Home manage Las Vegas Review-Journal
  Jobs Cars Homes Shopping Travel Weddings Golf Best of Las Vegas Photo   Search:

RECENT EDITIONS
Wed Thu Fri Sat Sun Mon Tue

sponsored by
News


Dialysis care for poor, illegal immigrants costly for many area hospitals

Sunrise officials deny sending illegal immigrants to UMC

Dr. Dale Carrison, head of emergency services at the taxpayer supported University Medical Center, has read some of the discharge documents that dialysis patients bring with them from for-profit hospitals in the Las Vegas Valley.

They instruct the patient, who is uninsured and usually an illegal immigrant, to go to UMC for follow-up care.


Most Popular Stories
  • 'YOU DON'T BLOW A BUNCH OF CASH IN VEGAS ...': Obama remark reopens wound
  • NORM: Ad's Strip scenes raised eyebrows
  • LAUGHLIN EDGEWATER: Two dead in casino car crash
  • Shutting down the Ritz
  • Shutting down the Ritz
  • Former commander of USS Cole considers run against Reid
  • NORM: $1 million wager on Super Bowl approved
  • Tourist describes chaos as car plows into Laughlin casino, killing two
  • Tourist describes chaos as car plows into Laughlin casino, killing two
  • IMAGES FROM 1860S: Photos show historic Nevada
  • Fighter battles rare disease that shatters mixed martial arts dream
  • Flood advisory for Las Vegas Valley




  • "It is clear that the patient needs more dialysis, and it is also clear that they don't want to take care of it because of the cost," Carrison said of the other hospitals. "It offends me that people offering care for profit would condone or do that."

    Last weekend, the Review-Journal reported that cash-strapped UMC is providing more than $20 million a year in emergency dialysis care for uninsured, illegal immigrants.

    This week, when Sunrise Hospital and Medical Center announced the layoff of 100 workers, it became apparent that care for the uninsured also affects for-profit health care institutions.

    According to spokesman Dan Davidson, Sunrise provided $110 million in uncompensated care in 2008, including nearly $1 million in emergency dialysis care for illegal immigrants for January through July this year. Davidson said that is part of the reason layoffs occurred.

    Under federal law, anyone who shows up at an emergency room requesting an examination or treatment for a medical condition must be given an appropriate medical screening to determine whether there is an emergency. If there is, treatment must be provided regardless of a patient's ability to pay or their citizenship.

    Officials at UMC, which provided $160 million in uncompensated care in 2008, and Sunrise said they don't know how much of their total uncompensated care for the uninsured goes to illegal immigrants. Under federal law, hospital staff cannot directly ask patients whether they are in the country illegally.

    U.S. citizens with end stage renal disease automatically qualify for Medicare to cover dialysis costs. Illegal immigrants are not eligible for Medicare. As a result, patients who have neither insurance nor Medicare to pay for dialysis are almost exclusively illegal immigrants, a distinction that allows hospital officials to estimate costs for their care.

    The Sunrise layoffs come as the trade magazine Modern Healthcare reports that HCA, the Nashville-based parent of Sunrise and the nation's largest hospital chain, doubled its profits in the second quarter, with revenue increasing to nearly $7.5 billion.

    "We had to do the layoffs to stay competitive," said Davidson, who said he could not reveal whether Sunrise was operating at a loss. "We had to reduce our cost structure to remain competitive with other hospitals in the area."

    Spokeswoman Ashlee Seymour said the Sunrise Health System, including Sunrise, Sunrise Children's Hospital, MountainView and Southern Hills hospitals, isn't steering illegal immigrants to UMC.

    She said there were 54 patient visits by illegal immigrants for emergency dialysis care in a seven-month period this year. That cost the hospital about $15,000 per patient.

    But Carrison said it is possible that physicians at for profit hospitals have been sending patients to UMC on their own.

    "They may not want to deal with them, or they may think the hospitals where they practice don't want that kind of patient," he said.

