Additional Titles









Sustainable Medicine + Sustainable Development = Duty to Die

Illegal Aliens & EMTALA








PART 1 of 2


Dr. Madeleine Cosman, Ph.D., JD
August 27, 2005

The sick Illegal Alien cries, �I�m sick. Help me!� Few Americans have the courage to say �No!� Could you?

Compassionate, generous Americans react differently to medical problems than to legal questions. Here is the legal scenario: Suppose you found a stranger in your house, eating your food, wearing your clothes, ready to enter your daughter�s bedroom. What would you do?

Now think about the medical version: same man, same acts but this time he says, �I�m sick. Help me!�

Even if the Illegal Alien clearly is not injured or ill, even if the Illegal Alien has admitted to a heinous crime, and even if the Illegal Alien has been cynically instructed in how to generate sympathy and compassion, and literally is reading from the illustrated instruction card, the Illegal Alien will get America�s best medical care free because he demands it.

Americans pride themselves on gracious goodness, bountiful compassion, and medical generosity to anyone in need. America�s scientific abundance and humane generosity, however, are used against our national immigration law to justify free medical care to Illegal Aliens.

Illegal immigration is being transformed into a medical problem just as drug addiction and gun control have been medicalized. Medicalizing is the process of studying, paying for, and directly intervening in a volitional, hazardous, social behavior by calling it a disease. In public health lingo, drug addiction, gun violence, and obesity are medicalized as epidemics we must be inoculated against to avoid contagion. Language of medicine absurdly but effectively describes the non-medical circumstance, generates compassion, and justifies medical action.

Medical effects are clumped together with volitional causes. Individual volitional acts such as using heroin or crossing a national border are divorced from personal responsibility for their medical consequences. Physicians diagnose, prognose, and treat social hazards as if they are contagious diseases or accidental injuries.

Medicalizing is said to benefit patients, compassionately honoring their humanity without blame and without stigma. Treating social hazards as disease makes otherwise ugly conditions attractive for foundation funds, for Centers for Disease Control epidemiological studies, and for public health and church money. Medicalizing also inflates the ranks of Medicaid beneficiaries. How can Americans be hard-hearted against vulnerable victims?

Three ways Illegal Aliens are now medicalized. First, the language of medicine is perverted to hide the crime of illegal border crossing, with migrant encounters said to be medical encounters.

Second, psychiatric medical excuses support Illegal Aliens� criminal acts, such as the cultural defense for Sexually Violent Criminals who claim cognitive disability because in their home country, such as some sectors of Mexico, rape is a minor crime ranking lower than stealing a cow. In fact, a mental health excuse justified the recent transfer of a Texas ranch to Illegal Aliens mentally injured when they were caught trespassing on private American ranchland.

Third, medical compassion plus the efforts of promoters of Illegal Aliens invite millions of Illegal Aliens into startlingly generous federal Medicaid programs. Those who invade this nation walk proudly through the open Golden Door of the benevolent Hospital to the World.[1] Here Illegal Aliens claim the world�s best medical care for free. Medicaid�s generous benefits will surprise even the most sophisticated Americans who mistakenly think that care for the poor is poor care. Medicaid provides amazing benefits that are even more costly to America�s taxpayers than very expensive Medicare.


Many groups that aid and abet Illegal Aliens use medical words meant to generate sympathy for suffering and empathy for pain. An example is the group called No More Deaths that meets and trains volunteers at Southside Presbyterian Church in Tucson, Arizona. It abides by �faith-based principles for immigration reform� that �work to end suffering and deaths of migrants in the Arizona-Sonora borderlands.� In addition to desert camps, water stations, migrant legal aid, �Samaritan patrols� that search the desert for migrants in need, No More Deaths wants Sustainable Development, income redistribution from the rich to the poor, and Open Borders among nations.

At a recent training session, the attorney for No More Deaths stressed that every migrant encounter is a medical encounter. Every border �crosser� is in medical distress. All unaccompanied minors are children requiring pediatric medical evacuation. That means transport of young Illegal Aliens. Transporting Illegal Aliens is a crime. Medically evacuating the ill, however, is thought a blessed religious obligation. Only greedy, hard-hearted racists would deny med-evac to the needy.

Any Illegal Alien in any medical need is transported by medical evacuation to St. Mary�s Hospital in Tucson that does not turn down Illegal Aliens and of course does not turn them in. No More Deaths has a list of physicians and nurses who sign off on medical transport as necessary. Medically-recommended respite care is available for Illegal Aliens in local churches.


Since many Illegal Aliens come to America for reasons other than peaceful work, Department of Homeland Security's Immigration and Customs Enforcement has had since 2003 a special division called Operation Predator. It catches and deports Illegal Aliens who are Sexually Violent Predators. Illegal Alien Sexually Violent Predators add to America�s medical statistics on acute syphilis, gonorrhea, and other sexually transmitted diseases. But Sexually Violent Predators send their victims to the morgue as often as to the clinic. Operation Predator in two years has caught 6085 Illegal Alien Sexually Violent Predators. That comes to 250 per month.

Most prey on children. Notorious rapists and killers that made headlines: in Iowa, Nicolas Sandoval-Medina, violently molested girls under age 12. In Minnesota, Jaime Sanchez-Hernandez bound, gagged, and raped a 5-year-old girl. In Florida, Milagro Cunningham raped an 8-year-old and buried her alive. She survived. In Texas, David Diaz Morales raped, stabbed, and murdered 16-year-old Jenny Garcia. He plea-bargained for 40 years instead of the death penalty.

