Recently, hospitals in Texas that participate in Medicaid or the Children’s Health Insurance Program were put on notice that the Governor, Greg Abbott, wants them to collect information on the citizenship status of their patients. The executive order says the hospitals must ask patients if they are U.S. citizens or are lawfully present in the country.  If not, data should be collected on the cost of caring for patients who are identified as being in Texas ’illegally’.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Abbott said as he announced his executive order.  Data are due next March.

I think this is a terrible idea. It risks public health, and it is offensive to the ethical requirements of medicine, which are to treat people regardless of citizenship and of their immigrant status especially when faced with medical emergencies.

In fact, that’s what existing federal law says. Emergency rooms have to stabilize people and treat them without regard to their status, income, or anything else. The statute is called EMTALA, the Emergency Medical Treatment and Labor Act, and it is a piece of legislation that Congress enacted explicitly to stop hospitals from refusing very ill people who couldn’t pay. In some cases, patients were just dumped outside the hospital, on the theory that those patients never really got into the emergency room, so there was no duty to take care of them.

Doctors, nurses, and EMTs should not be paying attention to the citizenship status of someone who needs care. I’m talking about emergency hospital care. They have the professional duty to help the community and to stand up for health. Why is that so? There are two reasons.

First, if you say the hospital is going to be collecting data on citizenship status, there are definitely people who are not going to come in. They’re going to stay away from the hospital. They fear getting identified. These include people who are grievously injured and pregnant women. Many will not show up at the hospital and instead try to tough it out. That isn’t the stance I think we should want the vulnerable sick to take relative to trying to get healthcare in a crisis.

The other problem is that, from a public health perspective, you don’t want people afraid to show up at the hospital. If someone has a venereal disease or a severe case of the flu or measles you want that treated so it is not spreading in the community. If someone has an infectious disease, you want him treated. Also, if someone has an acute mental health problem, you don’t want him going out and committing a violent act against somebody else because his mental health crisis was not addressed.

When you start to collect information on citizenship, you’re putting public health at risk because you’re saying we shouldn’t treat people who aren’t US citizens. If there are many people in Texas or other states who aren’t US citizens, it doesn’t mean they don’t have infectious diseases or health crises that can put others at risk.

At the end of the day, there’s certainly plenty to say and debate about immigration and citizenship status, but I think that belongs in the political sphere, the legislature and the courtroom. It doesn’t belong in the emergency room. It doesn’t belong at a hospital trying to figure out who’s eligible for admission and who isn’t in order to deliver care. Congress intended EMTALA to show mercy to the sickest. Texas and Florida, which has a law similar to that of Texas, are putting all Americans’ health at risk by demanding proof of citizenship when the need for care ought to be paramount.

Put public health first in Texas; have the fight over immigration somewhere other than the ER.