    Suzie Wood, a spokeswoman for the Valley Health System, refused to divulge how much dialysis care for illegal immigrants is done at either Valley or its other facilities, Desert Springs, Spring Valley, Centennial Hills and Summerlin hospitals.

    "I can't get that information," she said.

    Wood said it is possible that Valley Health System staffers at emergency rooms may ask individuals requesting dialysis whether they would rather go to UMC.

    "They may have a friend there," she said. "We give them an option. It really depends on the person."

    Carrison said he does not recall seeing illegal immigrant patients being sent to UMC for dialysis from the St. Rose Dominican Hospitals. A St. Rose spokesman, Andy North, said such care has been provided, but he wouldn't say how often it is done or at what cost.

    Carrison said UMC's situation may be improving.

    Recently, he said, UMC CEO Kathy Silver met with other hospital CEOs in the Las Vegas Valley. In the last month, he said, he has not seen illegal immigrants sent by other hospitals to UMC for dialysis.

    "She made it clear that this is not just a UMC problem," Carrison said.

    Three illegal immigrants who last week were receiving dialysis care at UMC told the Review-Journal they went to the publicly supported hospital because they heard from people in the community that it offered the treatment to anyone.

    Dialysis is almost four times more costly when done through the emergency room than through the usual doctor-guided treatment at a dialysis center.

    Carrison said illegal immigrants with failing kidneys figured out doctors will treat them if they go to the emergency room "in bad enough shape."

    The billed costs at UMC can run from $11,000 to $18,000 per visit because of required testing and added care that often requires costly in-patient treatment to keep them alive, UMC officials said.

    Most dialysis patients must go two or three times a week.

    Charles Duarte, head of the Medicaid division of the state Department of Health and Human Services, said Wednesday that Medicaid payments can be made to hospitals when dialysis for illegal immigrants is a true emergency. But state reviewers often characterize the visits as "regular chronic care," so hospitals aren't reimbursed.

    In 2008, the state reimbursed UMC for about $230,000 for emergency dialysis while UMC estimated the costs at $14 million. That reimbursement is less than 2 percent.

    "We have a different definition for emergency," said Brian Brannman, UMC's chief operating officer. "Our doctors think these patients will die and they (state officials) don't."

    Duarte said Medicaid payments of about $3,700 for emergency dialysis were made in 2008 to two St. Rose Dominican hospitals, and a $3,000 payment was made to Sunrise Hospital. No Valley Health System hospitals received Medicaid payments in 2008, he said.

    If health care professionals at UMC or any other hospital choose to do so, they could report illegal immigrants to U.S. Immigration and Customs Enforcement.

    But, Brannman said, "you're not going to get health care folks to do that. Physicians and nurses are focused on the patient. That's what their oaths are about."

    "That may not be something that people want to hear. But you're not going to solve this problem through doctors and nurses. ICE agents could take a walk through any emergency room in America if they wanted to and make arrests."

    Carrison, a former FBI agent, agrees. "I'm no longer in law enforcement. It's time for ICE to take some initiative. It's not up to me as a physician to be a law enforcement officer."

    Rep. Shelley Berkley, D-Nev., said Wednesday that health care professionals should not be working as law enforcement. "They have a big enough job to do caring for patients," she said.

    UMC spokesman Rick Plummer said it takes ICE several weeks to deport somebody.

    "And they don't want to eat the costs of providing medical care during that time," especially with a chronic condition like dialysis, he said.

    Lori Haley, a spokeswoman for ICE, said the agency uses several investigative tools to arrest illegal immigrants. She said the agency works on priorities but would not disclose how high illegal immigrants who are getting health care rate as a priority.

    UMC's problem isn't going away soon. Emergency room physician Christian Young said the hospital is giving two new illegal immigrants dialysis care since the Review-Journal's report on the issue.

    "They heard in the news that they could get it at UMC," he said. "Guess we have a long battle ahead of us."

    Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

    Newsvine Digg Fark Technorati reddit StumbleUpon del.icio.us Slashdot Propeller Mixx Furl Twitter MySpace Facebook Google Bookmarks Yahoo! Bookmarks Windows Live Favorites Ask MyStuff myAOL Favorites

    Leave Your Comment 71 Reader Comments
    Terms & Conditions
    The following comments are provided by readers and are the sole responsiblity of the authors. The reviewjournal.com does not review comments before publication nor guarantee their accuracy. By publishing a comment here you agree to abide by the comment policy. If you see a comment that violates the policy, please notify the web editor.

    Some comments may not display immediately due to an automatic filter. These comments will be reviewed within 48 hours. Please do not submit a comment more than once.
    Current Word Count:

    Note: Comments made by reporters and editors of the Las Vegas Review-Journal are presented with a yellow background.

    UMC Nurse wrote on August 23, 2009 08:48 PM: UMC can cut 38% from total expenditures the same way that the nonprofit University of Chicago Medical Center, UCMC, did in 2006. UCMC maintained their nonprofit tax status and federal subsidies while reducing charity care expenditures to 1.3%. The average charity care expenditures for other nonprofit hospitals in the same county, Cook County, were 2.1%.
    The UCMC program responsible for these savings was called the “Urban Health Initiative”. As, Executive Director of Community Affairs, Michelle Obama spearheaded this UCMC program. With a little help from David Axelrod’s spin machine, Mrs. Obama, touted the program as a way to “dramatically improve health care for thousands of South Side residents.” The program was a “free” shuttle service that moved the poor and poorly insured, such as Medicaid patients, from the UCMC Emergency room to “other” facilities. Hey, if we ever get the bullet train, “urban” patients can get a really sweet ride to the lovely California coast. Some may call this scheme “patient dumping”, I prefer “Obamanomics”, because even though it was totally unethical and exploitative, Mrs. Obama was well paid, helping her and her husband move up the “Chicago style” political ladder, and aren’t we all so very, very glad all those poor folks, like young Dontae Adam’s, a Medicaid patient who had his lip torn off by a pit bull and was turned away from UCMC in Feb. 2009, sacrificed themselves so that they, and we all can be “helped” by “Obamacare”?


    Terry Browning wrote on August 23, 2009 01:07 PM: Care for the sick is an essential part of any modern society...but FREE care is NOT.....we are NOT Socialists (YET...), and we CANNOT keep treating those who dismiss THEIR part in MedCare by NOT putting THEIR $$$ into the system...there was a children's story when I was but a wee lad I was read about an industrious ant that stockpiled food for the winter months, while all around him laughed...until THEY went hungry...ya know what?...I'm kinda mad about giving MY hard-earned food to the termites that REFUSED to apply hard work and savings to THEIR own survival...it may be an analogy, but the sentiment is the same...Thoughtfully, dabear


    concerned Nevadan wrote on August 23, 2009 10:27 AM: These illegal aliens figured out a way to use the health care system to their advantage. Unfortunately, it is at the expense of people losing their jobs because the hospital is not earning enough to support their staff. This ultimately affects the US Citizens who work hard and pay their taxes because patient care deteriorates. I say call ICE and have them on standby at the hospital ER's and have these people deported.


    MLM wrote on August 21, 2009 05:48 AM: Valley Health System should be embarrased to have Miss Suzie Wood as a spokesperson for their Hospitals. To say that at their ED patients get asked if they want to go to UMC because they may have friends there is ABSURD, what what she thinking? Did she know how ridiculous her statement is, what she should have said instead is WE at Valley Hospital sent every illegal and uninsured patient to UMC and she would have been believeable and correct on her statement!!!!


    Healthcare_Worker wrote on August 20, 2009 09:29 PM: @ Tom, Burbank

    First, I know what @ means. The comment was directed at / to that particular poster. please become familiar with internet slang.

