The Crisis of the Grady Hospital Dialysis Clinic Closing

• Grady clearly stated that each patient currently receiving care from
Grady’s dialysis clinic will continue to receive dialysis care elsewhere.
To do so, Grady has promised that they will either transfer patients to
Fresenius or other local providers, move interested patients to states
that provide broad Medicaid support including coverage for
undocumented immigrants, or move interested patients back to their
home country. Advocates for Responsible Care, ARxC, knows of and has spoken to
individual patients who have neither received assurance of their impending
transition, nor have received care at a different clinic. We also know that
undocumented patients without SSNs (regardless of county) were not given
information (written or verbal) that Grady would pay for private dialysis or transfer
these patients to a specific clinic for ongoing care. Instead, the patients were
provided with either a list of dialysis centers or an offer to relocate or move to home
country. We have received at least ten (10) calls from patients stating that Grady has
never offered to pay for private dialysis or treatment at a specific dialysis center. We
have a list of over twenty (20) patients who have confirmed this to us.

• Other centers will not see patients without any insurance or means to
pay. It could cost $6,000.00 per month for a patient to receive dialysis at a private
center. It is common practice that private centers tell all callers that, unless they have
insurance or Medicaid, they cannot take them as customers.

• It is not an option for the vast majority of these patients to move to

another state, with no family or support, and with the certainty of losing
their jobs that they rely on to support themselves and their children.
These are very ill patients whose fragile health is susceptible to any external
stressors, such as traveling or disruption to their lives.

• If immigrant patients return to their country of origin, they will not

receive the quality care they need. The financial burden this would impose
combined with the fact that medical care for many of these patients would be
practically impossible, would create a situation where patients would have to
struggle to receive their dialysis treatment. Some were told if that if they were to
return to their native country, they would receive only ninety (90) days of dialysis
treatment, yet beyond this, they did not receive any strong assurance that this would
even be possible. Many other patients have already investigated the possibility of
care in their home country and have come to know it would not possible for them to
receive dialysis or transplant there.

• Some patients have not been offered individual assistance by social

services. These patients were told the clinic is closing, and were given a printed list
of nearby private dialysis centers, yet, as mentioned above, these centers will not
take these patients. Last week, some patients were interviewed by another
organization, MEXCARE, and were verbally notified that they could be given plane
 tickets home and possible health coverage in Mexico for 90 days. However, there was
never a written contract, and patients are being pressured to sign this agreement
by September 18, 2009, although it does not provide any details on the terms of the
contract. They were firmly notified that this offer would not be valid beyond that
date. Also, one Mexican patient from Gwinnet was later told by the social worker that
she does not qualify for this offer. The patient does not understand why she is not
eligible.

• In order to receive “inpatient” dialysis, these patients must wait until

they are considered ‘critical,’ at which point they would be allowed to go
through the emergency room. However, to receive the quantity of care they
need, patients would have to go to the emergency rooms 2-3 times per week. It is
complete misinformation that these patients simply have go to any hospital in the
Atlanta area which has a dialysis unit in order to receive dialysis treatment. There is
a total disconnect between the reality of this as a treatment option and an actual
long-term solution for these patients. The reasons:

1. Hospitals do not have to provide any care for the patient via the emergency room
(ER) unless the patient is interpreted by the ER doctor as being on the verge of death
in the next 48 hours or so. Therefore, in many cases, these patients will be turned
down by emergency rooms.
2. The suggestion that patients visit hospital ERs once, twice or three times per week,
only to wait for hours to be seen by an ER doctor and undergo various additional
blood tests at each visit to determine "if they are near death if not treated," is a
wholly impractical solution to keeping these patients alive. It would be psychological
torture for these people. In addition, it would affect a tremendous financial burden
to the health system.

• If patients do not receive the care they need, their conditions would
deteriorate, leaving them unable to manage their job and family
responsibilities. It has been said by some physicians and the social services of
Grady that undocumented Fulton and Dekalb patients are only to receive dialysis
treatment, paid for by Grady, for one year, after which there is no guarantee that
they will have access to dialysis treatment. In another words, the private dialysis
companies can simply deny these patients treatment after Grady stops its
reimbursements. This piece of information, concerning the private sector’s
limitations, has not been provided to the patients or the public.

