By Tim Steller ARIZONA DAILY STAR

NOGALES, Ariz. - Immigration inspectors are trying to limit the number of poor Mexican patients they wave across the border to Arizona hospitals, but there's no evidence the effort is working.

Tucson Medical Center is on pace this year to treat more patients given medical waivers -or, humanitarian parole - at the border than it did last year.

The hospital treated 25 such patients last year at a cost to TMC of $1.5 million, said Robert Guerrero, the market administrator handling cross-border patients for TMC. Through the first nine months of this year, the hospital had treated 23 paroled patients at the same cost, $1.5 million.

Meanwhile, the long-term solution offered by Arizona hospitals to the problem of health care for Mexico's poor is stalled. The hospitals have offered donated medical equipment to Nogales, Sonora, medical facilities as part of an attempt to upgrade the city's health care system.

But for months Mexican customs has not permitted much of the equipment across the border. A pair of donated ambulances have been sitting most of the year in the parking lot of a Nogales, Ariz., warehouse, and their tires are beginning to flatten.

Arizona hospital officials have long complained of the bills they are forced to absorb when they treat people injured while crossing the border illegally. More recently, they've complained they are receiving too many patients who do not have proper documents to enter the United States but are granted humanitarian parole by the Immigration and Naturalization Service at ports of entry.

The INS is trying to minimize the number of people it paroles, said Gregory Burcham, the assistant director of the Arizona district for inspections. Since Nov. 2001 any requests for humanitarian parole must be approved by him or a higher-ranking INS official in Phoenix - not just a border inspector.

The INS does not track the number of humanitarian paroles it grants at given ports of entry, or in the state as a whole, said spokesman Russell Ahr. Burcham estimated he approves four such requests per week.

But Burcham said even when trying to limit the number of paroles, the INS is caught in a dilemma. The rule on humanitarian paroles is that people are to be allowed into the country only if they can pay for the medical treatment they will receive. But inspectors are sometimes faced with people who will not survive if they are prevented from crossing.

"I had a guy last week kicked in the head by a horse in Sasabe (Sonora). Serious head trauma." Burcham said Tuesday. "He comes in. You and I pay for it. You want to say no and let him die? You want to say yes and get (criticized) because he's going to bankrupt the hospital?"

"If someone is dying in an ambulance, we're not going to hold them up," Burcham said.

Last week at Nogales, Wendy Buelna was waiting for approval of a humanitarian parole that would allow her to return to Sacramento, Calif., and be with her hospitalized son. The 4-year-old boy, Jonathan Hernandez, was burned over his entire body during a May car wreck in Nogales, Sonora.

After a few days at the Social Security hospital there, Northern California Shriners Hospital said it would treat the boy. Buelna, who also was burned in the crash, recalls the period vaguely but said she and her son were swept through the border without delay.

"Everything went very fast," Buelna said.

She spent the next six months in Sacramento on the humanitarian parole, returned briefly this month to Mexico, then was granted another waiver last week to return to Sacramento.

Guerrero said he and others in the Tucson medical world don't necessarily object to treating such patients. They simply want to be paid for it.

"It's the federal government that allows them in, and it's the federal government that requires us to treat them," Guerrero said.

Therefore, he said, the federal government should pay for the treatment.

U.S. Sens. Jon Kyl and John McCain said during a visit to TMC on Dec. 4 that they plan to reintroduce a bill that would provide $200 million for the medical treatment of undocumented aliens. The bill does not specify that the money could also be used to reimburse the treatment of recipients of humanitarian parole.

U.S. Rep. Jim Kolbe has also introduced two bills that would reimburse hospitals and ambulance service providers for unpaid services to injured border crossers.

Officials on both sides of the border agree the long-term solution to the problem is to improve medical care on the Mexican side of the border so that patients don't have to cross the line for treatment.

In November, Kolbe announced a $350,000 grant to buy new medical equipment for the General Hospital in Nogales, Sonora. The money is to be administered by the U.S. Agency for International Development and University Medical Center.

But a pre-existing program of donating used equipment is faltering at the border.

While cross-border shipments of donated equipment for a triage room have arrived at the General Hospital this year, additional shipments have been stalled in storage in Nogales, Ariz.

Among the stored equipment: examining tables, emergency-room beds, autoclaves for sterilizing instruments, an X-ray machine and a colposcope for cervix examinations, as well as the ambulances and smaller items such as surgical gloves.

The problem, apparently, is that Mexican customs officials are hewing strictly to their regulations, a priority of Mexican President Vicente Fox's administration.

"A lot of it has to do with President Fox's initiative to quell corruption," said Dr. Cecilia Rosales, the head of Arizona's Office of Border Health. "Intentions are good; it's just that it sort of impedes our efforts to improve the hospitals across the border."

Fernando Valdez, the director of protection services at Mexico's consulate in Nogales, Ariz., said donors used to be able to go through consulates to get their materials across the border. But that isn't what the customs regulations demand.

"Now they're applying the law more strictly," he said.

-- Anonymous, December 16, 2002