No CrossRef data available.
Article contents
Emergency-Only Hemodialysis Policies
Ethical Critique and Avenues for Reform
Published online by Cambridge University Press: 01 January 2021
Abstract
An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms. ‘Emergency-only hemodialysis’ (EOHD) is associated with higher healthcare costs, higher mortality, and longer hospitalizations. In this paper, we present an ethical critique of existing federal policy. We argue that EOHD represents a failure of fiduciary and professional obligations, contributes to moral distress, and undermines physician obligations to be good stewards of medical resources. We then explore potential avenues for reform based upon policies introduced at the state level. We argue that, while reform at the federal level would ultimately be a more sustainable longterm solution, state-based policy reforms can help mitigate the ethical shortcomings of EOHD.
- Type
- Independent Articles
- Information
- Journal of Law, Medicine & Ethics , Volume 48 , Issue 3: A Bold Agenda for the Next Steps in Health Reform , Fall 2020 , pp. 527 - 534
- Copyright
- Copyright © American Society of Law, Medicine and Ethics 2020
References
Pew Research Center Hispanic Trends, “U.S. Unauthorized Immigrant Total Dips to Lowest Level in a Decade,” available at <https://www.pewhispanic.org/2018/11/27/u-s-unauthorized-immigrant-total-dips-to-lowest-level-in-a-decade/> (last visited Oct. 10 2019).+(last+visited+Oct.+10+2019).>Google Scholar
Rodriguez, R.A., “Dialysis for Undocumented Immigrants in the United States,” Dialysis for Undocumented Immigrants in the United States, 22, no. 1 (2015): 60–65.Google Scholar
Levin, A., Hemmelgam, B., Culleton, B., Tobe, S., McFarlane, P., Ruzicka, M., Burns, K., Manns, B., White, C., Madore, F., Moist, L., Klarenbach, S., Barrett, B., Foley, R., Jindal, K., Senior, P., Pannu, N., Shurraw, S., Akbari, A., Cohn, A., Reslerova, M., Deved, V., Mendelssohn, D., Nesrallah, G., Kappel, J., and Tonelli, M., “Guidelines for the Management of Chronic Kidney Disease,” Guidelines for the Management of Chronic Kidney Disease, 179, no. 11 (2008): 1154–1162.Google Scholar
Raghavan, R., “New Opportunities for Funding Dialysis-Dependent Undocumented Individuals,” New Opportunities for Funding Dialysis-Dependent Undocumented Individuals, 12, no. 2 (2017): 370–375.Google Scholar
Cervantes, L., Mundo, W., and Powe, N.R., “The Status of Provision of Standard Outpatient Dialysis for US Undocumented Immigrants with ESKD,” The Status of Provision of Standard Outpatient Dialysis for US Undocumented Immigrants with ESKD, 14, no. 8 (2019): 1258–1260.Google Scholar
Nguyen, O.K., Vazquez, M.A., Charles, L., Berger, J.R., Quiñones, H., Ruquay, R., Sanders, J.M., Kapinos, K.A., Halm, E.A., and Makam, A.N., “Association of Scheduled vs Emergency-Only Hemodialysis with Health Outcomes and Costs in Undocumented Immigrants with End-Stage Renal Disease,” Association of Scheduled vs Emergency-Only Hemodialysis with Health Outcomes and Costs in Undocumented Immigrants with End-Stage Renal Disease, 179, no. 2 (2019): 175–183.Google Scholar
Nguyen, supra note 6; Cervantes, L., Tuot, D., Raghavan, R., Linas, S., Zoucha, J., Sweeney, L., Vangala, C., Hull, M., Camacho, M., Keniston, A., McCulloch, C.E., Grubbs, V., Kendrick, J., and Powe, N.R., “Association of Emergency-Only vs Standard Hemodialysis with Mortality and Health Care Use Among Undocumented Immigrants with End-Stage Renal Disease,” Association of Emergency-Only vs Standard Hemodialysis with Mortality and Health Care Use Among Undocumented Immigrants with End-Stage Renal Disease, 178, no. 2 (2018): 188–195.Google Scholar
