Thread: For Illegal Immigrant, Line Is Drawn at Transplant

For Illegal Immigrant, Line Is Drawn at Transplant
By LINA BERNSTEIN
Published: December 20, 2011

Without treatment to replace his failing kidneys, doctors knew, the man in Bellevue hospital would die. He was a waiter in his early 30s, a husband and father of two, so well liked at the Manhattan restaurant where he had worked for a decade that everyone from the customers to the dishwasher was donating money to help his family.

Angel, with his niece, is hoping for a kidney transplant to avoid a lifetime of dialysis.

He was also an illegal immigrant. So when his younger brother volunteered to donate a kidney to restore him to normal life, they encountered a health care paradox: the government would pay for a lifetime of dialysis, costing $75,000 a year, but not for the $100,000 transplant that would make it unnecessary.
For nearly two years, the brothers and their supporters have been hunting for a way to make the transplant happen. Their journey has taken them through a maze of conflicting laws, private insurance conundrums and ethical quandaries, back to the national impasse between health care and immigration policies.

The waiter’s boss sought private insurance, she and the brothers said, speaking on the condition that their names be withheld for fear of provoking immigration authorities. The Catch-22: for the first year, the waiter, called Angel, would get no coverage for his "pre-existing condition," nor would he receive the dialysis that keeps him alive and able to work four days a week.

Doctors sought a transplant center that would take him. Hospitals in the city receive millions of taxpayer dollars to help offset care for illegal immigrants and other uninsured patients. But at one hospital, administrators apparently overruled surgeons willing to waive their fees. At another, Angel was told to come back when he had legal status or $200,000.

A last resort is a return to Mexico, where the operation costs about $40,000. But to pay off the necessary loans, Angel and his brother, a deli worker, would have to sneak back in through the desert. If they failed, they would be cut off from their children in Brooklyn, who are United States citizens.

