Without these treatments, Andres Diego will die.
That’s the message he received on July 16 from the medical director of the treatment center in Fitzgerald where he’s been getting kidney dialysis three times a week since 2003.
Diego, 49, has end-stage renal disease, which means his kidneys have reached the final phase of failure and can no longer filter the toxins and excess fluids from his body. Instead, he spends three hours a day, three days a week hooked up to a machine that drains blood from a port in his arm, cleanses it, and sends it streaming back through his veins.
For 15 years, Diego’s gotten treatment just a few blocks from his home, at what’s now a U.S. Renal Care facility in downtown Fitzgerald. But the center notified patients in a letter on June 29 that their last day of service would be Aug. 1, and the clinic would spend the next 30 days facilitating transfers to other dialysis centers.
The next closest renal care facility is more than 26 miles away, a far distance to travel three times each week.
“The patient population has not been steady enough to sustain operations and we have determined that the City of Fitzgerald does not currently have the need for a dialysis clinic,” U.S. Renal Care’s management team wrote in the June letter to its patients.
As the closing date looms nearer, all of the patients have been transferred but one.
“Each dialysis (center), they only send one person with no insurance. And there was me over here,” Diego said.
Diego has no health insurance. Because he’s also ineligible for Medicaid, few treatment centers are likely to take him on as a patient.
It started with blood in his urine. In 1996, Diego was working in Atlanta when he found out he had kidney stones and spent two days at Grady Memorial Hospital. With some medicine, the stones passed, but Diego still didn’t feel quite right.
Next came the nosebleeds. And the cramping. Doctors said it was from exposure to high altitudes and sent him home without a diagnosis.
One day in February 1998, Diego felt so weak that he could barely move. He called his wife, Wyona Diego, and told her he could hardly keep his head up. She took him back to his health practitioner’s office, where a nurse practitioner passing by in the hallway overheard him outlining his symptoms and asked if the couple would mind if she ran a hemoglobin test.
“I said, ‘No, ma’am, by all means,’ because I wanted to find out what was going on,” Wyona Diego said.
Her husband was in kidney failure.
“They said maybe if it had been one more day, he wouldn’t have been here,” she said.
Andres Diego was rushed to the hospital at the Medical College of Georgia in Augusta, where he stayed for a month while doctors treated him for glomerulonephritis, an inflammation of the kidneys that they attributed to his abnormally small kidney size. As the doctors tried to piece together a treatment plan, one major barrier stood in the way: Diego’s citizenship status.
Originally from Veracruz, Mexico, Diego crossed the border illegally in 1990. Though his wife is a U.S. citizen, she hadn’t yet sponsored her husband’s citizenship when he got sick two years after they married in January 1996. And when she applied for Diego’s citizenship after his diagnosis with a chronic condition, she said they were turned down.
“They didn’t want him to be ward of the state,” Wyona Diego said. “I even had them talk to me about him possibly drawing my Social Security. And I said that would be fine, you know, as long as he could get the help that he needed.”
An immigration liaison based out of Atlanta helped Andres Diego apply for Medicaid, which didn’t require proof of citizenship status at the time.
Then he spent a few years getting treatment at a DaVita dialysis center in Atlanta, before he and his wife moved their family to Fitzgerald. Diego’s spent nine to 10 hours each week at the dialysis center on South Grant Street ever since.
Dialysis has become a regular ritual for Diego over the past 20 years. When he rolls up his sleeves, raised tunnels of skin emerge from the surface of his biceps. That’s where the ports go.
“His lifeline,” his wife calls them.
The tubes filter his body’s fluids, but sometimes they drain too much, or not enough, leaving Diego feeling cramped and exhausted. He rarely has energy to do much of anything after treatment.
“He just didn’t feel good because I can remember him, like, getting off the machine and saying, like, that he was just drained, and he didn’t have the energy to do anything,” said Santiago Diego, the couple’s 18-year-old son.
Santiago said his dad always did his best to come to his wrestling matches and spend time with him after school. But Diego rarely had the energy to throw a ball with his son in the yard or play in the park on the weekends.
“We grew up knowing that your daddy’s sick, so you can’t do everything the other kids do,” said Abalene Diego-Gallegos, the couple’s 21-year-old daughter.
When he’s feeling up to it, Diego does odd jobs around town to earn money. But with treatment three times a week, it’s hard to find steady work.
Dialysis is just a part of the Diegos’ routine. For now.
No citizenship, no Medicaid
Since the dialysis facility in Fitzgerald decided to close last month, U.S. Renal Care has been working with patients to find them care at other clinics nearby. Though there are no other dialysis centers within a 25-mile radius, U.S. Renal Care told The Telegraph it’s managed to secure treatment elsewhere for all of its patients, except Diego.
Diego has appealed for treatment at multiple renal care centers, and he’s been turned down by one after the other. Diego doesn’t have private insurance, and he hasn’t qualified for Medicaid for over a decade.
In 2006, the federal government implemented a new law called The Deficit Reduction Act of 2005, requiring those applying for or renewing their Medicaid coverage to provide proof of citizenship status.
Since then, Diego said U.S. Renal Care has allowed him to receive treatment without Medicaid or private insurance coverage, paying out of pocket for his treatments. But the other treatment centers haven’t agreed to take him on as a patient. Wyona Diego said it’s because of his citizenship status.
In 2007, she filed an I-130 form, which allows U.S. citizens or lawful permanent residents to petition for the citizenship of a relative. She received an I-797 form in response, approving her application. She has been told by immigration officials that her husband has a visa waiting for him in Juarez, Mexico, but he must go to the consulate there to pick it up in person.
If he were to leave the country, Diego would be barred from reentering for a decade. Immigrants applying for citizenship who reside in the country unlawfully for more than a year and then leave must wait 10 years before they can legally return, according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996.
Saad Bedier, medical director of the U.S. Renal Care center in Fitzgerald, wrote in a July 16 letter that “Andres Diego is unable to travel out of the country due to health issues.”
The only dialysis center in town
U.S. Renal Care is a privately owned, for-profit dialysis provider with 300 treatment centers across the U.S. For a clinic to turn a profit, it needs to have enough patients. But in a town of just under 9,000 in rural Georgia, a small patient pool can lead the only treatment center in the area to shut its doors.
Though the rest of the patients have been transferred to other clinics, they’ll spend extra hours each week traveling to and from treatment.
A study published in The Journal of Rural Health in 2013 found that, on average, rural patients travel 2.5 times farther than urban patients for dialysis treatment. To reach the next-closest facility, the study found, rural patients have to travel four times as far as their urban counterparts.
Years of research have determined that rural patients have limited access to health care. However, the authors of the study wrote that shortages of dialysis centers and other types of specialized care are particularly problematic for rural patients because they can’t always get the treatment they need at the closest hospital or health clinic.
And for Andres Diego, the center’s closure leaves him with little chance at survival.
If a person with end-stage renal disease stops dialysis treatment, his or her body will fill with the toxic fluids that the failing kidneys can’t filter. Once that happens, patients typically only have a few weeks to live.
Wyona Diego said she and her husband are considering moving to Illinois, where they’ve been told there are more options for immigrants seeking treatment. Beyond that, their choices are limited.
“What do you do? ” she asked, tears welling in her in eyes. “I mean, am I supposed to sit there and watch him die?”
Another dialysis center still might take him on as a patient. If that doesn’t happen, they might take him to the emergency room for emergency dialysis once his body starts shutting down.
For now, they’ll wait.
Samantha Max is a Report for America corps member and reports for The Telegraph with support from the News/CoLab at Arizona State University. Follow her on Facebook at facebook.com/samantha.max.9 and on Twitter @samanthaellimax. Learn more about Report for America at www.reportforamerica.org.