Dear Friends of Grady Patients & Workers,

Please see below several articles and links related to the closing of the dialysis clinic at Grady. They are listed in this order: AJC on today’s ruling by the judge (with other AJC links), a link to Dr. Doug Bremner’s report from the courtroom on Monday, Dianne Mathiowetz’ article for Worker’s World, Wall Street Journal, & New York Times.

I will let you know details of our next action related to the dialyis clinic closure.  It will most likely be Monday, when the Grady Authority has a meeting & when the case is likely to be back in court.

Peace,

Bert

By Shelia M. Poole and Craig Schneider 

The Atlanta Journal-Constitution, 9/25/09

A Fulton County Superior Court judge this morning cancelled a temporary restraining order that had stopped Grady hospital from closing its outpatient dialysis clinic.

Related

·                                  

·                                 N.J.: No Grady dialysis patients

·                                 Advocates rally to demand Grady dialysis stay open

·                                 States won’t take Grady patients

·                                 Court orders Grady clinic open

·                                 Grady dialysis patients get reprieve

·                                 Grady offers to relocate patients

·                                 Grady dialysis center to close soon

The clinic is expected to close in about a week. Earlier, officials said the clinic was to close Saturday.

The hospital had planned to close the clinic Sept. 19, but patients and advocates asked the court to stop it, saying they would suffer harm without the service. Many of the patients are illegal immigrants who are poor and Grady is the only major hospital in metro Atlanta that offers them free outpatient dialysis service.

In a ruling this morning, Judge Ural Glanville said that the patients lacked the legal standing to bring the request to the court.

“The court is unpursuaded at this time that the plaintiffs have a constitutional right to the sought-after relief,” the judge wrote in his decision.

The judge had granted the temporary restraining order a few days ago pending a hearing. His decision followed the earlier hearing.

“I think it’s a travesty,” said Dorothy Leone-Glasser, patient advocate and co-founder of Grady Adovates for Responsible Care. “I don’t know how anyone involved in Grady can sleep at night because I can tell you that none of the patients that we know about — 34 of them — and their families will be able to sleep at night. I dont’ know how they can do it.”

Abebech Tadesse said her 69-year-old father, Tadesse A. Amdago, a green card-holder from Ethiopia, has no options other than Grady.

“The only option is to count the days until he dies. It’s not a peaceful death,” she said.  ”I will pray and see what’s going to happen.”

See just below to Dr. Doug Bremner’s report from the courtroom on 9/23, entitled “Do I have the right to live.”

http://www.beforeyoutakethatpill.com/index.php/2009/09/23/do-i-have-the-right-to-live/ 

 real death panel

Corporate board pulls plug on dialysis for poor patients

By Dianne Mathiowetz 
Atlanta 

Published Sep 23, 2009 6:24 PM

More than 100 patients, their family members, doctors, other health workers and community activists packed into the board room at Grady Hospital on Sept. 14 to press for the continued operation of the outpatient dialysis clinic, a function of the once-public hospital for 62 years.

Ignoring the appeals of the crowd, many of whom held signs reading “How Many Will Die?” and “Keep the Clinic Open,” the corporate-dominated privatized board voted unanimously to close the life-sustaining treatment facility on Sept. 20.

Protesters demand treatment for poor people at Grady Hospital’s clinic. Photo: Jonathan Springston, Atlanta Progressive News

Despite boasting of raising more than $280 million for the financially stressed hospital, Board Chairman Pete Correll, former head of Georgia-Pacific, justified the decision by stating that the dialysis clinic was “a big money loser.”

About 100 patients suffering from renal failure and kidney disease currently receive dialysis at Grady. Some of them must go three times a week to rid their bodies of the deadly toxins that build up. Many of them are long-time immigrant residents who have lived in the Atlanta area for decades but under Georgia law are ineligible for Medicaid coverage.

Others who are U.S. citizens or have a green card have not yet been approved for Medicaid. Georgia has one of the highest rates of application rejection in the country, requiring sick people to apply multiple times or wait extraordinarily long times for acceptance into the program.

In August, social workers began to tell these critically ill people that the clinic was closing. People were given a seven-page list of for-profit dialysis centers to call to see if the centers would accept them as patients.

Their other options were to return to their home country, move to another state where Medicaid is available to undocumented immigrants, or go to an emergency room when the poison build-up brings them dangerously close to death. Federal law mandates emergency dialysis treatment if death is likely.

