Madeleine Pelner Cosman, Ph.D., Esq.
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.
Illegal aliens. stealthy assaults on medicine now must rouse
Americans to alert and alarm. Even President Bush describes
illegal aliens only as they are seen: strong physical laborers who
work hard in undesirable jobs with low wages, who care for their
families, and who pursue theAmerican dream.
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.
What is seen is the illegal alien who with strong back may
cough, sweat, and bleed, but is assumed healthy even though he and
his illegal alien wife and children were never examined for
contagious diseases.
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.
The definition of emergency is flexible and vague enough to
include almost any condition. 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.
The hospital must have specialists on call at all times for all
departments that provide medical services and specialties within
the hospital.s capabilities. 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. But government pays neither hospital nor
physician for treatments. In addition to the fiscal attack on medical
facilities and personnel,EMTALAis a handy truncheon with which
to pummel politically unpopular physicians by falsely accusing
them of violatingEMTALA.
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
That geographic limit has figured in many lawsuits.
Los Angeles County Trauma Care Network, built in 1983, was
one of America.s finest emergency medical response
organizations. Consisting of 22 hospitals, state-of-the-art
equipment, superior emergency physicians, surgeons, specialists,
nurses, technicians, it offered 365-day, round-the-clock
emergency care for people suffering life-threatening car crashes,
industrial accidents, urban crime, natural disasters such as
earthquake and wildfire, or terrorism. Now most trauma hospitals
have left the network, and so havemany emergency physicians and
surgeons. EMTALA contributed to the Trauma Care Network.s
loss of focus and loss of money.
Illegal aliens perpetrate much violent crime, the results of
which arrive at EDs. .Dump and run. patients, often requiring
tracheotomy or thoracotomy for stab or gunshot wounds, are
dropped on the hospital sidewalk or at the ED as the car speeds
away. Usually such incidents are connected to drugs and gangs.
Even if the hospital is not exclusively dedicated to trauma care,
EMTALAstill governs treatment.
While most people coming to EDs throughout the United States
are not poor and have medical insurance, cities such as LosAngeles
with large illegal alien populations, high crime, and powerful
immigrant gangs are losing their hospitals to the ravages of unpaid
care under EMTALA. 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. The Lil. Cycos Gang, notorious for
murder, racketeering, and drugs in Los Angeles.s MacArthur Park,
was thought to be 60 percent illegals in 2002, and the percentage is
higher now. Francisco Martinez of the Mexican mafia ran the gang
while imprisoned for felonious reentry after deportation.
Illegal aliens move freely in crime sanctuary cities. In Los
Angeles, San Diego, Stockton, NewYork, 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 old INS or Immigration and
Naturalization Service). Los Angeles Police Department
, begun in 1979 by Chief Daryl Gates, 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. Government welcomes illegal aliens by refusal to police
our borders, by reluctance to prosecute people who violate basic
American law, and by fervor to please those who abuse our
generosity and cynically ply our compassion against us.
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 are , and 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.
Consider the story of one illustrative family to show how reality
is the sum of the seen and the unseen. The Silverios from Stockton,
California, are illegal aliens seen as hard-laboring fruit-pickers with
family values. Cristobal Silverio came illegally from Oxtotilan,
Mexico, in 1997 and brought his wife Felipa, plus three children
aged 19, 12, and 8. Felipa, mother of the bride Lourdes (age 19),
gave birth to a new daughter, her anchor baby, named Flor. Flor was
premature, spent three months in the neonatal incubator, and cost
San Joaquin Hospital more than $300,000. Meanwhile, Lourdes
plus her illegal alien husband produced their own anchor baby,
Esmeralda. Grandma Felipa created a second anchor baby,Cristian.
Anchor babies are valuable. A disabled anchor baby is more
valuable than a healthy one. The two Silverio anchor babies
generate $1,000 per month in public welfare funding. Flor gets
$600 per month for asthma. Healthy Cristian gets $400. Cristobal
and Felipa last year earned $18,000 picking fruit. Flor and Cristian
were paid $12,000 for being anchor babies. This illegal alien
family.s annual income tops $30,000.
