Undocumented Aliens—
Medical Care and Los Angeles Law

Dr. Brian Henderson and Rev. William Messenger

(This article appeared in the National Catholic Reporter, titled "Los Angeles law hits undocumented aliens". At the time, Dr. Brian Henderson was chairman of the Department of Family and Preventive Medicine at the University of Southern California, and Fr. William Messenger was associate pastor of St. Paul Church in Los Angeles)

Recently, the Los Angeles County Board of Supervisors passed a law requiring completion of a CA-6 form and Medi-Cal application for receipt of non-emergency medical care by undocumented persons.

There are many dimensions to the question of "undocumented persons" or "illegal aliens". We would like to begin with the simple fact that, regardless of any legality, they are here. What should be our response to their medical needs? The following two reflections deal only with that question.

There are many examples of how barriers to comprehensive, preventive and curative care can create greater morbidity and even mortality. Good, regular prenatal care is essential to insuring the optimum growth and development of the fetus and the health of the mother. Even now it is difficult to provide this care to undocumented persons who may not understand the reason for good prenatal care. Erecting further barriers could only increase the likelihood of maternal and infant sickness and even death.

There is more to good baby care than just immunization. Optimum physical and mental development of our population requires pediatric visits to detect a multitude of potentially harmful diseases that, if detected and treated early, are alterable. One has only to journey to the rural areas of any developing country to see the ravages that inadequate medical care can take on children.

Adults as well need regular, preventive medical care. Cervical cancer, of particularly high incidence among the Mexican population, is curable when detected and treated early. Prompt and thorough treatment of high blood pressure reduces the risk of cardiovascular and cerebrovascular disease. Treatment of minor trauma such as fractured bones may eliminate chronic infections and disabling deformities.

This list could go on and on. The Los Angeles County health system has been like a mission outpost for the immigrant population. The few free clinics lack X-ray and other facilities of the county hospital for referral. If these patients cannot freely and without fear receive such care at the county hospital, where shall they go?

It is already difficult to convince patients of the importance of preventive medical care and early detection of disease. If the fear of deportation causes further deferral or neglect of needed care, the costs in dollars and in human suffering will only increase. In the Hippocratic oath doctors promise to provide medical care to all, regardless of their ability to pay. Now doctors in the county hospital are asked to put a price on their care.

There is also a religious dimension to the question. Throughout the Hebrew Scriptures, there is a special concern on the part of Yahweh for the alien. The Jewish people are several times commanded not to oppress the alien. In Leviticus 19:34, the Lord goes beyond oppression: "You shall treat the alien who resides with you no differently than the natives born among you; have the same love for him as for yourself; for you too were once alien in the land of Egypt." There appears to be at least a twofold motivation for this care of the alien. The first is that the Israelites are to remember their own experience of having been alien. Second, as the Lord cared for them, their care for aliens is a reflection of Yahweh's love.

This care for aliens eventually translates into Jesus' concern for the poor. The parable of the Good Samaritan presents the challenge of viewing all people as neighbors and caring for them when in need. And in the famous last judgment scene in Matthew's gospel, Jesus identifies himself with the poor: "I tell you, whenever you refused to help one of these least important ones, you refused to help me" (Matthew 24:25). The traditional corporal works of mercy are based in strong part on this gospel scene.

From both a medical and religious point of view it would appear that we do not have an option in providing medical care for the alien. It can be argued that this is an individual and not a governmental responsibility. However, without attempting to mitigate personal responsibility, what is the government if not the people?

It can also be argued that the county, state or federal government should do something to restrict or, better yet, legalize the flow of undocumented persons into this country. But we believe that, once these people are here, we should provide the best health care we can. Finally, we do not see that the action is even defensible in economic terms. One day of emergency care in the hospital, because of delayed treatment, is certainly equivalent in dollar cost to several routine outpatient visits.