How bad is the humanitarian crisis in Texas as tens of thousands of unaccompanied children cross Mexico's border into the U.S.? Are these kids ending up in hospital emergency rooms?
It depends on whom you ask—and how much they will say if they decide to talk to you at all.
With hospitals across the country under increased media scrutiny, there are some clear parallels between how Texas hospitals are adjusting to the attention and how hospital administrators nationally can apply it to their own media relations practices.
Spokesman Lance Lunsford of the Texas Hospital Association told Healthcare Dive: "Part of the problem is everybody is scared to be a source for anything." He said the border patrol isn't even returning the state hospital group's calls for information.
According to THA, anecdotally, hospitals along the U.S.-Mexico border are reporting an influx of unaccompanied children. After children are detained by the border patrol, they are put under federal jurisdiction. Hospitals may request federal payment for the children's care in the same way they're already submitting payment requests for other undocumented patients.
Currently, personnel from a number of detention facilities are transporting children to nearby hospitals, mostly for dehydration and malnutrition, but also to treat chickenpox and scabies. A few cases of tuberculosis also have been identified.
If children are found to have medical needs, after screening by the federal ICE Health Service Corps, they are routed to hospitals on a rotational basis to avoid overburdening hospital emergency departments.
But for Mission Regional Medical Center, a 297-bed community hospital in south Texas, about five miles from the Mexican border, the situation has been manageable, an administrator said.
Nick Espinosa, Mission's director of marketing, told Healthcare Dive that he queried an emergency-room nurse yesterday (July 8): "What she basically told me is everything seems to be normal right now. But in the previous two months, they were busier than normal. If they'd normally see seven [undocumented people daily], they were seeing about 15 per day. [But] it wasn't something they couldn't handle."
Other hospitals on the front lines in south Texas kept tight-lipped about the matter that is polarizing some communities and worrying politicians and child advocates alike. Some hospitals downplayed it as business-as-usual in a state where undocumented people are constantly entering the U.S.
"We really don't have any comments. We haven't seen an impact [from the undocumented children]," said spokesperson Cari Lambrecht of South Texas Health System, a McAllen, Texas-based network of six acute-care hospitals and a behavioral-health hospital. "Granted, being on the border, we get patients from the border patrol. But it's nothing out of the norm."
Dallas seeks shelters for children
Even to the north, in relatively far-off Dallas, people are testy about the matter.
Dallas County Judge Clay Jenkins recently told local media about plans to bring about 2,000 immigrant children to the area by the end of July. He said county officials are looking at a Parkland Health & Hospital System building as one of three potential sites to shelter them. Parkland is one of the largest public hospital systems in the U.S., handling more than 1 million patient visits annually.
Dallas County officials also are considering other sites that offer security, exercise facilities, cafeterias and large play areas, media reported. The children are now in a detention center in McAllen, Texas, living under what one state lawmaker recently described as deplorable conditions.
Parkland responded quickly to the media report. "We have not yet received any formal indication from the federal government that they would like to use any Parkland facility. If anything changes, we will let you know," Mike Malaise, Parkland's interim senior vice president for external affairs, said in a July 7 statement.
Parkland spokesperson Catherine Bradley told Healthcare Dive her understanding is that Parkland's building in question, on Butler Street, was formerly used for another purpose and acquired from a non-health-care-related company. She declined further comment beyond Malaise's statement.
El Paso's ER visits are down
Lunsford, the state hospital group's spokesman, said he talked July 8 to El Paso's Regional Advisory Council. (RACs are set up across Texas to coordinate trauma and emergency care in 22 regions.)
Currently, El Paso hospitals' ERs are seeing about five undocumented children per day, down from 20 to 25 when the influx began, he said. El Paso's RAC reported "a couple of scabies cases, no chicken pox and no TB—but that was [only] one RAC," he said. The city has several major hospitals, he said.
When daily ER visits reached 20 to 25, "that was more of a concern," Lunsford said, so THA looked at a three-day rotation in which no hospital could get the children more than once over the three days.
"At this point, in Texas this is pretty standard operating procedure," Lunsford said, noting the state has the largest uninsured population in the U.S. and is used to many people crossing into the U.S.
But Lunsford stopped short of suggesting that no hospitals are feeling an impact. "Trend-wise, it isn't an explosive issue for [Texas] hospitals," he said. "But on a case-by case basis, some hospitals may be experiencing [larger populations of undocumented children] than others.”
So who is in charge in case matters worsen? State health officials in Texas see this as a federal issue, Lunsford said. But when El Paso's RAC tried to get help in treating the children from military medical staff, "JAG [Judge Advocate General's Corps] said it wasn't their jurisdiction. So it's falling to ICE and the Dept. of Homeland Security." DHS did not provide information by Healthcare Dive's press-time.
"I think the whole situation is incendiary and nobody wants to be responsible for saying something and ending up" in an unflattering media spotlight, Lunsford said, asserting that some journalists are being fed information to fit political messaging.
"Hospitals are not seeing the influx being portrayed in the mainstream media," he said.