HOSPITALS NOW A THEATER IN MEXICO'S DRUG WAR

TIJUANA, Mexico -- The sedated patient, his bullet wounds still fresh
from a shootout the night before, was lying on a gurney in the
intensive care unit of a prestigious private hospital here late last
month with intravenous fluids dripping into his arm. Suddenly,
steel-faced gunmen barged in and filled him with even more bullets.
This time, he was dead for sure.

Hit men pursuing rivals into intensive care units and emergency
rooms. Shootouts in lobbies and corridors. Doctors kidnapped and held
for ransom, or threatened with death if a wounded gunman dies under
their care. With alarming speed, Mexico's violent drug war is finding
its way into the seeming sanctuary of the nation's hospitals, shaking
the health care system and leaving workers fearing for their lives
while trying to save the lives of others.

"Remember that hospital scene from 'The Godfather?' " asked Dr.
Hector Rico, an otolaryngologist here, speaking about the part in
which Michael Corleone saves his hospitalized father from a hit
squad. "That's how we live."

An explosion of violence connected with Mexico's powerful drug
cartels has left more than 5,000 people dead so far this year, nearly
twice the figure from the year before, according to unofficial
tallies by Mexican newspapers. The border region of the United States
and Mexico, critical to the cartels' trafficking operation, has been
the most violent turf of all, with 60 percent of all killings in the
country last month occurring in the states of Chihuahua and Baja
California, the government says. And it has raised fears that
violence could spill across the border, because dozens of victims of
drug violence have been treated at an El Paso hospital in the last year.

The federal government argues that the rising death toll reflects
President Felipe Calderon's aggressive stance toward the cartels,
which has forced traffickers into a bitter war over the dwindling
turf that remains.

In fact, most of the deaths do appear to be the result of infighting
among traffickers. But plenty of innocent people are dying too, and
the spate of horrifying killings -- bodies are routinely decapitated
or otherwise mutilated and left in public places with handwritten
notes propped up nearby -- has left people from all walks of life
worried that they might be next.

"If a patient is in the E.R. bleeding, we should be focused on the
wounds," said Dr. Rico, who has led doctors in street demonstrations
to protest the rising violence in and around Tijuana, where 170
bodies were discovered in November alone, the bloodiest month on
record. "Now we have to watch our backs and worry about someone
barging in with a gun."

Doctors feel particularly vulnerable. When they leave their offices,
they say they face the risk of being kidnapped and held for ransom,
as about two dozen local physicians have been in the last few years.
Doctors also complain about receiving blunt threats from patients or
patients' relatives. "Salvame o te mato," save me or I will kill you,
is what one orthopedic surgeon said he was told by a patient, who
evidently did not grasp the contradiction.

Adding to the anxiety, hospitals and health care workers have to
notify the authorities when a patient comes in with a gunshot or
knife wound, a legal requirement that the traffickers know well. That
leads to further threats.

Then, there is the risk of shootouts.

Authorities suspect that the killers and the victim in the intensive
care unit at the private hospital, Hospital del Prado, had links to
the drug cartels that are wreaking so much havoc across Mexico.
Nowhere to be found were the police, who received a call from the
hospital authorities when the shooting victim, who was in his 20s,
first arrived, as is required by law. The police did not show up
until after the gunmen had come and gone and bullet casings littered
the hospital floor.

Hospital General de Tijuana, the city's main public hospital, has
twice been ringed by police officers and soldiers in the past 20
months. The first time, in April 2007, gunmen stormed the building
either to rescue a fellow cartel member who was being treated in the
emergency room or to kill a rival, said the police, who were not
certain which scenario it was. Two police officers were killed, and
all but one of the gunmen got away.

A video taken by a hospital worker revealed a terrifying scene, with
two state police officers firing inside the emergency room to protect
patients while doctors, nurses and others cowered in closets, under
gurneys and wherever else they could find cover.

An elderly woman in a wheelchair is seen hiding under a blanket,
while a patient in a hospital gown is sprawled on the floor near his
hospital bed.

Meanwhile, panicked patients were escorted out of the building, some
with IVs in their arms, to a nearby sports field.

The second time was this past April, when soldiers in camouflage
ringed Hospital General de Tijuana, shutting it down while doctors
treated eight traffickers who were wounded in various shootouts in
the city. The Mexican Army was apparently trying to prevent a repeat
of the 2007 shootout. In a recent third episode, soldiers were sent
to the hospital for a bomb scare.

"Fear has become part of our lives," said one of the doctors at
Hospital General de Tijuana, speaking on the condition of anonymity
for fear of reprisals from organized-crime figures. "There's panic.
We don't know when the shooting is going to break out again."

The violence is already affecting service, as hospitals armor
themselves with more police officers and guards. To protest the spate
of killings, some doctors closed their offices for a day in November.
And Tijuana clinics are closing earlier on a regular basis, with more
and more doctors shunning late-night medical care as too risky.

In Ciudad Juarez, which abuts El Paso, the local Red Cross hospital
called a halt to 24-hour emergency service earlier in the year after
gunmen killed four people who were being treated for gunshot wounds.
Emergency service now ends at 10 p.m.

Paramedics in Ciudad Juarez temporarily stopped treating gunshot
victims one day in August after receiving death threats over their
emergency radios. They resumed ambulance service later the same day,
but only after they were provided armed police escorts.

An episode that took place in the early morning hours of Oct. 5 in
Tijuana shows the complicated new environment in which health care
workers find themselves. After a major shootout, two wounded men were
carried to Clinica Londres, a private health clinic that was closed
for the night. There was a lone nurse inside the locked facility,
tending to the patients there, and she initially did not open up to
the small group of anxious people outside.

The nurse was not qualified to treat gunshot victims, and the clinic
did not offer emergency care. But the crowd outside included two men
dressed in law enforcement uniforms, who banged menacingly on the door.

Frightened of the men in uniform -- criminals routinely wear police
uniforms in Mexico -- she eventually relented, she told authorities.
What happened next is shrouded in confusion.

Tipped off, the army and the police arrived at the clinic and asked
the nurse and two other employees who had since arrived if they were
treating gunshot victims, and they were told no. Then, hearing a
groan from another room, the authorities discovered the two wounded
men -- the men in uniform had already fled -- and accused the health
care workers and the group of people who arrived with the patients of
having links to the drug traffickers.

The clinic workers, who have been detained for two months while
authorities decide whether to charge them, deny that they did
anything wrong. "It is not true that this is a narco-clinic," said
their lawyer, Rafael Flores Esquerro.

Another Tijuana doctor, Fernando Guzman Cordero, has also found
himself denying connections to traffickers. Dr. Guzman, a prominent
general surgeon, was kidnapped in April and suffered a bullet wound
to his leg. But the kidnappers released him 36 hours later, even
giving him cab fare home.

Then two weeks later, after another Tijuana shootout, a group of
gunshot victims were taken to his clinic for treatment. In radio
call-in shows and on Internet chat sites, local residents wondered
whether the traffickers were now in cahoots with Dr. Guzman,
something he vehemently denied.

"People can say whatever they want," he said. "They say I kidnapped
myself or made a pact with them. They say a million things. I know
who I am. Why would I get involved with criminals?"

The problem everyone in Tijuana faces, no matter their line of work,
is that they might be associating with traffickers without even
knowing it. Doctors say they now screen their patients carefully.
Traffickers pay well and in cash, but they are not worth the trouble
they bring, doctors say.

But hospitals do not have that luxury. "We're not judges," said
Carolina Aubanel Riedel, whose family owns Hospital del Prado. "We
treat those who arrive."