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Dialysis and the Right to Health Care

According to this Article from the Atlanta Journal Constitution, a court has ruled that at least some health care is not a right.

In October, I linked to an article about how Grady Memorial Hospital in Atlanta was closing its dialysis clinics due to the significant financial burden. Grady has agreed to pay for the patients to receive dialysis at a private dialysis clinic until January 3, 2010, but after that, the patients are on their own.

After Grady’s announcement, approximately 50 illegal immigrants sued to keep the clinic open, alleging that closing of the clinic “violated their constitutional right to the health care service” and that closing the clinic amounted to “medical abandonment.”

The court held that the plaintiffs had neither a state nor a federal constitutional right to outpatient dialysis services and that Grady Memorial was not legally bound to provide those services.

The attorney representing the patients stated that she realizes that some people don’t believe the patients are entitled to such care because they are illegal immigrants. “They are human beings, and we all have the right to live.” The attorney also stated that “these people are going to die without this.”

The lawyer misrepresented the plight of the patients. Under current federal law, renal failure patients will always have access to hemodialysis, and that access will likely be more expensive than the current system that Grady uses. I called this one seven months ago.

High levels of potassium in a dialysis patient is an emergency medical condition. Under federal EMTALA laws, hospitals are required to provide stabilizing treatment to anyone with an emergency medical condition that seeks medical care in an emergency department. All the patients have to do is call “911” and they will get door-to-door service to the hospital via ambulance, will get a bunch of expensive testing done to document their elevated potassium, will likely be admitted to the hospital, and will still get their dialysis.

The situation raises a second question, though: Should we be providing uncompensated care to illegal aliens?

I think that the answer should be “yes” – with an asterisk.

If people are violating federal laws, they should suffer the same consequences as anyone else who violates any other federal law. In this case, provide the patients with dialysis, contact police, take the patients into custody, and then initiate deportation proceedings – or whatever other action is appropriate under federal law.

If hospital personnel become aware that a patient has committed a crime, we already call police from the emergency department.
A patient has a gunshot wound? We call the police to report it.
A patient may be the victim of domestic abuse? We file a police report.
A patient in a car accident has an elevated blood alcohol level? We notify the police.

How hard would it be to contact the police to verify someone’s identity if a patient is unable or unwilling to provide a state-issued identification? Not only would doing so determine whether or not a person is in the country legally, but it would cut down significantly on health care fraudsters who obtain care in the emergency department using a fictitious name and fictitious address and then stiff the hospital for the bill.

If we don’t want to enforce our laws, that’s fine.

Then we need to stop complaining about providing care to those who violate the laws.

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  1. Are we comfortable with allowing people to die in this country, a slow and difficult death, when there is a treatment available? Are we going to pay for treatment in a cost effective and humane way, or as an emergency and at high cost?

    • That’s part of the problem, Matt.
      Everyone wants the treatment, but not everyone wants to pay for it. With many people, cell phones and iPods take precedence over medical care.
      I don’t know what cost savings the hospital will realize (perhaps none) by refusing to provide free outpatient dialysis services, but I’m sure that Grady Memorial would accept donations from you to continue running the clinic if you’re so inclined to help them cover their current $4 million annual loss.

    • You mean, the way we let people drink and smoke themselves to death, because they don’t care enough to make the change for themselves? The way they prioritize fingernails and escalades and bling above health care, and then expect the rest of the country to pay for it when their untreated ailments become emergent, high-dollar problems?

      Every 15th, when I pay more money in my quarterly taxes, and wind up with just a little less money after working more hours … I could get comfortable letting some of them die. Pretty damn comfortable. Deep overstuffed, 30-year old leather barcalounger comfortable. That answer your question?

      • I like whitecoat’s point about the Ipods. It seems that every uninsured patient that I see has the latest IPOD touch and is surfing the internet while I examine them. They will buy this stuff, not to mention the most expensive tennis shoes and gold chains but expect society to pay for their healthcare.

