There are now four more of them regularly making their way to the emergency room at University Medical Center. And doctors say the illegal immigrants coming in for dialysis treatment at University Medical Center are sicker than they were before, making their care even more expensive.
Six months after the Review-Journal revealed that 80 illegal immigrants with failing kidneys were running up about $2 million a month in bills for dialysis and other medical treatment at the only publicly supported hospital in Las Vegas, the situation for both patients and taxpayers only continues to worsen.
And despite promises by elected officials to look into the issue, there are few signs it will get better.
Federal laws that require hospitals to give emergency treatment to patients regardless of citizenship, combined with a lack of enforcement of immigration laws, make the problem insoluble right now, hospital and elected officials say.
Unable to receive the dialysis treatments that all American citizens qualify for under Medicare, illegal immigrants who need such treatment across the nation have increasingly turned to emergency rooms.
UMC officials, who project a budget deficit of more than $70 million for fiscal year 2010, say that encouraging illegal immigrants to return to their home countries for dialysis treatment hasn't worked.
In August, Jon Summers, a spokesman for Sen. Harry Reid, D-Nev., said the senator promised to find more funding to aid hospitals that help the indigent.
None has been forthcoming to UMC and Summers said recently that Reid now believes only health care reform and immigration reform can address UMC's dilemma.
And talk between local elected, hospital and foreign officials about addressing the issue hasn't materialized.
With nothing being done to correct its situation with dialysis patients, UMC officials say taxpayers can expect to pay more to wait longer for their own emergency services. Nearly every day, about eight illegal immigrants show up at the UMC emergency room hoping to receive dialysis care, hospital officials say.
"The cost to our taxpayers is astronomical," said Lawrence Weekly, the Clark County commissioner who also serves as chairman of the UMC board of hospital trustees. "Many people are justifiably outraged. If this kind of thing goes on, we might have to close our doors. But we're governed by federal law on this issue so some way the federal government has to help us out. We just can't stand by and let people die in the streets. We wouldn't want that on our conscience."
An hour after Weekly made his observations, 76-year-old Jose Diaz Ruiz, who freely admits he is in the country illegally, sat inside UMC Thursday afternoon tethered to a dialysis machine. He sat in one of four dialysis chairs designed for hospital patients who suddenly become ill, and not for those in need of chronic care.
A weary Diaz Ruiz, who could barely keep his eyes open, wept as he talked through an interpreter about how his kidneys began to fail about a year ago. The longtime agricultural worker in Idaho said he was on his way back to Mexico when his deteriorating health wouldn't permit him to continue traveling.
The vast majority of illegal immigrants receiving dialysis treatment through UMC's emergency room are from Mexico, hospital officials say.
Though he had no insurance or money to pay for treatment for his medical problems through a doctor, he heard from friends that UMC's emergency room treated people regardless of financial circumstance.
Often, he said, his condition worsens to the point where doctors must put him in the hospital for two or three days. He said he is grateful to the doctors and nurses at UMC for treating him so he can still spend time with his wife, two grown sons, and grandchildren.
What would he do otherwise?
"Die," he said.
Under the Emergency Medical Treatment & Labor Act, which was enacted in 1986, any patient, regardless of citizenship, who shows up at an emergency department requesting an examination or treatment for a medical condition must be given an appropriate medical screening to determine whether there is an emergency. If there is, treatment must be provided.
When the Review-Journal contacted Nevada's congressional delegation for this story, all said they recognized UMC's problem and that they must play the lead role in solving it. U.S. Rep. Shelley Berkley, D-Nev., put it this way: "The system is being abused by people using the emergency room for ongoing care, including dialysis services ... But this is about more than just access to care or the cost, it's an immigration issue that must be addressed. That is why we need comprehensive immigration reform that includes a humanitarian provision where we can repatriate patients to their country of origin with the guarantee that care will continue once they are home."
But no member of the delegation has any idea when the immigration issue will be addressed. And although this is a topic that has received press attention across the country, U.S. Immigration and Customs Enforcement (ICE) officials have not taken action.
"ICE arrests are prioritized, based on specific leads, evidence and information, and are made at the appropriate time and place," ICE spokeswoman Lori Haley wrote from her California office.
Asked if ICE would ever deem the abuse of emergency rooms by illegal immigrants as significant enough for her agency to make arrests, Haley read the statement she had e-mailed.
Dr. Dale Carrison, head of UMC emergency services and a former FBI agent, said arresting illegal immigrants in need of medical treatment isn't seen as "politically viable," either by top Republican or Democratic officials.
U.S. citizens with end stage renal disease automatically qualify for Medicare to cover dialysis costs and generally receive thrice weekly treatments through private dialysis clinics, the best way to manage the condition both medically and financially.
