Grady Health System officials on Monday, July 13, 2009, set in motion a series of steps that could lead to a change in how Grady delivers dialysis treatment.
Officials also announced the merger of two neighborhood health clinics in order to maximize efficiency and save money.
Grady Hospital is in a perpetual state of financial dire straits. This past summer is its latest reincarnation. There was a report earlier that Medicare overpayments are coming due and Grady owes the government about $20 million from prior Medicare overpayments. (that's not illegal but rather an accounting trick. The hospital collected too much up front and the bill is now due)
Grady Hospital is one of the world's largest hospitals in the world. It's one of the five biggest hospitals in all the U.S. It is primarily for the poor, Medicare, Medicaid, and undocumented/illegals in the area of Atlanta. In such a hospital, dialysis is one of the most difficult parts of medicine to maintain. That's because dialysis is extremely expensive. It can run north of $20,000 a year. Yet, Grady serves the poor. Many of those have no insurance. Even those with insurance are unlikely to have the sort of insurance that will allow Grady to keep this profitable.
So, cutting off dialysis in a time of dire financial straits. There's two things that raise my eyebrows. First, Grady is always in a period of financial straits but kept this division open. Second, I documented a history of systemic corruption at Grady Hospital. I don't have the sources I used to on that story, however, I have seen absolutely no evidence that the systemic corruption that occurred at Grady Hospital has been fixed. Neil Shulman , a professor at Emory University who's been following this particular situation closely, told me that he believed that most of the corruption has in fact been cleaned up in the last year or so.
For most people, this issue doesn't affect them. All those on insurance will be referred to another hospital in the area. There are, however, about 60 people that are either undocument/illegal that are facing death if this goes into effect. Grady told those folks that other arrangements will be made. Yet, those arrangements include a list of dialysis centers in the area. Of course, these folks have no insurance and so that will do them little good. Grady is also willing to buy these folks plane tickets to go home and get dialysis there. One lady was offered a ticket back to Honduras however her village has no dialysis.
There was recently a meeting about this sponsored by the Grady Coalition. I spoke earlier today with another Emory University professor, Doug Bremner. He attended the meeting. Here's the most poignant story he heard at that meeting.
Another social worker said she was working with a man who was a legal immigrant from Ethiopia but had lived in Georgia only three years, five years short of the time required to qualify for Medicaid. He had a social security number but hadn’t paid into it enough to qualify for Medicare. He was also on dialysis and was on the list of those who were being cut off.
His daughter asked, “So am I supposed to watch my father die now?”
It's important to note that the individual that is facing having their dialysis cut off is here legally. They have only been in Georgia for three years, however. In Georgia, you need residency for five years and then you qualify for Medicaid. As such, they have no insurance and so they will have no place to get dialysis if this goes through.
Grady is due to close its dialysis center later in the month. If nothing happens between now and then, about sixty people will be facing their dialysis treatment being cut off. Right now, legendary local retired surgeon, Elbert Tuttle, has been calling to many of the proteges he's created in his years to see if some or all are willing to take these folks on and eat the cost. Right now, however, about sixty lives are in danger and the clock is ticking for them.
This case raises several policy issues and I almost fear some of the feedback of some of my more conservative readers. Those should be debated but as Mr. Shulman told me, "there are sixty people about to die and we need to fix that first".