Atlanta Hospital's Plan to Shut Clinic Sparks Suit
By: Health Insurance
Submitted: 2009-10-04 18:56:24 | Word Count: 1033
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.
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"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
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