Roberto Godinez's words are soft and hesitant, deferential in tone, almost meek. He is clearly uncomfortable in the presence of strangers, but he speaks frankly about the uncertainty of his future and "this problem with my kidneys."
"They say I am going to die," Godinez said. "And I want to live."
Were it to end there, the 27-year-old man's story might just be one more of a catastrophic illness striking the young. But Godinez is different, and his illness and presence at UCI Medical Center in Orange are at the crux of an ongoing debate over the hospital's deepening financial crisis and its ability to continue serving the poor and those who otherwise cannot afford needed health care.
Two weeks ago, Godinez, an undocumented worker from Michoacan, one of Mexico's poorest states, came down with persistent headaches and fatigue. After searching in vain for a clinic that would treat him, he was admitted to the medical center and was quickly diagnosed as suffering from chronic and acute kidney failure.
One kidney was not functioning at all, the other was on the verge of a total collapse. Doctors immediately put Godinez on dialysis and said that without the mechanical treatment eliminating impurities from his blood, he would certainly die. Perhaps not immediately, but in time his kidneys would simply give out.
"His kidneys are in very bad shape," said Dr. Kenya Kozawa, one of Godinez's attending physicians. "You can live with one kidney, but his right one isn't working at all and the left is poorly working."
Without a kidney transplant, Kozawa said, Godinez would probably require dialysis three to four times a week, an expensive and exhausting prospect even for those with the most comprehensive of insurance coverage.
Godinez is now able to lift himself out of his bed and may be released from the hospital as early as today. But he is uninsured, in debt and residing illegally in the country with a pregnant wife and three children. And despite the gravity of his illness, there are no guarantees that he will be provided the long-term outpatient treatment he so desperately needs to survive.
Godinez is covered by Medi-Cal, but medical center officials say that even with this, they may not be able to continue treating him because his questionable legal status could throw his coverage into jeopardy.
The Godinez case highlights the problems faced by public hospitals across the country in trying to deal with rising costs and tighter budgets while continuing to provide service to the indigent and poor.
But the situation has become so grave at the UCI facility, which has only 6% of the county's hospital beds but is treating more than half of the county's indigent patients, that officials recently threatened to stop treating the county's poor in order to save the hospital from financial disaster.
Officials say the medical center is projected to run a deficit of more than $13 million in the fiscal year ending June 30, and it could reach $15 million next year. To reverse the gradual financial slide, UCI officials have asked the state to increase Medi-Cal funding and put a cap on the number of such patients the center must treat.
"Nobody wants anyone to die," Kozawa concluded. "But nobody wants to pay either. That's the social dilemma."
The statistical arguments concerning budgets and state reimbursements and Medi-Cal funding are lost on Godinez, a thin man who speaks little English and can only write his first name in awkward, large block letters.
He knows only what the doctors have told him--that his time is running out, and he is looking for answers on where he can go for help.
"A friend of mine said that maybe I can buy this (dialysis) machine for $10,000, if I had the money," he said. "If I could do that, I would go back to Mexico. But I don't know if that is possible. The doctors say I need the treatment, but they're not sure if they can give it to me."
Whether Godinez is eligible for long-term care under his Medi-Cal coverage, even as an undocumented alien, seems to be in dispute among the experts.
John LaRoche, medical program director for the County Social Services Agency, said it was his understanding that Godinez would be able to treated at UCI Medical Center's outpatient treatment program "as long as he meets other eligibility requirements, such as remaining a resident of Orange County."
LaRoche said he knew of no limitations on how long Godinez could be treated and added that he assumed "that UCI Medical Center is scheduling follow-up care for him."
But at UCI, Dr. Cyril Barton, an associate professor of nephrology who has been treating Godinez, said the medical center was reluctant to accept Godinez for long-term treatment because of questions over just how long Medi-Cal would continue to pay for dialysis.
"We would love to take care of him," Barton said. "I don't know where else he could go. If Medi-Cal would continue to provide for his care, it would be no problem."
'Letter of Denial' Needed