Documentation As a Barrier to Care: Dr. Marsha Griffin on Border Health Care and Split Families

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"Candle of Hope" by Alan Pogue

In October of last year, Rosa Maria, a 10-year-old girl with cerebral palsy, was being transported by ambulance from her hometown of Laredo, Texas to a nearby hospital for surgery when the ambulance was stopped at a checkpoint. Border Patrol agents determined that Rosa Maria lacked documentation [2] to live in the US, and followed the ambulance to the hospital. 

The agents then remained stationed at the hospital, maintaining a presence through her surgery and recovery and took her into custody when her doctors discharged her. The American Civil Liberties Union (ACLU) filed charges against Immigration and Customs Enforcement on Rosa Maria’s behalf, believing a child with such health concerns needs to be with a familiar caregiver, one who knows the child and her medical history. Marsha Griffin, MD [3], submitted an affidavit on her behalf, as a pediatrician from Brownsville, Texas.

10 year old Maria Rosa is at a hospital & @CustomsBorder [4] is right outside her room waiting to deport her Sign&Share https://t.co/IYVjAkF37w [5] pic.twitter.com/bIkRJzYwSa [6]

— DreamActivist (@DreamAct) October 25, 2017 [7]

“[There are] dangers of having a patient with cerebral palsy undergoing surgery or after surgery without a familiar caregiver who knows her health history and needs,” emphasized Dr. Griffin, who is also a board member [8] for Migrant Clinicians Network. Children with cerebral palsy may struggle to communicate their physical and emotional pains accurately. “A lot of children get them mixed up -- which could result in wrong treatment.” A solution is to have her with the caregivers who understand how she presents when she’s in pain or anxious, and how to calm her without medication, Dr. Griffin wrote. With the help of the affidavit, the ACLU managed to get Rosa Maria released. But the treatment of Rosa Maria is far from an isolated case.

“There were several cases at the same time,” Dr. Griffin said. Less than a month before, two parents without documentation in Harlingen, Texas -- in Dr. Griffin’s community -- were discussing how to get their infant boy who had pyloric stenosis to a hospital a few hours away for his surgery. The father suspects that the nurse had called immigration authorities after the parents told the nurse that they were scared to transfer the baby because they would be stopped at an immigration checkpoint. A Border Patrol agent showed up [9] at the waiting room shortly thereafter. Authorities escorted the ambulance carrying the baby and his parents to the hospital. Just like in Rosa Maria’s case, agents stayed close. The father was escorted to the bathroom; the mother had to have the door open as she breastfed her infant.

Photo by Janko Ferlič via Unsplash [10]

Dr. Griffin has too many stories to count. Along the border, newborns who are born premature or with complications have to be transferred via ambulance or air transport to a hospital in San Antonio, Houston, or Corpus Christi. Many cases are flown to San Antonio. For parents who cannot travel past the checkpoint for fear of arrest, the results are the separation of a newborn from its parents within hours of birth, for potentially weeks on end.

“NICUs have tried to establish some way, like through Skype,” for the parents to bond, “so they can at least see their baby every day,” Dr. Griffin said. Many parents with children who need to be transferred are counseled to give a trusted family member who is a US citizen or permanent resident the authority to make medical decisions for the separated child. Even with this workaround, children are still undergoing treatment without the support of their parents, who are often hundreds of miles away.

The separation leaves clinicians struggling to determine best treatment when parents aren’t present. When it became clear that a newborn was terminally ill and the parents were unable to come to the hospital, one NICU staff crew considered its options: Skype in the parents to see the death? Where would the body go after death? The infant was kept alive until he could be air transported back to the border to die in his parents’ arms. But the case, like many others, demonstrates how clinicians’ work is affected by the political environment outside the clinic’s walls -- and the importance of their advocacy for patients’ health needs. Dr. Griffin doesn’t see a letup in the number of cases in which families lacking authorization or of mixed citizenship are suffering health concerns that pull apart the families: “So what’s going on at the border right now? I’ve received two more calls today to talk about the separation of families. It’s horrendous.”

