Undocumented Immigrants on Dialysis Forced to Cheat Death Every Week

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For more than 650,000 American adults, end-stage renal disease is a manageable illness, treated with dialysis three times per week and covered by private health insurance, Medicare or Medicaid, no questions asked. But because Lucia is an undocumented immigrant, she is not eligible for traditional Medicare or Medicaid. And since she is unable to afford private medical insurance or pay for her expensive treatment out of pocket, she is forced to wait until her condition deteriorates to a life-threatening medical emergency.

She must wait to nearly die before she can be revived and brought back to life.

You are still more likely to die in a hospital on the weekend

{snip} The 1986 law compels hospitals with emergency rooms to care for anyone and everyone whose life is in imminent danger, regardless of their citizenship status or ability to pay.

What’s more, over the past five years of dealing with her disease, Lucia has learned that if she shows up at the hospital too early, she will be turned away because her life is not in immediate jeopardy. If she waits just a few minutes too late, she might need to be revived from cardiac arrest. Determining the precise minute to arrive at the ER is a critically important decision. Lucia’s life depends on it.

Drowning in her own body

“The function of the kidneys is to filter blood of excess toxins and excess fluid,” said Dr. Lilia Cervantes, a physician at Denver Health who is involved in Lucia’s care. “When both kidneys stop working, people, on average, will live anywhere from 10 to 14 days. And so, to continue living, you need some process to filter blood, which is a dialysis machine.

“If you don’t have dialysis, all that excess fluid and excess toxin builds up in the body,” Cervantes said. “For example, if someone takes a spoonful of soup or a bite of watermelon or even a small gulp of water, your body isn’t able to get rid of that through urine. Instead, it stays in their system.”

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It’s an unimaginable predicament to be in: needing water to live but knowing that consuming just a little too much of it could kill you.

“And so, for these patients, because they only come in … once every seven days instead of the three times per week, [the excess fluid] stays in their body, and it goes into the lungs,” Cervantes said. “It goes into their legs. Separate from that, the toxins build up, one of the most important toxins being potassium, which, at high levels, can make the heart stop.”

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The Centers for Medicare and Medicaid Services, which is part of the US Department of Health and Human Services, is responsible for making decisions as to what is and isn’t covered by Medicare, Medicaid and CHIP (the Children’s Health Insurance Program). {snip}

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Some states, including California, New York, North Carolina and Washington, have initiated programs and set aside funds to provide standard dialysis to undocumented immigrants who need it — before they are in critical condition. Not only is this type of treatment more manageable for patients, studies have shown that it saves the government and taxpayers a significant amount of money.

The economic and physical costs

A 2007 study conducted at the Baylor College of Medicine in Houston found that the cost of treating undocumented immigrants with emergency-only hemodialysis is 3.7 times more expensive than caring for them with standard dialysis three times per week. It’s because patients like Lucia are so much sicker and require more care by the time they come in for treatment. And that money adds up — to approximately $285,000 vs. $77,000 a year — according to the study.

In her research at Denver Health, Cervantes found that five years after initiating dialysis, undocumented immigrants with end-stage renal disease who receive emergency-only hemodialysis have on average a 14 times greater risk of death compared with people who receive three-times-a-week dialysis.

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What particularly aggrieves Cervantes is that patients like Lucia are not eligible for organ transplants, even from a family member, but they are encouraged to give the gift of life and donate their organs when they die.

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