Kidney Patient Caught Up in Care Crisis : UCI Medical Center May Not Continue Indigent’s Treatment

Roberto Godinez’s words are soft and hesitant, deferential in tone, almost meek. He is clearly uncomfortable in the presence of strangers, but he speaks frankly about the uncertainty of his future and “this problem with my kidneys.”

“They say I am going to die,” Godinez said. “And I want to live.”

Were it to end there, the 27-year-old man’s story might just be one more of a catastrophic illness striking the young. But Godinez is different, and his illness and presence at UCI Medical Center in Orange are at the crux of an ongoing debate over the hospital’s deepening financial crisis and its ability to continue serving the poor and those who otherwise cannot afford needed health care.

Two weeks ago, Godinez, an undocumented worker from Michoacan, one of Mexico’s poorest states, came down with persistent headaches and fatigue. After searching in vain for a clinic that would treat him, he was admitted to the medical center and was quickly diagnosed as suffering from chronic and acute kidney failure.

One kidney was not functioning at all, the other was on the verge of a total collapse. Doctors immediately put Godinez on dialysis and said that without the mechanical treatment eliminating impurities from his blood, he would certainly die. Perhaps not immediately, but in time his kidneys would simply give out.

“His kidneys are in very bad shape,” said Dr. Kenya Kozawa, one of Godinez’s attending physicians. “You can live with one kidney, but his right one isn’t working at all and the left is poorly working.”

Without a kidney transplant, Kozawa said, Godinez would probably require dialysis three to four times a week, an expensive and exhausting prospect even for those with the most comprehensive of insurance coverage.

Godinez is now able to lift himself out of his bed and may be released from the hospital as early as today. But he is uninsured, in debt and residing illegally in the country with a pregnant wife and three children. And despite the gravity of his illness, there are no guarantees that he will be provided the long-term outpatient treatment he so desperately needs to survive.

Godinez is covered by Medi-Cal, but medical center officials say that even with this, they may not be able to continue treating him because his questionable legal status could throw his coverage into jeopardy.

The Godinez case highlights the problems faced by public hospitals across the country in trying to deal with rising costs and tighter budgets while continuing to provide service to the indigent and poor.

But the situation has become so grave at the UCI facility, which has only 6% of the county’s hospital beds but is treating more than half of the county’s indigent patients, that officials recently threatened to stop treating the county’s poor in order to save the hospital from financial disaster.

Officials say the medical center is projected to run a deficit of more than $13 million in the fiscal year ending June 30, and it could reach $15 million next year. To reverse the gradual financial slide, UCI officials have asked the state to increase Medi-Cal funding and put a cap on the number of such patients the center must treat.

“Nobody wants anyone to die,” Kozawa concluded. “But nobody wants to pay either. That’s the social dilemma.”

The statistical arguments concerning budgets and state reimbursements and Medi-Cal funding are lost on Godinez, a thin man who speaks little English and can only write his first name in awkward, large block letters.

He knows only what the doctors have told him--that his time is running out, and he is looking for answers on where he can go for help.

“A friend of mine said that maybe I can buy this (dialysis) machine for $10,000, if I had the money,” he said. “If I could do that, I would go back to Mexico. But I don’t know if that is possible. The doctors say I need the treatment, but they’re not sure if they can give it to me.”

Whether Godinez is eligible for long-term care under his Medi-Cal coverage, even as an undocumented alien, seems to be in dispute among the experts.

John LaRoche, medical program director for the County Social Services Agency, said it was his understanding that Godinez would be able to treated at UCI Medical Center’s outpatient treatment program “as long as he meets other eligibility requirements, such as remaining a resident of Orange County.”

LaRoche said he knew of no limitations on how long Godinez could be treated and added that he assumed “that UCI Medical Center is scheduling follow-up care for him.”

But at UCI, Dr. Cyril Barton, an associate professor of nephrology who has been treating Godinez, said the medical center was reluctant to accept Godinez for long-term treatment because of questions over just how long Medi-Cal would continue to pay for dialysis.

“We would love to take care of him,” Barton said. “I don’t know where else he could go. If Medi-Cal would continue to provide for his care, it would be no problem.”