As a gesture of “care and compassion” for these patients, Grady officials offered to pay for plane tickets to Mexico, Thailand, Honduras and Ethiopia as well as transportation to the 11 states identified as providing immigrant care. Inexplicably, when contacted by reporters from the Atlanta Journal-Constitution, health officials in at least three of those states—North Carolina, Virginia and New Jersey—said they also do not pay for outpatient dialysis treatment for undocumented sick people. Florida, another state on the list, requires a six-month residency, an impossible wait for a dialysis patient.

The patients who testified at news conferences, rallies and at the board meeting repeatedly said they had nowhere to go. Many are unable to work. All have family and children in the Atlanta area who care for them, take them to their doctor appointments and dialysis treatments.

One woman said through her tears: “I have no one in Mexico. Who will look after me?” Her three young granddaughters carried a carefully printed sign that read, “Don’t send our grandmother away.”

Opponents of the closure won a temporary restraining order on Sept. 16 that mandated the hospital continue serving dialysis patients and prohibited it from pressuring patients to leave the state. On Sept. 23, there will be a hearing to determine if the injunction will stay in effect.

In his initial ruling, Judge Ural Glanville stated that before he would allow the clinic to close, Grady would have to provide all patients with a “plan that does not jeopardize their lives or medical needs.”

The Grady Coalition, which has been an activist voice for quality patient care and for workers’ rights at the hospital for 10 years, is being joined in the struggle to save the dialysis clinic by Grady Advocates for Responsible Care, a group of doctors, clinicians and patients.

Articles copyright 1995-2009 Workers World. Verbatim copying and distribution of this entire article is permitted in any medium without royalty provided this notice is preserved. 

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·                                 SEPTEMBER 24, 2009, 11:06 A.M. ET

Atlanta Hospital’s Plan to Shut Clinic Sparks Suit

·                                  

By MIKE ESTERL, Wall Street Journal

ATLANTA — Publicly funded Grady Memorial Hospital has served as a lifeline for this city’s indigent for more than a century, but a plan to shutter its dialysis clinic has sparked a lawsuit on behalf of dozens of undocumented immigrants who say the decision amounts to a death sentence.

The case in Fulton County Superior Court throws into sharp relief some of the hottest issues in ongoing skirmishes over health care and the government’s role in providing medical services: how and whether undocumented aliens should receive free treatment, and how far hospitals must go to provide lifesaving care for them.

“The issue is, do my clients have a fundamental right to life?” said Lindsay Jones, an attorney for the plaintiffs, during a packed hearing before Judge Ural Glanville on Wednesday.

Mr. Jones said one elderly patient, a partially paralyzed and undocumented immigrant from Colombia who was wheeled into the courtroom on a bed, recently returned from Florida after being told he wasn’t immediately eligible for regular dialysis treatment there. He had been receiving such treatment at Grady.

Bernard Taylor, a lawyer for Grady, told the judge that the charity hospital can no longer afford to provide regular dialysis treatment for the slightly fewer than 100 patients of the clinic. He said the clinic is posting annual losses of about $2 million and would require another $2 million to bring the facility up to date even though it serves a tiny portion of the hospital’s patient base.

Mr. Taylor said Grady has taken steps to help about 90% of the patients find alternative care and is committed to finding solutions for the remaining patients, who require dialysis to prevent kidney failure. Grady is the only large hospital in Atlanta still providing regular dialysis for undocumented immigrants — most of whom can’t afford the treatment, which typically costs a few hundred dollars a session.

Judge Glanville said he expected to rule on the matter later this week. He ordered a temporary injunction last Thursday — one day before Grady planned to close the dialysis clinic — requiring the hospital to continue providing the service until it presents “a suitable alternative treatment plan” for affected patients.

Grady estimates about two-thirds of the patients who use its dialysis clinic are undocumented immigrants without health insurance. Mexicans make up the largest single group; others are from countries including El Salvador, Nigeria, Egypt, India and Cambodia.

The dispute highlights conflicting views in state capitals of what constitutes emergency care. Under U.S. law, hospitals are required to treat patients in danger of death regardless of their immigration status or ability to pay. Treatment typically takes place in emergency rooms, with the resulting costs split between the states and the federal government.

