Yesterday we converged at Emory University to present a letter to President Jim Wagner requesting that Emory join with other dialysis centers in Atlanta, GA to help provide care for the 33 dialysis patients whose extension of life-saving dialysis ends next week. We then traveled to the Fresenius Dialysis Center at 231 14th St in Atlanta, where treatment of the patients is ending Aug 31 2010, to present a similar letter. Today there was a protest at Grady Hospital. Time is running out for these patients and it is really disheartening that money is thrown after expensive medical procedures in this country that do not clearly work, while something like dialysis that means the difference between life and death is denied to some people.

Read prior posts on the history of this issue here.

 

I invite doctors and other healthcare workers to speak out about the death sentences being handed out to patients.

Sign the petition to save the Grady dialysis patients here.

After August 31, 2010, thirty three (33) uninsured End-Stage-Renal Disease patients of Grady Memorial Hospital will no longer receive their life-sustaining dialysis treatments.

- In September 2009, Grady Memorial Hospital closed its outpatient dialysis clinic. At that time the thirty three (33) uninsured patients, most of whom are immigrants, were promised dialysis for one year from Fresenius dialysis facilities as specified in the Grady Memorial Hospital – Fresenius contract.

- On August 31, 2010 the Grady Memorial Hospital – Fresenius contract expires.

- To date, no alternative source of dialysis treatment has been made available to the remaining thirty-three patients.

- The patients will die within weeks of the August 31st deadline if they are not provided with ongoing dialysis treatment.

As advocates for human life, please sign the petition below to encourage the private dialysis providers of Atlanta, Georgia, to supply the 33 indigent patients of Grady Memorial Hospital with life saving dialysis care.

Here are some facebook groups you can join to keep abreast of the issue.

Protest the Grady Dialysis Cuts

Protest Grady Hospital’s Sentence of Death for Dialysis Patients.

Advocates for Responsible Care – Group

Read all posts about the Grady dialysis situation here.

and imminent sentence of death for 33 patients on Aug 31 2010. Interview by Grady physician Neil Shulman MD

Part 1

Part 2

Part 3

The situation at Grady Hospital in Atlanta of cutting off dialysis for poor patients without insurance (which will make them, um, die) is an echo of the national political farse of throwing out public option health insurance and throwing more good money after bad (Karen Ignagni and her group of health insurance criminals). I am glad to see that Max Baucus (D-Mont) who was the author of the bogus healthcare reform bill (and a top recipient of pharma contributions) was able to get some extra healthcare money for some miners from Libby, Montana, as well as shell out even more profits to the pharmaceutical industry, health insurance, etc. Here he is in action shelling out the pork.

Here is an update on the Grady story from Neil Shulman MD:

IT IS SAD.  I had a meeting with the woman who wrote the book THE GRADY BABIES and a woman who works at Channel 11 and the nurse from Nigeria who has been here ten years, Is married to an American and just got her Green card.  SHE NEEDS TO BE HERE 5 MORE YEARS BEFORE GEORGIA MEDICAID PAYS FOR HER DIALYSIS.  The Channel 11 lady and the author (WROTE A GREAT BOOK WITH DICK GREGORY) are connecting with Dorothy to get the book on the dialysis crisis rolling (30 people who may lose their lives after Jan 3rd when the inner city hospital stops supporting dialysis for their kidney failure.)  They are planning on putting personal stories about the patients on the internet.

In the meantime,  there is a movement by some docs within Grady Hospital to change things such that humanization takes precedence over monetazation. ALSO,  THERE IS A PLAN TO TAKE A BUS LOAD  OF THE DIALYSIS PATIENTS TO A HOSPITAL EMERGENCY ROOM ……….ALL AT ONCE…EVERY FEW DAYS ……after Jan 3rd.

 ON another front,  the medical volunteerism conference WWW.EMORYIMVC.ORG  is MOVING ALONG VERY WELL…………..we have some fantastic presenters,  the first edition of the book about  these heroes is almost ready,  the White House is sending folks………….AN OUTPOURING OF SUPPORT FROM HUMANIZERS.

IF YOU HAVE SOME TIME,  WE SHOULD AT LEAST CHAT ON THE PHONE TODAY.  I AM AT 404-321-0126.  IF NO ANSWER,  JUST LEAVE YOUR NUMBER AND I WILL RETURN YOUR CALL SHORTLY.