Renal Physicians Association, “RPA Position on Dialysis for Non-Citizens,” RPA Position on Dialysis for Non-Citizens, 54, no. 3 (2000): 253–254.Google Scholar
Campbell, G.A., Sanoff, S., and Rosner, M.H., “Care of the Undocumented Immigrant in the United States with ESRD,” Care of the Undocumented Immigrant in the United States with ESRD, 55, no. 1 (2010): 181–191; Raghavan, R., “Caring for Undocumented Immigrants with Kidney Disease,” American Journal of Kidney Diseases 71, no. 4 (2017): 488-494; Howley, L., DeCamp, M., George, M., and Shannon, D., “SGIM and Advocacy: Coalition for Kidney Care of Non-Citizens (CKCNC),” SGIM Forum 38, no. 10 (2015): 1-2.Google Scholar
Campbell et al., supra note 9; Social Security Amendments of 1972, Pub. L. No. 92-603 § 299I (1972).Google Scholar
Campbell et al., supra note 9.Google Scholar
Renal Physicians Association, supra note 8.Google Scholar
Cervantes, L., Richardson, S., Raghavan, R., Hou, N., Hasnain-Wynia, R., Wynia, M.K., Kleiner, C., Chonchol, M., and Tong, A., “Clinicians’ Perspectives on Providing Emergency-Only Hemodialysis to Undocumented Immigrants,” Clinicians’ Perspectives on Providing Emergency-Only Hemodialysis to Undocumented Immigrants, 169, no. 2 (2018): 78–86.Google Scholar
Raghavan, supra note 4.Google Scholar
Raghavan, supra note 4.Google Scholar
Kelley, T. and Tipirneni, R., “Care for Undocumented Immigrants — Rethinking State Flexibility in Medicaid Waivers,” Care for Undocumented Immigrants — Rethinking State Flexibility in Medicaid Waivers, 378, no. 18 (2018): 1661–1663.Google Scholar
Cervantes, L., Grafals, M., and Rodriguez, R.A., “The United States Needs a National Policy on Dialysis for Undocumented Immigrants with ESRD,” The United States Needs a National Policy on Dialysis for Undocumented Immigrants with ESRD, 71, no. 2 (2018): 157–159.Google Scholar
Nguyen et al., supra note 6; Zhang, H.H., Cortés-Penfield, N.W., Mandayam, S., Niu, J., R.Atmar, L., Wu, E., Chen, D., Zamani, R., and Shah, M.K., “Dialysis Catheter-Related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-Only Basis: A Retrospective Cohort Analysis,” Dialysis Catheter-Related Bloodstream Infections in Patients Receiving Hemodialysis on an Emergency-Only Basis: A Retrospective Cohort Analysis, 68, no. 6 (2019): 1011–1016.Google Scholar
Renal Physicians Association, supra note 8.Google Scholar
Raghavan, R. and Nuila, R., “Survivors — Dialysis, Immigration, and U.S. Law,” Survivors — Dialysis, Immigration, and U.S. Law, 364, no. 23 (2011): 2183–2185.Google Scholar
Linden, E.A., Cano, J., and Cortisidis, G.N., “Kidney Transplantation in Undocumented Immigrants with ESRD: A Policy Whose Time Has Come?” Kidney Transplantation in Undocumented Immigrants with ESRD: A Policy Whose Time Has Come? 60, no. 3 (2012): 354–359.Google ScholarPubMed
Cervantes, L., Fisher, S., Berlinger, N., Zabalaga, M., Camacho, C., Linas, S., and Ortega, D., “The Illness Experience of Undocumented Immigrants with End-Stage Renal Disease,” The Illness Experience of Undocumented Immigrants with End-Stage Renal Disease, 177, no. 4 (2017): 529–535; Kansal, P. and Voskoboynik, K., “Dialysis Access for Undocumented Immigrants in Indiana,” Indiana University Robert H. McKinney School of Law Health and Human Rights Clinic.Google Scholar
