They knew that she had been born in Mexico, was a 15-year-old student at a Dallas high school and had gone to her prenatal checkups. They knew she was scared about giving birth.
What the hospital staff did not know, because they did not ask, was whether Ms. Domínguez was an illegal immigrant.
“I don’t want my doctors and nurses to be immigration agents,” said Dr. Ron J. Anderson, the president of Parkland.
Patients like Ms. Domínguez — uninsured Hispanic immigrants with uncertain immigration status — have flocked in recent years to public hospital emergency rooms and maternity wards in Texas, California and other border states. Their care has swelled costs for struggling hospitals and increased the health care bills that fall to states and counties, giving ammunition to opponents of illegal immigration who complain of undue burdens on local taxpayers.
As a result, health care has become one of the sorest issues in the border states’ debate over illegal immigration. Facing harsh criticism from residents, public hospitals are confronted with an uneasy decision: demand immigration documents from patients and deny subsidized care to those who lack them, or follow the public health principle of providing basic care to anyone who needs it.
In Texas, two of the biggest public hospitals chose differently.
The Parkland Health and Hospital System, which serves Dallas County, offers low-cost care to low-income residents with no questions asked about immigration status.
“We decided that these are folks living in our community and we needed to render the care,” Dr. Anderson said.
In Fort Worth, in neighboring Tarrant County, JPS Health Network requires foreign-born patients to show legal immigration documents to receive financial assistance in nonemergencies, like elective surgery and the treatment of routine or chronic illnesses. Executives said that their first responsibility was to legal residents, but that they were uncomfortable about having to make such distinctions.
“I don’t think you should ask the hospital to make moral decisions for the State of Texas or, for that matter, for the United States,” said Robert Earley, a senior vice president of JPS.
To some Fort Worth residents, the hospital — which does provide emergency and maternity care to illegal immigrants — has nonetheless sent a message that illegal immigrants are not welcome.
“Whenever immigrants go to the hospital, the first thing they are asked is, ‘Who are you and where are your immigration papers?’ ” said José Aguilar, a leader of Allied Communities of Tarrant, a coalition of church-based community groups that has pressured the JPS board to reverse its policy. “They are being scared away.”
Across Texas, the debate over illegal immigration has spilled into county commission hearings and hospital board meetings. A study ordered by commissioners in Harris County, which includes Houston, found that about one-fifth of the patients in its health system last year were immigrants without documents, most of them from Mexico. Their numbers had increased 44 percent in three years, the study found, and their care had cost the county $97.3 million, about 14 percent of the health system’s total operating costs.
“We have a lot of United States citizens that need our help in health, and we should pull them up before we pull up someone here illegally,” said Tim Gallagher, 45, a software salesman from Plano, north of Dallas, who in an interview expressed views widely shared in the state. Mr. Gallagher said he favored deporting illegal immigrants who sought care from public facilities, even if the patient was a mother who gave birth to an American citizen.
“If somebody here needs health care, they should get it, and then if they are illegal, they should go bye-bye,” said Mr. Gallagher, who wrote a letter on the subject to The Dallas Morning News.
In California, hospitals spent at least $1.02 billion last year on health care for illegal immigrants that was not reimbursed by federal or state programs, according to federal government estimates. Hospital officials there said the ailing health care system was being pushed to its limit.
