Dozens of patients are facing a life-or-death situation after Jackson Health System stopped paying for treatment for their failing kidney
BY JOHN DORSCHNER AND JUAN CARLOS CHAVEZ
The financially strapped Jackson Health System has stopped paying for dialysis treatments for 175 poor patients with failing kidneys — a decision that experts say could be deadly.
“It is no game,” says Emelina García Cordoví, 67, whose treatments at a South Miami-Dade center were cut off Dec. 31. “We are talking of the lives of persons who depend exclusively on their dialysis.”
Jackson, Miami-Dade’s government health system intended to be a safety net for the poor and uninsured, said it expects to save $4.2 million by stopping payments for outpatient dialysis treatment for the 175 patients. Of those, other avenues for care have been found for all but 41, says spokesman Robert Alonso. About a third of those are undocumented immigrants, who are not eligible for government programs.
“This decision was not taken lightly,” said Eneida Roldan, chief executive of Jackson, which is trying to reduce a projected loss of $168 million for fiscal 2010. She said patients can still get treated in the emergency room.
The situation is so serious that Brian Keeley, chief executive of Baptist Health South Florida, suggested Wednesday that, if Jackson cannot handle the patients, a “public-private partnership” of hospitals be formed to provide care. Jackson officials said they would welcome anything that helped solve the problem.
“These people are going to seek treatment,” Keeley said. “They’re going to migrate to the nearest emergency room,” after they become sick, meaning care will be more expensive. Such a scenario is “very very inappropriate” when they could be kept well at outpatient dialysis centers, he said.
Under the healthcare reform proposals now before Congress, the emphasis is on getting cheaper basic care for an additional 30 million Americans so that they don’t need expensive ER visits.
Raul de Velasco, a longtime Miami-Dade nephrologist who serves on several local ethics panels, said Jackson’s decision was “almost cruel.”
Kidney failure results in impurities building up in the blood. Missing dialysis and waiting to get sick before going to the ER could lead to inflammation of the heart, nerve damage and other problems. “They will not die quickly or suddenly — but they will die, a slow death,” he said.
De Velasco says ER treatment in such cases will also be considerably more expensive because the patients will be sicker when they enter the ER. “So trying to save money — that doesn’t work.”
Gerard Kaiser, Jackson’s chief medical officer, said the system will indeed save money, because various government programs pay for inpatient dialysis that don’t pay for outpatient treatment, and patients may end up at ERs other than Jackson’s.
Most patients need care three times a week — at a cost of about $50,000 a year. Federal law allows virtually all Americans with end-stage kidney failure to get on Medicare, which will pay for their treatment. But it can take more than a year to get that coverage, and people need to have paid into the Medicare fund for a certain period of time in order to be eligible. People in the United States illegally don’t qualify under any circumstances.
In the case of Garcia, she has been in this country legally for about five years, but doesn’t have the work history to qualify for Medicare. Her trips to the Kidney Treatment Center of South Florida stopped last week. Her husband, Pedro Valdés, 66, said they received notification of the change last month, with a list of 36 centers offering dialysis.
“When we went to those sites to seek help, they told us they could not attend to us,” Valdés said. “They asked for an insurance card or the option of paying with our own money, but that is impossible.” A one-time private security guard, he has been unemployed for almost two years.
Linda Quick, president of the South Florida Hospital and Healthcare Association, said patients’ decisions are shaped by federal law, which requires hospitals to treat all patients who come to their ERs. There is no such requirement about those showing up at dialysis centers.
For some time, Jackson had been paying for dialysis for such Miami-Dade residents who fell through the cracks by contracting with outpatient dialysis centers throughout the county. The system does not provide outpatient dialysis on its own.
About a year and a half ago, Jackson stopped funding outpatient dialysis for indigents who had gone to other hospital ERs. The Baptist system reports that last year it spent $1.4 million to pay for outpatient dialysis for people who had gone through its ER.
Keeley said Baptist had done that “for both humanitarian and practical reasons,” since the unfunded patients would otherwise end up sick and needing expensive treatment at the hospital once again. “We face up to our responsibilities. What we don’t want is to be a deep pocket for all the hospitals who want to dump on us.”
That’s why Keeley recommends that the county’s public and private hospitals fund three nonprofit dialysis centers — in the north, center and south — to help those who need life-saving care. Reaction from other hospitals to the idea was not immediately available.
Several other South Florida hospitals said that they treat dialysis patients in their hospitals, but don’t pay for outpatient treatment.
Lourdes Garridos, spokeswoman for the HCA hospital chain, said, “Unfortunately, this is a system where the funding does not follow the patient and resources need to be identified to assist in their care.”
The South Broward Hospital District, a government entity, reports it spends about $800,000 a year on outpatient dialysis for the uninsured. North Broward also provides such services.
Susan Witzel-Kreuter, a social worker at the North Beach Dialysis Center in Miami Gardens, said she has been scrambling to find treatment for a half-dozen patients Jackson had been paying for. “This is absolutely a life-or-death issue.”
So far, she has been successful — but at a cost. Her most poignant case is a man who has been in the United States legally for a year and was working full-time — at a company that didn’t offer insurance.
When Jackson stopped its support, Witzel-Kreuter said, he quit his job so he could qualify for Medicaid, the government health insurance for the poor.
“So now he’s on food stamps and all that, when he could have been working,” she said. “It’s a very very sad story.”