Some Sexually Violent Predators prefer adult women. Some specialize in nuns, such as Maximiliano Esparza, a man with seven known aliases, who raped and murdered Sister Helen Chaska in Klamath Falls, Oregon. Other Sexually Violent Predators who are Illegal Aliens favor men and boys. Some are so versatile that, modeling themselves on Reynaldo Elias Rapalo in Miami, Florida, they rape women ranging in age from girls of 11 to seniors age 79.

Among child sex predators ICE caught are those in Oregon who number: 148; Arizona: 207; Illinois: 282; New York: 365; New Jersey: 423; and Texas: 545. California wins the prize for most Sexually Violent Predators: 1578. The city of San Diego outranks most states with a total of 685.

What happens when Illegal Alien Sexually Violent Predators get hauled into court? Routinely their court-appointed attorneys and interpreters use the common legal defense: He is depraved because he was deprived. He came from a primitive, poverty-stricken homeland. His culture caused mental illness simply expressed in violent sex. He is not at fault. He needs a hospital not a jail.

A second legal defense of the Illegal Alien sexual criminal also is cultural. If his culture considers women chattel, his mental context for rape and murder is that of his home country where rape is ordinary, a compliment to the raped woman�s beauty, and she ought to be grateful. If his home culture, such as those Mexican jurisdictions that rank rape below cow-stealing, minimizes rape as crime then the rapist�s mental state logical for Mexico conflicts with laws in Des Moines, Iowa, where he raped 12-year old girls. He should be judged as suffering from an immigrant cognitive dysfunction, a mental disability, not the crime of rape.

Acute mental distress was the medical reason for awarding Illegal Aliens the ranch. In March, 2003, on a ranch in Hebbronville, Texas, Casey Nethercott and other members of a local citizen border patrol called Ranch Rescue caught two Illegal Aliens from El Salvador, Edwin Alfredo Mancia Gonzales and Fatima del Socorro Leiva Medina. Ranch Rescue detained the pair for about an hour, gave them cookies, water, and a blanket, and warned them never to come back.

They returned, with lawyers. At trial, they claimed that Nethercott hit Mancia with a pistol. Nethercott denied it. The jury deadlocked on pistol-whipping. But it concluded that the Illegal Aliens� one-hour �ordeal� horribly mentally injured them. The pair feared Ranch Rescue men would kill them. The Illegal Aliens thought the men were soldiers. Ever after they have suffered post-traumatic stress.

This mental health problem was so severe that Nethercott�s ranch was awarded to the Illegal Aliens. The trial judge thought the Illegals suffered mental anguish so serious that he issued default judgments against the founder of Ranch Rescue for $500,000 and against Nethercott for $850,000. Thanks to attorney Morris Dees of the Southern Poverty Law Center, Nethercott who apprehended Illegal Aliens invading America�s territory and trespassing on private land lost his own ranch to the Illegals. Worse, Nethercott did not see the taking of his ranch. He is serving a five-year sentence in a Texas prison for possessing a gun. Since in the past he had been convicted in California for assault, he technically was a felon for whom weapon possession was illegal.


Promoters of open borders and elevating the status of Illegal Aliens brilliantly use Americans� medical compassion against ourselves. If it bleeds, it leads. If a victim, we treat �im.� Medicalizing Illegal Aliens transforms their crimes of border-crossing, trespassing, and stealing into diseases or injuries that we in our wealthy, scientific medical competence feel compelled to treat, to coddle, and to reward.

One medical reward is Medicaid. That is the subject of the next essay. I appeared with Lou Dobbs on CNN in July, 2005, to speak about America�s generous awards of expensive Medicaid benefits. Lou asked, �Is it true that only four states check for citizenship before awarding Medicaid?�

My answer may startle you. So will Medicaid benefits that in some states go beyond basic medical office and hospital care to include dazzlingly generous prescription drugs, nursing home care, home repairs, hairdressing, gardening, even pest control. If it bleeds, it leads. If a victim, we treat �im. Medicalizing is the pernicious process of studying, paying for, and directly intervening in a volitional, hazardous, social behavior by calling it a disease. Medicalizing is expensive, intellectually dishonest, fiscally irresponsible, and encourages cheating.

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While social hazards such as drug addiction and the invasion of Illegal Aliens have medical effects, the volitional acts are not medical. Costs are astronomical. America�s medical generosity must not be abused.

Part -----> 2 of 2


1, See Madeleine Pelner Cosman, Hospital to the World Welcomes Illegal Aliens and Contagious Diseases,

� 2005 Madeleine Cosman - All Rights Reserved

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Dr. Cosman is a medical lawyer located in California. Her forthcoming book in 2005 is Who Owns Your Body?: Doctors and Patients Behind Bars. She lectures worldwide on medical law and medical policy, has testified before Congress on medical law issues, and has spoken in Washington for Cato Institute and Galen Institute. She wrote the ABCs of the Clinton Medical World for Congress in 1993. A Director of California Rifle and Pistol Association, she writes "Guns and Medicine" for Firing Line. One of her 15 published books was nominated for the Pulitzer Prize, National Book Award, and was a Book of the Month Club Dividend Selection.

Madeleine promotes free-market, patient-centered medicine, and Health Savings Accounts.

Her J.D. is from New York's Cardozo School of Law, Ph.D. from Columbia University, M.A. from Hunter College, and B.A. from Barnard College. She is a member of the New York State Bar, New Jersey Bar, American Bar Association's Health Law Section, and American Inns of Court. Madeleine is Professor Emerita of City College of City University of New York and a Life Fellow of the New York Academy of Medicine.











Promoters of open borders and elevating the status of Illegal Aliens brilliantly use Americans� medical compassion against ourselves. If it bleeds, it leads.