But because illegal immigrants are not eligible for Medicare, they have figured out a way "to at least stay alive," Carrison said.
"They realize we'll dialyze them if they're in bad enough shape," he said.
Using emergency rooms this way is costly and dangerous, Carrison said, adding that a full screening with lab tests is done each time an individual comes to the emergency room.
Patients on Medicare who go to private dialysis clinics, Carrison noted, don't need expensive tests repeated because their private doctors are carefully managing their conditions.
Carrison said unless an individual with failing kidneys has a true emergency, meaning that person could die without treatment, dialysis isn't done.
"That means when they come back a few days later, their bodies are in really bad shape," he said, adding that it often results in expensive hospital stays in intensive care.
Carrison said private hospitals in Southern Nevada often send illegal immigrants to UMC for dialysis care.
"They could be doing this far more than they are but they send them here," he said.
Sunrise Health System officials said uncompensated care for dialysis for illegal immigrants' cost nearly $1.1 million for 2009. They denied steering illegal immigrants to UMC.
Valley Health System officials said they have given dialysis treatments to illegal immigrants but won't reveal the number of treatments given.
In August the Review-Journal interviewed dialysis patients who had to be hospitalized for up to two months because they waited too long to get the care.
The cost of care over that period would be at least in the tens of thousands of dollars, with the final cost dependent on the life-saving measures that had to be taken.
Brian Brannman, UMC's chief operating officer, has said the billed costs at UMC per visit for dialysis done on illegal immigrants can run into the thousands of dollars.
With four new illegal immigrants now having their dialysis done at UMC's emergency room -- and monthly visits jumping from 216 in August to 243 currently -- the billed charges for the 84 illegal immigrants are now at about $2.4 million a month -- or $28 million a year.
Actual costs -- in other words, UMC's costs for carrying out the dialysis care -- is about $700,000 a month, or about $8.4 million a year. That doesn't include, however, costs for extra care because the patient has become more ill. Brannman said that kind of analysis hasn't been done because hospital officials "haven't seen a need."
Private hospital officials generally don't divulge actual costs of treatment, considering the information proprietary to their business model. But under the law, taxpayer-supported hospitals have to be more transparent.
Brannman said UMC has never tried to help illegal immigrants who are dialysis patients relocate, noting there appears to be little interest. He did say the hospital, in conjunction with the Mexican consulate in Las Vegas, has helped to get Mexican nationals back to their homeland for care in other emergency situations, such as serious accidents.
Brannman said UMC social workers repeatedly counsel illegal immigrants on the benefits of getting dialysis treatments in their homeland. He said the social workers are in constant contact with the staff of Mariano Lemus Gas, the consul for Mexico in Las Vegas.
"The patients aren't interested in going back," Brannman said.
Gas said in August that UMC leaders should meet with him personally to talk regularly about the problem.
"I will do all I can to see if we can get people from our country to leave Las Vegas and return to Mexico for their health care," he said.
But Gas said last week that no UMC leader has contacted him about Mexican nationals receiving dialysis care at UMC.
"I thought that problem was over because so many Mexican nationals are going back to Mexico because of the bad economy here," he said. "The hospital needs to talk about this on a high level if they want results."
Gas has said his country provides some funding to send Mexican nationals back for some medical treatment.
Brannman said he never met with Gas because he didn't think it would do any good, seeing as the hospital's social workers have unsuccessfully brought the message to illegal immigrants about returning home.
County Commissioner Steve Sisolak said he was stunned when he learned top UMC officials have not met with Gas.
"I asked them to make sure and do that when I saw the consul really wanted to help out," he said. "When you've got somebody who says he'll try to work out a problem with you, you've got to take him at his word."
Sisolak also said he wants to explore subcontracting out the dialysis treatment for illegal immigrants. Although the cost for dialysis would essentially be the same, it may be the thing to do because patients would be seen on a regular basis and not become sick and require costly extra care, said hospital spokesman Rick Plummer.
Brannman said it doesn't seem right, however, to enter into a legal contract that benefits illegal immigrants. It may seem, he said, that Las Vegas condones the behavior.
But Sisolak said that the reality is that taxpayers are paying for health care for illegal immigrants.
"Whatever saves taxpayer money, we should be for," he said.
Brannman noted that the hospital receives no reimbursement from federal, state or local sources to provide the life-saving treatments for people who have entered the country illegally.
Health care costs for illegal immigrants, a hot-button issue in the health care reform debate, vary widely because of the difficulty in obtaining accurate information on illegal immigrants. But all estimates run into the billions of dollars.
Diaz Ruiz didn't want to talk about money as he received dialysis at UMC Thursday.
"I only want to live," he wept.
Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.