NOW A SHORT OVERVIEW OF THE CURRENT CIVIL WAR IN THIS COUNTRY:

We are in the middle of a war in this coutry between the monetizers and the humanizers.  Sadly,  the victims of this war are poor sick people.  IF everybody was a humanizer as the folks involved in the medical volunteer activites………….there would be no problem.  We would have peace and poor sick people would not suffer and die……. One of the major obstacles to winnning this war is the barrier between the poor sick patients and everybody else.  The caring nurses and doctors AND LAY FOLKS who are on the front lines Understand the current atrocitIES.  The further one is away from connecting with poor sick people,  the less likely you can empathize with them.  It is easy to use words like “ILLEGAL ALIENS”  OR “LIMITED RESOURCES FOR POOR SICK AMERICANS”  and just let people suffer and die when you don’t have to look in the eyes of these people or hear their stories. 

One of the free clinics in South Atlanta struggles with getting patientsurgent health care by specialists every day.  Recently, there was a case of a man needing back surgery before “he became paralyzed.”  The community clinic (docs, nurses, and pastors) FOUGHT HARD AND got the patient into Grady Hospital for the surgery.  On the other hand, there are folks like the 23 year old woman who recently died in Grady because she was shut out of her access to steroids for her Lupus.  She did know how to overcome the new barriers (more paperwork and more upfront fees to be seen for a few minutes so she could get her refills).  She ended up in Grady’s ER very very sick. She was admitted and died. Medical students and staff docs told me the story.  Many folks are familiar with this recent tragedy.  There are many folks in similar situations every day who die at home without even getting to the emergency rooms.

In developing countries where there is lack of access to health care………..at least there is not a COVER-UP.  When we brought a little girl from Kenya to Univ of Alabama Med Center for heart surgery…………..the Kenya media, the local Kenya politicians,  the local roatary club,  THE HAVES AND THE HAVE NOTS…..ALL JOINED TOGETHER AND HELPED SAVE THIS LITTLE GIRL’S LIFE.  IT WAS AN ENTIRELY DIFFERENT CULTURE.  THERE WAS NO HIDING OF “THE FACTS.”  THERE WAS NO INTIMIDATION OF THE CARING FOLKS BY  MONETIZERS.  We are experiencing a larger and larger class of HAVE-NOTS in this country because of the economy.

DAILY MEDIA ATTENTION SHOULD BE FOCUSED ON EFFORTS OF THE HUMANIZERS TO HELP POOR SICK PEOPLE.  THIS WOULD GALVANIZE EVEN MORE PEOPLE TO JOIN IN.  THIS WOULD GALVANIZE MORE PEOPLE TO ADVOCATE FOR LEGISLATION TO ELIMINATE THESE ATROCITIES.  Maybe we could even get the Georgia Legislature to allow poor people to get medicaid coverage BEFORE THEIR CANCER SPREADS.  THE MEDIA WILL NOT INFOMORM THE PUBLIC THAT IF YOU HAVE A MALIGNANT MELANOMA ON YOUR SKIN AND YOU ARE POOR…………..THE STATE MEDICAID EMPLOYEES ARE FORCED TO TELL YOU “SORRY MEDICAID DOES NOT COVER YOU UNTIL YOUR CANCER SPREADS THROUGHOUT YOUR BODY.” 

 We need more media attention, legal action, and MORE folks EDUCATED AND involved.  IT IS A STRUGGLE WHICH CAN ONLY BE WON WITH AN ARMY OF HUMANIZERS.  I have found that people with resources who are humanizers are MUCH HAPPIER than people with resources who are monetizers.  You are surely one of the humanizers.

 IF THE MAJORITY OF MEMBERS OF THE US CONGRESS WERE NOT MONETIZERS………….THEN TRULY MEANINGFUL NEW LEGISLATION WOULD BE PASSED TO ELIMINATE THE BASIC HEALTH DISPARITIES BETWEEN  THE HAVES AND THE HAVE-NOTS.  WE CAN STILL HAVE PEOPLE WITH BIG HOUSES AND SMALL HOUSES, PEOPLE EATING AT FANCY RESTAURANTS AND PEOPLE EATING BASIC HEALTHY FOOD AT HOME,  PEOPLE GOING ON  EXPENSIVE VACATIONS AND FAMILIES DOING MEDICAL MISSIONS………..BUT AT LEAST WE WOULD HAVE A COUNTRY WHERE POOR SICK PEOPLE HAD ACCESS TO BASIC HEALTH SERVICES AND BASIC MEDICAL THERAPIES……….WHICH ARE AVAILABLE TO MOST PEOPLE IN EUROPE, CANADA, JAPAN, KOREA, ETC.

