Thread: Undocumented immigrants in Houston desperately needing kidney dialysis overwhelm publ

Undocumented immigrants in Houston desperately needing kidney dialysis overwhelm public hospitals

Undocumented immigrants, health care system face'crisis situation' over dialysis treatment for kidney patients

By Markian Hawryluk
June 18, 2016 Updated: June 18, 2016 10:03pm

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Photo: Marie D. De Jesus, Staff
Guadalupe Alba, 48, receives dialysis at Harris Health's Riverside Dialysis Center, which treats undocumented patients.



Ricardo Delgadillo arrives at Ben Taub Hospital well before sunrise as part of a weekly ritual, close enough to death to maximize his chances for emergency kidney dialysis.

As an undocumented immigrant, he must wait until his renal failure becomes sufficiently dire for federal law to kick in and require doctors to hook him up to a machine that will cleanse his blood, then he'll come back in a few days and do it all over again.

Harris County's public health system is overwhelmed treating 200 to 300 undocumented patients like Delgadillo who need dialysis at least several times a month to stay alive. Taxpayers foot the entire patient cost of about $285,000 a year for the emergency treatment and complications that often arise, the most expensive way to provide the care.

In 2008, Harris County opened a farsighted dialysis clinic for undocumented patients as a means of cutting the cost of emergency services. The clinic provides 50 percent more dialysis treatment per patient at a cost of about $77,000 a year, but it is full, and Harris Health, facing a $70 million deficit, now finds it hard to invest in expanding such alternatives.

Even better care and greater savings could be realized, Harris Health physicians say, by performing kidney transplants on undocumented individuals in the Houston area whose relatives could serve as donors. But putting the undocumented on transplant lists, which could radically improve their life expectancies, is considered a political nonstarter in Texas.

Harris County's current system for providing dialysis on an emergency basis has proven to be the least efficient and humane way to provide ongoing care. "Some of them spend most of their life in the emergency department waiting to qualify for dialysis," said Dr. David Sheikh-Hamad, chief of renal services at Ben Taub, Harris County's largest public hospital. "These are essentially our community residents, and we can't really close our eyes to them and ignore them as if they didn't exist. … We're operating under a crisis situation from day to day."

Worst cases first

Delgadillo must drive 30 to 40 minutes to Ben Taub, sometimes alone, sometimes with his wife, Ebette. She owns a clothing store where Delgadillo works when he can muster the strength. They have two children, a 14-year-old daughter and a 13-year-old son. His brother-in-law takes the kids to school on days when he and his wife are at the hospital.

The dialysis room at Ben Taub doesn't open until 7 a.m., but Delgadillo has learned that he has to arrive early to maximize his chances of getting in. "Sometimes we get through on the first round, sometimes we're going to be second one or the third," he said. "Depends how you are looking after the blood testing."

One recent Wednesday morning, before dawn, Delgadillo went through the agonizingly slow drill: a technician drained two vials of blood from his arm, first step toward confirming that his sodium and potassium levels were high enough to require immediate treatment. Some patients admit to eating entire bunches of bananas or drinking the fluid from canned tomatoes to boost potassium levels and increase their odds of treatment.

Then it was almost an hour before he was called back for the EKG. He lifted the bottom of his hooded sweatshirt, revealing a catheter wrapped in gauze hanging from his chest.

In some ways, this catheter, known as a permacath, identifies Delgadillo better than the hospital bracelet on his wrist, a tell-tale sign of his health problems and his immigration status.

He grew up about an hour outside of Mexico City. When he was 19, economic stagnation drove him north to seek work in the United States, and "a better life for my family."

He had been diagnosed with high blood pressure, and doctors told him he would have problems with his kidneys. Two years ago, when he lost his appetite for food or drink, doctors performed an ultrasound and a CT scan, and immediately admitted him to the hospital with kidney failure. Over the next four days, he underwent dialysis twice, and ever since, he's had to come back for treatment every four to five days.

Dialysis replaces only some of the work of the kidneys, removing waste products, salt and excess water from the blood stream. Without it, urea builds up in the brain, causing headaches and nausea. Fluid seeps into the lungs and potassium levels can climb so high they disrupt normal heart rhythms.

