All right, well this is Marcela Nava and I am here with Eileen Love. Eileen is a nurse Cook Children's Medical Center, which is the only Children's Hospital here in Tarrant County. And they've been around for 102 years and so Eileen, can you well welcome. Thank you for making time to talk with us today. >> Thank you. So I am a registered nurse here at Cook Children's Medical Center. I have been a registered nurse for the last 11 years. 8 of which I have spent in case management. Three of those years I worked as a nurse, health advocate for Anthem Blue Cross and the last five years I've been here with children and working specifically with our undocumented patient population. >> Okay, so I'd love to hear a little bit more about what that looks like. So can you tell me a little bit of just just the very fact that there that this is your role to work with these families. So can you tell me about what are some of the challenges that you see children and families experience when they're undocumented, when they're uninsured and so on? >> Yeah, of course. So among many of the challenges that these families face whether it's a language or a cultural barrier or a literacy difficulty, both of these things tend to lend themselves towards what I would consider the most challenging aspect of this, which is the family's ability to understand and navigate our health care system. In all of these concerns they tend to go hand in hand. You don't typically have one without another. And another major challenge is the affordability of care. So for example our historical data has shown that we have a higher incidence rate for any visits for our undocumented patient population. And roughly 40% of the visits are potentially avoidable, meaning they were not emergent. And so over the years, we've learned that a lot of these families tend to use the emergency room as a PCP because they either just aren't aware of the resources within their community. Or they just don't have that knowledge of the different levels of care within our health care system, meaning understanding when to go to a PCP versus an urgent care facility versus the emergency room. And as far as the cost is concerned, if a child is brought into the emergency room and it's not an emergent issue belly ache or fever, headache. Ultimately the family ends up being financially responsible for the entire cost of that visit. Whereas if it was a true emergency maybe that belly, it turns into appendicitis, which requires surgery, then these families may potentially be eligible for emergency Medicaid, which would cover the cost of that visit. So having that knowledge of understanding our health care system and how to navigate it is so very beneficial for everyone, but it seems to be the biggest challenge. >> Yeah I'm thinking about that, that Bill that I'm imagining a family member opening after their child's gone into the emergency department for what you said something avoidable, something that could be treated in a primary care, PCP provider's office. So what might that look like to get an emergency department bill for for a severe belly ache for a child? What cost is that family looking at? >> You're probably looking at anywhere from 8 or $900 up to $1500? I mean, sometimes it depends maybe they might give them a Tylenol or something and one would think that Tylenol could be inexpensive, but if you're getting it in the hospital that that cost adds up. So it's very expensive yeah. >> And that's and I'm thinking if this is a family that hasn't whose child it doesn't have a primary care provider, then that means that there are, I'm guessing that they haven't these situations, they haven't been participating in preventative care visits. So that means it's $1,500, essentially what you said, a Tylenol and that's their experience with the health care system. So that's that must really shape, I guess, does that shape the thoughts and ideas that people have in their willingness to interact with people in their health care system? >> Well, sometimes that's all they know, depending on where they're from. A lot of these countries don't have the health care system that's similar to the way that ours works and in their home countries, that's what they do. They go to the emergency room for any small ailment. So that may seem like something normal for them. But when we have people in the emergency room, such as our social workers, help educate them on when the appropriate time is to come to the emergency room and maybe give them a list of community clinics that are able to see them for these minor issues. That does tend to help a little bit. >> Okay so would you say that then one of the biggest, because I'm trying to think in terms of families across the board, not necessarily immigrant families or Children who are undocumented, Just families who are uninsured. So how would you say that it's the knowledge of the health care system that might be the biggest difference between children that are immigrant children that come from immigrant families versus other families that group in the United States but are uninsured I guess. Does that? Is there a groups? >> Well yes for sure. So I mean I think that the knowledge a is definitely the biggest factor but also having the right people there to sort of screen the patients for different programs and resources that their that they may be eligible for where a legal citizen or US citizen. They have different and many more resources and programs available to them. So while they may be uninsured they come to the ED. We're not going to automatically just self pay bill them because they don't have insurance. We have folks that work there who will screen them to say well are there any insurance programs we can get your child on? Now these resources, like I said there's so many more for us citizens and legal permanent residents than that of an undocumented patient. So sometimes even just getting them connected to immigration legal immigration resources, someplace that might offer low cost or free legal aid services which could potentially pave the way for them to gain some sort of legal status which in turn would open doors to programs that they may not have been eligible for in the past. So sometimes that's the first step as well. >> Okay and it's really interesting. I'm going to say thank you for answering that question because I'm going to sit here and think about something that you said which is that an emergency room department. And department visit can be an urgent situation where there is some type of reimbursement where the family doesn't have that bill versus it's not necessarily an urgent situation where they still have to foot the bill, they just happen to be using that emergency department. So thank you for answering that. That's a very interesting idea. >> Yeah no problem of course. [MUSIC]