‘Letter of Denial’ Needed

Barton said the problem would come after the first 90 days of treatment, when Medi-Cal would have the option of cutting off Godinez’s benefits if he did not apply for benefits under the federal Medicare program, which he would likely be denied.

To satisfy Medi-Cal, Barton said, those applying for long-term treatment for kidney failure must first prove that they are not eligible for Medicare.

“He needs a letter of denial from Medicare,” Barton said. “But we looked into this, and Medicare will not issue that letter of denial because he (Godinez) does not have a Social Security number. This means they have a way of closing the loophole. If they have a guy who doesn’t have a legitimate Social Security number, they are not obligated to pay for the treatment of end-stage kidney disease.”

Barton said follow-up visits would be scheduled for Godinez and that dialysis treatment would continue for the time being, but no decision had been made by the admissions director on long-term treatment.

“The reason is that this is a small unit,” he said. “If they dropped his Medi-Cal coverage after 3 months, the unit would no longer be able to treat him. And after 3 months, a lot of bonds have been formed. It is better to get him in another unit right off the bat.”

“(But) until he can get dialysis someplace else, or the questions about his funding are cleared up, we will continue to treat him. We’re not going to let anyone die. This guy isn’t going to be kicked out and told not to come back.”

Barton said Medi-Cal reimburses the hospital $90 for each dialysis treatment, which covers the medical center’s cost. In a case such as Godinez’s, the weekly costs could range from $270 to $360, depending on the treatment schedule. Additional expenses for medicine could run as much as $200 a week, some of which is reimbursed by Medi-Cal.

Barton said the case points to the inability of governments at all levels to come to terms with the presence of thousands of undocumented and uninsured people.

“There are a lot of people here who are undocumented and they get sick, and somebody is going to have to pay for it,” he said. “You can get by with if it is a minor problem. But when you are talking about end-stage kidney disease it is catastrophic. The hospital here is $13 million in the hole and getting worse. This is the type of a problem we have.”

Stan Dorn, staff attorney for the National Health Law Program, a Los Angeles-based advocacy group, said he was aware of the problem that undocumented aliens have in obtaining the Medicare letter, but said it is easily overcome.

“What they do in Los Angeles is issue immigrants non-working Social Security numbers, and that allows them to get the letter,” Dorn said. “UCI is the principal provider of indigent care in the community, and they ought to know this. Only negligence, stupidity or malevolence will result in payment being denied.”

In addition, Dorn said, the state requires that undocumented people be afforded full Medi-Cal coverage to cover kidney dialysis treatment.

“Anyone needing long-term care should receive it,” Dorn said. “There are providers all over the state who get the dialysis paid for, and if UCI acts intelligently, they will too. For UCI to say we’re going to deny this person treatment, endangering his life because we are not 100% certain of being paid, is outrageous. We expect any doctor to save the human life and then act to get reimbursement.”

But even with full coverage, physicians said Godinez would probably be too ill to hold down the type of steady job he needs to support his family.

‘I’m Strong and I Can Work’

Godinez said that just as he had no choice in leaving the country of his birth, he had little regarding the need to work. “We left Mexico because there was no work there,” said. “And I have to work here. I’m strong and I can work. We have to eat.”

Godinez, whose weathered hands and tattooed arms belie his youth, came to the United States to “see if I could make a better life for my family here.”

For more than 3 years, he worked the fruit fields of Southern California and picked up odd jobs as a mechanic and day laborer before returning to his hometown of Los Reyes last Christmas to bring his wife and three children back to California.

“I thought things were going well,” he said from his hospital bed. “I thought we could make it. We wanted to do this for the children. The children should grow up here.”

Six months ago, the family rented a room in a boarding house in Santa Ana, the children in one bed and Godinez and his 22-year-old wife, Brigida, in the other. And Godinez went to work repairing cars and working part-time in a junkyard. It was not the promised land, but with his $200 a week salary, the family found itself able to buy all the things that had eluded them in Mexico.

“Here, even with a little money, you can buy pants and shoes for the children,” he said. “Sure it’s hard, but life has always been hard. It has always been a struggle.”

With the illness, Godinez said, he must face the future “with my faith. My wife says only faith in God will help us now.

“We are in his hands now.”

Times staff writer Lanie Jones contributed to this report.