Dallas County is planning to bill Mexico and other countries for treating their indigent citizens at Parkland Memorial Hospital, a practice that county leaders say is becoming a drain on their resources.

County Judge Margaret Keliher said she doesn't expect the foreign countries to pay up, just as she doesn't expect neighboring counties to pay for treating their indigent residents.

The county is already preparing to send bills to several counties for treating their residents. Last year, the county had $76.5 million in health care costs associated with treating noncounty residents, according to numbers prepared by county staff.

Of that, $26.8 million was not reimbursed. However, only about $300,000 of those unpaid bills was for patients who qualified as indigent in other counties.

"This is a very strange posture on the part of [Ms. Keliher]. There is no contract between [the county] and the Mexican government that would sustain such action," Mr. Juarez said.

Under a new federal law, Parkland has already been reimbursed by the federal government for a portion of the costs of treating illegal immigrants. The payments are only for the first 48 hours of emergency care, but those reimbursements fall short.

Most of the unpaid bills for Parkland's out-of-county patients, however, did not involve indigent care. A report to county commissioners, dated June 6, indicated that the Dallas County hospital was stuck paying $298,161 for unpaid out-of-county indigent care in 2005. The total cost for out-of-county indigent care that year was $672,649, according to figures provided by Parkland's financial staff.

Much of the uncompensated care for out-of-county residents stems from underpayment by Medicaid, the state-federal insurance program for low-income people. Medicaid payments for non-Dallas County residents fell $11.9 million short of reimbursing Parkland's costs in 2005.

"How does she [Ms. Keliher] know who is Mexican? I understand nobody asks for your nationality nor immigration status when you go into the hospital," Mr. Juarez said. "This is simply an act of discrimination."

Parkland does not ask patients about their citizenship, he said, but under some circumstances, they know what it is. For example, some patients may carry foreign ID cards. But those represent a fraction of the number of foreign patients treated, he said.

"The likelihood of them paying us is not high," Mr. Gates said. "But we would know that it is an appropriate claim to bill them for. We're not going to bill anybody if we do not know for sure."

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