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Ga. patients get sicker as dialysis debate goes on

- Associated Press - Wednesday, September 7, 2011

ATLANTA (AP) - After being denied the regular dialysis treatment she needs to survive, Reina Andrade became so sick last week that she passed out and had to be treated in a suburban Atlanta emergency room. With prospects for future treatment uncertain, she boarded a plane Wednesday for her native Honduras.

Andrade is one of nearly two dozen indigent patients, most of them illegal immigrants, whose dialysis treatment has been in limbo several times since budget cuts forced Atlanta's safety-net hospital to close its outpatient dialysis clinic two years ago.

Patients with end-stage renal failure need regular dialysis two or three times a week to survive. After closing its clinic, Grady Memorial Hospital paid for treatment for about three dozen patients at private clinics through the end of last August. Under an agreement reached last year, three private clinics took on 13 patients as charity cases, and Grady agreed to pay Fresenius Medical Care to treat those remaining.

The hospital has seen further budget cuts this year, and spokesman Matt Gove said it simply can't afford to pay for the care anymore. After Grady's agreement with Fresenius expired Aug. 31, Fresenius turned away patients who arrived for care, telling them to go to Grady.

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.

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 spend.

Andrade, who had lived in the U.S. illegally for 11 years, has needed dialysis for the last five years. She was among a group of patients who were turned away from a Fresenius clinic last Thursday and from Grady's emergency room Saturday because her condition was not considered critical enough, said Dorothy Leone-Glasser, a patient advocate. On Sunday evening, Andrade's condition deteriorated and she passed out. Her sister took her to Gwinnett Medical Center, where she received emergency dialysis treatment.

"I feel so terrible because I can't help my sister," said Marlen Andrade, sobbing during a phone interview from the Atlanta airport where she had just dropped off Reina for a flight to Honduras where she is hoping to receive care. "We didn't want to wait for her to be in that condition again."

Bineet Kaur came to the U.S. from India on a tourist visa in 2000 and applied for political asylum, saying she didn't feel safe in her country as a single woman living alone. It was denied, making her an illegal immigrant. She was diagnosed with kidney failure in 2003, but she didn't get dialysis because she had no insurance. After several years of extreme pain, she fainted while driving in early 2009, and eventually ended up getting regular treatment at Grady.

She also was turned away from Fresenius last week and from Grady on Saturday. She went back to Grady Tuesday night and was deemed sick enough for emergency treatment.

"I'm so stressed out," she said. "I'm getting dialysis today, but I don't know when I'll get it next. It's scary."

Grady has offered Fresenius $270,000 to treat the patients, whom it says are now Fresenius' responsibility since it has been treating them for the last two years, but that offer hasn't been accepted, Gove said.

Fresenius said the patients are Grady's responsibility but has offered to pay for dialysis for them for 60 days at hospitals in the area, including Grady, until a long-term solution is found, said spokeswoman Jane Kramer.

Grady no longer has a license or the facilities to provide regular outpatient treatment, Gove said. If Fresenius really wants to help, he said, it should continue to treat the patients at its clinics until a solution can be found.

"We're doing our share," Kramer said. "It's a community-based problem, and we're trying to help lead the way for a community-based solution."

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