By LYNN BREZOSKY Associated Press Writer

December 10, 2002, 1:41 PM EST

BROWNSVILLE, Texas -- Ambulances regularly race across the bridges of the Rio Grande, bringing some of Mexico's sickest to the nearest U.S. emergency room.

Obligated by federal law, the hospitals provide the care and worry later about whether the billing addresses patients give them are accurate. Often the addresses are false -- and the hospitals get stuck with the bill.

Immigrant patients have inflated medical expenses for insurance companies, Medicaid and paying customers, officials say, and are overwhelming already busy hospitals in one of nation's fastest-growing regions.

One recent study by the U.S.-Mexico Border Counties Coalition, an American lobbying group, found U.S. border hospitals provided at least $200 million a year in uncompensated emergency care to illegal immigrants, $74 million of that in Texas.

"Shh, don't tell Iowa farmers that part of their taxes are paying for trauma that occurs south of the border," Dr. Lorenzo Pelly, a south Texas doctor, told state lawmakers at a recent hearing.

Republican state Sen. Chris Harris said he was shocked by what he called the "dumping" of Mexicans on U.S. hospitals.

Policymakers are just being to assess the size of the problem.

Brownsville Medical Center estimates losses averaging at least $500,000 per month. At Thomason Hospital in El Paso, officials said their first attempt to estimate the cost found $1 million over just three months.

Thomason Hospital responded by retaining a Mexican lawyer and requiring patients to sign "pagares," or promissory notes, that carry weight under Mexican law. It also signed on with a firm that specializes in collecting past due accounts in Mexico.

Even without the influx from Mexico, U.S. border hospitals are straining to meet the region's growing medical needs. Some have resorted to importing doctors and offering nurses tuition grants and signing bonuses.

But the load really jumped as Mexicans looking for work stream to factories along the border. The North American Free Trade Agreement has stimulated business on both sides of the border, but hospitals have not kept up.

NAFTA "lacks the social economic infrastructure and capacity" to address the growth, said Eva Moya of the Mexico Border Health Commission, made up of U.S. and Mexican officials.

For the sick or injured on the Mexican side of the border, the choice in a life-or-death situation can be a three-hour journey inland to Monterrey, Mexico, or a minutes-long trip to Brownsville, Laredo or El Paso.

The issue drew attention in September, when 4-year-old Larissa Guajardo, a U.S. citizen, died of heart problems after crossing the Hidalgo-Reynosa international bridge on the way to a hospital. Family members blamed a delay caused by immigration officials, who would not let the mother enter the country. The mother lacked paperwork and had crossed the border illegally before.

The Immigration and Naturalization Service said the inspection process took only a few minutes and that inspectors did not know the girl's illness was critical. Once the seriousness was discovered, the mother was allowed to enter on humanitarian grounds, the INS said.

The Sept. 11 attacks have also complicated the situation along the border, with some authorities worrying about what the ambulances might be holding.

"It is a security threat if they are going across the border unchallenged, but at the same time, we don't want to interfere with an emergency procedure," said Carl Rusnok of the INS in Dallas.

The B&M International Bridge, which links Brownsville with Matamoros, Mexico, has emergency crossings down to a science, said Joe Galvan, president of the company that runs it. The company has its own security guards staffing both sides of the crossing, and in medical emergencies a call goes out for the U.S. side to clear a lane for fast passage.

Under a 1986 federal law, U.S. hospitals must treat anyone who seeks emergency care, without regard to immigration status or ability to pay. The government gives hospitals extra funding to help poorer regions absorb the costs of unreimbursed care, but hospitals say it is not enough.

"This becomes a particular philosophical question that these doctors are having," said Dominic Dominguez, an administrator at Brownsville Medical Center. "Part of my signing to serve in this community is, I'll cover this emergency room. But I didn't sign on to cover Mexico."

-- Anonymous, December 10, 2002