The author cites a number of cases in which the law proved difficult to enforce. One example is seen when looking at the difference in residency application acceptance rates between different locales/prefects. The much larger and metropolitan areas would accept down to 47% of the applications, indicating a possibly fair division of candidates reviewed. Other more rural areas would accept over 90% of the applications, showing almost no distiguishment between ailments. The question becomes whether this is reflective on the doctors' judgements of "serious ailment" given location, the political beliefs of the prefect, or simply the lack of caring whether someone emmigrates or not. Another example of the flaws in this law is highlighted by a personal anecdote from a patient. The patient was given a diagnosis when originially coming to France on a personal visa. They were told their condition was quite serious and would require ongoing care. However, when the doctor who diagnosed him was asked to sign for evaluation for the residency permit, the doctor changed his diagnosis to something much less serious. The political thought behind the poicy came into play and interrupted the normal proceedings, tearing doctors between their obligations to the law (and only allow exceptional cases) and to medicine (and err on the side of caution).
The author also highlights the development of this law and its effects in three stages. Pre-1990: Serious illness was a factor in residency completely at the discretion of local government. Immigrants were seen as workers and they served that purpose only. If a worker was sick, they were of no use to society. 1990-1998: Illness was more often factored into the decision making process, but those allowed to stay received no paid employment or social wellfare benefits. Post 1998: Written into law, ill immigrants were allowed to stay with the opportunity for pay and legal status in France.
