The Crisis Of The Grady Hospital Dialysis Clinic Closing

The Crisis of the Grady Hospital Dialysis Clinic Closing •

Grady clearly stated that each patient currently receiving care from Grady’s dialysis clinic will continue to receive dialysis care elsewhere. To do so, Grady has promised that they will either transfer patients to Fresenius or other local providers, move interested patients to states that provide broad Medicaid support including coverage for undocumented immigrants, or move interested patients back to their home country. Advocates for Responsible Care, ARxC, knows of and has spoken to individual patients who have neither received assurance of their impending transition, nor have received care at a different clinic. We also know that undocumented patients without SSNs (regardless of county) were not given information (written or verbal) that Grady would pay for private dialysis or transfer these patients to a specific clinic for ongoing care. Instead, the patients were provided with either a list of dialysis centers or an offer to relocate or move to home country. We have received at least ten (10) calls from patients stating that Grady has never offered to pay for private dialysis or treatment at a specific dialysis center. We have a list of over twenty (20) patients who have confirmed this to us.

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Other centers will not see patients without any insurance or means to pay. It could cost $6,000.00 per month for a patient to receive dialysis at a private center. It is common practice that private centers tell all callers that, unless they have insurance or Medicaid, they cannot take them as customers.

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It is not an option for the vast majority of these patients to move to another state, with no family or support, and with the certainty of losing their jobs that they rely on to support themselves and their children. These are very ill patients whose fragile health is susceptible to any external stressors, such as traveling or disruption to their lives.

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If immigrant patients return to their country of origin, they will not receive the quality care they need. The financial burden this would impose combined with the fact that medical care for many of these patients would be practically impossible, would create a situation where patients would have to struggle to receive their dialysis treatment. Some were told if that if they were to return to their native country, they would receive only ninety (90) days of dialysis treatment, yet beyond this, they did not receive any strong assurance that this would even be possible. Many other patients have already investigated the possibility of care in their home country and have come to know it would not possible for them to receive dialysis or transplant there.

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Some patients have not been offered individual assistance by social services. These patients were told the clinic is closing, and were given a printed list of nearby private dialysis centers, yet, as mentioned above, these centers will not take these patients. Last week, some patients were interviewed by another organization, MEXCARE, and were verbally notified that they could be given plane

tickets home and possible health coverage in Mexico for 90 days. However, there was never a written contract, and patients are being pressured to sign this agreement by September 18, 2009, although it does not provide any details on the terms of the contract. They were firmly notified that this offer would not be valid beyond that date. Also, one Mexican patient from Gwinnet was later told by the social worker that she does not qualify for this offer. The patient does not understand why she is not eligible.

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In order to receive “inpatient” dialysis, these patients must wait until they are considered ‘critical,’ at which point they would be allowed to go through the emergency room. However, to receive the quantity of care they need, patients would have to go to the emergency rooms 2-3 times per week. It is complete misinformation that these patients simply have go to any hospital in the Atlanta area which has a dialysis unit in order to receive dialysis treatment. There is a total disconnect between the reality of this as a treatment option and an actual long-term solution for these patients. The reasons:

1. Hospitals do not have to provide any care for the patient via the emergency room (ER) unless the patient is interpreted by the ER doctor as being on the verge of death in the next 48 hours or so. Therefore, in many cases, these patients will be turned down by emergency rooms. 2. The suggestion that patients visit hospital ERs once, twice or three times per week, only to wait for hours to be seen by an ER doctor and undergo various additional blood tests at each visit to determine "if they are near death if not treated," is a wholly impractical solution to keeping these patients alive. It would be psychological torture for these people. In addition, it would affect a tremendous financial burden to the health system.

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If patients do not receive the care they need, their conditions would deteriorate, leaving them unable to manage their job and family responsibilities. It has been said by some physicians and the social services of Grady that undocumented Fulton and Dekalb patients are only to receive dialysis treatment, paid for by Grady, for one year, after which there is no guarantee that they will have access to dialysis treatment. In another words, the private dialysis companies can simply deny these patients treatment after Grady stops its reimbursements. This piece of information, concerning the private sector’s limitations, has not been provided to the patients or the public.

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Patients have not even been informed of the one year of treatment that Grady plans to provide. Because these patients understand are aware of the high cost of dialysis —up to $6,000 per month—this tactic of withholding information may be used to scare the patients into finding other sources of care. This way, Grady would not have to pay for care or acknowledge their rightful responsibility to the patient and their family, although the hospital understands that the patient cannot receive care when they have no resources. This "psychological torture" is real and is being felt by the patients and their families.

