GALVESTON — The University of Texas Medical Branch is considering a policy that would deny cancer care to indigent, undocumented immigrants — an unusual and controversial move for a state-funded institution.

Medical branch officials are forming the policy as they strain to stretch dwindling state dollars for uninsured patients and while illegal immigration ranks among the most divisive issues in the nation.

Turning away undocumented cancer patients undoubtedly would pull the oldest medical school east of the Mississippi into a fierce contemporary debate about the legality and fairness of treating illegal immigrants with tax dollars when millions of uninsured legal residents can’t afford health care.

It also will force the institution to face thorny questions about simple compassion and the limits of a physician’s duty to treat the ailing.

“Certainly it’s not a decision we’re taking lightly,” said Karen Sexton, vice president and CEO of hospitals and clinics at the medical branch. “We are in the process of looking at cancer patients and the demand and the resources we have, and thinking through how to decide who gets care.”

The number of undocumented indigent cancer patients the medical branch treats each year also is undocumented. That’s because medical branch employees only ask for residency documentation to determine whether a patient is eligible for government-funded Medicaid or Medicare, not to deny access.

About 5.4 million Texans, or 24.6 percent of the state’s population, is uninsured, according to a 2005 report by the Texas Comptroller of Public Accounts.

In Texas, noncitizens are almost three times as likely to be uninsured as native U.S. citizens, according to the report.

Medical inflation, state funding cuts and the growing number of Texans without health insurance are putting financial pressure on the medical branch, which has a $1.4 billion yearly budget and a mission to treat the state’s poor.

The medical branch has set aside about $12 million this year to treat indigent cancer patients and still is not able to meet demand, Sexton said.

The medical branch has about $118 million a year to provide indigent care. With rising medical costs, it is seeing only about half the indigent patients it did three years ago.

Painful cost-cutting measures included 381 layoffs last year, which shattered morale at the island campus and may have driven off some highly regarded staff and faculty members.

But medical branch leaders argued they had few options.

In the last legislative session, lawmakers declined to increase or even replace state funding cut in the past.

Faced with less money and escalating costs, the medical branch’s teaching hospital began a few years ago curtailing care to indigent patients through its Demand and Access Management Program.

Under the program, which rations health care to the poor at a hospital best known for treating the medically underserved, indigent patients are required to undergo financial screening.

Also, about four years ago, the medical branch stopped treating undocumented people in advanced stages of renal disease, an illness that affects the kidneys. But that was a logistical decision, Sexton said. The medical branch does not have an outpatient dialysis facility and outside providers would not accept uninsured undocumented immigrants, she said.

Even if the new policy were put into effect, the medical branch would not stop treating cancer patients already in its care. Once cancer treatment begins, hospitals and doctors are ethically bound to continue until patients recover or die.

The medical branch’s Cancer Patients Acceptance Committee, composed mostly of physicians, has for months been studying the issue of turning away undocumented immigrants. The committee began deliberating before the arrival of David L. Callender, who in September took over as medical branch president. Although Callender did not initiate the idea, he supports it, medical branch officials say.

Still, denying health care to anyone is a bitter prospect for medical professionals, Sexton said.

“Any time there’s any restriction in access to care, there’s pushback from people who are concerned about that,” Sexton said. “It doesn’t feel right to us, either.”

Some people turned away by the medical branch may be able to find treatment in the counties where they live, Sexton said.

If the medical branch turns away undocumented immigrants, the Harris County Hospital District likely will see an increase in its patient load, said King Hillier, vice president of public policy and government relations of the district that operates Ben Taub General, Houston’s largest public hospital.

“I have a problem with that,” he said.

A hospital receiving state funding for indigent care should not turn away the uninsured simply because they aren’t legal residents, Hillier said.

“We do not question citizenship status,” he said. “If they live in Harris County and can prove residency, then they are paying taxes; if they’re paying rent then their landlord is paying property taxes to the hospital district.”

The hospital district, with a $1 billion yearly budget, in 2005 spent $92 million in services to undocumented people, Hillier said.

The issue of providing taxpayer-funded health care to undocumented workers flared in 2001, when then-Attorney General John Cornyn issued a legal opinion that federal welfare reforms in the mid-1990s prohibited states from offering nonemergency, preventive care to illegal immigrants.

All hospitals, whether public or private, must treat emergency room patients.

In 2004, Attorney General Greg Abbott issued a legal opinion that said hospital districts could use state funds to provide nonemergency care to illegal immigrants, but aren’t legally required to.

Hospital districts argue that providing preventive care to undocumented workers would save taxpayers millions of dollars in emergency care.

Public hospital systems in Texas, except for Tarrant County’s John Peter Smith Hospital, give preventive care to illegal immigrants.

Denying cancer treatment to undocumented residents raises ethical questions.

But Texans also must answer how to pay for indigent care, said Dr. Howard Brody, director of the Institute for the Medical Humanities and chair of the medical branch’s ethics committee.

Medical branch physicians, many who work at the medical branch because of its mission to help the poor, are anguished and conflicted about turning patients away, Brody said.

“In the ethical ideal, no physician would ever ask for papers,” Brody said.

Unless Texans address the overall problems of the uninsured and funding for public hospitals, cash-strapped institutions must begin drawing lines, he said.

“If what voters of Texas want is Harris County shouting at Galveston and Galveston shouting at Harris County and everybody pointing fingers and saying, ‘You should be doing more than you’re doing,” then they can have that,” Brody said. “If they want indigent folks to get care and want everybody in Texas to at least have a chance to have more access to medical care, then voters of Texas should step up and provide more resources.”

While the medical branch still is shaping a formal policy about undocumented cancer patients, employees may already be turning some away, Sexton said

“This is not UTMB’s problem,” Sexton said. “It’s the nation’s problem; we’re trying to do the best we can to help our physicians and others with a decision by making it not so subjective. We’re trying to put up some parameters, but it hurts my heart.”