  2. I’m sure that you have seen this, but as soon as an illegal hits the ED door, ICE wants nothing to do with them so they don’t get stuck with a hospital bill. The same is true for all but the worst criminals. We have had some patients arrested as soon as they are discharged so the law enforcement agency does not have to pay the bill.

    Right now, the illegals just move on to the next sanctuary city to rob them of their healthcare dollars and resources until they too go belly up.

  3. And the cascade of failure begins.

    As WC indicated, the dialysis patients will continue to present to the Emergency requiring dialysis. As EMTALA dictates, the emergency will be required to stabilize the condition by…. dialysis. At a greatly increased cost. The patient will now have to be transferred to a facility that does dialysis. Until the next hospital can no longer do dialysis, and closes its dialysis unit. And so on.

    The problem long has ceased to be if we should ration care, but rather how we ration care. Should non-citizens get care? If you answer yes, then you are you prepared to forego, say annual mammogram screening for 40-50 yr old women?

    Difficult choices will need to be made. The only thing the recent health care debate has proved is that the lawyer/politician class is incapable of making them.

  4. Though I can understand the sentiment that treating illegal immigrants and deporting them is a possible approach, this will only lead to unnecessary suffering when these people don’t seek treatment because of the fear of being found and deported. If there is real concern about illegal immigration, then the federal government needs to crack down hard on businesses and individuals that employ people who are not American citizens. Only by eliminating the job opportunities will the flow of illegal immigrants be slowed.

    It makes no sense to hold a carrot in one hand and a whip in the other. Decide on whether you need to employee people and give them citizenship or work permits or decide that the net benefit that these workers provide is not worth the cost and make coming to America illegally not worth the effort.

    • “Though I can understand the sentiment that treating illegal immigrants and deporting them is a possible approach, this will only lead to unnecessary suffering when these people don’t seek treatment because of the fear of being found and deported.”

      These people’s existence in our country is a violation of our country’s laws. They knew this when they came across the border. If they’re experiencing “suffering” because they refuse to seek treatment, then it’s THEIR OWN DAMN FAULT.

      Let me turn this around. I jump off a bridge and break my arm. Would you have sympathy for my suffering? After all, according to you, the source of suffering is irrelevant; I’m suffering, treat me! For free! Right now!

      • “Let me turn this around. I jump off a bridge and break my arm. Would you have sympathy for my suffering?”

        If you jumped for a good reason, such as to put food in your kids’ bellies or a roof over their heads, then you’re damn right I would have sympathy. It sounds like you wouldn’t, and I find that very disturbing.

  5. So if somebody has an infectious disease, you would be comfortable with them knowing that if they go to the hospital to get treated, they will be deported? Because that sounds kind of scary to me.

    We (meaning you and I and other people who have money, power, education, and who vote) have the ability to dramatically improve the healthcare (and immigration) situation. The guys living hand-to-mouth as they pick our grapes and mow our lawns, do not. And yet we get so angry at THEM, call them thieves, and blame them for everything from our healthcare problems to drugs to crime to the state of our schools.

    At the same time, WE ensure that the drug lords who turn their countries into war zones are well financed; WE subsidize US corn until they can no longer make a living growing it in Mexico; and WE pollute the water that they use until it is unsuitable for fishing or irrigation.

    Of course, wealthy and corrupt Mexicans have a hand in the problem as well. But perhaps we should tend to the log in our own eye before we go after the speck in our neighbors’.

    The English, Germans, Canadians, and French have dramatically improved their healthcare systems. Sure, some of them may complain…then you ask if they would prefer US-style healthcare, and they stare at you in horror. Why do so many Americans think so little of our nation, that they think that the rest of the industrialized world can institute universal healthcare but we cannot?

  6. McDreamy, the only things you HAVE to report to police are GSWs and stabbings as well as suspected child abuse/elder abuse to whoever you report that to. Everything else you shouldn’t. You can’t automatically report a domestic assault to the police w/o the patient’s permission nor can you report someone as an illegal alien.