AND BY THE WAY,  IT WOULDN’T HURT IF MEDICAL LITERACY WAS AN INTEGRAL PART OF OUR EDUCATIONAL SYSTEM………..WHY DO JUST DOCTORS AND NURSES LEARN HOW TO EXAM THE HUMAN BODY, WHAT SYMPMTOMS ARE IMPORTANT, HOW TO PERFORM SIMPLE PROCEDURES LIKE TAKING BLOOD PRESSURES?……………..WHY NOT EMPOWER CONSUMERS SO THEY CAN USE THE HEALTH CARE SYSTEM MORE EFFICIENTLY.  READING, WRITING AND ARITHMETIC ARE IMPORTANT BUT YOU CAN’T DO ANY OF THOSE IF YOU ARE DEAD.  MARTIN LUTHER KING EMPOWERED FOLKS BY TEACHING THEM HOW TO VOTE.

LET’S EMPOWER AMERICANS BY TEACHING THEM MEDICAL LITERACY………….LET’S EDUCATE THE SCIENCE TEACHERS SO THEY ARE MEDICALLY LITERATE, SO THEY CAN TEACH OUR FUTURE GENERATIONS ON HOW TO EFFICIENTLY USE THE HEALTH CARE SYSTEM.

BEST,

NEIL SHULMAN

INFRINGEMENT: FREEDOM OF SPEECH: MEDICAL PROFESSIONALS

The United States is a country where freedom of speech is supposed to be a basic right. Administrative power and personal wealth should not give any American the right to infringe on one’s freedom of speech. MANY DOCTORS FEEL THAT a downturn in the economy can create an UPSWING IN VOLUNTEERISM. LACK OF MONEY DOES NOT HAVE TO MEAN A LACK OF SERVICES. MANY OF THESE DOCTORS
ARE VERY CRITICAL OF BLATANTLY INSANE POLICIES BUT ARE AFRAID TO SPEAK OUT FOR FEAR OF PERSONAL REPERCUSIONS.

There are many caring doctors and other health care professionals who intentionally take lower paying jobs and/or volunteer their services because their goal in life in NOT TO MAXIMIZE THEIR BANK ACCOUNT OF MONEY BUT RATHER TO MAXIMIZE THEIR BANK ACCOUNT OF GOOD DEEDS. Many of these people have more global insights into the life-threatening impact and economic inefficiences of certain institutional and political policies. HOWEVER, IN MANY INSTANCES, THERE ARE ATTEMPTS TO INFRINGE ON THE FREEDOM OF SPEECH OF THESE HEALTH CARE PROFESSIONALS. Even well meaning journalists who wish to expose certain inefficiencies in humane health policies are often restricted from reporting.these stories. The executives of these media outlets are too often fearful of “losing revenue” from advertisers when such ‘CONTROVERSIAL” news stories are reported.

THE FOLLOWING ARE A FEW EXSAMPLES OF INSANE POLICIES WHICH FRUSTATE MANY “CARING” HEALTH CARE PROFESSIONALS EVERY DAY:

1. Medicaid rules which DO NOT ALLOW COVERAGE TO REMOVE AN EARLY CANCER BUT REQUIRE PATIENTS TO WAIT UNTIL IT SPREADS THROUGHOUT THEIR BODY.

2. Managers of health care institutions who prohibit cooperative institutional volunteeerism in order to address health care needs of the poor. Example: Executives of dialysis clinics NOT JOINING TOGETHER to keep uninsured patients with kidney failure alive.

3. Executives of hospitals not joining together to provide a few weeks supply of free essential medications to hospitalized uninsured poor patients upon discharge. The reality is often that these patients DO NOT HAVE INSTANT ACCESS TO MONEY OR TRANSPORTATION TO OBTAIN THESE MEDS thus they bounce back to hospital emergency rooms …………uneccesary personal suffering and avoidable expensive rehospitalizations.

4. Incremental increases in upfront fees for outpatient visits with NO EXCEPTIONS.
Therefore patients with VERY LIMITED RESOURCES can’t get essential refills of medications thus they suffer/bouncing back for expensive emergency room visits when their chronic illnesses become life-threatening.

5. Pharmaceutical companies often blast the public with PR CAMPAIGNS about
free medication programs for the poor HOWEVER the companies often create so many time-consuming roadblocks for instant access to these medications that health care professionals cannot get the meds to the patients in a timely manner.

I DO NOT SPEAK FOR MYSELF ALONE BUT FOR MANY HEALTH CARE PROFESSIONALS WHO ARE AFRAID OF NEGATIVE PERSONAL CONSEQUENCES IF THEY SPEAK OUT ON THESE ISSUES.

