Access to Medical Care and Undocumented Workers

Saturday, February 25, 2006 | 0

The following are observations by Peter Rousmaniere posted on his web log ('blog') at www.workingimmigrants.com that the editors felt would be of interest to the workers' compensation community.

Access to medical care denied by ID requirements

Something that American citizens take for granted -- picking up your medical prescription at the pharmacy. Not so if your personal ID is iffy and the state is trying to crack down on medication abuses. This case is from Mississippi.

The state began to insist on personal identification to crack down on drug abuse and by failing to educate pharmacies made life more complicated for innocent undocumented workers. Mississippi recognizes the right of work-injured undocumented workers to protections of the workers compensation system. It introduced drug procedures to help in fraud and abuse control.

Pharmacists are asked to get a unique identifier for the patient at the time a controlled substance prescription is filled, for example for pain medication. The website of the Board makes no mention of these ID requirements. The regulations posted there mention only the name and address of the patient.

Angela Stuesse of the Mississippi Poultry Workers' Center reports that pharmacies have insisted on social security number or driver's license. In two instances she gave her own identification to have the patients receive their medication. She called the state Board of Pharmacy. An individual told her that the ID requirement is "not voluntary, but not yet mandatory" and that other identification can suffice. The Board just hasn't clearly told the pharmacies.

He said the Board has received such calls before and has quickly been able to remedy the situation - if the patient were at the pharmacy. She asked if there is any formal process for reporting pharmacists who are abusing/misusing the system, as in the examples I have experienced. There were none.

Inconsistent quality of healthcare for work injured immigrant workers

Many low income immigrant workers go to hospital emergency departments and to free care community health clinics with their work injuries. Emergency departments and community health clinics typically do not understand how to determine the occupational cause of injury, and do not try to contact the employer and to make sure that an injured worker accesses the workers comp system.

The clinics in particular often appear to be tone deaf to the special needs of injured workers. Example: I contacted the Joseph Smith Community Health Center in Boston, which actively serves low income immigrants, a dozen times to ask them about how they handle work injuries. To get a response I finally conducted a sit-in in the reception area, refusing to leave until I spoke with some one. Eventually the director of the clinic came downstairs. While pleasant, she showed zero interest in the special needs of injured workers, and in investigating them further.

My several contacts with the Health Resources and Services Administration, the federal agency responsible for providing financial and technical assistance to community health clinics, revealed that this agency has little interest in addressing the special needs of injured workers.

Migrant Clinicians Network

The Migrant Clinicians Network engages in healthcare delivery and healthcare research for low income workers including but not exclusively migrant workers. Their new Saving Lives by Changing Practice project is attempting to improve the quality of service to work injured clients. Amy Liebman is coordinating the program. She provided me with this introduction to the program.

For an earlier posting on community health clinic services to injured workers, go here.

Amy K. Liebman, MPA
Migrant Clinicians Network
410.860.9850, aliebman@migrantclincian.org

There are numerous barriers to recognizing and treating environmental and occupational health (EOH) problems in the primary care setting. Some of the underlying reasons are the limited EOH training front line providers receive as well as institutional challenges that prevent clinicians from adequately addressing EOH problems.

For migrant farm workers and other vulnerable populations employed in hazardous jobs, an occupational injury or exposure is often the reason for first point of contact with the health care system, underscoring the need to begin addressing EOH concerns at the primary care level.

MCN's program, Saving Lives by Changing Practice, is part of a five-year cooperative agreement with the US Environmental Protection Agency, Office of Pesticide Programs, to address pesticides and other EOH issues in the practice setting. Through this program MCN will work to link primary care clinicians in Migrant and Community Health Centers with occupational and environmental specialists and clinics by:

* Developing occupational/environmental medicine clinics in Migrant Health Centers.
* Facilitating clinical consults between the primary care clinician and the occupational medicine clinician.
* Developing referral mechanisms for complicated pesticide cases.
* Training primary care providers in occupational/environmental medicine.

MCN will also recruit and work with six to eight Migrant and Community Health Centers to develop a flexible center-based model to integrate EOH in the primary care setting. This will involve working to incorporate key practice skills outlined in National Environmental Education Training Foundation's, National Pesticide Practice Skills Guidelines for Medical and Nursing Practice (2003).

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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.