Immigrants stranded in Connecticut hospitals without access to ambulatory services

Six months have passed since Maria was released from Yale New Haven Hospital.

No fresh air. No wind, rain or sun on his skin. No home cooked meals. Just the air conditioning, lukewarm cafeteria meals and the view from her window overlooking the hospital parking lot.

She also has access to the dialysis treatment she needs. Without her, her doctor leaves her only a few days to live.

If she returns home, she will not be able to get dialysis at a clinic or other cheaper program because she is an undocumented immigrant.

So Maria is stuck in the hospital, although she is well enough to leave YNHH and get outpatient dialysis. Her only other alternative is to leave and return to the emergency room every few days when her kidneys start to shut down.

“I just want to get out of here now. I’m bored, ”said Maria, who went to the hospital on December 8 when her kidneys started to shut down. “I used to think my life was ending, and that’s how I feel now that I’m trapped here… I consider being here to be even worse than being in jail. They tell you you can’t go out. Just look out the window.

The CT Mirror is not disclosing Maria’s real name at her request as she is undocumented.

Hospitals are required by federal regulations to provide life-sustaining treatment to uninsured undocumented immigrants who present to the emergency room and to treat them until they can be safely discharged. In Connecticut, however, undocumented migrants do not have access to outpatient services or cheaper nursing home care if they need ongoing treatment after hospitalization.

So patients like Maria have to stay in the hospital to stay alive.

It is both extremely expensive and, in the opinion of civil rights lawyers, a form of “humanitarian imprisonment”.

“Allowing someone to die an excruciating death – or endure repeated rounds of severe and terrifying acute symptoms, followed by an emergency room visit, hospital admission, then stabilization and of an outing, to be repeated a few days later – may not be what the citizens of Connecticut expect from their government, ”a coalition of legal aid lawyers wrote on April 27 of senior administration officials. by Governor Ned Lamont.

The Department of Social Services declined to comment on state policy not to cover certain vital outpatient services for undocumented immigrants and legal immigrants who have moved here in the past five years. Medical care for these patients stranded in hospital is paid for with a combination of state and federal dollars through Medicaid. Since dialysis was not on Connecticut’s list of covered medical care, undocumented immigrants cannot access treatment unless they report to the emergency room.

Lawyers for New Haven Legal Assistance Association Legal Aid, Greater Hartford Legal Aid and Connecticut Legal Services have also not received a response from the Lamont administration.

Failure to cover treatment is costly for taxpayers.

The cost of Maria’s six-month hospital stay is now more than $ 1 million, according to estimates by her legal aid lawyers, compared to around $ 91,000 per year for dialysis treatment. ambulatory.

The state and federal governments bear the brunt of that bill, as undocumented immigrants are eligible for Medicaid when they require life-sustaining measures in the hospital. At least 14 other states cover outpatient dialysis treatment, including Massachusetts and New York.

An unquantified problem

National estimates suggest that between 5,000 and 9,000 undocumented people in the United States have end-stage kidney disease, which requires dialysis.

Connecticut officials don’t know how many of these “permanent patients,” as some hospital officials call them, are subsidized by the state to live in the hospital. They also don’t know how much Connecticut could save by allowing Medicaid to cover outpatient dialysis and other reduction treatments for some chronic health conditions.

Civil rights attorneys and Pro Senate Speaker Tem Martin Looney D-New Haven believe there are other undocumented immigrants trapped in Connecticut hospitals on any given day.

“I do not believe it [Maria] is the only Connecticut patient in this situation, ”Looney wrote to the state commissioner in the Department of Human Services on May 25. “This policy seems not only inhumane, but also financially unhealthy. Allowing Medicaid coverage for outpatient dialysis would allow that patient to go home, and it would also save money for the state. I urge you to make this change as soon as possible.

Yale New Haven Hospital declined interview requests and did not respond to specific questions for this story.

Hartford hospital officials said they decided to cover the cost of outpatient dialysis so those in need of treatment can be discharged without delay. The hospital is currently paying for 10 undocumented patients to receive outpatient dialysis, which costs around $ 520 per treatment. The annual cost for the hospital to cover this is $ 270,000 per year.

“We don’t have to keep our patients in the hospital for a long time to wait to find a place that will take them, or find a way to fund that,” said Dr Suparna Dutta, chief of medicine at the hospital. ‘hospital. hospital.

The hospital, however, struggles to remove some undocumented immigrants who do not necessarily need to stay in the hospital but are not stable enough to return home and could benefit from a nursing home or nursing home. a less expensive setting to receive care.

“They are doing well with their medical problem. They no longer need to be in the hospital, but the problem then becomes, where do they go next? Dutta said. “Sometimes our recommendation is a care facility so they can get stronger before they go home, so you don’t worry about them coming home and falling. But, of course, if you don’t have insurance, it costs quite a bit. So when you don’t have the option of sending your patients to a more controlled environment, you sometimes keep them in the hospital a little longer until you are absolutely sure they will be okay at home. .

It is not known how widespread this problem is, although Dutta suspects that undocumented immigrants disproportionately require dialysis treatment. This is because undocumented immigrants often do not have private insurance, are not eligible for Medicaid, and therefore are unable to obtain a kidney transplant to avoid a lifetime of dialysis treatment. Dutta suspects that they also have difficulty accessing necessary medications to possibly avoid requiring dialysis.

Community health centers, which serve as a safety net for vulnerable populations, are struggling to fill the void.

Dr Ben Oldfield, chief medical officer at Fair Haven Community Health Center in New Haven, said people with diabetes too often land in the emergency room due to lack of access to insulin and an endocrinologist. One in four patients who come to their clinic is undocumented.

“We have certain resources to provide our patients with specialized care through certain programs, but often these programs depend on this condition which [the patient’s] condition will be life threatening, ”he said. “If they are not insured [and need to see an endocrinologist], we don’t have a lot of recourse to get there… They don’t get the care they need, so there’s a greater chance of ending up in the hospital.

The constraints imposed on treatment by the medical system have negative effects on the quality of care received by undocumented patients; a study of undocumented immigrants with end-stage kidney disease found that those who only received dialysis in an emergency had a 14-fold higher death rate. Undocumented immigrants also face financial barriers to receiving kidney transplants, which are considered the best treatment for the disease.

Annual efforts to expand access to the state’s Medicaid plan – known as Husky – have failed to gain General Assembly approval. However, the Democratic-controlled legislature sent a bill to the governor’s office to open the door for children under 8 this year.

“If there was basic coverage that allows people to go to doctors, get preventive care, have Medicaid coverage if they have newly diagnosed diabetes or high blood pressure, they can start immediately. treatment and being closely monitored, and we “there will be fewer people who will even be admitted to hospital or need dialysis or have to hang around in hospital while waiting for this rehabilitation,” Dutta said.

The Connecticut Hospital Association, in a statement, said all too often undocumented people present in crisis to their emergency departments.

“No one should have to wait for a medical problem to become an emergency to seek treatment. Unfortunately, Connecticut hospitals often see cases where delays in care due to lack of insurance or immigration status lead to much more serious illnesses, requiring more intensive care, and resulting in less positive outcomes. The Connecticut Hospital Association supports extending insurance coverage to low-income undocumented immigrants living in our state. Investing in earlier and more appropriate access to care means healthier communities and lower costs of care for all.

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About Genevieve Swain

Genevieve Swain

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