court system that consists of the U.S. Immigration Court (USIC) plus an appellate court, the Board of Immigration Appeals (BIA).
Rescind the citizenship of anchor babies. We must overturn the misinterpretation of the Fourteenth Amendment to the U.S. Constitution. The Constitution grants citizenship to all persons born or naturalized in the United States and "subject to the jurisdiction thereof." An illegal alien mother is subject to the jurisdiction of her country. The baby of an illegal alien mother also is subject to that home country's jurisdiction.
When the Fourteenth Amendment was ratified, its purpose was to assure rights of freedom and citizenship to newly emancipated Negro citizens. American Indians, however, were excluded from American citizenship because of their tribal jurisdiction. Also not subject to American jurisdiction were foreign visitors, ambassadors, consuls, and their babies born here. For citizenship, the person was required to submit to complete, exclusive American jurisdiction, owing allegiance to no other nation.
Long ago the Supreme Court correctly confirmed this restricted interpretation of citizenship in the so-called 'Slaughter-House cases' [83 US 36 (1873)] and in [112 US 94 (1884)]. In Elk v.Wilkins, the phrase 'subject to its jurisdiction' excluded from its operation 'children of ministers, consuls, and citizens of foreign states born within the United States.'
In Elk, the American Indian claimant was born in America, but considered not An American citizen because the law required him to be 'not merely subject in some respect or degree to the jurisdiction of the United States, but completely subject to their political jurisdiction and owing them direct and immediate allegiance.' To obtain citizenship, an American Indian had to separate from his tribe and be accepted by the United States as a citizen. A special act of Congress was needed to grant full citizenship to American Indians.
The Citizens Act of 1924, codified in 8 USC 1401, provides that: The following shall be nationals and citizens of the United States at birth: (a) a person born in the United States and subject to the jurisdiction thereof; (b) a person born in the United States to a member of an Indian, Eskimo, Aleutian, or other aboriginal tribe.
Congress by legislation has the right to create uniform rules on naturalization, and to create dual citizenship and similar variations upon 'jurisdiction.' We must be vigilant against congressmen voting to extend the list of those born here to include illegal aliens or other lawbreakers, conferring American citizenship and its generous social and medical benefits on babies born to criminals.
Aiding and abetting illegal aliens is a crime. Punish it. This will anger devotees of illegal aliens who believe that the Constitution guarantees them civil rights that trump American administrative, civil, and criminal laws.
Grant no new amnesties. We must choose either to surrender medicine to illegal aliens, or to fight illegal aliens. Surrender to illegal aliens is surrender to collectivist America: land of moral ambiguity and home of pacifist appeasement. Fighting against illegal aliens is fighting for individualistic America: land of moral strength, and home of responsible liberty.
As we fight to reclaim medicine, so we defend our nation.
Madeleine Pelner Cosman, Ph.D., Esq., is a medical lawyer, who formerly taught medical students at the City University of New York.