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Grady stated, “[Our] mission calls for us to care for the underserved in Fulton Dekalb counties… If we are to expand our coverage, it must be with expanded funding from state and federal sources.” This acknowledgment only highlights the fact that Grady could get the money to keep the clinic open if it was willing to make an account of how they spend the money they receive. It is THEIR job to appeal to the Governor and Federal officials to get the money to save these patients’ lives, especially considering that their treatment is not optional. Treatment is a matter of life or death for these patients. We should not have to be the ones who tell them this, BUT WE WILL. The Grady position is that Grady "can't take care of everybody." However, there is no reference to the fact that Grady has an obligation to these people because they have served as their sole provider of care for some time. The Grady position is that Grady's mission is “not to be the safety net provider for all these people”. We feel it necessary to respond by reminding Grady that they have already made a commitment by taking care of these patients for years—that is to say, we are not asking for Grady to take on new patients, but simply to ensure the continuance of care for the patients they already serve. In effect, Grady is denying their responsibility to these patients by simply “passing the buck” to other states that might care for them, rather than attempting to devise a workable solution within Georgia.

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Grady does have an agreement in place with Fresenius; however the patients and their advocates have not been assured that the clinic will provide care, covered by Grady, for EVERY Fulton and Dekalb patient that has not chosen to leave Atlanta or settle with another provider. If Grady truly planned to ensure and provide continued care for these patients, it is doubtful that the hospital would have suggested these patients go to the emergency room as inpatients to receive their care. We have spoken to over twenty (20) patients and have two (2) patients testifying today and more documented patient cases stating that these facts are true: Grady has not provided them with any document outlining, in detail, the care they will receive, thereby denying these patients any assurance of their continued care. Although undocumented patients comprise many of the patients at the Grady Dialysis Clinic, some of these patients are American citizens and legal residents of DeKalb or Fulton Counties and have been under dialysis care at Grady ranging from one to three years.

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The patients of the Grady Dialysis Clinic have contacted The Advocates for Responsible Care and have willingly given us their names and numbers pleading for help. They do not know where they will get dialysis treatment after Saturday, September 20, 2009.

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It appears that these patients have been deliberately frightened into leaving Atlanta, leaving the country, or accepting their grim fate as kidney patients without access to life-saving dialysis treatments. This coercion applies not only to those who live outside Fulton and DeKalb counties, for even those patients residing within Grady’s district of care have been the subject of the hospital’s bullying. It is clear that Grady has taken this position of patient neglect and cultural incompetency to the highest

limit, targeting those patients who are the sickest and most vulnerable. As healthcare professionals, human rights believers and patient advocates, we are vehemently and unequivocally opposed to Grady’s unacceptable policy of deliberately denying lifesustaining care to the uninsured and underinsured of Atlanta. We see this as a community and medical issue.

Posted on the wall of the Hemodialysis Clinic of Grady Hospital, in clear view of all, are the words: You have the right to considerate and respectful care at all times. You have the right to be well informed about your diagnosis, treatment, prognosis, possible treatment and outcomes.

We are asking Grady to delay the closing of the Dialysis Clinic and to provide the continued dialysis treatment for all of the clinic’s patients and to regain the respect and consideration for the lives of every dialysis patient at the Grady Clinic. We cannot stop this call to action until every patient can be at peace with knowing they will be able to continue to live by receiving the dialysis care the so desperately need.

We will continue to be their voice until their voices are heard.

Advocates for Responsible Care: Neil Shulman, MD Dorothy Leone-Glasser, RN, HHC Cristina Drenkard, MD, PhD Elbert Tuttle, MD Doyt Conn, MD S. Sam Lim, MD, MPH Daniel S. Blumenthal, MD, MPH Ines Colmegna, MD Kim Schofield Sam Newcom, MD Sandy McMath

Community Supporters: Health Action Network The Wisdom of Wellness Project, LLC.

Georgia Council of Nephrology Social Workers Georgia Society of Rheumatology The Grady Coalition S.T.A.R.S. for Patients Hispanic Health Coalition of Georgia, Inc. Racial and Ethnic Concerns Working Group Atlantans Building Leadership for Empowerment Universal Abundance Lupus Foundation of America, Georgia Chapter Diabetes Foundation of Georgia Students and Volunteers of Advocates for Responsible Care Metro Atlanta Task Force for the Homeless Please contact: Advocates for Responsible Care (ARxC) Dorothy Leone-Glasser, [email protected]