Cristobal Silverio, when drunk one Saturday night, crashed his
van. Though he had no auto insurance or driver.s license, and owed
thousands of dollars, he easily bought another van. Stockton Police
say that 44 percent of all .hit and runs. are by illegal aliens. AnchorBabies
had been seriously injured, the EMTALA-associated entitlement
would provide, as it did for the four-year rehabilitation of a
quadriplegic neighbor illegal alien. Rehabilitation costs
customarily do not fall under the title .emergency care,. but
partisans clamor to keep paraplegics in America rather than deport
them to more primitive facilities south of the border.
My mechanic employs an illegal I shall call Umberto, who said
when I came for my truck, .Dr. Cosman, my children lost their
shadows! Help me!.
What does this mean? Umberto has five disabled children: two
are autistic, two have attention deficit hyperactivity disorder, and
one has oppositional defiant disorder, with additional obsessivecompulsive
disorder. All take California government-supplied
medications, including Ritalin. The autistic children had
.shadows. or personal attendants, one per child, under the federal
Individuals with Disability Education Act of 1975 (IDEA). The
program provides a shadow, plus an .individual education
program. that cost about $30,000 per year per child. Umberto and
his wife dine out alone each week, thanks to California-provided
respite-care babysitters.
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. In one clinic,
300 people diagnosed as .mildly mentally retarded. all had the
same translator, same psychiatrist, same symptoms, and similar
stipend. Fraud is an equal-opportunity employer that flouts
America.s generosity to the feeble, the crippled, and the poor.
Illegal aliens have powerful legal facilitators who litigate and lobby
for .Open Borders. and for welfare benefits for all who cross onto
America.s soil. Open Borders proponents imperil America.s
sovereignty by obliterating distinctions between legal immigrants
and illegal aliens, and between American citizens and all other
people of the hungry world.
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.
Cases of .permanent disability. have burgeoned because its
definition is vague [a 12-month problem that interferes with work:
see Disability Income, 42 U.S.C. 423(d)-(1)(A), and Supplemental
Security Income, 42 U.S.C. 1382c(a)(3)(A)]; flexible, thanks to
the case; and individualistic, thanks to government
regulations. Mental, social, behavioral, and personality
disorders are included. More than 500,000 .mentally disabled.
children on psychotropic drugs for ADHD and ODD have
incentives to bad, bizarre behavior. Children.s disability
stipends are called .crazy money,. for crazy behavior.
Drug addiction and alcoholism are classified as diseases and
disabilities. Disability CodeDA&Ahad in 1983 only 3,000 stipend
recipients, but in 1994 exploded to 101,000. In 2003, between
250,000 and 400,000 got lump-sum grants of disability money via
SSI. When Linda Torres was arrested in Bakersfield, California,
with about $8,500 in small bills in a sack, the police originally
thought it was stolen money. It was her SSI lump sum award for her
disability: heroin addiction.
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 garnered for immigrants expensive cancer
treatments, prenatal care, and critical health services by means of its
litigation. Sometimes NILC worked in collaboration with lawyers
from the American Civil Liberties Union and the Mexican
American Legal Defense and Education Fund. Though the 1996
Welfare Reform Legislation reduced all welfare payments to all
recipients nationwide, NILC cleverly managed to restore to its
constituency of legal and illegal immigrants: $12 billion in
Supplemental Security Income, and more than $800 million in food
stamps. For many illegal aliens, America is land of the victim
and home of the entitled.
When my grandfather came to America, he first kissed the
ground of New York.s Ellis Island, then he stripped naked and
coughed hard. Every legal immigrant before 1924 was examined
for infectious diseases upon arrival and tested for tuberculosis.
Anyone infected was shipped back to the old country. That was
powerful incentive for each newcomer to make heroic efforts to
appear healthy.Today, immigrants must demonstrate that they
are free of communicable diseases and drug addiction to qualify for
lawful permanent residency green cards. Illegal aliens simply cross
our borders medically unexamined, hiding in their bodies any
number of communicable diseases.
