Decision delayed on Fresno County care for undocumented immigrants

The Fresno BeeJune 12, 2014 

A Fresno County judge has issued a tentative ruling that would allow the county to end a three-decade commitment to providing medical services to undocumented immigrants.

But no final decision was made at a hearing Thursday.

Instead, Superior Court Judge Donald S. Black gave both sides until Monday to argue whether he has the authority to extend an order he issued in April.

Black ruled at that time that the county did not have to follow a 30-year-old court order requiring it to pay for medical services for undocumented immigrants.

But he stayed his decision until June 21, and Clinica Sierra Vista, which operates health centers in Fresno and Bakersfield, filed a motion asking the court to continue the stay.

Thursday, the county countered that Black did not have the power to continue the stay and Black said he was not sure of his authority.

Clinica said an extension of the stay could give the Legislature more time to consider legislation to exempt the county from repaying $5.5 million in Proposition 42 road funds. Fresno County was hit with the bill after it failed to maintain its own level of spending on transportation projects from the late 1990s. Proposed legislation would exempt the county, so long as it provides medical services to indigent people.

The proposal has been combined with trailer bill language and may or may not be heard by Sunday, said a spokeswoman for Assemblyman Jim Patterson, R-Fresno. Legislators do not have to vote on trailer bills by the budget deadline this month.

In his April ruling, Black appeared to open the door for Clinica to challenge the county on the grounds that public health would be harmed if it stopped paying for care for undocumented immigrants.

Black said then that he could not find that "dissolving the injunction is in the interests of justice," and cited arguments by Clinica that ending the injunction would harm the health and well-being not only of undocumented people, but also the public at large.

But in his tentative ruling issued Wednesday, Black said Clinica could not revive a public health claim that had been resolved in the original complaint brought in the 1980s by Sequoia Community Health Foundation.

Sequoia and the county agreed in 1983 to dismiss a part of the complaint that alleged the county had a duty to the general public to provide care to undocumented persons to prevent epidemics and the spread of communicable diseases.

On Thursday, attorney Jerry Behrens, representing the county, said Clinica's motion to continue the stay was just a rehash of arguments it had presented before and that the judge had ruled the county cannot be mandated to provide care to undocumented people.

Clinica's lawyer, Mona Tawatoa of the Western Center on Law and Poverty, said the health center has a viable complaint and that the county has an obligation to preserve and protect public health.

The county has made no plans to address public health issues that could arise from cutting an estimated 5,000 undocumented people from the county's Medically Indigent Services Program, she said.

In its written motion to continue the stay, Clinica said ending the county's role in providing health care to undocumented immigrants would further stress an already overburdened health clinic system that provides primary care.

Patients will wait longer to be seen, the motion said. "Specifically, this means more cases of sexually transmitted diseases such as chlamydia, gonorrhea, syphilis and HIV infections will go undiagnosed and spread to others."

The county countered that the public health department has programs to immunize people for vaccine-preventable diseases and programs to prevent the spread of communicable diseases.

Undocumented immigrants will have no access to specialty care except through hospital emergency departments, said Clinica CEO Stephen Schilling in an interview after the hearing. "No one is asking the county to take on primary care, and we're not asking the county to pay us a dime to provide primary care," he said. "The argument here is about specialty care -- the pulmonary care, the dermatology care, the surgical care."

Before Thursday's hearing, members of Fresno Building Healthy Communities, an organization to improve health funded by The California Endowment, gathered outside the B.F. Sisk Courthouse to rally support for maintaining care for undocumented immigrants.

Faced with the judge's tentative ruling, the group is turning its focus on the county Board of Supervisors, which has not yet decided about maintaining health care for undocumented people in the county.

The supervisors have said they want to ensure there is help for farmworkers put out of work during the drought, said Sandra Celedon-Castro, hub manager of Fresno Building Health Communities. "What good is a job when you can't get out of bed?"

The reporter can be reached at (559) 441-6310, or @beehealthwriter on Twitter.

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