Clinician Voices Help Patients Get the Care They Need

In addition to shaping the clinic into a safe location for all members of the community to gain access to health care, clinicians can make a lasting impact on the health of the community by advocating for the health needs of people with health concerns who are taken under custody by immigration authorities. Dr. Griffin has submitted affidavits like the one she wrote for Rosa Maria for several children to push for proper health care. “If [advocacy groups like the ACLU] can get a doctor to send in an affidavit, it often carries additional weight,” Dr. Griffin maintained. Authorities have acted on her affidavits -- and ignored them as well, she said. But, as a pediatrician, she wants to assure that all children are provided with the healthiest circumstances possible, whether under the care of their family in the community, or in a deportation processing facility. Dr. Griffin recommends getting clearance from your institution before signing affidavits that include their name.

Marsha Griffin, MD with patients

Sensitive Locations and Assuring the Clinic is a Safe Space

Health care facilities, like schools and places of worship, have been considered “sensitive locations” since ICE adopted a policy on such locations in 2013. Within sensitive locations, immigration agents “must exercise caution and avoid enforcement actions unless there are exigent circumstances,” according to a 2017 Farmworker Justice brief [11]. The policy was established by an internal memorandum, not a law, and therefore is not legally binding. However, health facility staff have made efforts across the country to assure the safety of patients and to avoid patients being fearful of seeking health care. Signage indicating what is public and what is private space, policy development and training of clinic staff on how to communicate with ICE agents if they arrive at the clinic, and engagement with the local community are all steps that clinics have taken around the country. Dr. Griffin notes that, in some cases, hospital staff may have invited immigration authorities into sensitive locations where they would not have otherwise gained access.

Photo by Earl Dotter

This may send a message to the larger community that the health facilities are not safe spaces in which to seek care when ill. Clinics need to be viewed by the public as a welcoming and safe space, says Karen Mountain, MBA, MSN, RN, Chief Executive Officer for MCN. “When people are discouraged from going to a health care provider when they are sick, they put off care until they end up in the emergency room,” Mountain contended.

“If we catch it earlier, in a non-emergency primary care setting, the cost of care is less and the treatments are often more successful, and patients will be more likely and able to pay their co-pay, return to work, and lead healthy and productive lives wherein they can contribute to our local communities. The hospitals and clinics, in turn, aren’t stuck with costly procedures for which the patient is unable to pay.”

Across the Country

Even clinicians a thousand miles away from the concerns at the border may still find their immigrant communities on edge -- and uncomfortable seeking care even when they desperately need it. Clinics are encouraged to not just establish policies to give safe access to all community members when sick, but to reach out to the community to publicize such policies and commitments. The increased use of mobile clinics and reliance on community health workers to spread the word and provide services are two critical steps. Dr. Griffin has been taking a medical van to the local school district to serve homeless children to make sure there are no barriers to getting to school. She’s found several of the children are homeless because a parent was deported. Dr. Griffin has also partnered with organizations to help encourage authorities to develop a better protocol for treating the health needs of asylum seekers when released from border detention centers. Detention centers are also located a thousand miles from the US-Mexico border. Many of those released scatter to communities across the country -- with little or no access to health services. These same concerns that plague Dr. Griffin’s border communities are also largely present in communities around the country.

Despite the political climate and the reality at the border, Dr. Griffin remains hopeful. “We have to hang on to hope. I have to hope that separating families is not what we in the US are about. We’re about family values,” she said.

She is confident that the ongoing coverage of the health repercussions of the current strategies enacted at the the border will “turn the tide -- we’ll have more people in the streets, more people running for office, more people voting.” And more clinicians stepping up to voice the health needs of the most vulnerable members of their communities.

The reporting and resource development for this article have been paid for by generous contributions from clinicians, health justice advocates, and MCN supporters. We need your support to be able to fund our advocacy work. Please support our work on the intersection of social justice, migration, and health -- make an individual donation to MCN today [19].

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