"As a physician, it puts you in a real ethical dilemma," said Dr. Eric Manheimer, Bellevue’s medical director, noting that a transplant would sharply reduce Angel’s risk of death from complications. "The ultimate irony is it’s cheaper to put in a transplant than to dialyze someone for the rest of their life."
Bellevue performs no transplants but, as a trauma center, often supplies organs harvested, with family consent, from illegal immigrants fatally injured at work.
"Here’s the paradox: he could donate, but he can’t receive," Dr. Manheimer said, calling the imbalance troubling. Organ registries do not record illegal status, but a study estimated that over a 20-year period noncitizens donated 2.5 percent of organs and received fewer than 1 percent.
To those focusing on immigration enforcement, however, the inequity runs the other way. "They should not get any benefit from breaking the law, especially something as expensive as organ transplants or dialysis," said Representative Dana T. Rohrabacher, Republican of California, who contends that care for illegal immigrants is bankrupting American health care and has sought to require that emergency rooms report stabilized patients for deportation unless they prove citizenship or legal residence.
"If they’re dead, I don’t have an objection to their organs being used," Mr. Rohrabacher added. "If they’re alive, they shouldn’t be here no matter what."
To Ruth Faden, the director of the Johns Hopkins Berman Institute of Bioethics, the brothers’ case, like the transplant statistics, illustrates how quickly firm principles on both sides unravel in practice.
"We tie ourselves up in knots," she said, "because we’ve accepted as a country and in international human rights law that if someone shows up in extremis in your emergency room, the nurses and doctors and technicians are morally obligated, and legally obligated, to provide that life-saving care."
How to begin refusing care, she added, becomes a dilemma for "real people in real time."
The sudden onset of the waiter’s illness in January 2010 left no time to spare. At Bellevue, he underwent surgery to implant a temporary venous catheter in his neck, to cleanse his blood of lethal toxins. The cause of his renal disease is most likely genetic: when he was 8 — about the age of his own sons now — his father died of kidney failure.
Through quirks of legislative history, nearly everyone with end-stage renal disease in the United States, regardless of income, is covered under federal Medicare for dialysis and transplantation, except illegal immigrants. But regardless of a patient’s immigration status, hospitals can be reimbursed for emergency care by Medicaid, the federal and state insurance program for the needy.
Unlike most states, New York, California and North Carolina define outpatient dialysis as an emergency measure. Studies show such regular dialysis is cheaper, with fewer life-threatening complications, than waiting until toxin levels require hospital treatment.
"What do I have to do to become normal?" Angel remembers asking. The medical answer was clear: a transplant, and anti-rejection drugs costing about $10,000 a year. But news that his brother and sister were compatible donors came with a blunt warning, the waiter recalled: "As long as you don’t have your papers, you won’t get a transplant."
Like many Mexican New Yorkers, Angel has relatives who migrated years ago without visas and are now citizens. An uncle still works for the restaurateur who helped him legalize. But immigration rules have changed, eliminating such paths.
"My boss, she tried to help me," said the waiter, who supported his mother and half-siblings from the age of 16, and worked his way up from busboy, paying taxes, mastering English and learning enough French to counsel diners on the wine list. "We find no way."
His boss kept hunting. "He deserves every break he can get," she said.
They consulted lawyers at LegalHealth, which counsels low-income patients. Randye Retkin, the director, said the waiter was one of a dozen patients in need of transplants who were referred to the nonprofit program by hospitals last year because of immigration barriers.
For many there is no remedy, Ms. Retkin said. She cited a Mexican mother of two who died without the small-bowel transplant she needed, just as lawyers won a yearlong legal battle for Medicaid to pay for it.
The waiter turned to the Mexican consulate, which appealed to Dr. Manheimer. The doctor said he persuaded surgeons at NYU Langone Medical Center to waive their $20,000 fees, but administrators would not absorb the rest. The hospital declined to comment.
Two other doctors, Hector J. Castro, a critical care specialist, and Kann H. Patel, a hematologist, sent Angel to Mount Sinai Medical Center. But there a financial transplant counselor told him he would have to pay double the typical cost in advance, to cover any complications.
"Personally, I’m troubled by it," said Dr. Sander Florman, who directs the Recanati/Miller Transplantation Institute at Mount Sinai. "We’re looking at human beings."
But Dr. Florman confirmed that the waiter’s experience reflected policies at the hospital. "Our general approach is we’re not the immigration police," he said. "On the other hand, there has to be a mechanism to pay for it."
Mount Sinai officials say they provided $67.3 million in uncompensated care last year, and received $25 million from the state to offset such costs. "Mount Sinai struggles each day to balance its limited resources with its strong commitment to provide compassionate medical care," it said in a statement, noting that kidney transplantation, unlike dialysis, is not an emergency procedure under Medicaid.
For nearly everyone else, however, there is a Medicare option. Scholars trace the unusual program, now costing $40 billion a year, to a 1962 Life magazine article titled "They Decide Who Lives, Who Dies," about laymen at a Seattle hospital who judged which patients would get scarce treatment on the first "artificial kidney machine." The outcry that followed is often credited for the birth of bioethics and for the 1972 law guaranteeing coverage.

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http://www.nytimes.com/2011/12/21/ny...t-covered.html

He should go back to Mexico and get his treatment there. Make the Mexican consulate pay to send him back. He should not be treated here. We must stop illegal immigrants from receiving organ transplants in this county when they are paid for by the taxpayer.

yes you are right Our Citizen need help & they can not get it how come all other Country get help & the hell with us
this has to stop
No amnesty or Dream act at all

I'll reserve my sympathy for American citizens without insurance and without the option of traveling to Mexico. We cannot and should not become the world's free clinic.