    You can, of course, report someone who is committing a crime on your premises like a theft or someone who uses a fake name to get narcotics and things of that nature, however.

    • Nurse K,

      Some states have mandatory reporting of domestic violence. The usual statute states that a report be made to the police that domestic violence was reported to the healthcare professional – the patient still has the right to refuse to speak to the officer. In some other states, physicians are mandated to report seizure patients to state DMVs. And don’t forget – we also have to report many types of infectious disease.

      • I’m talking about the police/authorities. I wouldn’t think there would be any state where you could just randomly phone in one of your patients as an illegal immigrant and not be violating HIPAA even if you do the full medical screening exam or whatever. The ER shouldn’t be an arm of the law where you have to phone in every assault (against the patient’s wishes), illegal immigrant, person with an outstanding warrants, prostitutes, drug users, or whatever. It’s no place to be using your status as a doctor or a nurse to be fighting the war against illegal immigrants especially.

        Where I am, if someone says they were abused or you suspect it, you call an advocate, and the advocate encourages them to report it, gives them info about restraining orders, shelters, etc. This is better and more productive than just calling the cops when they don’t want to report it IMHO.

  7. Yes, an undocumented person can go to the ER for dialysis when they are on death’s door. But as soon as they are out of immediate danger…out!

    ER care is more expensive than out-patient dialysis, but what’s really expensive is that same patient who hasn’t gotten consistent treatment and now has out of control diabetes &/or hypertension, heart failure, bone disease, anemia, needs part of a leg amputated, on and on and on.

    I’m a dialysis social worker in a small non-profit chain. We treat undocumented patients and get reimbursed by Medicaid part of the time. (They have to reapply every 3 months which is hard to do when you’re illiterate in English and Spanish, have gone blind and had a leg amputated due to inconsistent treatment for diabetes, had a stroke last time benefits lapsed, etc.) We absorb the rest of the cost, and do what we can to help them get necessary medication. If we sent them “home”, they’d die plain and simple so there is no other humane choice.

    I don’t know what the answer is. I do know it would be nice if the for-profits took a patient or two pro bono rather than leaving the non-profit and public providers to shoulder the entire burden.

  8. Illegal immigration is not so black and white, folks. Lots of people were brought to this country as infants/children, were raised here and have siblings who are legal. What would you have them do?

  9. I think we should give illegal immigrants green cards and tax their incomes. The vast majority of these folks are here to have a better life for their kids and earn money to send back home. Sounds like the same reason my Irish great grandparents came here. The taxes could mayhaps pay for some of these health care costs, rather than having all the money flow under the table and then have hospitals eat the cost of emergent care.

    • Really??? I, for one, believe we should be following Reagan’s ridiculous law that we are all illegal immigrants until we prove otherwise (read the regulations behind the I-9, if I offend thee). And, that also means we should incarcerate and fine the employers of illegal immigrants. But, your sentiments and the ones above leave a big problem in logic. If the immigrants are “mowing our lawns” and “cleaning our houses” ,their incomes are not enough to be subject to tax- and would get cash back on no taxes (EIC)- so you would be draining our coffers instead. I certainly believe that if you are not a citizen, you are entitled to pay for your services, just like we do for every visitor (legal)- and like every country where I have visited and got sick- or my children got sick- demanded and got a credit card prior to or simultaneous to treatment.

  10. Breaking the law is wrong, isn’t it? And if ICE won’t touch it, they are as guilty as the law breakers. That said, illegal immigrants knew when they came here in violation that they would have to take their chances. Treat them and call the police.

    I ask the readers…what other country would let you in illegally and give you what America has given? Answer: There are none. If you break the laws in other countries, you are thrown out on your ass. Period. People might take pity on you, but you’re done. It is the same with terrorists. What country would have waited 18 months to retaliate against killing 3000 of their citizens and not obliterated the snot out of the perpetrators and then given them religious items and medical, dietary ammenities? Answer: None.

