Local medical professionals and public health officials worry that a bad situation is about to get much worse.

The physician stares at the floor a few moments and says nothing. Then slowly, deliberately, James Lew, a doctor at Clinica de Salud in East Salinas, recounts a heart-wrenching experience.

About two years ago, a 40-year-old man walked into the privately-run clinic on Sanborn Road with a bag full of empty medicine bottles. Lew examined the man, a longtime local farmworker. “It fast became clear to me that he was very, very sick,” Lew recalled last week over lunch in a Mexican restaurant near the clinic. The patient had advanced diabetes, as well as heart and kidney diseases. After some additional exams, Lew found that the man’s kidneys were on the verge of breaking down completely. “I told him he required immediate medical attention,” Lew says. “He needed to go to the hospital.”

But there was a problem. Lew’s patient (whose name he can’t release) had no money and no health insurance. About a year earlier, he had been erased from Natividad Medical Center’s medically indigent program, which provides coverage for Monterey County’s poorest adults.

He was kicked off because he was an undocumented immigrant. Faced with a desperate fiscal crisis, the County-run hospital’s administration in late 2003 eliminated all undocumented workers from the medically indigent program as a way to save money. The decision saved the hospital millions of dollars. And it sealed the fate of Lew’s patient.

Because he knew his patient could not obtain government-sponsored health coverage, Lew told him that he should go to Natividad’s emergency room. There, doctors would be obliged to treat his acute ailments regardless of his immigration status, since federal law requires emergency rooms to screen and “stabilize” the health of every single person who shows up.

The man declined. “He said he didn’t want to be a burden on the system or on his family with another hospital bill,” Lew says. “That was the last time he came in.”

A few weeks later, Lew learned that his former patient had suffered a cardiac arrest at home and was rushed via ambulance to Natividad’s ER. There, doctors hooked him up to a life-support machine in the intensive care unit. He remained there for 10 days, and then he died.

“The irony of the situation is that his stay in the intensive care unit at the hospital undoubtedly cost more money than was needed to treat his illnesses,” Lew says bitterly.

While this tragic tale is thankfully rare, Lew says, it illustrates a widespread problem. “There’s no question that the system failed this man,” he says, his hands pressed together as he raises his head. “He had a disease that was treatable, but he was abandoned by the bureaucracy.”