New York Times examines challenges faced by a Minneapolis hospital that treats many Somali, Hispanic patients

The New York Times on Sunday profiled the Hennepin County Medical Center, a Minneapolis-based hospital that "offers an extraordinary vantage point on the ways immigrants are testing the American medical establishment."
About 20% of patients at Hennepin are foreign-born and many have conditions uncommon among those born in the U.S., such as vitamin deficiencies, intestinal parasites and infectious diseases like tuberculosis. In addition, some have "unusually high levels of emotional trauma and stress," and others question common treatments for chronic diseases like obesity, diabetes and heart disease, the Times reports.

The 446-bed public hospital spends $3 million annually on interpreters for 50 languages -- Somali and Spanish are most in demand -- and about $100 million of $500 million in annual expenses go toward treating foreign-born patients. Mike Harristhal, the hospital's vice president for public policy and strategy, said immigrants are a "major contributor" to the $45 million annual uncompensated care costs. The hospital and its affiliates do not ask patients about their immigration status.

There are an estimated 35,000 to 40,000 Somalis in Minnesota, more than any other U.S. city, according to the Times. Most of the Somalis are legal residents and can qualify for Medicaid and other health programs, but Hennepin also offers care on a sliding-fee scale. The influx of Somali refugees prompted the hospital to tailor some of its practices. For example, Hennepin now has an entire obstetrical staff comprised only of women because Somali women had objected to male doctors delivering infants. In addition research has found that rates of depression and post-traumatic stress disorder are "shockingly high" among the group, and the state also is currently investigating "unusually high rates of autism," the Times reports (Grady [1], New York Times, 3/29).

Hispanic Population

Hispanics represent the largest share of the hospital's foreign-born patient population, according to the Times. The hospital has a separate, part-time clinic exclusively for patients who speak Spanish. Carmen Divertie, who founded the clinic 15 years ago, said most of the Hispanic patients are from Ecuador and Mexico. She said she assumes nearly all of them are undocumented, but does not ask.

According to Veronica Svetaz, a physician at a Hennepin neighborhood clinic, teenage pregnancy is a huge problem in the Hispanic community. A large number of teenagers and adults have back pain, injuries, diabetes, high blood pressure, depression, anxiety and stress, she added. Svetaz said, "Mental health is huge. The levels of anxiety and depression are amazing," adding that Hispanics "tend to somatize more. ... This is where cultural competence comes in."

In addition, many Hispanics delay seeking care because of fear that they will be asked about their legal status. However, as a result, some Hispanics with diabetes arrive at the clinic with "blood sugar so high that they are sent straight to the hospital" or "have severe diabetic complications, even gangrene," the Times reports (Grady [2], New York Times, 3/29).