"Liver transplants for illegal aliens: Entitlements + open borders = disaster

By Michelle Malkin • April 14, 2008 10:11 AM
I’ve written before about organ transplants for illegal aliens–and been attacked by the usual socialist suspects as cruel, heartless, and racist for questioning the wisdom of US public policy that indiscriminately allocates scarce health resources at taxpayer expense to illegal immigrants. The open-borders entitlement mentality has only grown deeper since the last time this issue went national with the case of Jessica Santillan. The ideologues who believe that America should be the medical welcome mat to the world have prevailed. Via the Los Angeles Times:

Ana Puente was an infant with a liver disorder when her aunt brought her illegally to the U.S. to seek medical care. She underwent two liver transplants at UCLA Medical Center as a child in 1989 and a third in 1998, each paid for by the state.
But when Puente turned 21 last June, she aged out of her state-funded health insurance and was unable to continue treatment at UCLA.
This year, her liver began failing again and she was hospitalized at County-USC Medical Center. In her Medi-Cal application, a USC doctor wrote, “Her current clinical course is irreversible, progressive and will lead to death without another liver transplant.” The application was denied.
The county gave her medication but does not have the resources to perform transplants.
Late last month Puente learned of another, little-known option for patients with certain healthcare needs. If she notified U.S. Citizenship and Immigration Services that she was in the country illegally, state health officials might grant her full Medi-Cal coverage. Puente did so, her benefits were restored and she is now awaiting a fourth transplant at UCLA.
Puente’s case highlights two controversial issues: Should illegal immigrants receive liver transplants in the U.S. and should taxpayers pick up the cost?
The average cost of a liver transplant and first-year follow-up is nearly $490,000, and anti-rejection medications can run more than $30,000 annually, according to the United Network for Organ Sharing, which oversees transplantation nationwide.
Donor livers are also in scarce supply. In California, nearly 3,700 people are on a waiting list for livers, according to the network. Last year, 767 liver transplants were performed in the state. More than 90% of the organs were given to U.S. citizens.
Donor livers are generally allocated through a geographically based distribution system on the basis of how sick the patients are and how long they have been on the transplant waiting list.
Immigration status does not play a role in allocating organs.

Doctors and illegal alien patients rely on DHS incompetence and the deportation abyss to abet them:

If illegal immigrants inform the state in writing that U.S. immigration services “is aware of their presence and does not plan to deport them,” they could be eligible for full-scope Medi-Cal, said Norman Williams, spokesman for the state health department. Medical condition is one factor that would make immigrants eligible for coverage.
The immigrants send a form to Citizenship and Immigration Services, but the agency said it does not respond to patients or make any promises about their immigration status.

And the game continues, with illegal immigrants now voicing indignation at the inconvenience:

Jose Lopez said he came to the U.S. with his mother illegally as a child. Soon after, he contracted hepatitis A and received his first liver transplant. Eight years later, he got cirrhosis and received another transplant.
Both were performed at UCLA and paid for by the state.
As his 21st birthday approached, his mother, Maria Elena Lopez, searched for clinics that might agree to treat her son. She applied for Medi-Cal for him but has not received a response.
Her son turned 21 on Aug. 7. He said the UCLA doctors gave him extra medications to hold him over.
About a month later, his mother found the Roybal clinic, which provided Lopez with medication and monitored his care. Though his drugs never lapsed, his liver is still in rejection.
“I’m just mad,” he said from the Los Angeles apartment he shares with his parents. “You can’t just leave a person to die. That’s pretty much what they’re telling me: ‘You’re illegally here. We’re just gonna let you die.’ ”
He said he doesn’t blame UCLA for not wanting to treat him free, but added, “I was hoping for some miracle.”
Lopez just learned about the relief Puente received and said he may follow the same route. He hopes to return to UCLA for treatment.

Question: Would the Mexican government stand for illegal aliens on its soil demanding such entitlement?
Hell, no.

http://michellemalkin.com/2008/04/14...-open-borders/

Closing thread/ duplicate article/ post new comments here: http://www.alipac.us/threads/246243-...-at-Transplant