Cervantes et al., supra note 22.Google Scholar
AMA Council on Ethical and Judicial Affairs, “AMA Code of Medical Ethics’ Opinion on Physician Stewardship,” AMA Code of Medical Ethics’ Opinion on Physician Stewardship, 17, no. 11 (2015): 1044–1045, at 1044.Google Scholar
Nguyen et al., supra note 6.Google Scholar
Nguyen et al., supra note 6; Zhang et al., supra note 18.Google Scholar
Linden et al., supra note 21.Google Scholar
Wong, G., Howard, K., Chapman, J.R., Chadban, S., Cross, N., Tong, A., Webster, A.C., and Craig, J.C., “Comparative Survival and Economic Benefits of Deceased Donor Kidney Transplantation and Dialysis in People with Varying Ages and Co-Morbidities,” PLoS ONE 7, no. 1 (2012): e29591; Tonelli, M., Wiebe, N., Knoll, G., Bello, A., Browne, S., Jadhav, D., Klarenbach, S., and Gill, J., “Systematic Review: Kidney Transplantation Compared with Dialysis in Clinically Relevant Outcomes,” American Journal of Transplantation 11, no. 10 (2011): 2093-2109.Google ScholarPubMed
Shen, J.I., Hercz, D., Barba, L.M., Wilhalme, H., Lum, E.K., Huang, E., Reddy, U., Salas, L., Vangala, S., and Norris, K.C., “Association of Citizenship Status with Kidney Transplantation in Medicaid Patients,” Association of Citizenship Status with Kidney Transplantation in Medicaid Patients, 71, no. 2 (2018): 182–190.Google Scholar
Cervantes et al., supra note 13.Google Scholar
Salyers, M.P., Bonfils, K.A., Luther, L., Firmin, R.L., White, D.A., Adams, E.L., and Rollins, A.L., “The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis,” The Relationship Between Professional Burnout and Quality and Safety in Healthcare: A Meta-Analysis, 32, no. 4 (2016): 465–482.Google Scholar
Cervantes et al., supra note 13.Google Scholar
Ansell, D., Pallok, K., Guzman, M.D., Flores, M., and Oberholzer, J., “Illinois Law Opens Door to Kidney Transplants for Undocumented Immigrants,” Illinois Law Opens Door to Kidney Transplants for Undocumented Immigrants, 34, no. 5 (2015): 781–787.Google Scholar
Berlinger, N. and Raghavan, R., “The Ethics of Advocacy for Undocumented Patients,” The Ethics of Advocacy for Undocumented Patients, 43, no. 1 (2013): 14–17, at 15.Google Scholar
Cervantes et al., supra note 13; Berlinger and Raghavan, supra note 34.Google Scholar
Rodriguez, supra note 2; Campbell et al., supra note 9; Cervantes et al., supra note 13.Google Scholar
Nguyen et al., supra note 6; Wong et al., supra note 28.Google Scholar
Renal Physicians Association, supra note 8.Google Scholar
Teegardin, C., “Grady Dialysis Deal Finalized,” The Atlanta Journal-Constitution, Sept. 13, 2010, available at <https://www.ajc.com/lifestyles/health/grady-dialysis-deal-finalized/XYr2cazJC8akhqouRkRAQI/> (last visited Oct. 14, 2019).+(last+visited+Oct.+14,+2019).>Google Scholar
Pew Research Center Hispanic Trends, “Overall Number of U.S. Unauthorized Immigrants Holds Steady Since 2009,” available at <https://www.pewhispanic.org/2016/09/20/overall-number-of-u-s-unauthorized-immigrants-holdssteady-since-2009/> (last visited Oct. 14, 2019).+(last+visited+Oct.+14,+2019).>Google Scholar
Fabi, R.E.., “Public Health in the Context of Migration: Ethics Issues Related to Immigrants and Refugees,” The Oxford Handbook of Public Health Ethics (New York: Oxford University Press, 2019): 245–258.Google Scholar
