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Injunction Halts Grady Dialysis Closure after Board Approves It
With additional reporting by Jonathan Springston.
Photograph by Jonathan Springston
(APN) ATLANTA -- This week, a Fulton County Superior Court Judge approved of an emergency injunction on Wednesday, September 16, 2009, to temporarily halt the closure of the Grady Health System Outpatient Dialysis Clinic. The judge's decision comes after Grady's privatized board voted Monday, September 14 to approve a contract that essentially puts Grady out of the dialysis treatment business and sets the stage for the clinic's closure.
THE JUDGE'S RULING
Grady "is prohibited from engaging in any further efforts to induce patients currently receiving dialysis treatment at the Grady Dialysis Clinic to discontinue their treatment at Grady... including but not limited to, encouraging in any way patients to move to other states, return to their countries of origin or seek dialysis alternative through emergency room admission, until such time as [Grady]... presents a suitable alternative treatment plan that this Court approves subject to hearing and considering the positions of concerned parties with respect the proposed alternative treatment plan," Judge Ural Glanville wrote.
Grady "is prohibited from taking any steps to close or otherwise limit the existing operations and services of the Grady Dialysis Clinic, until such time as [Grady]... presents a suitable alternative treatment plan," he wrote.
Grady "is required to provide all persons who may be identified within the putative class, written notice in their primary language of their right to receive continued dialysis treatment at the Grady Dialysis Clinic until and unless this Court approves a suitable alternative treatment plan that does not jeopardize their lives or medical needs. Further, such notice shall also advise the putative class that they shall receive written notice of any and all future Court hearings in which the Court might consider proposed alternative treatment plans," he wrote.
Activist Dorothy Leone-Glasser, with Grady Advocates for Responsible Care, tells Atlanta Progressive News, however, that according to patients they're working with, Grady has not been complying with the Judge's order, and that even after the order was issued, that Grady social workers continued to tell patients that the clinic was closing and that they should consider moving to another state or country.
The suit was brought by Attorney Lindsay Jones, whom Atlanta Progressive News readers will remember was active in helping the public housing residents during their efforts in 2007 and 2008 to stop the recent demolitions; a formal injunction like this was never served against Atlanta Housing Authority, however.
As previously reported by APN, Grady sent letters on August 13 and 14, 2009, to its dialysis patients informing them that the clinic would close, providing them a list of other clinics in their area. Grady social workers told patients that they had three options: to either move to their home country, to move to another state where they may qualify for emergency Medicaid, or to wait until they get really sick and go to the emergency room for dialysis.
In the original lawsuit, Jane Doe I and II versus Grady Memorial Hospital Corporation (GMHC), Jones argued on behalf of a real patient, referred to as Jane Doe, and all others similarly situated, that "Each of the three alternatives offered to Jane Doe by the Grady social worker are unduly burdensome and unworkable as means to maintain Jane Doe's life, and in fact each of the three alternatives present a likelihood of causing Jane Doe irreparable injury, including the possibility of death."
An emergency hearing is scheduled for this Wednesday, September 23, at 9am, room 5-F. A rally will occur before-hand at 8:30am. Although, it appears this is just an initial hearing, as the Judge also required that new letters informing affected patients of the hearing be sent from Grady to them 10 days before the hearing; this suggests a formal hearing will likely not occur for at least a couple weeks.
GMHC'S VOTE ON DIALYSIS
Previously, the GMHC Board voted on September 14 to enter into a two-year contract with Fresenius Medical Care, the world's largest provider of dialysis services and products, to provide inpatient and outpatient dialysis treatment for many of the 96 clinic patients receiving care at Grady.
However, advocates say the Fresenius contract will not be enough to assure the continued care of all patients. "I don't know of anybody going to Fresenius. When I spoke to Fresenius, they were only looking at patients from Fulton and Dekalb Counties with social security numbers," Leone-Glasser said.
Prior to the injunction, this decision paved the way for the clinic to close on September 20. However, a group led by the Grady Coalition and Grady Advocates for Responsible Care said at least 28 patients have not been well-consulted and argued closing the clinic could lead to needless deaths.
Leone-Glasser told APN that of the 28, when they asked the patients whether Grady had offered them anything, 4 said yes and 24 said no.
"There is a big disconnect with what these well-meaning people think is happening and what is really happening," Dr. Neil Schulman, a nephrology doctor and member of Grady Advocates for Responsible Care, said. "This really involves whether or not some of these people die in two or three weeks."
Grady Senior Vice President for Operations Denise Williams told the board and about 100 passionate spectators who packed the Grady boardroom that staff social workers had been consulting individual patients since July, sending out specialized packages in the appropriate language to each patient, informing each of their options and dialysis providers in their area.
"Our goal from the start has been to connect our patients with the right assistance," Williams said.
However, ensuring the continued care of all of the patients is not so simple. Many are undocumented immigrants; yet, due to a 2006 Georgia General Assembly decision, the State no longer offers Medicaid programs for undocumented immigrants.
Others are citizens but do not qualify for Medicaid yet in Georgia because the state requires people to live here five years before they can qualify. Still others live outside of Fulton and Dekalb Counties and have not received assurances from Fresenius or other clinics as to whether they will receive continued care.
In addition, even if some patients are eligible for Medicaid, it would take them about four months to be approved even if they applied today. "A responsible clinician would help them apply and say don't worry about the three of four months," Leone-Glasser said.