Neil Shulman MD
Atlanta,Georgia

Today in Fulton County court the courtroom was packed with dialysis patients and advocates who were scheduled to have their dialysis turned off last week but for whom a temporary restraining order had kept the Grady clinic in Atlanta GA open until today, I guess. Lawyers for Grady Hospital argued that the patients don’t have a right to healthcare (that one made me kind of wonder) and that Grady (whose mission is to care for the sick and indigent poor) didn’t have any obligation to them. They provided an affidavit saying that 88 patients had been provided with followup. Now I am not a math major, but originally there were 95 patients and there were at least 25 in the court and 95 minus 25 equals…

Oh, and their “followup” was to send at least two to Mexico which doesn’t have long term dialysis, and therefore they will die there.

The lawyer for the patients argued that closing the clinic was sentencing them to death, therefore depriving them of the right to live. I mean, doesn’t the US Constitution give us the right to live? If we have someone on death row for killing someone we spend millions to give them due process, but if they are a Grady dialysis patient we just turn off the plug. People go nuts over pulling the plug on brain dead Terry Schiavo but we have no compunction turning off dialysis.

One of the patients has a green card and is short of one year to qualify for Medicaid. But, I guess, she must die. One was sent to Florida because they said he could get dialysis there but couldn’t get it, had a stroke and came back to Atlanta.

There is something seriously messed up with a country that allows people to die like this. The Judge is supposed to give a ruling today or tomorrow.

Join the FB cause “Protest Grady Hospital’s Death Sentence for Dialysis Patients” here.

Today I attended a protest going on at Grady Hospital over dropping dialysis for non-US citizens and then we attended the open board meeting at Grady Hospital. You can get some background by reading ““Grady Hospital Tells Dialysis Patients to Leave or Die” in which I explain how Grady sent letters a couple of weeks ago telling people that their dialysis is over and they should go back to their home countries (which often don’t have dialysis) or move to Virginia, and “Should I Watch My Father Die Now” in which a daughter described how her father would die because although he had a green card he needed to live in Georgia for five years and he had only three.
Today concerned doctors, social workers, community activists and the dialysis patients and their families convened on Grady Hospital to protest and voice their concerns to the board.

Giving dialysis as an emergency event only is a death sentence as your potassium goes up and everyone knows that these people will soon die from a cardiac event or something like that. The board claimed that they would give followup but none of the patients can get treated at private clinics because they don’t have private insurance or medicaid. Several people expressed the outrageousness of the situation of dumping people in the streets and the medical unethics of just telling people get lost, go die.

Grady administrators claimed that they were providing follow up but the clinic closes this week and there is no plan for these patients!
Elbert Tuttle, MD, who is 88 years old, brought dialysis to Atlanta, and whose father of the same name brought desegregation to the South, appeared to express his view that Emory and Morehouse Schools of Medicine should get involved with local medical centers to help out.
A dialysis patient from El Salvador who works cleaning houses in DeKalb County and who has children, said “I Need the Dialysis. I Think I Will Die.”

Indeed.
Afterwards we waited for an hour and a half for the Chief Operating Officer, Denise Williams, to come talk to us about how these people are going to be taken care of. She never showed up. I guess she doesn’t really give a crap.
It really makes you wonder when all our local paper can cover is the angry people being bused to Washington to protest healthcare reform. How can any humane person allow this to happen? One sign said “Healthcare is a human right”.
I couldn’t agree more.
For more information contact Dorothy Leone-Glaser of Grady Advocates for Responsible Care, (404) 633-5843, dlg [at] wisdomofwellnessproject.com.

There has been a recent movement to get some greater accountability in research these days. One of the things that has happened is the development of clinicaltrials.gov. That system involves logging on an registering your clinical trial and saying what it is you are actually hypothesizing your result will be. In the lingo the result is called the primary outcome, which is what you think the result will be.

To make this simple, let’s say that you think a drug will make your face turned blue. In this case the “primary outcome” would be “make your face turn turn blue.” So what if your face turned red? Maybe you would like that your drug actually “did” something and you decided that was better than nothing. So after the fact you *changed* the primary outcome and said that you actually had wanted the drug to turn your face red? Pretty dishonest, huh? Well it actually happens all the time in clinical research, especially for drug trials where pharma companies have billions riding on the outcomes of these trials. 

So lets turn to the evidence. Guys like the investigators in the Paxil 329 study, which I have written about previously here, were deciding that the primary outcome they were studying should change after they found that it didn’t turn out to be significant, and they should come up with something else. In the case of the 329 study there was a rather arrogant letter on the behalf of the lead author along the lines of “I know best and I changed the outcome because I wanted to and I am an expert and leader in my field.”