Some states also offer undocumented immigrants regular dialysis treatment three times a week outside of the emergency room if the patients don’t have money or insurance. That is because many such patients would return to the emergency room every two weeks or die without regular treatment. Local hospitals can then be reimbursed under Medicaid, a state-federal health-care plan. But other states, including Georgia, don’t approve regular dialysis treatment under Medicaid.

“States have flexibility” in determining what qualifies as an emergency medical condition, said Mary Kahn, a spokeswoman at the Center for Medicare and Medicaid Services, the federal agency that oversees government-funded health care benefits.

Grady has nearly 1,000 beds, serving mostly the poor and uninsured in downtown Atlanta since 1892. It posted an overall loss of $33.5 million last year and relies heavily on federal funding to support operations. Two local counties have provided massive subsidies to bridge Grady’s deficits.

In an effort to shore up the finances, management of Grady was handed over to a nonprofit corporation last year. The board is chaired by A.D. “Pete” Correll, the former head of Georgia-Pacific Corp. But the hospital is still owned by the public Fulton-Dekalb Hospital Authority.

Grady says it can’t afford to keep running the money-losing dialysis clinic without cutting off essential services to other patients in need. It says funds currently being spent on treating nearly 100 dialysis patients could finance 75,000 outpatient visits at its neighborhood health centers, which provide preventive care.

“Those who are less fortunate or who have less access to care will always have a home at Grady. But even in that context, Grady has some tough decisions to make. Otherwise, we won’t be in business,” said Matt Gove, a senior vice president at the hospital.

The hospital began informing dialysis patients earlier this summer that it would be closing the clinic. It recommended patients return to their home countries for treatment or move to one of about a dozen states it says provide the service for undocumented immigrants under Medicaid. Grady also has offered some financial assistance.

Salvador De Lara, the Mexican consul general in Atlanta, said half a dozen Mexican patients had returned to their home country as of Tuesday. He said the consulate was working to ensure continued care for the repatriated patients in Mexico and helping them financially.

But several patients told The Wall Street Journal they still hadn’t lined up alternative care and weren’t sure where to go if the Grady clinic shuts down.

“I don’t know what I’m going to do,” said Rosa Lira Ramirez, a 78-year-old immigrant from Mexico who lives in the Atlanta area. She said she obtained a U.S. permanent resident card four years ago but that she won’t qualify for medical benefits until next year.

Write to Mike Esterl at mike.esterl@wsj.com

Immigrants Cling to Fragile Lifeline at Safety-Net Hospital

By KEVIN SACK , New York TImes

Published: September 23, 2009

ATLANTA — If Grady Memorial Hospital succeeds in closing its outpatient dialysis clinic, Tadesse A. Amdago, a 69-year-old immigrant from Ethiopia, said he would begin “counting the days until I die.” Rosa Lira, 78, a permanent resident from Mexico, said she also assumed she “would just die.” Another woman, a 32-year-old illegal immigrant from Honduras, said she could only hope to make it “back to my country to die.”

David Walter Banks for The New York Times

An illegal immigrant says treatment is hours away in her home country.

David Walter Banks for The New York Times

Tadesse A. Amdago says the Atlanta clinic’s closing would have him “counting the days until I die.”

David Walter Banks for The New York Times

Rosa Lira, like Mr. Amdago, said she would expect to die if the clinic closed.

Enlarge This Image

Erik S. Lesser for The New York Times

A lawsuit has put in limbo a plan to close a dialysis clinic at Grady Memorial Hospital in Atlanta.

The patients, who have relied for years on Grady’s free provision of dialysis to people without means, said they had no other options to obtain the care that is essential to their survival. But the safety-net hospital, after years of failed efforts to drain its red ink, is not backing away from what its chairman, A. D. Correll, calls a “gut-wrenching decision”: closing the clinic this month.

The sides confronted each other in state court on Wednesday morning as lawyers for the patients sought to keep the clinic open until other arrangements for dialysis could be secured. Dialysis patients and their families packed the benches and 60-year-old Nelson Tabares, a seriously ill illegal immigrant from Honduras, was wheeled into court in a portable bed.

Despite a judge’s urging that the two sides negotiate a solution Wednesday, there was no agreement by the end of the day on how to go forward. For the time being, a restraining order keeping the clinic open stands. The judge is considering whether to extend it.