Kansal, and Voskoboynik, , supra note 22; Raghavan, R. and Sheikh-Hamad, D., “Descriptive Analysis of Undocumented Residents with ESRD in a Public Hospital System,” Descriptive Analysis of Undocumented Residents with ESRD in a Public Hospital System, 40, no. 2 (2011): 78–81.Google Scholar
Zarembo, A. and Gorman, A., “Dialysis Dilemma: Who Gets Free Care?” Los Angeles Times, Oct. 29, 2008, available at <https://www.latimes.com/archives/la-xpm-2008-oct-29-medialysis29-story.html> (last visited Oct 16 2019).+(last+visited+Oct+16+2019).>Google Scholar
Kansal and Voskoboynik, supra note 22.Google Scholar
Yasenov, V.I., Lawrence, D., Mendoza, F.S., and Hainmueller, J., “Public Health Insurance Expansion for Immigrant Children and Interstate Migration of Low-Income Immigrants,” Public Health Insurance Expansion for Immigrant Children and Interstate Migration of Low-Income Immigrants, 174, no. 1 (2020): 22–28.Google Scholar
Fabi, supra note 41.Google Scholar
Linden et al., supra note 21.Google Scholar
Gupta, C., “Immigrants and Organ Sharing: A One-Way Street,” Immigrants and Organ Sharing: A One-Way Street, 10, no. 4 (2008): 229–234.Google Scholar
Raghavan and Sheikh-Hamad, supra note 42.Google Scholar
Colorado Department of Health Care Policy & Financing, “Provider Bulletin Reference: B1900427,” available at <https://www.colorado.gov/pacific/sites/default/files/Bulletin_0119_B1900427.pdf> (last visited Oct. 15 2019).+(last+visited+Oct.+15+2019).>Google Scholar
Brown, J., “Immigrants Here Illegally Were Waiting Until Near Death to Get Dialysis. A New Colorado Policy Changes That,” The Colorado Sun, Feb. 25, 2019, available at <https://coloradosun.com/2019/02/25/undocumented-immigrants-dialysiscolorado-medicaid-policy/> (last visited Oct. 14 2019).+(last+visited+Oct.+14+2019).>Google Scholar
Arizona Health Care Cost Containment System, “Emergency Services,” available at <https://www.azahcccs.gov/Members/GetCovered/Categories/emergencyservices.html> (last visited Oct. 14 2019).+(last+visited+Oct.+14+2019).>Google Scholar
Illinois Department of Human Services, “MR #18.05: Emergency Medical Coverage for Noncitizens not Meeting Immigration Status,” March 23, 2018, available at <https://www.dhs.state.il.us/page.aspx?item=53219> (last visited Oct. 16 2019).+(last+visited+Oct.+16+2019).>Google Scholar
Ansell et al., supra note 33.Google Scholar
Rodriguez, M., “Immigrants in State Illegally to Get State-Funded Kidney Transplants,” Chicago Tribune, Dec. 29, 2014, available at <https://www.chicagotribune.com/news/ct-immigrant-kidney-transplant-law-met-20141226-story.html#page=1> (last visited Oct. 16 2019).+(last+visited+Oct.+16+2019).>Google Scholar
Illinois Register: Illinois Department of Healthcare and Family Services, “Notice of Emergency Amendment,” Oct. 1, 2014, available at <https://www.illinois.gov/hfs/SiteCollectionDocuments/118700ER.pdf> (last visited Oct. 16 2019).+(last+visited+Oct.+16+2019).>Google Scholar
Ansell et al., supra note 33.Google Scholar
Department of Health Care Services, “Medi-Cal Eligibility and Covered California — Frequently Asked Questions,” available at <https://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/Medi-CalFAQs2014b.aspx#4> (last visited Oct 15 2019).+(last+visited+Oct+15+2019).>Google Scholar
Campbell et al., supra note 9; Raghavan and Nuila, supra note 20.Google Scholar
Zarembo and Gorman, supra note 43.Google Scholar
Cervantes et al., supra note 17.Google Scholar
Raghavan, supra note 4.Google Scholar
Raghavan, supra note 4.Google Scholar