    Secondly, if you are from or in Burbank, it's your people who have ruined this state. Californicators.

    Thirdly, we do require a govt. ID for all services. Did you happen to know that the Mexican consul gives out ID's to illegals in Las Vegas? It's a valid govt. ID by law.

    Fourthly, Bedpan? You better not need a catheter on my watch buddy. I can promise you, it will be a long, slow, excrutiating procedure.


    Scott#2 wrote on August 20, 2009 08:44 PM: Lets not forget about how much the long running Anchor Baby program is costing us. Try defending this program to someone while sober.


    Delaware Bob wrote on August 20, 2009 08:34 PM: Illegal aliens are bankrupting our social hospitals and social services. Now more than ever, our government or the States have got to get these illegal aliens out of this Country and back to their own country where they belong.

    I for one, am sick and tired of these ILLEGAL ALIENS snubbing their nose at our immigration laws and the many other laws of this Country. If our Federal Government can not ENFORCE our immigration laws, and get these ILLEGAL ALIENS out of this Country, then let the States do it! One way or another, an end has to come to this illegal immigration, and not with AMNESTY! Amnesty will only encourage more ILLEGAL ALIENS to invade our Country and reward those who broke our laws and raped the American taxpayer in many ways...depressing our wages, taking our jobs, overwhelming our schools with their ILLEGAL ALIEN children, driving without a license or car insurance, all the crime from stolen identities to rape, drugs and everything else.

    Not to mention the BILLIONS sent out of this Country every year. How does that help our economy? Yes, how does it help?

    It's time for ZERO TOLERENCE with these ILLEGAL ALIENS. It's time for them get out of this Country and back in their own Country where they belong. When we get rid of the ILLEGAL ALIENS, we will get rid of all the problems that go with them. THAT IS A FACT!


    Joe C wrote on August 20, 2009 08:19 PM: I don’t know how anyone else feels about Kennedy but he now wants to change the state law so the governor can immediately replace him.
    If he cannot vote for the democratic agendas including amnesty for illegal aliens.

    Now the law is they can wait five months before a vote.
    This is a law that democrats put into place in 2004 so the republican governor Mitt Romney could not replace the senate seat with a Republican.
    Now they want to rig another senate seat to push their agendas.

    I don’t care who thinks I’m crude but when Kennedy dies, I’m having a dead Kennedy party.
    Kennedy and OJ have much in common they both got away with murder but Kennedy is also guilty of murdering a country.

    I am sick of those that have destroyed our country and I’m including Bush and his gang.


    Berkley and Obama hang our OBGYN's out to dry in the ER wrote on August 20, 2009 08:05 PM: TO: Tom Burbank, I worked admissions in the ER Trauma unit in Reno.

    I left that eight years ago, and everyday I remember no I.D.'s, no Social Security numbers, no health insurance, no co-operation.

    The Dr.'s were treating patients who who wouldn't give any information. Nice sitting duck mode for the doc's to be in.

    The Obama's and Berkley's put our Dr.'s at professional risk everyday.


    Tom, Burbank wrote on August 20, 2009 07:31 PM: TO: Healthcare worker (not @, which means 'at'), pull your head out of your bedpan.

    - 100 job lost at Sunrise? Start thinking of reporting illegals as saving your own job.

    - Calling ICE isn't playing cops.' Just out of curiosity, how much money would be enough to decrease your apathy?

    - Require ID from ALL patients, and voila!, no lawsuit.

    - Federal money is still taxpayer money. A shell game with money doesn't really change things. (In addition, both California and Texas have tried going after the Feds, to little avail iIt was Gov. George Bush, er, Boosh, who sued the Feds to collect money, if you can believe that). Vote out all incumbents and replace them with politicians who won't tolerate this farce.

    You have lots of complaints and as many excuses. Don't 'play politician,' and simply blow hot air up our blogs, DO SOMETHING. We all have the power to change this, and it starts with removing all incumbents from office.


    Read All Comments