Hospitals cut dialysis to indigent patients

ATLANTA | Before she started receiving dialysis treatments at Atlanta's Grady Memorial Hospital, Bineet Kaur was so sick from kidney failure that 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 Miss Kaur, are illegal immigrants, so facilities that give them routine treatments receive no federal money for their care.

Since the clinic closed in October, Miss 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.

Miss 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 had 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," Mr. 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, a 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.