Silver Spring Hospital Struggles to Serve

Some weeks it seems as if the whole world, with its many troubles, has walked through the doors of Holy Cross Hospital.

Daily, the second-floor women's clinic fills to overflowing with patients from countries in Central America, Africa and Asia. Some have never had care during previous pregnancies -- and never had a child born alive. "We ask, 'Do you know why?' " says director Nancy Nagel. "And they say, 'I just lost the baby.' "

Elsewhere, from the emergency room to the primary medicine clinic, doctors and nurses confront conditions and diseases they did not see a decade ago -- malaria, infectious diarrhea, parasites such as tapeworm. Even many common ailments can be more challenging, because they often require translation from a panoply of foreign tongues and cultures.

Serving the underserved is integral to Holy Cross's mission, and the Silver Spring hospital has long shouldered much of the care for poor, uninsured residents of Montgomery County. But as that population has expanded rapidly with the continued arrival of immigrants, legal and illegal, it has become a much more difficult and expensive proposition.

And now a generous mission is reaching its limit. After yet another sharp increase in the prenatal program it runs for the county, Holy Cross has drawn a line. Starting today, for the first time since it opened in 1963, Maryland's biggest community hospital will restrict how many uninsured obstetrics patients it will accept.

"It has taxed the system enormously," said physician Imad Mufarrij, a native of Lebanon who can converse with patients in five languages.

Barely half an hour from the congressional chambers where the nation's immigration policies have been rancorously debated, there is little dissent over what is right to do. It is why Holy Cross opened its primary health clinic two years ago, agreeing to cover what in 2005 was a $460,000 operating deficit. And why it spends almost half a million dollars annually on interpretation services and ethnic-specific programs for patients and Spanish classes for employees.

From 2000 to 2005, the cost of the institution's yearly charity care more than doubled to $9 million; the care is significantly but not entirely for immigrants. A third of the total now goes to the low-income women, a veritable United Nations, who are seen through Holy Cross's Maternity Partnership with the county.

President and chief executive Kevin Sexton has no qualms: "As much as I am interested in public policy and public issues, I basically suspend that at the door of a health care facility and believe that everyone needs care."

The pressures on Holy Cross mirror those at other facilities in the region, though they fall far short of the intense demands that providers face in towns and cities along the U.S.-Mexican border. Washington Hospital Center regularly translates documents and physician-patient communication into nearly a dozen languages, including Turkish and Tagolog. Inova Health Systems estimates that it spends at least $10 million on such services, outreach programs and charity care for uninsured immigrants in Northern Virginia. In Fairfax County, more than one in seven births are to immigrants, according to one estimate.

Critics cite the burden they say newly arrived immigrants place on health care as one rationale for restricting their numbers. Last year, the federal government set aside $1 billion to cover emergency room care for illegal immigrants through 2009. The full medical bill to U.S. hospitals, clinics and taxpayers probably exceeds $6 billion annually, calculates Steven Camarota of the Center for Immigration Studies, a research group that seeks "fewer immigrants but a warmer welcome for those admitted."

Still, Camarota thinks proposals to deny access to treatment misdirect the debate. "Either you select immigrants who are self-sufficient and don't need help from the government, or you shut up about the cost," he said. "There's no middle ground."