    • I’m not so sure that is true, but I am not as intimately familiar with the immigration laws of every other country in the world as you are.

      What you fail to recognize, and as has been pointed out by numerous others, is that threats of deportation will only lead to the illegals showing up at the hospitals when they are about to die. Instead of showing up when their leg is infected, they show up when all that is left is to amputate. You need to treat the disease of illegal immigration (if that’s how you see it) rather than the symptom.
      I would also point out that medical care to illegal immigrants is only a small piece of this large puzzle. We should be more concerned about Pharm companies fixing prices and similar such acts of fraud and market fixing.

      • I fail to recognize your “fact” – because there is no data to substantiate same. The concept of not calling the police because they know they will be subject to deportation is true- and why we have such rampant growth of gangs (MS-13) that threaten us all; but the illegal immigrants show up routinely in hospitals, playing Russian Roulette as to their deportation chances.

      • RAA-
        The suggestion is to start reporting illegals after they receive medical care. Since that isn’t happening now, I don’t know how I would prove my point with data. It does seem like a rational and logical conclusion to draw. I doubt you have any “facts” to back up that illegals don’t call cops because they are afraid of being deported. They may be afraid of the gangs as opposed to deportation.

        Regardless, if you believe illegals don’t call cops for fear of deportation, why wouldn’t the same hold true for hospitals?

  11. I am not without compassion, but look. The deal is that in the attempts to cover *everyone* with EMTALA, regardless of legal status or ability to pay, it has bankrupted many systems and forced higher prices, etc…

    If the new health care is passed, we will then be forced to insure far more people than can be dealt with in terms of access and quality of care, right? It will take a hell of a system to catch up and stay caught up to what we have now.

    Now, what happens when an Amnesty bill is passed and we are also forced into providing health care for the projected 20 million illegals, because there could be many more than that, right? (don’t forget to add in the rest of the population who will be forced to buy insurance who didn’t before). The amount of money being thrown around now is a complete farce and will not even touch what is going to be needed to care for that many and this is AFTER a potential bill for healthcare is passed.

    Someone like me, whose earning capability is slim in comparison to some, I will need to find another job in order to make up for the 10k more I will have to pay because of a mandate. I suffer a drop in access and quality as well.

    I stand hard and fast that if you don’t come here legally, you should not be allowed a free ride. If it’s worth it to get here, then it should be worth doing it right. That’s just the way it is. Our system is crumbling under the burden of its compassion and lack of law enforcement on this.

    We must put our citizens first– as the rest of those who violate our laws do know the consequences already.

  12. “if we send them home they’d plain die…”

    By all means, then, let’s get everyone who lives in an impoverished third world country on the next plane to the US so we can save them, too. (Or is it a matter of out of sight, out of mind?) If you try to fit fifty people in a twenty person lifeboat, all fifty of them DIE.

    It is true that we cannot be the World’s Policemen, but we can’t be the World’s free clinic, either. Am I also obligated to feed and house a burgler who breaks in and finds my mid-century mid-class home more comfortable than his own?

  13. Here in the USA (United States of Amnesia) we are so offended by someone “taking” something that is not “legally thiers”. Anyone here recall that US citizens forceably took Texas and most of the southwest from Mexico by lying, cheating and brute force? People who were respected citizens in Texas for a hundred years, were stripped of their rights and priveleges when it became a US state…simply because they were of Mexican descent. Oh but that was a long time ago…easy to say if you are on the winning side. I say it is just the chickens coming home to roost.

  14. One major problem with this proposal is that you are requiring everyone in the country to carry “identification papers” at all times. Acutually, it can be argued that this law would be unconstituional because states can not make laws that limit privalages (such as emergency health care) to it’s citizens (said citizen left there required ID at home).
    Plus, this law would bring up memories of bright yellow stars on Jews in Poland during the 30s. But of course, those stars were just there so that they could be identified.

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