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. This
M is resistant to at least two major
antitubercular drugs. OrdinaryTB usually is cured in six months with
four drugs that cost about $2,000. MDR-TB takes 24 months with
many expensive drugs that cost around $250,000,with toxic side
effects. Each illegal with MDR-TB coughs and infects 10 to 30
people, who will not show symptoms immediately. Latent disease
explodes later.
TB was virtually absent inVirginia 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. The
Centers for Disease Control and Prevention ascribed 42 percent of
all new TB cases to .foreign born. people who have up to eight
times higher incidence. Apparently, 66 percent of all TB cases
coming to America originate in Mexico, the Philippines, and
Vietnam. Virulent TB outbreaks afflicted schoolteachers and
children in Michigan, adults and children in Texas, and
policemen in Minnesota. Recently TB erupted in Portland, Maine,
and Del Rey Beach, Florida.
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. Chagas affects blood
transfusions and transplanted organs. No cure exists. Hundreds of
blood recipients may be silently infected. After 10 to 20 years, up
to 30 percent will die when their hearts or intestines, enlarged and
weakened by Chagas, burst. Three people in 2001 received
Chagas-infected organ transplants.Two died.
Leprosy, a scourge in Biblical days and in medieval Europe, so
horribly destroys flesh and faces it was called the .disease of the
soul.. Lepers quarantined in leprosaria sounded noisemakers when
they ventured out to warn people to stay far away. Leprosy, Hansen.s
disease, was so rare inAmerica 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 inWebb County, Texas, which borders Mexico.
Though dengue is usually not a fatal disease, dengue hemorrhagic
fever routinely kills.
Polio was eradicated fromAmerica, but now reappears in illegal
immigrants, as do intestinal parasites. Malaria was obliterated,
but now is re-emerging inTexas. About 4,000 children under age
five annually in America develop fever, red eyes, .strawberry
tongue,. and acute inflammation of their coronary arteries and
other blood vessels because of the infectious malady called
Kawasaki disease. Many suffer heart attacks and sudden death.
Hepatitis A, B, and C, are resurging. Asians number 4
percent of Americans, but account for more than half of Hepatitis B
cases. Why inoculate American newborns for Hepatitis B when
most infected persons areAsians?
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.
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). The equation EOIR = USIC + BIA
usually provides amnesty for the illegal alien, plus another level of
appeal against deportation in federal circuit court.
Internment and deportation are politically incorrect. But
America.s inadequate federal border enforcement permits massive
daily border penetrations that violate the integrity of our medicine
and our national security.
.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 .
.. 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 , 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 , the
American Indian claimant was born in America, but considered not
anAmerican 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 CitizensAct of 1924, codified in 8USCS§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. It
is irrelevant that some lawbreakers are hard-working women
willing to do hard jobs for low pay, or that they are wives,
daughters, cousins, lovers, or concubines of men willing to do
America.s hard work. Gravid wombs should not guarantee free
medical care and instant infant citizenship in America. We must
reestablish the original limits on citizenship, and remove incentives
for indigent Mexicans and others to break America.s immigration
law. Proud legal immigrants applaud order, reason, and law.
. 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.
. 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.
(editors note: one must look at all sides of an issue and get good data to make good decisions). The following is from
http://www.pbs.org/newshour/indepth_coverage/health/uninsured/whoaretheuninsured.htmlClick on to read the article. The last two paragraphs are telling:
Hoffman said that the idea that the growth of the uninsured rate is being fueled by immigrants is myth. "The numbers just don't support that," she said. "The large majority of the uninsured are U.S. citizens. While immigrants and the undocumented are less likely to have health insurance, there just aren't enough of them to make a difference in the overall rate."
But Fronstin disagreed. He said that his research found that immigration accounted for about 85 percent of the increase in uninsured rates between 1998 and 2003.
