Sunday, September 11, 2011

Grady Hospital Dialysis Patients Have a Home - For Now

Last week I wrote about the ping pong match being played between Grady Hospital and Fresenius. Unfortunately, the ping pong balls were patients with advanced kidney failure.

Grady's contract with Fresenius for the remaining patients who had been under the care of Grady's dialysis program when it closed in 2009 had ended on August 31. Grady said it could not pay the price being asked for by Fresenius. Fresenius refused to care for patients without being paid.

Fresenius said these were Grady's patients and Grady's responsibility. Grady said Fresenius had been treating them for two years and they were Fresenius's responsibility.

On Friday September 9, Grady and Fresenius reached an agreement. Fresenius will care for the patients at no cost to the patients for three years. Grady will pay $15,500 per year, approximately half of what they had been paying.

If this were an ordinary business or labor management negotiation, it would be ho-hum ordinary. It's typical to go to the brink, to point accusatory fingers, and then to settle.

But between the expiration of the contract on August 31 and the deal reached on September 9, patients had to go to the emergency room to be evaluated for emergency dialysis. Some were turned away as "not sick enough." One patient who was turned away on Saturday and then admitted briefly on Sunday returned to Honduras just before the deal was signed. Her family scraped together enough money to pay for two weeks of dialysis at home, but her fate after that, her sister said, is "in God's hands."

The deal between Grady and Fresenius settles the crisis by providing dialysis care for three years - except for the patient in Honduras, who may be on her own in two weeks. The deal is a small victory for people in need.

But given that the Grady problem will continue to occur for undocumented patients all around the country unless we craft a national solution, it's also a form of "enabling." The crisis is off the front page and the evening news, so we can go about our business until the next crisis occurs.

(For Kevin Sack's New York Times report on the Grady-Fresenius deal, see here. For an excellent policy brief from the American College of Physicians that argues in detail for the "federalization" of local problems like Atlanta that I've been advocating for, see here.)

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