Not surprisingly, opponents of Proposition 187 have seized on Julio’s case to drive home their political objections. It’s not at all clear that the boy died from a delay in treatment; a coroner’s report notes that he had leukemia. Even so, the episode offers a glimpse of the perverse consequences the new law could have. Proposition 187 is supposed to deter the influx of illegals, enabling the state to cut spending and improve social services. But the measure could cost the state money by eliminating cheap, basic care while preserving emergency services. And the medical impact won’t be confined to illegals and their children. As newcomers start avoiding clinics and hospitals, their untreated diseases could threaten the larger population. Dr. Thomas Peters, director of health and human services for Marin County, calls it ““a disaster in the making.''
Surveys of California’s Asian and Central American immigrants have found that as many as 70 percent arrive carrying the germ that causes tuberculosis. Though most carriers remain healthy and noncontagious, they’re always at risk of developing TB and transmitting it to others. California Gov. Pete Wilson, a 187 enthusiast, says he’ll preserve medical services that help ““protect the general public.’’ But if doctors become de facto INS agents, they’ll have trouble persuading people without papers to seek any kind of care. ““It’s hard to educate them to the need for prevention when there’s [a] threat attached,’’ says Dr. Shirley Fannin, director of disease-control programs for Los Angeles County.
Prop 187 also could undermine mater-nal and child health. Illegals now qualify for free prenatal care if they can demon-strate financial need. The new measure would deny those women any treatment unless they showed up at a hospital in labor. No one pretends that makes medi-cal sense. ““We believe [pregnant women] should get prenatal services,’’ says Shannon Bowman, Wilson’s health-and-welfare spokeswoman. ““They should just go back to their country to get them.’’ But there’s no reason to assume that will happen. And if it doesn’t, health experts predict a rise in maternal and infant deaths.
If 187 cut off all medical care for undocumented immigrants, it might well save the taxpayers some money (no one knows how much). But the measure does nothing to curtail emergency services, which are costlier and less effective than other forms of care. Just about any toddler can fight off a strep infection with a round of antibiotics. If her parents are afraid to take her to a clinic, however, she may end up in an intensive-care unit, getting her drugs intravenously. ““If you’re lucky, the kid comes out fine,’’ says Dr. Francesca Gany of the New York Task Force on Immigrant Health, ““but you’ve spent $20,000 on a problem you could have solved for $45.’’ Some kids wouldn’t be so fortunate. Dr. David Wood estimates that 10 percent of the 150 young asthmatics he treats at L.A.’s Clinica para las Americas would suffer life-threatening attacks if they couldn’t stop in for checkups and medication. Some would make it to emergency rooms. Others would probably die.
The legal battles over Proposition 187 could drag on for months, if not years. In the meantime, California officials are working to translate the vaguely worded measure into specific regulations. Some doctors say they’ll defy the new law before they’ll help enforce it. But as the story of Julio Cano suggests, 187 could have serious consequences even if it’s never enacted. The Community Health Foundation of East Los Angeles normally immunizes about 400 children every two weeks. During the first half of November the number plummeted to 83. ““This is driving people away,’’ says executive director Rudy Diaz. Politics aside, the challenge is to bring them back.