With only a dozen dialysis chairs at the hospital, doctors take the worst cases first. Others are told to wait or to try again tomorrow.

One week, Delgadillo was deferred four days in a row.

Harris Health System sees about 20 to 30 patients each day seeking emergency dialysis, 500 patient visits per month at Ben Taub, another 350 at Lyndon B. Johnson Hospital across town.

"They don't all get dialysis, but they all get an EKG and blood work," Hamad said. "A lot of resources are being put into these patients."

The ideal frequency of dialysis depends on how badly the kidneys are damaged and how much residual function remains. Dialysis three times a week is considered the standard, but even then, it's a losing proposition. The kidneys work 24 hours a day to cleanse the blood, so a three-hour dialysis session can only do so much. As a result, life expectancy for dialysis patients runs from three to 10 years, although some survive for decades.

"There's a spectrum, those patients who come once or twice a month for dialysis, and then we have patients who come every day," said Dr. John Foringer, a nephrologist with UTHealth and Harris Health.

Emergency patients only get dialyzed on average once per week. That increases the risk of complications, which often leads to hospital and intensive care stays and drives up costs. One study found that skipping at least one dialysis session per month is associated with a 25 to 30 percent higher risk of death.

More rational approach

When Hamad became chief of renal services at Ben Taub in 2000, the situation was much worse. Patients were getting temporary catheters each time they showed up for emergency dialysis, damaging their veins and leading to infections. Hamad instituted the use of permacaths, a soft plastic tube inserted into a large vein in the base of the neck. About 6 inches of the tube extend outside of the body, splitting into two ends that can be connected to the dialysis machine. Patients with permacaths can get into dialysis faster and with fewer complications at a lower cost.

Hamad also was bothered by the way the hospital was treating patients who had long been a contributing part of the community. Some were in the country legally, but had not yet paid enough into the Social Security program to qualify for Medicare benefits. Moral and ethical considerations aside, he thought he could make an economic argument for a more rational approach.

In 2007, Hamad published a study that compared the health care costs incurred by those receiving emergency dialysis with those getting regularly scheduled dialysis in outpatient clinics.

Armed with the potential for cost savings, he convinced county and hospital officials to open the Riverside Dialysis Center in 2008, where undocumented patients could get dialysis three times a week. While most dialysis clinics have a mortality rate of 5 to 10 percent per year, at Riverside, it's less than 5 percent. Moreover, the clinic provides dialysis at an average cost of $33,000 per year per patient.

"We can provide better care at lower cost," Hamad said.

The original proposal was to serve one Medicare patient for every two uninsured patients, to offset the costs.

"Within a year of this place being open, it was already saturated with unfunded patients, sending all the funded patients to other places," said Dr. Michael Gardner, the administrator of ambulatory care services at Harris Health.

Medicare pays about $75,000 to $80,000 per year for dialysis, more than double what it costs the clinic. The rate is so lucrative it's driven huge growth in for-profit dialysis clinics. If Harris Health turns away Medicare patients, those private clinics are happy to take them. The uninsured and undocumented have nowhere else to go.

"Obviously, from a business point of view, that's a poor choice," he said.

The Riverside clinic started with three shifts per day using all 21 chairs, for a total of 126 patients per week. Demand was so great they added a fourth shift, bringing the total to 168, and keeping the clinic open a staggering 20 hours per day.
Last August, Mario Flores, a 56-year-old roofer who came to the U.S. from Mexico in 1986, was fortunate to gain a patient slot in the clinic after years of treatment in the emergency room at Ben Taub. His health has rebounded.

"It's three times a week, and it's perfect," Flores said through an interpreter of his current regimen.

Costly care

A few years ago, Harris Health paid to have 45 patients get dialysis through private clinics around town. That may have lowered the deferral rate in the emergency room, but it didn't save any money as new patients quickly took their places. Now the cash-strapped public health system couldn't come up with the money to outsource patients if it wanted to.

"Harris Health is projecting another deficit next year, so where does that money come from?" Gardner said.

Gardner recently spent time at Grady Hospital in Atlanta, where administrators shut down their outpatient dialysis centers because they couldn't absorb the costs of treating undocumented immigrants.

"They don't have the undocumented population that we have in Houston," he said. "Dallas doesn't do this. El Paso doesn't do this. Fort Worth doesn't do this."

The exception among safety-net hospitals in Texas is in San Antonio, where the dialysis center is big enough to handle both Medicare-funded and unfunded patients.

The dialysis room at Ben Taub was intended for patients who had been admitted to the hospital for other reasons. It is so small, that if it opened today, it would no longer meet code for the necessary space between patients.

Some patients are so unstable when they arrive, they must be dialyzed in the intensive care unit or one of the shock trauma rooms. It's not uncommon for one or two of Ben Taub's five trauma bays to be tied up for hours with dialysis patients.
"Both Ben Taub and LBJ struggle almost on a daily basis to try to transfer out," Gardner said. "It's getting difficult to find hospitals that will even accept the patients. These are sick people, and their health care is costly."

Harris Health officials are in the process of implementing a peritoneal dialysis program that could shift a significant number of patients to home dialysis. Peritoneal dialysis involves filling the abdominal cavity with dialysis fluid through a catheter. The liquid pulls waste products out of the blood over a couple of hours and is then drained from the body. After the two- to three-week initial training, the patient can do the dialysis at home, coming in to a clinic only once a month.

"It's my hope that by summer 2017, if you present to Harris Health with end-stage renal disease, that peritoneal dialysis will be our first-line therapy," Gardner said. "We don't think it will be a panacea. But we think it will be a step in the right direction."
The better solution, Hamad said, is a kidney transplant. Not only are the quality of life and outcomes better, over the long haul, it saves money. The average cost of a transplant is recouped in dialysis savings in less than three years. Undocumented immigrants might be even better transplant candidates because they are generally younger than the average American with kidney failure.

But there is political resistance to putting undocumented immigrants on transplant waiting lists. Even if they show up with a family member willing to donate a kidney, without insurance, they're unlikely to be able to afford the cost of the transplant or the immunosuppression drugs to prevent rejection.

Nationwide problem

"There's this urban myth that by offering these (dialysis) services, we're attracting the undocumented to come," Gardner said. "That just isn't the case."

California has implemented statewide outpatient dialysis coverage for undocumented immigrants and has not seen its caseload increase.

Public hospitals throughout the country are struggling with how to deal with the emergency dialysis problem. Texas and several other states have determined that the need for dialysis is not automatically an emergency that qualifies an individual for Medicaid. Harris Health officials are trying to make the case for outpatient dialysis by calculating how much money Medicaid loses by waiting until patients are near death.

Meanwhile, by 7:11 am, after more than three hours of waiting at Ben Taub, Delgadillo was one of the lucky ones. A nurse led him and another patient to the elevator, up to the sixth floor and down a long hallway to the dialysis room. Delgadillo was right on the nurse's heels, but the other man could barely shuffle along in his flip-flops. Ebette would wait outside for three hours as her husband's blood was cleansed and then they would drive home, completing their eight-hour ordeal.

Every four or five days, they'll repeat the same grueling process.

http://www.houstonchronicle.com/news/houston-texas/houston/article/Undocumented-immigrants-in-Houston-desperately-8311380.php?t=56112a84d8&cmpid=fb-premium

It's very simple how you deal with this problem, you deport them. These problems are not our problems to solve, pay for, work around or deal with. For any hospital to provide this type of maintenance care to illegal aliens while Americans wait in line is wrong, immoral, indecent and treasonous.

Now get these people out of here and back to their home country where they can deal with their medical matters.

MARCH 21, 2013 BY ALFREDWCLARK
Mexico’s Diabetes Epidemic

Note: Shortly after writing this, Mexico was declared the official fattest country in the world.

As Steve Sailer has pointed out (here, here and here), Mexico is the second fattest country in the world, next to the United States, and, according to experts, on its way to becoming most obese. I suspect that if you were to subtract the Hispanics / mestizos and blacks from the American data and only compare European Americans with Mexicans, Mexico would already be the most obese country in the world. As was recently reported:

“With each bite into a greasy taco and slurp of a sugary drink, Mexico hurtles toward what health experts predict will be a public health crisis from diabetes-related disease.

A fifth of all Mexican women and more than a quarter of men are believed to be at risk for diabetes now. It’s already the nation’s No. 1 killer, taking some 70,000 lives a year, far more than gangster violence.”

Mexicans are facing a diabetes epidemic, perhaps the worst the world has ever seen. Mexico currently has the second highest diabetes rate in the world, and soon expected to have the highest.

What the causes of this rapid obesity and diabetes epidemic are, health experts are still arguing.

First, Mexican food, on average, is extremely low in nutritional value and extremely high in calories. While traditional Mexican meals already were quite high in calories and low in nutritional value, add to these recent popular food items like the chocolate filled Twinkie-like cake called “Gansito” and you have an extremely high-calorie diet.

Second, recent wealth and more contact with the USA have increased opportunities for Mexicans to eat more Westernized foods, especially fast, junk and high-carb foods. Someone on NPR recently suggested that Mexicans’ diets have drastically changed over the last decade or two.

Yet, all of this seems to be symptomatic, not getting at the real roots, for even if Mexicans’ diets have changed, they’re eating the same garbage that whites or now many North Asians are eating, yet they seem to suffer more.

Looking at the racial demographics of Mexico, Mexico is roughly 30% Amerindian and 60% Mestizo (of whom the average admixture, at least for the lower classes, is 59% Amerindian, 34% Spaniard, and 6% black).

I wonder whether something else might be going on.

Using Dennis Mangan as a point of departure, the recent increased wealth in Mexico added to increased access to calories might be acting as supernormal stimuli. Mexicans also might have lower impulse-control, making it more difficult for them to withstand the temptation of nearly limitless access to calories.

Another possibility, given the largely non-European ancestry of most Mexicans, is that Mexicans might not be well adapted to eat Western foods and are suffering accordingly. This would be an interesting study.

Already there have been some studies showing that different races gain and lose weight differently.

Regardless, this could have real consequences in the USA. A recent study found that people with diabetes usually make around $160,000 less over a 40-year period because of complications. Healthcare costs for people with diabetes are around 2.3x higher than for the non-diabetic. Current costs for diabetes in the USA are staggering. Add to this the rising Hispanic population in the USA of whom many will probably develop diabetes and the fact that many Mexicans will come to the USA to try to receive free treatment for diabetes, and there very well could be a healthcare crisis.

Mexicans

Update:
Mexico was just declared the fattest country in the world.
“Mexicans, fattest people on planet, at genetic risk for diabetes?”

https://occamsrazormag.wordpress.com...etes-epidemic/

http://www.alipac.us/f12/does-anybod...border-267648/

http://www.alipac.us/f12/more-than-3...gal-im-201668/

http://www.alipac.us/f12/group-urges...igrants-15918/

http://www.alipac.us/f12/illegal-imm...-system-27174/

http://www.alipac.us/f12/immigrants-...tlement-53520/

http://www.alipac.us/f12/ias-getting...sulates-85781/

http://www.alipac.us/f12/inmates-car...budget-105646/

http://www.alipac.us/f12/illegal-imm...alysis-129932/

http://www.alipac.us/f12/dialysis-im...o-debt-158361/

http://www.alipac.us/f12/2-3s-atlant...llegal-161851/

http://www.alipac.us/f9/illegal-immi...ve-pay-169828/

http://www.alipac.us/f19/medicare-ra...alysis-170116/

http://www.alipac.us/f12/illegal-ali...d-care-177635/

this is 2010, it is more now..
http://www.alipac.us/f12/illegal-imm...ollars-189281/

http://www.alipac.us/f12/2-3s-atlant...llegal-161851/

http://www.alipac.us/f12/free-dialys...tlanta-200542/

http://www.alipac.us/f12/dialysis-pr...tients-201674/

Hospital Falters as Refuge for Illegal Immigrants

By KEVIN SACK
NOV. 20, 2009

ATLANTA — Each had crossed the border years before, smuggled across the desert by a coyote, never imagining the journey would lead to a drab and dusty clinic on the ninth floor of Grady Memorial Hospital in Atlanta.

Some knew before the crossing that they had diabetes or lupus or high blood pressure, but it was only after they arrived that their kidneys began to fail. To survive, they needed dialysis at a cost of about $50,000 a year, which their sporadic work as housekeepers, painters and laborers could not begin to cover.

And so they turned to Grady, a taxpayer-supported safety-net hospital that would provide dialysis to anyone in need, even illegal immigrants with no insurance or ability to pay. Every Tuesday, Thursday and Saturday morning, the 15 or so patients would settle into their recliners, four to a room, and while away the monotonous three-hour treatments by chitchatting in Spanish.

That all changed on Oct. 4, when the strapped public hospital closed its outpatient dialysis clinic, leaving 51 patients — almost all illegal immigrants — in a life-or-death limbo.

For Grady, which has served Atlanta’s poor for 117 years, it was an excruciating choice, a stark reflection of what happens when the country’s inadequate health care system confronts its defective immigration policy.

Like other hospitals, particularly public hospitals, Grady has been left to provide costly treatments to nonpaying illegal residents who most likely could not have obtained such care in their home countries. American taxpayers and health care consumers have borne the expense.

Over time, the mounting losses have compromised Grady’s charitable mission, forcing layoffs, increases in fees and the elimination of services.

“Years and years of providing this free care has led Grady to the breaking point,” said Matt Gove, one of the hospital’s senior vice presidents. “If we don’t make the gut-wrenching decisions now, there won’t be a Grady later. Then, everyone loses.”
But for the dialysis patients, the sudden end to their reassuring routine has prompted a panic.

“We didn’t know what to do,” said Ignacio G. Lopez, 23, who had been sustained by the clinic for more than three years. “We can pass away if we stay like two weeks without dialysis. They were just sending us out to die.”

The chairman of Grady’s recently reconstituted board, A. D. Correll, has said the hospital would not let that happen. “We made a commitment right up front that people are not going to die on the street because of these actions,” said Mr. Correll, a former chairman of the Georgia-Pacific Corporation and a prominent civic leader here.
Soccer and Telenovelas

In fact, the future for many of the patients remains uncertain. Like most of the country’s estimated 11 million illegal

immigrants, they have little access to continuing health care, a reality not addressed by the legislation now under discussion in Washington.



Fidelia Perez in a hospital room after receiving emergency dialysis on Oct. 13.CreditDavid Walter Banks for The New York Times

Across the years, the Grady dialysis patients had forged a community, a family, really, of people who share a history and language, as well as a life-threatening condition. As the machines cleansed the toxins from their blood, they would talk about the scarcity of work, the ruthlessness of their disease and their hopes for a transplant. Some would sleep, while others crooned folksongs to drown out the snores.

Any given morning might find Mr. Lopez bickering with Fidelia G. Perez about whether to watch their soap operas, or telenovelas, in English or Spanish. From another chair, Rosa Lira, a frail grandmother, would look up from her prayer book to boast of the previous night’s exploits by Club America, her favorite Mexican soccer team. Rosa Palma de Gamez, from El Salvador, would grin when Ismael Sagrero arrived with his trademark greeting — “Hola-hola!” — which had become his nickname.

Now the patients are trying desperately to figure out their next steps.

With limited exceptions, illegal immigrants are ineligible for public insurance programs like Medicaid and Medicare and often cannot afford private coverage. When major illness strikes, they have few options but to go to emergency rooms, which are required by federal law to treat anyone whose health is deemed in serious jeopardy.

Officials at Grady, which will provide more than $300 million in uncompensated care this year, estimate that as many as a fifth of its uninsured patients are illegal immigrants. Although the numbers are elusive, a national study by the RAND Corporation concluded that illegal immigrants account for about 1.3 percent of public health spending.

The recession has prompted some state and local governments to pare programs that benefit illegal immigrants. And although illegal immigrants may account for about seven million of the country’s 46 million uninsured, the health care bills being negotiated by Congress exclude them from expansions of subsidized public insurance. (The House bill that passed on Nov. 7 would allow illegal immigrants to buy policies at full cost on government-run exchanges, while legislation being considered in the Senate would forbid it.)

Calling it “a horrible situation,” Mr. Correll said that governments at all levels had decided that immigrants were not their problem. “But somehow,” he said, “they’ve become Grady’s problem, which seems totally unfair.”

Some of the Grady dialysis patients have chosen to return to their countries, encouraged by the hospital’s offer of free airfare, cash payments, three months of paid dialysis and assistance in seeking insurance or other long-term remedies. Others are trying their luck in states where Medicaid policies may be less restrictive.

But most remain in Atlanta, taking full advantage of a last-minute offer by the hospital, in response to a lawsuit, to pay for three months of dialysis at commercial clinics. They are hopeful that the reprieve will buy time for the lawsuit to progress or for private dialysis providers to take them as charity cases.

What they fear, however, is that their already fragile lives will soon be reduced to a frenzied search for their next dialysis, most likely in an emergency room after a descent into crisis.

Looking for a Better Life

They need only look to Ms. Perez to see what the future may hold.

After hearing that the clinic would close, Ms. Perez, 32, set out for Alabama on Sept. 6 because cousins told her they might be able to procure dialysis there. Grady was not yet offering its deal for three months of treatment, and instead gave her $1,300, enough to cover dialysis for a week or two.

Ms. Perez said the money was quickly spent on rent, food and transportation. After going without dialysis for 16 days, she walked into an emergency room near Birmingham, which found that the potassium levels in her blood were high enough to require immediate filtration. Eight days later, she did the same at another Birmingham hospital.

“They said this was the first and last time they would help me,” she said. “They told me I didn’t have any right to be there.”



Bertha A. Montelongo, 59, a longtime diabetic, went blind last year and relies on her daughter’s family. She has few relatives in Mexico. CreditDavid Walter Banks for The New York Times

She went back to the first hospital, where she was dialyzed again, and then found a third hospital that was willing to provide three treatments. A doctor there tried to find a private dialysis clinic that would accept her but came up empty, she said.

So she returned to Atlanta on Oct. 11, and underwent one more emergency treatment before agreeing to fly home to Mexico with assistance from Grady and a California company, MexCare, that the hospital has hired to help repatriate interested patients.
Ms. Perez’s parents live in Mexico and can care for her, but in many cases the patients’ families and sources of support are in the United States. Some do not want to uproot their American-born children, or abandon their spouses or jobs. Often they do not trust the quality or availability of dialysis in Latin America.

Like other patients, Adolfo D. Sanchez, 31, said he was astonished to learn when his kidneys failed in 2004 that Grady would provide him ongoing dialysis without charge. A subsistence farmer in Mexico, he said he had paid a coyote $1,500 in 2001 to lead him on an eight-day trek across the Arizona border to Phoenix and then to Atlanta, where his sister had settled.
Three years later, while working in construction, he found he could not keep down the small tacos he ate for lunch. A local clinic referred him to Grady, which diagnosed his kidney failure and placed him on dialysis.

“No place in Mexico would have offered dialysis for free,” he said, sitting in the spare apartment he shares with his girlfriend and their 13-year-old son. “It was better to be here. I am really grateful that this is possible in this country, because if I were in my country I would already have died”

Bertha A. Montelongo, a 59-year-old widow who said she entered the United States illegally in 2005, started having seizures and shortness of breath about a month after arriving in Atlanta.

“I came to look for a better life,” she said, “but then I became sick, and that was it.”

A diabetic, Ms. Montelongo has survived for four years on dialysis, but lost her vision last December. That has made her dependent on her daughter, who baby-sits and sells homemade tamales; her son-in-law, an out-of-work landscaper; and her granddaughters. They live in a rented house in the suburbs where the mantel is lit with votives.

For a blind woman, returning to Mexico, where few family members remain, is not an option, Ms. Montelongo and her family said.

“All the people here on dialysis think the same thing,” said her daughter, Letecia. “They all think that if they go back to Mexico, they will die sooner. In Mexico, it’s different. There, you have to pay.”

Creating a Crisis on Purpose

It has been different for the 25 or so United States citizens who were patients at the dialysis clinic. They were either already on Medicare or about to become eligible, and are thus being readily treated by private dialysis clinics. After a three-month waiting period, the federal insurance program covers anyone with end-stage renal disease, regardless of age, and pays 80 percent of the cost of dialysis.

But illegal immigrants are not eligible for Medicare, and legal immigrants must wait five years to qualify. A few states use emergency Medicaid programs to cover ongoing dialysis for certain illegal immigrants, but Georgia discontinued the practice in 2006.



From left, Rosa Palma de Gamez, Rosa Lira and Fidelia G. Perez were among the 51 patients whose lives were thrown into chaos last month when Grady Memorial Hospital in Atlanta closed its dialysis clinic. With the hospital’s help, Ms. Perez has since returned to her native Mexico. CreditDavid Walter Banks for The New York Times

That sent waves of uninsured dialysis patients from across the region to Grady, which is supported by direct appropriations from Fulton and DeKalb Counties, ostensibly to care for their own residents. The hospital lost $3.5 million on the dialysis clinic last year, said Mr. Gove, the Grady spokesman. Its 88 dialysis patients accounted for a 10th of total losses at a hospital with more than 800,000 patient visits a year, he said.

The board acted, Mr. Correll said, because Grady’s dialysis equipment had become obsolete, requiring heavy investment. It was evident, given that so many patients were undocumented and uninsured, that the losses would never stop.

“It was just financially hopeless,” Mr. Correll said. “For every vacancy that opened up, another nonpaying patient would walk in the door, so it was going to last forever.”

Mr. Correll said the hospital “had to precipitate a crisis” in the hope that other hospitals, dialysis centers and governments might pitch in.

Each of the remaining patients has signed an agreement stipulating that Grady will pay for private dialysis provided by Fresenius Medical Services for no more than three months, Mr. Gove said. The patients agreed to work with the hospital during that period to devise long-range plans for their care, possibly including repatriation.

What Grady has not told the patients is that its contract with Fresenius, which sets a price of $280 per treatment, covers their care for up to one year. Mr. Gove said the contract gave Grady the flexibility to continue paying for patients who fail to make other arrangements by Jan. 3. But he said the hospital’s offer to arrange repatriation would end at that point.

“As patients, they are ultimately responsible for their care,” Mr. Gove said.

The hospital’s agreement with MexCare, obtained through a state open records request, calls for Grady to pay $18,000 for every patient relocated — $6,750 in travel expenses and escort fees, a $750 administrative fee, and payment for 30 dialysis treatments at $350 each.

Two years ago, the Grady board, then dominated by political appointees, undercut its chief executive’s plan to close the dialysis clinic. The new board, now led by business leaders, hopes to save the hospital by convincing corporations and other potential donors that its fiscal discipline is worthy of support.

Mr. Correll said closing the dialysis clinic was “important to the future financial and operational success of Grady, because people have confidence now that the board will make a tough decision if it has to, and do it in the most humane way possible.”

When Mr. Lopez first showed up at Grady in 2006, five years after he had crossed into Arizona at age 15, his disease had turned his skin a pallid gray. The doctors told him he was lucky he had not waited another day.

The charge for the initial hospital stay ran to $40,000; he said his stack of bills now totaled more than $100,000. “I try to pay little by little,” he said, “but I’m never going to finish.”

He said he had never expected such generosity from American health care, calling it “very humane.” After each dialysis treatment at Grady, he said, he would thank the nurses.

“You saved my life,” he would tell them. “One more time, you saved my life.”

http://www.nytimes.com/2009/11/21/he...y/21grady.html

Our stupid government hasn't got a damn brain in its head. None of these people should be in our country, they should all be deported and returned to their home countries, Mexico and others, this burdening Americans and our systems of charity, Medicare and Medicaid for illegal aliens of any type from any country is illegal, unconstitutional, and immoral. To serve illegal aliens, absorb the cost, while making Americans wait in lines adn charging them either directly or through insurance programs they fund, is WRONG!

VOTE TRUMP! He'll straighten out this gawd damn mess.

Send them to hospitals in THEIR countries!