• Patients have not even been informed of the one year of treatment that Grady plans
to provide. Because these patients understand are aware of the high cost of dialysis
—up to $6,000 per month—this tactic of withholding information may be used to
scare the patients into finding other sources of care. This way, Grady would not have
to pay for care or acknowledge their rightful responsibility to the patient and their
family, although the hospital understands that the patient cannot receive care when
they have no resources. This "psychological torture" is real and is being felt by the
patients and their families.
• Grady stated, “[Our] mission calls for us to care for the underserved
in Fulton Dekalb counties… If we are to expand our coverage, it must be
with expanded funding from state and federal sources.” This
acknowledgment only highlights the fact that Grady could get the money to keep the
clinic open if it was willing to make an account of how they spend the money they
receive. It is THEIR job to appeal to the Governor and Federal officials to get the
money to save these patients’ lives, especially considering that their treatment is not
optional. Treatment is a matter of life or death for these patients. We should not
have to be the ones who tell them this, BUT WE WILL. The Grady position is that
Grady "can't take care of everybody." However, there is no reference to the fact that
Grady has an obligation to these people because they have served as their sole
provider of care for some time. The Grady position is that Grady's mission is “not to
be the safety net provider for all these people”. We feel it necessary to respond by
reminding Grady that they have already made a commitment by taking care of these
patients for years—that is to say, we are not asking for Grady to take on new patients,
but simply to ensure the continuance of care for the patients they already serve. In
effect, Grady is denying their responsibility to these patients by simply “passing the
buck” to other states that might care for them, rather than attempting to devise a
workable solution within Georgia.

• Grady does have an agreement in place with Fresenius; however the

patients and their advocates have not been assured that the clinic will
provide care, covered by Grady, for EVERY Fulton and Dekalb patient
that has not chosen to leave Atlanta or settle with another provider. If
Grady truly planned to ensure and provide continued care for these patients, it is
doubtful that the hospital would have suggested these patients go to the emergency
room as inpatients to receive their care. We have spoken to over twenty (20) patients
and have two (2) patients testifying today and more documented patient cases
stating that these facts are true: Grady has not provided them with any document
outlining, in detail, the care they will receive, thereby denying these patients any
assurance of their continued care. Although undocumented patients comprise many
of the patients at the Grady Dialysis Clinic, some of these patients are American
citizens and legal residents of DeKalb or Fulton Counties and have been under
dialysis care at Grady ranging from one to three years.

• The patients of the Grady Dialysis Clinic have contacted The Advocates for
Responsible Care and have willingly given us their names and numbers pleading for
help. They do not know where they will get dialysis treatment after Saturday,
September 20, 2009.

• It appears that these patients have been deliberately frightened into leaving Atlanta,
leaving the country, or accepting their grim fate as kidney patients without access to
life-saving dialysis treatments. This coercion applies not only to those who live
outside Fulton and DeKalb counties, for even those patients residing within Grady’s
district of care have been the subject of the hospital’s bullying. It is clear that Grady
has taken this position of patient neglect and cultural incompetency to the highest
 limit, targeting those patients who are the sickest and most vulnerable. As healthcare
professionals, human rights believers and patient advocates, we are vehemently and
unequivocally opposed to Grady’s unacceptable policy of deliberately denying life-
sustaining care to the uninsured and underinsured of Atlanta. We see this as a
community and medical issue.

Posted on the wall of the Hemodialysis Clinic of Grady Hospital, in clear view of all, are the
words: You have the right to considerate and respectful care at all times. You have the
right to be well informed about your diagnosis, treatment, prognosis, possible treatment
and outcomes.

We are asking Grady to delay the closing of the Dialysis Clinic and to provide the continued
dialysis treatment for all of the clinic’s patients and to regain the respect and consideration
for the lives of every dialysis patient at the Grady Clinic. We cannot stop this call to action
until every patient can be at peace with knowing they will be able to continue to live by
receiving the dialysis care the so desperately need.

We will continue to be their voice until their voices are heard.

Advocates for Responsible Care:

Neil Shulman, MD

Dorothy Leone-Glasser, RN, HHC

Cristina Drenkard, MD, PhD

Elbert Tuttle, MD

Doyt Conn, MD

S. Sam Lim, MD, MPH

Daniel S. Blumenthal, MD, MPH

Ines Colmegna, MD

Kim Schofield

Sam Newcom, MD

Sandy McMath

Community Supporters:
Health Action Network

The Wisdom of Wellness Project, LLC.

 Georgia Council of Nephrology Social Workers

Georgia Society of Rheumatology

The Grady Coalition

S.T.A.R.S. for Patients

Hispanic Health Coalition of Georgia, Inc.

Racial and Ethnic Concerns Working Group

Atlantans Building Leadership for Empowerment

Universal Abundance

Lupus Foundation of America, Georgia Chapter

Diabetes Foundation of Georgia

Students and Volunteers of Advocates for Responsible Care

Metro Atlanta Task Force for the Homeless

Please contact:

Advocates for Responsible Care (ARxC)

Dorothy Leone-Glasser, dlg@wisdomofwellnessproject.com