Crisis De Salud: They were running out of time

Concern refills the lives of more than thirty dialysis patients in Atlanta. They are reaching the date will no longer receive the treatment that keeps them alive.

On 31 August contract expires on Grady Hospital signed with Fresenius private clinic for further treatment of these patients, mostly illegal immigrants.

Grady sent patients a letter informing it will not pay more treatments and a list of local providers of dialysis.

"I came again the concern, mostly because we do not live without dialysis," said Adolfo Sanchez, one of the 33 patients who are covered by the contract about to expire.

Sanchez, 32, received dialysis at the clinic of Grady for five years until August last year the hospital closed the center as a means of controlling the financial deficit facing.

Sanchez now relive the anguish he felt a year ago.

"It was a terror to know that the hospital would close the doors. There were days when not sleeping thinking what I would do, "said the Mexican, who lives in Georgia for eight years with his wife and son.

For now, round the uncertainty. At least six patients temporarily receive treatment in private clinics, according to DeKalb County Commissioner Larry Johnson, who held several meetings with these centers.

Johnson was informed on 10 August MundoHispánico 10 patients receive treatment, but that figure was later corrected.

Others think dialysis in the emergency room, but this may only do so when they are very serious.

"It is not recommended as medically, but there is no other way out," said Dorothy Leone-Glasser, president of Advocates for Responsible Care, one of the organizations that advocates for these patients.

The origin

The crisis in dialysis patients began to take shape in 2006 when the eligibility requirements of Medicaid public health insurance changed, denying access to certain services to illegal immigrants in the state.

Until then, and in accordance with federal law requiring that any person will attend in an emergency regardless of their immigration status, undocumented outpatient receiving dialysis treatment as a Medicaid covered emergency.

But when the law changed in the state decided that dialysis was required to treat a chronic illness, not an emergency, and, therefore, Georgia is not reimbursed to providers offering this treatment through Medicaid.

Although not receive this reimbursement, the Grady Health System was commissioned to provide treatment to more than 90 undocumented or uninsured patients all these years, until the economic crisis struck the hospital last year.

More than money?

According to Grady, the dialysis clinic will represent a loss of between 2 and 4 million dollars a year and after several months of discussions, the board decided to close the center.

But Leighton Ku, a professor of public health at George Washington University, the reasons for the closure of the clinic were not only economic.

"The issue here is how the state chooses to interpret the law," said Ku, an expert on Medicaid and the relationship between immigrants and the health system. According to the academic as well as California, North Carolina, New York and Arizona, Georgia could have continued with the rules that consider dialysis as an emergency treatment.

"But I suspect that behind this political interests and a clear intention not to help illegal immigrants," said Ku.

"Does anyone have done a financial analysis showing that actually saves money to close this clinic? I doubt it, "he added.

In 2008, the outpatient dialysis clinic Grady lost $ 3.5 million, according to the New York Times. The 88 patients, mostly undocumented, accounted for one tenth of the losses of the hospital.

Last year, the hospital 
 showed a deficit of $ 34 million, according to The Atlanta Journal-Constitution.

Ku is not the only suspect political motives behind it. Rudolph Rodriguez, nephrologist Washington state, coincides with the academic and even suggests that the anti-immigrant environment has had an impact on this.

"Georgia is going through a very toxic environment. Just look at the comments from readers when a newspaper publishes news about the patients (dialysis unit of Grady). It seems that people want these patients disappeared, "said the doctor.

However, this is not the only concern of the nephrologist. For him, the moral commitment to society every physician has an ethical implication in this crisis.

"What is happening is completely unethical. Everyone knows, but the problem is that dialysis is a treatment that is very expensive, "said Rodriguez, who expressed his disillusionment with the apathy of the medical community.

"No large medical association has ruled. No one has said anything. No group of physicians or health professionals who have come forward to seek a solution, "he complained.

Rodriguez cited the example of Miami, Florida, where earlier this year similar to what happened to Grady.

Jackson Memorial Hospital for the poor and uninsured people in Miami, was forced to close its outpatient dialysis facilities, leaving scores of patients without treatment. However, in three days, several private providers pledged to cover the cost of the procedure for patients.

"In the case of Atlanta, we are still waiting for something," said Rodriguez. 

It could happen to anyone

Not only those who need dialysis treatment suffer from the changes made to Medicaid in 2006. Some illegal immigrants who previously received emergency Medicaid to treat serious conditions and have no access.

For example:

"Those who are paralyzed by accidents and require special care.

"Patients suffering from cancer, who are emergency Medicaid covers some part of the treatment, but when they are stabilized, no longer an emergency and suspending coverage.

 Source: Rudolph Rodriguez, MD.

Linda Carolina Perez made this research as part of a project supported by The California Endowment Health Journalism Fellowship at USC's Annenberg School for Communication & Journalism.

Carolina Perez Linda wrote this story while Participating in The California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism.