The hidden cost of dialysis

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The hidden cost of dialysis
Mounting deficits have led the Montreal General Hospital to abolish free transportation service for patients who must receive treatment up to three times a week. The bill can be as high as $1,056 a month
 
CHARLIE FIDELMAN
The Gazette

Monday, June 16, 2008

Kidney patient Jozef Litynski taps the pulsing red tubes stretching from his chest to a machine the size of a mini-bar fridge and says that he feels like a prisoner.

Litynski is hooked up to a machine that does what his failed kidneys once used to do - clean his blood of impurities. The job takes four hours, three times a week.

Sitting among two dozen kidney patients at the dialysis unit of the Montreal General Hospital, Litynski notes that none of them can live without dialysis.

But getting to the hospital for many has turned into a nightmare.

Mounting deficits - the budget has decreased and patients have increased - have led the hospital to abolish its free transportation service in favour of a pro-rated system some are calling a user fee.

And what a user fee - up to $1,056 a month.

The new financial burden is forcing some elderly patients on fixed incomes to choose between food, medication and their dialysis sessions, patients' representatives said.

A retired meteorology professor, Litynski, 79, says he can't afford that on his fixed income, and the unpaid invoices have been piling up since October.

That's when the McGill University Health Centre abolished its free shuttle service after warning patients to find alternative means.

Some patients with incomes of $35,000 or more are facing taxi fees as high as $13,000 a year.

The MUHC is demanding patients provide government income tax returns as proof of revenue to be considered for a fare reduction.

Litynski refused. It's a privacy issue, said his wife, Anna.

"They have no right to request that kind of thing," she said. "It's an outrageous amount of money - more than what I pay for my mortgage. We are unable to pay it.

"And they say they may charge us for the previous year's transportation."

The restructuring of transportation for dialysis patients in Montreal has been in the works since 2005.

Other hospitals also cut back on subsidized shuttles in taxi vans that can take wheelchairs, but only the General is sending out hefty bills to cover its costs.

Not one dialysis patient has been left in the lurch since the service was cut, said Terry Meehan, director of logistics at the MUHC.

"No patient that requires financial assistance has ever suffered from this," Meehan said.

Litynski is one of seven "delinquent" patients who is still using the service and is getting billed for its total cost. The taxi cost is anywhere from $12 to $70 per ride, depending on where the patient lives.

"We're sorry, but unless he can prove to us that he needs financial assistance, we assume he doesn't," Meehan said. "We have be able to assess needs."

Two years ago, the hospital's budget for transportation was $325,000, but the service cost $750,000, he said.

"That money was taken out of the global budget used for other clinical areas, like nursing," Meehan said. "We did not have the funds; we were in a deficit position."

The change affected 284 dialysis patients, including 74 who used the shuttle.

All dialysis patients once got the shuttle service automatically; now it's determined case by case, said Pascal Mailhot of Maisonneuve Rosemont Hospital.

"It used to be open bar," he said. "We paid for taxis for everyone. But we cover a huge territory, the number of patients doubled and it became very expensive - $1 million a year."

Now, only those who are very sick and on welfare qualify for full subsidy, he said.

Patients were redirected to public transportation, he said.

"There's a delay of two months (for the service) and in the meantime, we pay."

Some rely on friends and family, volunteer drivers from the community health department and subsidized taxi services.

Those who are too sick to use the public system are subsidized, if there's a financial need, he added.

"We try to find a solution, but our mission isn't transportation," Mailhot said.

Litynski drove to the hospital for seven years until his doctor said it was too dangerous given his weakened state. He has relied on the shuttle service for three years. The family offered to defray costs to the tune of $200 a month but have yet to get an answer.

Litynski has since applied for Transport adapté, a drop-off service that costs the same as a bus ticket.

In reality, that is not always workable. Patients have long complained that Transport adapté is not reliable and it works on a rigid timetable.

It is absolutely crucial that dialysis patients have access to safe and reliable transportation, said Gael Campbell, co-chair of the MUHC patients committee.

"Transportation is part of the care for these patients," Campbell said. "As a dialysis patient, you are a prisoner of many things you cannot control."

The patient's users' group at the Montreal General Hospital is calling on the Montreal Health Agency to increase funding for dialysis patients.

"The government says that it's not in the transportation business. I do understand that. But what happens to these patients?

"They are falling through the cracks."

The provincial Health Department is looking at the situation, said Matthieu Leroux, spokesperson for the Montreal Health Agency.

As for Transport adapté, the service is aware that dialysis patients are "fragile" and require special care, said Marianne Rouette of the Montreal Transit Corp.

"But that's not how the service works. We don't prioritize these clients because it is public transportation," she said. "We're looking for solutions."

The dialysis unit of the Montreal General Hospital is noisy with the hum and gurgle of 25 dialysis machines and the buzz of televisions - also one per patient.

Litynski is whiling away the hours by reading Polish-language magazines.

In the waiting room, a woman checks a wall clock. Her dialysis was delayed by more than an hour. Transport adapté had dropped her off last instead of first.

cfidelman@thegazette.canwest.com

KIDNEY DISEASE AND DIALYSIS QUICK FACTS

Hemodialysis means "cleaning the blood," and that's exactly what this treatment does. Blood is withdrawn from the body by a

machine and passed through an artificial kidney. The artificial kidney cleans the blood but is not as efficient as healthy kidneys.

- Kidney disease can strike anyone at any age.

- An estimated 2 million Canadians have kidney disease, or are at risk.

- If kidney failure is not treated, people die within days or weeks.

The Kidney Foundation of Canada

http://www.canada.com/montrealgazette/news/story.html?id=1b7364da-9dab-44f9-8e80-396eb3596b07