Well now a lot of investigators have piled on to registering their trials and some government and funding agencies are requiring it. That is why it is interesting that a recent study has actually looked at the relationship between the registry and what people actually reported in the literature. What they found is that 46% of trials were properly registered. However of those, 31% had changed their primary outcome. In those studies in which it could be evaluated they favored results that were statistically significant over those that were not in 83% of cases.

In other words, 1/3 are blatantly lying and cheating. And that is in the ones that have registered. What about the ones that never did or in era before clinicaltrials.gov? Can we trust the data collected by all those drug company trials? If not what does that mean

After writing about the egregious goings on at Grady Hospital, which provides healthcare for the poor and indigent in Atlanta, GA, where they proposed denying dialysis patients to non-US citizens as a way to cut costs (which is a death sentence) (see “Grady Hospital Tells Non-US Dialysis Patients to Leave or Die“), I generated a lot of comments, and got dragged along to a meeting of the Grady Citizens Alliance, a grass roots organization, by my fellow MD writer friend Neil Shulman MD, who promised me it would be an “interesting meeting.”

Well it was a pretty interesting meeting, and people expressed pretty strong opinions about the fact that a hospital was going to be pulling the plug on the only thing that is keeping some people alive, namely dialysis. A physician brought a woman from Honduras who didn’t speak English, and translated her story. She was a fairly young and healthy looking person who was suffering from uncontrolled high blood pressure which had been associated with kidney failure for which she needed dialysis to live. She got a letter (in English, which she can’t read) from a social worker at Grady informing her that after Sept 19 dialysis would no longer be available to her at Grady. The letter attached a list of private dialysis clinics in Atlanta (none of which will of course provide care to someone without insurance) and suggested that she could move to Virginia Beach or North Carolina. Through tears she explained that she didn’t know anyone in Virginia Beach.

Oh, and they offered her a free ticket back to Honduras. How generous.

Another social worker said she was working with a man who was a legal immigrant from Ethiopia but had lived in Georgia only three years, five years short of the time required to qualify for Medicaid. He had a social security number but hadn’t paid into it enough to qualify for Medicare. He was also on dialysis and was on the list of those who were being cut off.

His daughter asked, “So am I supposed to watch my father die now?”

Hmm. Good question.

Neil Shulman pointed out that you can go provide free healthcare in Africa, and you are good and a missionary. But if someone comes from Africa and you provide healthcare for him here in Georgia you are a socialist.

People in the Grady Hospital Alliance have been trying to identify clinics in Atlanta that will provide care for these people, but the fact is that even the so-called “not for profit” hospitals won’t provide care to people without insurance. And Grady’s administration’s statement that they would provide referrals and transitions of care were, quite simply, a lie.

As someone said at the meeting, a city that simply pulls the plug and lets people die because they don’t have insurance is not a civilization. Doctors who let people die because they cannot pay are violating their Hippocratic oaths and should have their licenses yanked; those who come up with justifications about being against socialism or who claim that they are providing free care are sociopaths and enemies of civilization. CEOs of hospitals have the same responsibilities. They are saving lives, not making paper clips. And this thing of turning off dialysis is just the start. Next it will be the clinics, and the powers that be will eliminate their duty to care for their own people.

If my city is going to let people die just like that, they do not deserve to call themselves a part of civilization.

Anyhoo there is going to be a rally and a press conference held at the main entrance to Grady Hospital in Atlanta, GA, on this Thursday at 10 am. We want to get out as many people as possible to make our message known that as people that care about people we will not tolerate bureaucrats pulling the plug on the dialysis machines and letting people die. For ANYONE. Come on down.

Grady Hospital, the public hospital here in Atlanta GA that provides care for the indigent sick, has been having financial troubles in recent years with multimillion deficits. Now based on the recommendations of an outside consulting firm they have proposed saving money by denying dialysis treatments to Non-citizens. For those who are not familiar with it, dialysis is a procedure performed two or three times a week in patients with kidney failure which uses a machine to remove toxins from the body that are normally removed by the kidneys. Taking away dialysis is a death sentence. The brilliant plan of Grady includes giving people plane tickets to Connecticut or back to their home countries, or letting them go to the Emergency Room if and when they start dying.

This is so obviously an unethical procedure that it makes you wonder how anyone who calls him/herself a member of the medical profession can go along with this. It obviously is a violation of the Hippocratic oath which states that doctors should not do harm. Come to think about it, our entire medical system, which has people making a profit from people’s sickness, along with everything that goes along with that, like riscission (insurance companies dropping people after they develop a chronic illness), churning tests and procedures that do not benefit patients health, and now making non-citizens walk the plank in the name of saving money, is a violation of the Hippocratic oath. I think a system that incentivizes medical personnel to undercut health is immoral.