When Doctors Are Unable to Provide Proper Care to Undocumented Immigrants, the Patients Are Not the Only Ones Who Suffer

Doctors, nurses and medical students march to the Tornillo Port of Entry on June 23, 2018 in Tornillo, Texas, to demand an end to separation of immigrant children from their parents. - The Trump administration's erecting of a tent city to house minors separated from their parents has drawn sharp criticism, and is still under fire, despite President Trump's executive order to stop family separation. (Photo by Paul RATJE / AFP)

American medical care is currently in shambles. Compounding the difficulties surrounding our fractured system is the issue of how immigrants receive appropriate healthcare.

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An article released by NBC News details the story of Dr. Lilia Cervantes, a physician who treated an undocumented patient who didn’t have government insurance and, as a result, received inadequate medical care to treat her kidney disease. Over the course of three years, the mother-of-three visited the emergency room multiple times for kidney failure. During that time, the patient has flatlined more than once and eventually decided to stop further treatments, due to the stress on her body and the emotional toll on her children.

Often, emergency medical services are the only option for undocumented individuals. Emergency kidney treatments, such as dialysis, have a hugely negative impact on the human body. The risk of death for someone only receiving emergency medical care for kidney disease is 14 times higher than someone who has access to consistent and stable treatment. Medical professionals who treat these patients are often unable to provide the medically-warranted standard of care. They are often required to deny care to visibly ill patients whose condition is not deemed serious enough to require emergency medical care. It’s emergency care or nothing.

The patient's death had a significant impact on Cervantes, an internal medicine specialist and a professor of medicine at University of Colorado in Denver. Cervantes decided to research trends in the overuse of emergency medicine, especially by undocumented individuals.

The results were shocking, if not unsurprising. Her research demonstrated that physician burnout and poor morale are expected outcomes for physicians who are required to provide substandard care to immigrants — individuals whose undocumented status is the primary barrier to receiving help. Many of these individuals are unable to afford private health insurance and are barred from accessing Medicaid or Medicare.

Burnout occurs when an individual loses control of how they carry out their job, spends time working towards goals that do not resonate with personal values, and when they receive little to no professional and social support.

According to Cervantes, “clinicians are physically and emotionally exhausted from this type of care.“You may get to know a patient and their family really well. Then the following week, you might be doing CPR on this same patient because they maybe didn’t come in soon enough. I’ve known people that have transitioned to different parts of the hospital because this is difficult.”

According to Melissa Anderson, a medical professional who was not involved in Cervantes’ story, agrees with findings. “I practically had to take a class in immigration to understand what’s going on,” she said. “Physicians just don’t understand it, and we shouldn’t have to.”

In an effort to provide better care to undocumented individuals, as well as reduce doctor burnout, several states have taken small steps to address this immigration and healthcare nightmare.

“Several states, like Arizona, New York and Washington, have modified their emergency Medicaid programs to include standard dialysis for undocumented immigrants. Ideally, we could come up with federal language and make this the national treatment strategy for undocumented immigrants,” said Cervantes.

Ultimately, the goal of many physicians like Cervantes is to provide better accept to consistent medical care on a federal level so that undocumented individuals can receive the same standard of care as anyone else. Of course, given our current political climate and the Trump administration's stance on immigration, only time will tell if sufficient improvements can be made.

Even beyond providing inadequate healthcare to undocumented individuals, doctors in general are experiencing burnout at a precipitous rate. A recent study shows that at least a third of physicians are at risk for burnout.

According to Rena Xu, a healthcare professional, an inability to treat a patient to the best of her ability compromises her sense of morale. “I felt deflated. For hours, my attention had been consumed by challenges of coordination rather than actual patient care. And still the patient was at risk of experiencing delays for both of the things she needed.”

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