9-15-09, 9:26 am

Original source: The Atlanta Progressive News

(APN) ATLANTA – A coalition of advocacy groups on Thursday, September 10, 2009, called on officials to delay the closure of the Grady Health System Outpatient Dialysis Clinic until care can be found for all patients using those services.

The private, non-profit corporation that runs Grady will meet later today, Monday, September 14, at 3:30pm to discuss the issue. Another protest is planned today at 2:30 in front of Grady.

About 50 activists, led by the Grady Coalition and Grady Advocates for Responsible Care, rallied in front of Grady Memorial Hospital to protest the closure of the dialysis clinic, which could occur as early as September 19.

'This is a life and death situation,' the Rev. Timothy McDonald, pastor of East Atlanta’s First Iconium Baptist Church and Grady Coalition co-chair, said. 'Grady will be issuing a death sentence if they do not find a way to continue services.'

The coalition sent a letter last Saturday to the Grady Memorial Hospital Corporation (GMHC), asking them to delay closing the center and to meet with them in order to find ways to make sure all clinic patients receive proper treatment.

'We’re going to keep coming back until they change the decision,' State Sen. Vincent Fort (D-Atlanta), Grady Coalition co-chair, said. 'No father’s daughter ought to ask... why does my daddy have to die?'   The dialysis clinic, located on Grady’s ninth floor, serves between 90 and 100 patients and is set to post a $2.5 million loss this year.

The clinic’s patient mix breaks down as follows: 20 percent paying patients; 21 percent undocumented, uninsured immigrant patients from Fulton and DeKalb Counties; 14 percent uninsured patients from other counties; 10 percent 'pending payment'; 8 percent prisoners from Fulton and DeKalb; and 27 percent documented, uninsured patients from Fulton and DeKalb.

The GMHC and CEO Michael Young have argued dialysis services should be farmed out to the private market not only to save money but to better serve the patients.

As previously reported by Atlanta Progressive News, the GMHC’s July 2009 meeting, Senior Vice President of Operations Denise Williams and Chief Nursing Officer Rhonda Scott recommended Grady contract with Fresenius Medical Care, the world’s largest provider of dialysis products and services.

Fresenius has 25 centers within a 25-mile radius of Grady, the closest located on 14th Street, 2.5 miles away. Williams and Scott argued these clinics are equipped with modern technology, have much more space, offer better parking options, and are accessible via public transportation, most notably MARTA’s paratransit service for disabled riders.

The Board voted to give staff permission to begin negotiating a contract with Fresenius, which had already expressed a willingness to enter into a two-year contract, according to Williams and Scott.

While officials promised to help all patients receive the treatment they need, several activists on Thursday said that is not entirely true.

'We have not been assured nor have the patients been assured they will continue receiving treatment,' Dorothy Leone-Glasser, a Grady nurse, said.

APN obtained two letters dated August 13 and 14, 2009, respectively, sent to two different, unnamed dialysis patients informing them the clinic would close either September 19 or 20, depending on the letter.

The August 14 letter came with a list of dialysis providers located in the patient’s county of residence and assured the patient that staff 'will continue to provide dialysis placement resources and information to you as we move forward with this transition.'

Leone-Glasser said many of the referral clinics would only treat patients who could provide tax identification and Social Security numbers, a conundrum that poses a particular problem to the undocumented immigrant patients.

She noted many of these undocumented patients have been told verbally to consider returning to their native country, moving to another state, or to use emergency room services for dialysis when they get very sick.

'To tell dialysis patients to go home or to go to another state... is a death sentence,' Fort argued.

According to activist Dianne Mathiowetz, this issue will not only affect undocumented immigrants, but also individuals who may be US citizens but have not lived in Georgia long enough--five years--to qualify for Medicaid.

'If you've lived here less than five years you don't qualify for assistance,' Leone-Glasser told APN.

One option for these individuals is to move to another state where they may be able to apply for Medicaid right away, because the rules in other states are different than those in Georgia as far as how long you have to live there to qualify for Medicaid; they would still have to wait three or four months to see if their application is approved.

In addition, several patients who may be eligible for Medicaid in Georgia, even if they applied immediately, would likely not begin receiving coverage for several months while their application is processed, Mathiowetz said.

For those patients, it is up to them to contact other hospitals and ask whether they will provide free care for them until Medicaid kicks in. Some of the individuals affected speak little English, she said. And the private clinics are likely to say no, she argued.

'The private clinics will definitely say no if they don't have a contract with Grady, if they don't have private insurance or Medicaid. The cost is approximately $6,000 for dialysis per patient. I only know of one company right now that has a contract with Grady. According to the most recent info, that company is not taking everyone. Also, there are patients from outside Fulton and Dekalb, and they're absolutely not taking anybody that's not from Fulton or Dekalb Counties,' Leone-Glasser said.

Dr. Neil Schulman, a Grady doctor, said many of the patients have nowhere to go.

'Under no circumstances should these people be sent anyplace without an absolute, 100 percent guarantee they won’t miss their dialysis.'

'We don’t care if the patients are documented or undocumented,' McDonald said. 'What does it say about this new Board if we can simply put people out to pasture to die?'

'The main thing is grady has been telling the press and the public that they are going to be taken care of. I've heard of 23 patients who haven't heard from Grady yet, and definitely there are no written contracts for them to be ensured that they are getting transitional care at another facility,' Leone-Glasser told APN.

'These is one contract, but the details of who will be covered under that contract has not been shared despite our attempts to obtain that information,' Leone-Glasser said.

--Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News, reachable at jonathan@atlantaprogressivenews.com.