Public hospitals try to cut dialysis care; some illegal immigrants offered plane tickets home

Cuts leave indigent dialysis patients in limbo

ATLANTA — Before she started receiving dialysis treatments at Atlanta’s Grady Memorial Hospital, Bineet Kaur was so sick from kidney failure she could hardly walk. The memories of that pain came flooding back in September, when she received a letter saying the clinic was closing.

The treatment typically costs $40,000 to $50,000 a year, and Grady is just one of the struggling public hospitals cutting the service to reduce costs. Many indigent dialysis patients, including Kaur, are illegal immigrants, so facilities that give them routine treatments receive no federal money for their care.

Since the clinic closed in October, Kaur and other former clinic patients have been getting private dialysis treatments funded by Grady, which is struggling to find new providers for them and has even offered to buy them plane tickets to their home countries.

New patients who show up in Grady’s emergency room in need of dialysis will get it only in life-or-death situations, and after they improve will be told that they must go elsewhere for regular care.

Kaur, a bubbly 26-year-old who studied nursing and once did an internship at Grady, said she doesn’t know where she will get the treatment she needs to survive.

“I really hope God helps,” the Indian native said on a recent morning. “Otherwise it’s like having a death sentence.”

Public hospitals are often the only option for illegal immigrants and others without health insurance because they will treat anyone. But many of those hospitals have severe funding problems, and several have given up dialysis treatment to control costs. Grady officials say its clinic was losing $2 million to $4 million a year.

Jackson Health System, the public hospital in Miami-Dade County, stopped paying for outpatient dialysis treatment for 175 indigent patients on Dec. 31. A month later, 40 patients — about half of them illegal immigrants — were still looking for alternate treatment. The hospital said it expects to save more than $4 million a year by stopping the payments.

The University Medical Center in Las Vegas has seen its budget strained as emergency room visits for dialysis more than doubled from December 2008 to December 2009, from 116 to 243. The Las Vegas hospital stopped paying for people to get private dialysis, but now spends about $700,000 a month on dialysis in its emergency room.

“You try to figure out what service lines to cut and that seemed like an easy one,” said hospital spokesman Rick Plummer. “But it ended up just shifting the burden because now the dialysis patients show up very ill in the emergency room.”

Larry Gage, president of the National Association of Public Hospitals and Health Systems, said many hospitals are rethinking the services they offer.

“It comes down to a decision about how to allocate scarce resources,” Gage said. “As sad as some of the individual cases are, you really almost have to ask which services are the greatest number of uninsured patients going to benefit from, including uninsured immigrants.”

Some argue that illegal immigrants are a burden that the nation’s health care system should not have to shoulder.

“When you have long-term health conditions that need continuing care, the government needs to send these people back to their countries,” said Ira Mehlman, spokesman for the Federation for American Immigration Reform, which favors tougher immigration enforcement. “They cannot expect the taxpayer is going to endlessly pick up the tab.”

Medicare, the federal health insurance program for people 65 and older, covers routine dialysis for U.S. citizens regardless of their age, but illegal immigrants are ineligible.

Changes to the health care system being considered in Congress are unlikely to improve the situation. The current bills specifically exclude illegal immigrants.

Patients who need dialysis can’t survive long without it. Hospitals can get reimbursed by Medicaid, the state-federal program that helps low-income people, when they provide emergency dialysis for illegal immigrants in life-or-death situations. But the reimbursement doesn’t come close to covering what hospitals actually spend.

Emergency room dialysis is much more expensive than regular treatment, in part because patients are so sick they may need to be hospitalized until their conditions stabilize. But giving up routine dialysis still could help public facilities like Grady because at least some of their patients could end up in ERs at other hospitals.

“In communities that don’t have a Grady, or other public hospital, all of the private providers pick up these patients,” said hospital spokesman Matt Gove. He said that as long as other hospitals and clinics see Grady as the “solution” to providing dialysis for the uninsured, no one else will step in to help.

Kaur and several of Grady’s other illegal immigrant patients have not been able to find a hospital or clinic to take care of them once Grady stops paying for private treatment later this year.

“The only option I have is to go to the emergency room at Grady every time I feel sick,” she said. “That’s an option but it’s not really an option because they can turn me away if they think I’m not critical.”

Kaur came to the U.S. on a tourist visa in 2000 and applied for political asylum, saying she didn’t feel safe in India as a single woman living alone. Her asylum request was denied, making her an illegal immigrant.

In 2003, she was diagnosed with kidney failure and told she needed dialysis, but she didn’t get treatment because she had no insurance. After several years of extreme pain, she fainted while driving early last year, crashing her car into a pole. That landed her in a suburban hospital where she received dialysis treatment for a month. But hospital staff kept telling her she needed to return to India, where she says she no longer has family.

When she got sick again, she went to Grady and was treated at its outpatient clinic. She said her health improved dramatically, though she is weak on the days she gets treatment and relies on an aunt to take care of her.

Grady closed the clinic in October and has paid for its former patients to get treatment at private clinics for several months. The hospital has said it can’t continue the payments indefinitely and has been trying to find placements for the patients, but many have not found another clinic that will take them.

About a dozen patients have accepted Grady’s offer to return them to their home countries, but others don’t want to leave their families in Georgia. They are also concerned because, in most cases, regular treatment is unreliable or unavailable in their home countries, said Dorothy Leone-Glasser, a patient advocate who has been helping the Grady patients.

A group of patients has sued Grady, claiming the hospital is abandoning them. A judge threw out the case in December but the patients are appealing.