Atlanta dialysis patients left to die

At least 22 indigent patients suffering from kidney failure in Atlanta, Georgia have been literally left to die for the past several weeks. Patients whose kidneys have failed need to receive regular dialysis treatment 2 to 3 times a week in order to stay alive. Poor patients in the city have been struggling to receive regular care since 2009.

These former patients of Atlanta’s sole nominally public hospital, Grady Memorial Hospital, were cut off from regular dialysis after the expiration of a contract, on August 31, between Grady and a private corporation Fresnius Medical Care. Fresnius was previously contracted to treat these patients at its dialysis center under the contract.

Immediately after the expiration of the contract, on September 1, Fresnius refused to provide treatment to these patients, forcing them to wait until their medical condition had become dangerous enough to seek treatment in Grady’s emergency room.

The patients have frantically sought dialysis. One woman even flew to her native Honduras in desperation on Wednesday last week after losing consciousness at home earlier.

Most of the patients are undocumented immigrants and some others do not qualify for either federal government’s Medicaid or Medicare coverage.

Grady and Fresnius announced on Friday, September 9 that regular treatment of these patients would resume immediately after another short-term agreement was reached. Both of these entities have been haggling over the financial terms for treatment while the patients were left in limbo.

According to Grady spokesperson Matt Gove, this latest deal is to last until 2014 and Grady has agreed to pay Fresnius $15,500 per patient per year or about $325,000 for the 21 remaining patients.

Given the sordid history of Grady’s mistreatment over the past two years, no confidence can be placed in the assurance that these patients will receive their regular dialysis until 2014.

Crass corporate-minded hospital management has over the past few years repeatedly hounded these helpless patients to find “other long-term arrangements.” Grady management has also frequently goaded the patients to either leave the state or the country, all in order to save money for the hospital.

In 2009 the hospital closed its dialysis center. This decision was taken only on the basis of counting dollars and cents rather than patient health. Patients’ advocates had attempted to keep the clinic open by filing a lawsuit.

The court, as could have been expected, issued a ruling in September 2009 siding with the management despite being well aware that the shuttering of the clinic was akin to passing a death sentence upon these desperate patients. The number of indigent patients at that time was over fifty and this has now dwindled to just 21 either due to death or migration.

After the closure of the dialysis center at Grady, the only public facility left open to perform dialysis for indigent and uninsured or underinsured patents was the hospital’s emergency room. Thus many of the patients were compelled to wait until their condition became so medically desperate that they could then seek dialysis in the emergency room.

In October last year the management threatened to cut off treatment of the patients, giving them three months to make other arrangements for their dialysis treatment. This warning came despite the fact that the Grady management had already contracted with private clinics for the patients’ treatment until September 2011. When the 3-month deadline arrived on January 2 of this year the hospital management extended the “deadline” again by another month to February 3, 2011.

Grady Hospital, founded in 1892, has over the past 120 years grown into one of the largest public hospitals in the US. Countless thousands of uninsured and poor people both in the state and elsewhere have come to rely upon the hospital for care.

The hospital is owned by the Fulton-Dekalb [County] Hospital Authority. While on paper it still retains its mission of providing treatment to all the needy patients irrespective of their legal status in the US, there has been increasing corporatization of its management.

In January 2008, Fulton and Dekalb counties created the non-profit Grady Memorial Hospital Corporation to administer the hospital. This step revealed the intent of the counties to run the hospital like a corporation where the primary occupation of hospital management would be to balance its books irrespective of its impact on public healthcare.

Raising funds from private donors has also become an increasing preoccupation of the board. The appointed board members are all steeped in corporate culture and by the actions that it has taken so far, such as closing the dialysis center, it is clear that board members do not see healthcare as a basic social right. The GMHC has been given a 40-year lease to oversee the hospital.

Steep funding reduction by the counties especially after the onset of the economic crisis in 2008, has impacted the hospital budget very hard. Reportedly, Grady faces a budget deficit of $25 million this year.

Concomitantly, due to the ongoing economic crisis, the number of patients unable to pay for healthcare has gone up exponentially, thus increasing the need for hospitals’ services.

In order to balance the books the counties have turned to newly hired corporate managers to bring Grady’s budget to balance. These highly paid managers have gone about their mission with gusto, gutting longstanding medical facilities such as the dialysis center and implementing staff layoffs. Earlier this year the hospital announced that it plans to lay off 100 people to save $6 million.

The callousness with which officials of Grady and Fresnius have treated the patients who lack the means to pay reveals the consequences of a health care system administered in the interest of corporate profits, where live-saving care is available only for those who can pay rather than for everyone as a basic human right.