Doctors around the state say a growing fervor over illegal immigration may scare illegal immigrants away from seeking health care and create a public health threat.
A recent case in Alamance County -- in which medical records may have been used to help prosecute a library worker who was in the country illegally -- has prompted many to speak out about what they see as an unprecedented breach of trust between doctor and patient.
"Whether you're legal or illegal, it's always been assumed that your medical information is private and can't be used against you," said Dr. Christopher Snyder III of Concord, president of the N.C. Academy of Family Physicians. "The doctor-patient relationship is sacred, and I'm not sure that has really been challenged until now. We're in uncharted territory."
Snyder was among several doctors who said that if patients become afraid to seek care, infectious diseases could spread, infant mortality could rise, and emergency costs could increase.
Immigrants have high rates of infectious diseases such as tuberculosis, once a scourge that killed thousands, and often do not have health insurance. Public health clinics, along with some private ones, provide basic care that doctors say is key to maintaining the health of the broader community, offering prenatal care, immunizations and screening, and treatment for contagious diseases.
Pam Silberman, president of the N.C. Institute of Medicine, which studies health care issues, said it is not in the public interest to build more obstacles to immigrant health care.
"If they cough on somebody and they have tuberculosis," Silberman said, "that doesn't stop with them."
Strict federal laws prohibit the release of medical records in most cases. But records can be released on the order of a judge, which is what happened in the case of the library worker.
Alamance County Health Director Barry Bass said that during a recent State Bureau of Investigation inquiry into his health department, a judge ordered him to release the records of about five patients, one of whom was library worker Marxavi Angel Martinez. Martinez, who had been brought to North Carolina by her parents when she was a toddler, now faces federal felony charges for using the Social Security number of a dead person.
New trend feared
Chris Hoke, a lawyer with the state Division of Public Health, said judges frequently order the release of medical records in criminal and civil cases, but he said he does not know of any previous cases where public health records were used to help prosecute people for being in the country illegally.
Some doctors worry that it could become a trend.
There is growing sentiment among anti-illegal immigration groups that taxpayer-funded health care constitutes a public benefit that illegal immigrants should not receive, even though federal law requires that public health care be provided regardless of immigration status.
"Why are we giving away free health care?" asked Ron Woodard, an anti-illegal immigration activist from Cary. "If people have enough money to send home, which is what many of them are doing, then they've got money to pay some of their medical bills."
Woodard said he still favors providing emergency care and public health care for children. Otherwise, he said, all services should be denied -- including immunizations -- and the money used for the care of legal residents.
Alamance is among several counties across the country that have adopted that philosophy and have begun asking whether they should provide health services to illegal immigrants. Beaufort County, in Eastern North Carolina, has considered cutting some public health programs that are used by illegal immigrants, such as prenatal care for poor women.
Those efforts haven't gone far because most public health programs receive state and federal funding and must be provided under state law.
Lynette Tolson, director of the N.C. Association of Local Health Directors, said no public health departments in North Carolina have cut off care based on immigration status. But she said some health directors feel under siege.
"The doors are open at local health departments," Tolson said. "But health directors have to defend the essential public health services practically every day."
Peter Morris, medical director for Wake County Human Services, said he now fears that he could be forced to turn over patients' medical records for use in immigration cases. And he said he is concerned that public pressure eventually will push Wake County to question the services it provides to illegal immigrants. He said that if public outrage is strong enough, federal and state laws requiring care for illegal immigrants might be challenged.
If that happens, Morris said, years of work to build trust in the state's growing Hispanic population could be destroyed.
"Any person who lives in our community presents a potential public health risk," Morris said. "To scare them away could mean that a public health risk goes undetected until it has affected more of us than it should have."
HEALTH CARE ACCESS
Health advocates note that access to health care is important not only to prevent the spread of infectious diseases; it also keeps health care costs down.
A Pew Hispanic Center study released last week shows that Hispanics are less likely than other minorities and whites to have a regular health care provider.
"When people don't get the information or treatment that would allow them to manage illnesses at an early stage or avoid a disease altogether, the costs of health care escalate and the burden of expensive late-stage medicine often falls to publicly funded health services," the report concluded. "An important strategy to reduce chronic illness, and the costs associated with it, is through prevention via regular monitoring and educational initiatives."
* 73 percent of Latino adults report having a usual place where they seek medical help or advice, while 27 percent have no usual health care provider. As in the general population, males, the young and the less educated are less likely to have a usual health care provider.
* 30 percent of Latinos born outside of the United States lack a usual place for health care, compared with 22 percent of U.S.-born Latinos.
* 32 percent of Latinos who mainly speak Spanish lack a regular health care provider, compared with 22 percent of Latinos who mainly speak English.
* 49 percent of Latinos who have lived in the United States for less than five years lack a usual health care provider, compared with 21 percent of those who have lived in the United States for 15 years or more.