UCI Vows to Continue Treating Undocumented Alien

A young Mexican man suffering from acute kidney failure will be admitted to the dialysis treatment program at UCI Medical Center and may be eligible for a transplant despite concerns that he might lose his Medi-Cal coverage, officials said Thursday.

But in guaranteeing the long-term security of Roberto Godinez, medical center officials stressed that many more such cases of caring for uninsured indigents could bankrupt the hospital.

“We think the situation is resolved,” said Dr. N.D. Vaziri, chief of nephrology and head of the dialysis unit at the hospital. “In the interest of helping this individual and our commitment to human services, we will accept the risk and accept the patient.”

Godinez, an undocumented worker from Michoacan, Mexico, has been hospitalized at UCI Medical Center for the past 2 weeks. Doctors said one of his kidneys was not functioning at all and the other was on the verge of collapse.

Without dialysis or a transplant, they said Godinez would die within a matter of months, if not weeks.

Questions over his treatment arose when some medical center officials expressed concern that because he was in the country illegally, Godinez’s Medi-Cal coverage might expire after 3 months, leaving the financially strapped hospital picking up the expenses of his treatment.

Officials originally were reluctant to accept Godinez into the dialysis program, which is run separately from the hospital, because they might later have to release him if his insurance was cut off.

But after consulting with other officials, Vaziri said it was decided to admit Godinez into the program on the chance that his insurance coverage would continue uninterrupted. And even if it is cut off, Vaziri said, Godinez would not be denied treatment.

“That is the risk we are taking,” said Vaziri. “You cannot abandon a person if you know you would be jeopardizing his life.”

Vaziri said that Godinez, 27, would begin regular, 3-day-a-week dialysis treatment as an outpatient once he is released from the hospital Friday. As with all of the 80 patients currently undergoing dialysis at UCI, Vaziri said Godinez and his physicians will explore the possibility of a kidney transplant, which would enable him to lead a normal and active life.

“That is just one of the options you have,” he said. “You don’t rule out that option just because he doesn’t have any money.”

Vaziri said the Godinez case was a clear example of the problems institutions like UCI Medical Center face when called on to treat the uninsured and indigent.

“This is a responsibility that lies with the society as a whole--the state government, the federal government and the international nature of it--and it must be resolved,” he said.

Because the dialysis unit is “free-standing” and does not receive financial support from the hospital, Vaziri said, it could not run on a deficit. If Godinez loses his insurance, Vaziri said, “we could stretch that out to cover it, but if we had enough of these cases and the funding gets cut, what happens? At that point we would have to make some difficult decisions” about closing the unit.

The medical center itself is running deep in the red--a projected loss of $13 million this year--precisely because of its care for the poor and indigent and what it says are insufficient reimbursements from Medi-Cal. Unless more funding is found, hospital officials said, the center may have to stop treating the poor entirely and may stop accepting Medi-Cal patients.

At the dialysis unit, Vaziri said, “the problem is not with the doctors, who donate their time and work for free. But we have to pay for the supplies and the technicians. We are running on a very thin margin.” He said dialysis costs about $134 a session.

The questions over Godinez’s insurance arose because Medi-Cal will stop paying after 3 months unless Medicare also rejects him. But Medi-Cal requires a letter to that effect. Medicare, however, won’t write the letter because Godinez, as an illegal, has no Social Security number.

By late Thursday, however, local officials said they were reviewing the Medi-Cal policy regarding undocumented workers and said they believe that Godinez may be eligible for long-term coverage even without a letter from Medicare.

John LaRoche, medical program director for the county Social Services Agency, said he was optimistic that Godinez does not need the letter and in fact is eligible for long-term care under Medi-Cal.

“I have contacted the Department of Health Services eligibility branch, and I am waiting a return call for confirmation of this,” he said.

Jean Teetor, administrator of the Renal Dialysis Center, said she was “real hopeful at this point that all the problems we earlier anticipated may not cause us the concern that we originally thought.”

“This is a concern that has permeated the entire dialysis community,” she added. “We will basically trust the system to work it out.”

Jean Newcomer, head of the medical center’s social services department, said Godinez’s case reflected the difficulty in “dealing with cumbersome bureaucracies” and how to interpret a new state law guaranteeing certain medical rights and services to people in the country illegally.

“It is just a matter of working this out,” she said. “The intent was to help these people.”