The dialysis unit on Grady’s ninth floor might as well be ground zero for the national health care debate. It is there that many of the ills afflicting American health care intersect: the struggle of the uninsured, the strain of providing uncompensated care, the inadequacy of government support, and the dilemma posed by treating illegal immigrants.

Grady is one of many public hospitals that have been battered by the recession as the number of uninsured has mounted. New York City’s public hospital system is eliminating 400 positions and closing some children’s mental health programs, pharmacies and clinics. University Medical Center in Las Vegas has closed its mammography center and outpatient oncology clinic.

“It comes down to which service do you need to keep open,” said Larry S. Gage, president of the National Association of Public Hospitals. “You try your hardest to cut back on services that are going to be available elsewhere in the community.”

Public hospital officials are concerned that the health care legislation being negotiated in Washington could worsen their plight before making it better. Under bills traveling through both houses of Congress, as the number of uninsured declines there would be commensurate reductions in Medicaid subsidies to hospitals that provide large amounts of uncompensated care.

At Grady, about four in 10 patients are uninsured, and an additional 25 percent are insured by Medicaid, which reimburses at rates so low they often do not cover actual costs. As a result, the hospital lost $33.5 million last year, with the dialysis clinic accounting for about $2 million of that total, said Denise R. Williams, the hospital’s executive vice president.

Nonetheless, as a taxpayer-supported hospital with the mission of serving the indigent, Grady is expected to take all comers in need of emergency care, like dialysis. Treatment there does not depend on a patient’s insurance or immigration status.

The hospital has been encouraging some of the dialysis patients to move to other states or back to their home countries, offering to defray some costs.

Hospital officials estimate that two-thirds of the outpatient clinic’s roughly 90 patients are illegal immigrants. They do not qualify for Medicare, which covers dialysis regardless of a patient’s age, and they are excluded in Georgia from Medicaid and other government insurance programs. Legal immigrants face a five-year waiting period before becoming eligible. That leaves Grady to absorb costs of up to $50,000 a year per dialysis patient, some of whom have availed themselves of the thrice-weekly treatments for years.

After years of fiscal desperation and management turmoil at Grady, Atlanta business leaders stepped in last year to force a restructuring, from a quasi-governmental authority to a nonprofit corporate board. In response, the Robert W. Woodruff Foundation pledged $200 million over four years to replace dilapidated beds and modernize computers. A $20 million gift from Bernie Marcus, a founder of Home Depot, is helping to update the emergency department, which provides regional trauma services.

But the hospital’s operating deficits have continued. Grady’s senior vice president, Matt Gove, estimated that its uncompensated care would grow by $50 million this year, up 25 percent. The new nonprofit board eliminated 150 jobs this year, closed an underused primary care clinic and began charging higher fees to patients who live outside of the two counties that support Grady with direct appropriations.

The closing of the outpatient dialysis clinic was recommended by consultants in 2007, who said that equipment was outmoded, that most hospitals did not provide outpatient dialysis and that Atlanta had scores of commercial dialysis centers. When the hospital’s chief executive at the time tried to shut it down, the resulting firestorm helped prompt his dismissal.

This July, the new board voted to try again. The hospital gave patients a month’s notice of the scheduled Sept. 19 closing, and vowed to assist them in finding local dialysis providers, relocating elsewhere and qualifying for public insurance. “We committed that not a single person would be left behind,” Mr. Correll wrote in a newspaper advertisement published on Sunday.

About a third of the patients have been successfully moved, including several illegal immigrants who returned to Mexico with the hospital’s financial help, Mr. Gove said. But others have said they have no place to go, have no means to pay for dialysis or are too ill to travel.

The female illegal immigrant from Honduras, who has a 7-year-old son, said her parents live more than a four-hour drive from the nearest dialysis center, in Tegucigalpa. She is mindful that her sister died from a stroke while being driven to a hospital there. She said she had no money to pay for dialysis because she was too weary from her kidney condition to hold down a job.

“I feel like they are trying to get rid of me because I don’t work,” she said, her eyes tearing. “But being sick is not my fault.”

Samuel Tabares, who rolled his father into court in his bed, said his father, who was paralyzed by a stroke, would probably not survive the strain of relocation or repeated trips to the emergency room in search of treatment.

“They’re treating the closing of this clinic like it’s the closing of a dental clinic,” Mr. Tabares said, “as if people’s lives don’t depend on it.”

 
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