Dialysis Unplugged: "It's Different Down Here"

About a year ago I wrote a commentary about the terrible plight of uninsured dialysis patients at the Grady Hospital dialysis unit. There had been publicity swirling about the dialysis program at Grady Hospital, the major public hospital in Atlanta, Georgia. Recall, about 3 years ago Grady decided to close it's outpatient dialysis program. By September 2011, from over 100 patients Grady hospital had winnowed the number of patients down to around 20. Some patients were transferred to other units in Atlanta, others were "encouraged" - their air fare's were paid - to move to other states, and some died. Most of the patients who remained could not be transferred. In September 2012, Grady came to a 3-year agreement with Fresenius to take 21 uninsured dialysis patients for a period of 3 years.

So, Grady has extricated itself from a tight corner. It would be nice to believe that this sorted the problem. Wait a minute, what happens to illegal immigrants now in Georgia? 

In the state of Georgia if you happen to need initiation of chronic dialysis and don't have insurance you're in trouble. The same is true for patient's at Grady. You need to identify a dialysis unit that is willing to dialyze you for free - the chances of this are very low, or you can go back to your home country and see if you can receive dialysis there, or you can move to another state where some mechanism is available to pay for your dialysis. Most patient's end up receiving dialysis care sporadically in the emergency department, according to a social worker I spoke with.

The social worker I spoke with today while visiting Atlanta had worked in the dialysis unit at Grady. She told me about what happens to uninsured undocumented patients in Georgia: the situation is "different down here". She told me that the feeling in Georgia is that safety net should be provided by the church and other charitable organizations. Dialysis should not be paid for by the state government. 

Of course I am not saying that tax-payers should provide endless unlimited support for the uninsured and undocumented, but no support? Really? How in the world can Grady hospital send patient's initiated on dialysis home with instructions to come back to the ED "when they need dialysis." Really?