HNF Stories
1:41 am
Thu August 7, 2014

No Documents? No Problem Here

The dirt road and lush tree canopy leading to the Catholic Charities medical clinic is in stark contrast to the bright lights surrounding the nearest hospital.

Here, sirens would be drowned out by choruses of crickets and katydids.

But this refurbished double-wide trailer off a rural highway in Dover is a medical refuge for some agricultural workers and their families.

Dozens show up at the San Jose Mission medical clinic every Monday night, knowing Sister Sara Proctor and her team of volunteers won't ask for what they don't have: money or documentation.

“Around 80 to 90 percent would be my “guesstimate” of those who cannot - let me say - have questionable documentation,” says Proctor. “So that’s my population.”

Proctor, a Catholic nun and licensed physician assistant, doesn't want a reporter hanging out on clinic night, which is bustling with families and people afraid of the media. She wants to protect clients who numbered nearly 2,000 last year. And she's focused on providing them with basic primary care.

“The bulk of what we see is what I frame as itzel-ditzel. You know, it’s the rashes, it’s the sore throat, it’s the stomach ache, it’s the headache, it’s the cough, it’s the whatever, whatever,” she said.

The Pew Research Center estimates that 825,000 immigrants in Florida today live here illegally. And regardless of any government policy or ongoing political debate, they sometimes get sick.

Health care charities like the Mobile Medical Services ministry Proctor oversees are among the agencies that try to help this mostly poor population. Also, federal law requires hospitals to see anyone who comes in their doors, whether they are American citizens or not.

Her aim is to keep as many people as possible from ending up in the hospital. But when someone pulls up with a buddy in the backseat with a broken leg or a woman who needs to deliver a baby, she has no choice.

“It’s not that we just send them ‘willy-nilly,’ go find a hospital,” she said. “We are very directive in where we send them.”

Many end up at facilities owned by BayCare Health System, an 11-hospital system across the Tampa Bay area. Chief Financial Officer John Gantner said the non-profit chain doesn't question providing medical care to undocumented aliens.

“Well first of all it’s our mission to treat them. And frankly we’re happy that we’re able to treat them. We’re proud of what we do,” he said. “We really, really are. And it’s also law that we treat them.”

Gantner is talking about the Emergency Medical Treatment & Labor Act or EMTALA. The federal law was created in 1986, guaranteeing access to emergency medical treatment, regardless of a person's ability to pay. It covers citizens and non-citizens alike.

In fiscal year 2012, Florida hospitals asked the state to help pay for treating 30,880 undocumented immigrants, which cost them more than $178 million, according to the Agency for Health Care Administration. The state distributes the federal “Emergency Medicaid” fund exists to help pay for part of the emergency department services and other hospital costs.

Undocumented patients cost BayCare hospitals between $1 million and $3 million a year - a small portion of the chain's roughly $250 million it budgets for charity care, Gantner said. That $250 million accounts for 10 percent of the hospital system’s total revenue.

“Well it sounds like small potatoes, and I guess if you just look at the $1 million dollars in isolation, it could sound like small potatoes,” he said. “The fact of the matter is about 45 percent of BayCare’s revenues comes from some sort of governmental payer. The majority is Medicare and Medicaid, but there are other smaller sources, like the one we’re talking about here today.”

Gantner said the hospital doesn’t expect to cover all expenses from the care of undocumented immigrants. Like Medicaid and Medicare payments, it will still lose money, he said.

But many hospitals balked when the state in 2010 drastically reduced how much it says would be paid from the Emergency Medicaid fund to hospitals from the for the care they are required to provide. AHCA also asked hospitals to repay some money dating back to 2005.

That's why BayCare and other hospital groups sued the state over how much it pays for the emergency room care of roughly 30,000 undocumented immigrants a year.

"We have to be very cautious, understandably, we have to be concerned anytime that there’s a reduction in these programs,” he said.

AHCA declined to comment on the three-year-old dispute. Earlier this summer, the First District Court of Appeal reiterated previous rulings, in favor of the hospitals. Though the state appealed this latest decision, it recently withdrew its appeal without explanation. 

Attorney Tracy Cooper George wrote in earlier court documents that EMTALA is not expected to be a “cure-all or to solve the larger problem of providing medical services” to undocumented aliens.

And they maintain the entire dispute centers on a 2003 rule about payments that the agency clarified in 2010. It’s been holding hearings about the rule this summer, but the hospital attorneys have challenged those proceedings as well.

Sister Sara Proctor isn't involved in the lawsuit. But she says hospitals need financial support for treating patients who come through the emergency room doors.

"It's all of our, our responsibilities. It should be all of our concerns, first and foremost,” she said. “And second of all, it's social justice. We are all humans. We all are of the same human race."

So, she said she will instead stay focused on her small part, at the little medical clinic down the dirt road.

--Health News Florida is part of WUSF Public Media. Contact Reporter Mary Shedden at (813) 974-8636, on Twitter @MaryShedden, or email at For more health news, visit