Do we let Grady dialysis patients die?

Grady’s decision on Oct. 4 to close the lifesaving outpatient dialysis unit impacted all the patients served but particularly the nondocumented immigrants.

All knew that without dialysis for several weeks, all these patients would inevitably die. What happened to them?

Thanks to an article that appeared in the New York Times, Jan. 1, we have some idea. The article, “Ailing immigrants find no relief back home,” describes the fate of one person who took Grady’s offer to return to their home country and went back to Mexico.

The decision split her family, leaving her husband and older son to stay here and work to send money back to her in Mexico for her care.

She has exhausted the three-month free dialysis care provided by Grady and now has to pay. She can only pay for two dialyses per week, which are not enough, leaving her sick and weak.

This is depleting the money that the family saved for transplantation. Her future looks bleak.

Since the closing of the Grady dialysis unit, two patients have died in Mexico and one here as a result of kidney failure, presumably due to lack of effective dialysis. There may be more to come.

Dialysis is a lifesaving procedure for patients with end stage renal disease. Because of this, years ago, Medicare decided to cover dialysis for all patients with end stage renal disease.

For years, Grady Hospital has provided chronic outpatient dialysis for indigent patients, and many were nondocumented immigrants. Grady received no reimbursement for this lifesaving care.

This is one of the many financial drains that Grady endures as it cares for more and more poor people of Fulton and DeKalb counties. Grady receives payment from less than 50 percent of the patients it serves.

As society has contributed less and less to help, Grady has been forced to institute a number of cost-saving measures. As part of this effort, the Grady outpatient dialysis unit was closed Oct. 4, affecting approximately 40 nondocumented immigrants.

The Grady administration offered to pay to relocate patients to their home countries, mostly Mexico, or to other states (which have more humane policies) and to pay for dialysis at for-profit dialysis centers for three months. This has now been extended to February 2010. Some took the offer to relocate and moved.

We all know that without dialysis these patients will die. I have seen several of these patients and have observed their distress and anxiety and the distress of their loved ones as they confront this possible end.

What ethical or religious principle dictates that we, as a society, deny lifesaving care to another human being because they are poor and a nondocumented immigrant? Should this be purely a financial decision? Where is the public outrage at this injustice?

Fellow physicians of Atlanta, is this consistent with our medical ethics?

People and organizations of faith should be alarmed and demand a humane resolution.

Gov. Sonny Perdue, Georgia legislators, and officials of Fulton and DeKalb counties, this human crisis is partially the result of your apparent lack of concern and lack of funding.