Grady Advocates for Responsible Care September 14, 2009
The Crisis of the Grady Hospital Dialysis Clinic Closing
- Grady’s states that patients are being assured every patient receives dialysis care, including moving patients to Fresenius or other providers, moving interested patients to states that provide broad Medicaid support including coverage for undocumented immigrants and moving interested patients back to their home country. We know of ‘real’ patients who have not been told they can believe they will get dialysis. We know that undocumented patients without SSN (regardless of county) were not given information (written or verbal) that Grady will pay for private dialysis or that they will be transferred to any specific private center. They were provided with a list of centers, or offers to relocate or move to home country. We have received at least ten (10) calls from patients stating, Grady has never offered to pay for private dialysis or treatment at a specific dialysis centers. We have a list of over twenty (20) patients who have confirmed this to us.
- Other centers will not see patients without any insurance or means to pay. . It cost over $6,000.00 per month for a patient to receive dialysis at a private center. The private centers will tell anyone that calls that they cannot take them as customers if they do not have insurance or Medicaid.
- It is not an option for patients to move to another state, with no family, support and with the certainty of losing their jobs they have now to support themselves and their children. These are very ill patients and traveling anywhere and disrupting their lives is dangerous to their health.
- Immigrants cannot return to their country of origin. This is true financially and for the fact that medical care for many of them may be practically impossible. They cannot easily receive dialysis treatment. Some were told if they return to their native country they will receive ninety (90) days of dialysis treatment without any assurance this would even be possible. Many other patients have already investigated the possibility of care in their home country and know it is not possible for them to receive dialysis or transplant.
- Every patient has not been offered individual assistance by social services. They were told the clinic is closing. They were given a printed list of surrounding private dialysis centers, which as I mentioned, will not take these patients. Last week some patients were interviewed by another organization, MEXCARE, and were verbally told they could be given plane tickets home and possible health coverage in Mexico for 90 days. There was never a written contract and patients are being pressured to sign an agreement that does not provide any details on the terms of the contract by September 18, 2009. They were strongly told this offer will not be valid beyond that date. 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.
- For them to receive “inpatient” dialysis means they must wait to be ‘critical’ to go through the emergency room. They would have to do this 2-3 times a week! It is a total point of misinformation to state that all the patients have to do is to go to any hospital in the Atlanta area which has a dialysis unit and they can get dialysis. There is a "total disconnect" between reality and this being a solution for these patients. The reasons:
- 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.
- Anybody who suggests that patients visit hospital ERs once, twice or three times per week and wait for hours to be seen by an ER doctor with all sorts of additional blood tests at each visit to determine "if they are near death if not treated" has no understanding of the total impracticality of this route that a patient would have to take to stay alive. It would be psychological torture for these people. In addition, it will represent a tremendous financial burden to the health system for the time these patients remain alive.
- They cannot manage their jobs and children while their condition deteriorates. This is not a “plan”, as Grady has stated, by any medical standard .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 that time there is no guarantee that they will have access to dialysis treatment. In another words, the private dialysis companies can just say "Sorry, no more dialysis because Grady is not paying us any more”. This information of the private sectors limitations has not been provided to the patients or to the public.
- These patients have not been informed that they even have one year of treatment. It cost over $6,000.00 per month for a patient to receive dialysis at a private center. The tactic might be to scare the patients into finding other sources so Grady does not have to pay or assume their rightful responsibility person and their family that they don't have care when they have no resources. This "psychological torture" is being felt by the patients and their families.
- “Grady’s 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”. 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 the Federal officials to get the money to save theses patient’s lives since their treatment is not optional. 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." There is no reference to the fact that Grady has an obligation to these people because they have been their care-givers for some time. The Grady position is that Grady's mission is “not to be the safety net provider for all these people”. We must respond by saying, we are talking about being the provider for the people Grady has already been caring for. Grady is saying, we don't want to be the safety net for the patients we have been caring for but we want other states to be the safety net for our patients!
- Grady does have an agreement in place with Fresenius; however the patients and their advocates have not been assured that they will provide care (which Grady will cover) for EVERY Fulton and Dekalb patient that has not chosen to leave Atlanta or settle with another provider. If this was true, there would not be any talk by Grady of patients going to emergency and being inpatients. We have spoken to over twenty (20) patients and have two (2) patients testifying today and more documented patient cases stating our information is correct. Grady has not provided them with any document stating where they can be assured they can receive treatment. This is a very small fraction of the patients at the Grady Dialysis Clinic. Many 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.
- The patients of the Grady Dialysis Clinic have contacted The Grady Advocates for Responsible Care and 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.
- It appears that these patients have been deliberately frightened into leaving Atlanta, the U.S.A. or accepting that they will die with out dialysis; even the ones who live in Fulton or DeKalb counties and certainly those who do not. Grady has taken this position of patient neglect and cultural incompetency to its highest limit with the sickest and most vulnerable of patients. As healthcare professionals, human rights believers and patient advocates we visibly and unequivocally have community and medical opposition to Grady’s unacceptable policy of deliberately denying life-sustaining care to the uninsured and underinsured of Atlanta.
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. 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.
The Grady 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
Sam Newcom, MD
Health Action Network
The Wisdom of Wellness Project, LLC.
Georgia Council of Nephrology Social Workers
Georgia Society of Rheumatology
S.T.A.R.S. for Patients
Hispanic Health Coalition of Georgia, Inc.
Racial and Ethnic Concerns Working Group
Atlantans Building Leadership for Empowerment
Lupus Foundation of America, Georgia Chapter
Diabetes Foundation of Georgia
Students and Volunteers of Grady Advocates for Responsible Care
Metro Atlanta Task Force for the Homeless
Grady Advocates for Responsible Care
Dorothy Leone-Glasser, firstname.lastname@example.org