Williams told the public at the recent Board meeting that since August, Grady has transitioned 50 patients out of the clinic into alternative locations; Leone-Glasser could not confirm this number.
"In a few instances, we have examined back billing to make sure patients who qualify could receive emergency Medicaid," Williams said.
Williams said 12 patients have communicated plans to move to one of several states where emergency Medicaid coverage is available, with 10 of those already completing that transition. Those states include New York, New Jersey, Virginia, Washington, North Carolina, Massachusetts, Connecticut, Ohio, Illinois, and Wisconsin.
Williams said Grady is helping patients who are leaving the state with apartment rentals, moving costs, and airline travel.
However, the Atlanta Journal-Constitution newspaper recently contacted at least three of these states--New Jersey, North Carolina, and Virginia--and found out that they too have residency requirements for Medicaid. Grady officials could not explain discrepancy and said the list came from an outside consultant, whom they would not name to the AJC.
"Why is Grady telling people to go to another state? I don't know," Mark Van Sciver, spokesman for the North Carolina Department of Health and Human Services, told the AJC.
"We're disturbed to hear that this might be happening to vulnerable patients," Suzanne Esterman, spokeswoman for the New Jersey Department of Human Services, added.
"I know of a patient told to go to Florida. But they have the same residential restrictions as Medicaid," Leone-Glasser told APN.
One patient will move back to their home country and Williams said anyone else who chooses that option will receive passport assistance, airline tickets, and dialysis treatment in their home country.
However, Leone-Glasser tells APN that a patient who has moved back to Mexico--it's not clear if it's the same one described by Williams--was only promised by the Mexican Consulate three months of dialysis. "They're gonna live for three months," she said of people who take that option. "Then what, he dies?"
Jane Doe 1, who was told to consider going back to Honduras, would live six hours away from a nephrologist if she did move back, which is extremely dangerous given her special condition, Leone-Glasser said.
The eight patients who are prisoners will continue to be treated via inpatient services. There are 25 other patients Williams said who have not made a decision as of Monday.
"Every patient is or will be accounted for by Sept. 20," Williams said.
The meeting broke down during the public discussion time, with Schulman and others participating in angry exchanges with GMHC members and CEO Michael Young.
"Is there not one member of this Board that is going to make a motion to delay closure?" Schulman yelled during an exchange with GMHC Chairman Pete Correll.
"No one, no one, has offered to help us," Correll said. "We are not going to be responsible for the death of citizens."
At one point, State Sen. Vincent Fort (D-Atlanta) accused GMHC member Tom Bell of not caring about poor people and suggested he resign from the GMHC. Bell responded Fort had not done anything as a state lawmaker to help Grady and suggested he resign.
"It's not enough to say the State and other providers have turned a blind eye," Fort said. "Cutting dialysis centers equals a death sentence for the poor."
As barbs continued to fly, GMHC member Michael Hollis made a motion to allow Grady to extend the license on the dialysis clinic for another year.
Young suggested extending it six months and the Board approved the motion. Young said the six-month extension does not mean the clinic would stay open another six months but rather the clinic will remain open until each of the patients is properly located into another clinic.
However, given the so-called extension, it is unclear why Grady is continuing to tell patients who have not established adequate alternative plans that the clinic is still closing on the 20th.
After Correll and Young hastily called for a recess, ushering the rest of the board into an anteroom, public members with questions were allowed to move to Grady's Steiner Auditorium across the street and ask further questions.
About 40 people, mostly Hispanic, went to the auditorium and listened to Senior Vice President for Marketing and Strategic Planning Matt Gove answer questions with the help of a translator.
"Our social work team should be staying in touch," Gove told one questioner. "If they can't get an arrangement by the end of the week, we will work with Fresenius or another company to get them the treatment they need."
"The point of this process is to treat everyone with compassion and care," he told another. "If that's not happening from our end, then we need to know."
HOPING THEY WOULD GO AWAY
"We brought the injunction because they said every single patient would be taken care of. They told the patients on the 14th [of August] that it would be closing on the 20th of September. They were just hoping they would disappear," Leone-Glasser said.
"If we tell them we're closing, they would just all go away," Leone-Glasser said in her perspective on the Board's thinking. "They didn't count on the doctors and nurses and patient advocates."
"If these patients have been under your care, you have a responsibility to provide a bridge of care," Leone-Glasser said.
Leone-Glasser said she's been very disappointed with the GMHC, to whom she's written two letters since August. "The Board and Administration's position with us is very condescending and dismissive."
She added it is not just about the current patients. While the judge's order may ensure each of them do not slip through the cracks, future Georgians without private insurance, who do not qualify for Medicaid--who need dialysis--will have nowhere to go. "Someone in the future will have to go to the ER and pray the doctor will admit them. People will wait until they're really sick, until they're really teetering between life and death."
"Sending somebody to the emergency room- you can't treat somebody like that. It's financially incompetent," she said.
Leone-Glasser said she's instructed patients to continue going to Grady for dialysis, given the judge's order, despite what they may have heard otherwise.
"When it came before the judge, it became obvious they didn't have a plan; not a plan that would keep them alive."
About the author:
Matthew Cardinale is the News Editor for Atlanta Progressive News and is reachable at firstname.lastname@example.org. Jonathan Springston is a Senior Staff Writer and is reachable at email@example.com.
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