Prenatal Caregivers Caught Between Aid Edict and Oath

Having once been an illegal immigrant herself, Dr. Luz Medina well understands the pervasive apprehension she detects these days from expectant mothers who come to the Eastside clinic where she works.

“I try to tell them we won’t let their benefits be cut off,” Medina said during a break between examinations at the Community Health Foundation of East Los Angeles.

It is advice being offered time and again by those who work with illegal immigrants following a controversial directive by Gov. Pete Wilson this week. Wilson issued an executive order directing state agencies to carry out the new federal welfare reform act’s ban on state and local assistance to illegal immigrants.

Among the first targets, Wilson vowed, would be prenatal care--a service universally acclaimed as vital to fetal and maternal health, and to averting astronomical emergency-room and intensive-care costs.

While not disputing the health benefits, Wilson says California taxpayers simply cannot afford the $70-million-a-year cost and should not “simply say we will take all comers, whether they are citizens or not.”

After Wilson’s directive, Mike Antonovich, chairman of the Los Angeles County Board of Supervisors, introduced a motion that directs the county’s chief administrative officer to prepare a report regarding “the steps being taken by county departments to conform with the governor’s executive order.”

In places like the Community Health Foundation, where most of the patients are working poor without medical insurance, there is a palpable sense of resignation that the aid will eventually be cut.

“I just want to have my baby safely,” said Rosa Espinoza, an undocumented seamstress from Mexico who is eight months pregnant with her fourth child.

Espinoza and her husband both work in near-minimum-wage jobs that do not offer insurance. She worked at a sewing factory until just a few weeks ago, she said. Paying for private health care would be prohibitive on her precarious family budget, balanced month to month.

“This aid is critical for us,” said Espinoza, who appears far older than her 29 years.

As is so often the case, Espinoza’s offspring are a mix of statuses. Her eldest, 14 and 12, remain undocumented, she said. Her youngest, 4, was born in the United States and is therefore a U.S. citizen, as will be the child she carries. It is an irony of the impending prenatal care cutoff that fetuses denied prenatal care will still become U.S. citizens upon birth. A proposal now pending in Congress would deny such birthright citizenship.

Health advocates have excoriated Wilson for setting off a sense of panic in some quarters.

“To me, what the governor did is the equivalent of crying ‘Fire!’ in a crowded theater,” said Lynn Kersey, who heads a Los Angeles-based service program for pregnant women and families.

In fact, Wilson’s edict removes no one from the public care rolls until state agencies report back with implementation plans. Civil-rights advocates have pledged to sue in federal court to block any cutoff.

But Antonovich said he wants to ensure the county is prepared.

“What I’m asking is how do we comply with the state and federal legislation, which requires verification of citizenship and the termination of people not entitled to those services,” said Antonovich.

The motion will be heard at Tuesday’s Board of Supervisors meeting.

Meanwhile, at Olive View-UCLA Medical Center in Sylmar and High Desert Hospital in Lancaster, officials said they are waiting for direction from downtown and Sacramento before they stop offering prenatal care to illegal immigrants.

“We’re just waiting to see what happens, but it is possible that we might end up denying care,” said Carolyn Rhee, chief operating officer at Olive View where the hospital’s prenatal clinic had 875 visits in July.

“We’re looking to see the numbers, and trying to figure out who will be affected,” said Mel Grussing, administrator at High Desert. “Up here though, we don’t expect to be affected as much as other [county] areas.”

Currently, county facilities have a policy of not inquiring about the citizenship status of its patients, so county officials do not know how many people would be affected if the executive order is enforced.

To many, the current scenario is an unwelcome reminder of the confusion following the passage of Proposition 187 two years ago, when many health providers reported steep declines in attendance. Patients voiced fears of being turned in to immigration authorities. Much of the anti-illegal-immigration measure has since been blocked in federal court.

Along with worrying about when her care will be terminated, Rosa Espinoza wonders whether her two eldest children might be thrown out of public school because of their illegal status--another proposal floating in Washington and endorsed by Wilson.

“I guess it’s going to reach a point where they want to kick all of us out of here,” said Susana Aranda, 18, now eight months pregnant with her first child and also undocumented. But, asked if she would consider returning to her native Mexico, Aranda responded, “No. What is there for me now?”

For health providers, the governor’s order has meant more time spent soothing anxieties, explaining to puzzled patients that the governor’s decision, splashed all over the ethnic- and English-language press, does not by itself end any aid.

“A lot of this is just reassurance,” said Medina.

Like many physicians in this kind of practice, Medina says she has eschewed higher-paying opportunities to work with a vulnerable community. She arrived as an illegal immigrant from Mexico when she was 7, Medina notes, settling with her family in Hollywood, a neighborhood whose reality as a haven for struggling new immigrants is at odds with its glitzy media image.

“As physicians we believe that everyone has to be cared for regardless of status,” Medina said. She said her clinic, funded by a mix of federal, state and private assistance, will continue to serve the undocumented population regardless of the state actions, charging on a sliding scale based on income.

Medina works alongside Dr. Son Nguyen, who arrived in Orange County legally in 1979 as a refugee from Vietnam. Nguyen struggled to learn English and eventually obtained university and medical school degrees here. He credits his success in part to welfare benefits now readily available to refugees, but which will be cut under the new federal welfare overhaul.

Official pronouncements about aid cutoffs to immigrants produce predictable results at the clinic, he said: “When something like this happens, the patients disappear.”

The doctor is blunt about what he calls the inevitable consequences: added prenatal and maternal deaths, along with more premature births and other complications that require costly treatment.

“Prenatal care, prenatal nutrition--that is essential,” Nguyen said. “If you’re born right, you can fight for whatever you want. But you have to be born right.”