Dialysis patients lose access to treatments at national provider

By Misty Williams

The Atlanta Journal-Constitution

Twenty-two former Grady Memorial Hospital patients, many of them uninsured illegal immigrants, had potential life-saving dialysis treatments discontinued Thursday after a contract between the hospital and a national dialysis provider expired.

Most of the patients, because they are in the country illegally, don’t qualify for Medicare, which covers dialysis for most Americans with end-stage renal disease. Without regular dialysis, experts say, people suffering from the disease can die within weeks.

The emergency room is now the immigrants’ only option, said Dorothy Leone-Glasser, president of the nonprofit Advocates for Responsible Care.

“These patients are left in a very dangerous situation,” she said. “We’re asking them to decide, ‘When do you think you’re critical enough to go to the ER?’”

Last year, Grady agreed to pay Massachusetts-based Fresenius Medical Care $750,000 to provide dialysis for 25 uninsured immigrants for a year. The deal followed the 2009 closure of Grady’s outpatient dialysis unit, which officials said was losing roughly $4 million per year. The hospital faces a shortfall of up to $25 million this year.

Negotiations between Fresenius and Grady broke down on Wednesday, said Jane Kramer, a Fresenius spokeswoman.

“It is disappointing,” she said. “We were negotiating in good faith.”

Fresenius continues to provide free care to four additional patients, all immigrants, but Kramer declined to comment on whether the company would treat any of the other patients who received treatment under the contract on a charity basis. Emory Healthcare and dialysis provider DaVita Inc. also provide free care to an additional eight former Grady patients.

Meantime, Fresenius has directed patients to go to Grady.

Since closing its dialysis unit, the hospital has spent more than $2 million on patients’ treatment, a cost it can no longer bear, Grady spokesman Matt Gove said. The hospital’s financial situation has deteriorated this year, forcing it to cut more than 200 jobs and close two neighborhood clinics.

Grady offered Fresenius $270,000 to continue caring for the patients for a year, but the offer was rejected, Gove said. The hospital is no longer licensed to provide outpatient dialysis services but will still treat patients who come to the ER.

“We believe that’s more than reasonable for a hospital that’s looking at a $20 million loss this year,” Gove said.

Despite the lapsed contract, a dozen patients showed up early Thursday morning to an Atlanta dialysis clinic run by Fresenius but were turned away.

Bineet Kaur said she and other patients planned to show up at Grady’s ER on Saturday morning to seek treatment. The immigrant from India, who lives with her aunt and uncle in Alpharetta, came to the U.S. in 2000 on a visa and stayed after it expired.

“It’s scary,” Kaur said. “We really don’t know what’s going to happen.”

Illegal immigrants using the ER for non-emergency reasons is a huge drain on the health care system -- impacting hospitals, insurers and consumers alike, said state Rep. Matt Ramsey, R-Peachtree City.

“Every time someone doesn’t pay a bill at the hospital, it ultimately gets passed on to people who are paying the bill,” Ramsey said.

With 100-plus dialysis clinics in metro Atlanta, other providers should be able to help shoulder the burden, Gove said.

“[We] understand that people’s health and well-being is at stake, but the time where Grady could be all things to all people has passed,” he said.