Ariel Gonzalez woke up the morning of January 15, 2014 feeling under the weather. Within hours he was doubled over in pain, had a searing headache, and was vomiting. He rode his bike, his only means of transportation, twenty minutes to the local clinic, Florida Community Health Centers, Inc., where he was diagnosed with abdominal pain and sent home with some medications and instructions to go to an emergency room if his condition worsened.
Later that same day, feeling much worse, Gonzalez got a friend to drive him to the emergency room at a local public hospital where he was found to be in acute kidney failure. He was then rushed by ambulance to Lawnwood Regional Medical Center, in the next county, for emergency dialysis and hospitalized for a week.
Had Miami Law’s Health Rights Clinic not stepped in and advocated on behalf of Gonzalez, a 35-year-old undocumented farmworker without a primary care physician or health insurance, he would have not seen the end of the Florida growing season and been sent back to Mexico in a body bag.
Gonzalez endured six weeks of 90-minute round trips to Lawnwood and was admitted only if he was in kidney failure, as the law students were frantically pushing to get him approved into a clinical dialysis regime. On top of that the condition left him listless, weak, and unable to go back to picking oranges and the majority of the medical instructions, both in writing and spoken, were in English, a language he doesn’t understand, read, or speak.
Aside from only treating him when he was in kidney failure, the hospital’s other solution for Gonzalez’s life-threatening condition was to offer him “medical repatriation” —sending him back to his border town home of Matamoros, Mexico at the hospital’s expense. Even if Gonzalez survived the trip, he would be faced with certain death with no access to dialysis treatment in his hometown.
What Gonzalez didn’t know – because the patient navigator contracted by the hospital didn’t know – was that he qualified for federally funded emergency Medicaid. This is when Health Rights Clinic students, Kanchi Doshi, Jenna Feldman, Rebecca Greenfield, and Nicole-Suzette Velazquez sprang into action and began firing off letters demanding the hospital and other agencies follow state law and apply for emergency Medicaid and provide three-times-a-week dialyses for Gonzalez.
That process would take 20 days of round-the-clock support by the students, paralegal Vanessa Alpizar, clinic administrative assistant Albert Arguello, and the clinic’s two supervising attorneys, JoNel Newman and Melissa Swain.
What the Health Rights Clinic students found was that none of the agencies charged with securing emergency care for people like Gonzalez had the slightest knowledge of the benefits available or the protocol and process to apply. Lawnwood Regional Medical Center didn’t know how to apply for the aid, and Florida’s Department of Children and Families, charged with administering the state’s Medicaid program, was grossly unaware of their own process.
The Health Rights Clinic has become adept at the process through their work with the immigrant community in Miami, through their advocacy at Jackson Memorial Hospital and public health clinics.
Today, Gonzalez is receiving thrice-weekly dialysis at the Big Lake Kidney Center, just 10 minutes from the house where he lives with more than six other farmworkers. The process takes about forty hours a week, leaving him unable to work, even if he had the strength. His many roommates in the tidy, but run down house, with a dirt yard, have allowed him to stay on in exchange for cleaning, cooking, and other chores.
Soon his roommates will leave to head to North Carolina for the harvest season. However, through the Clinics many contacts in the migrant community, an apartment has been applied for nearby where Gonzalez can live in exchange for taking on a caretaker role at the apartment house.
“If you think about the number of man hours just our clinic expended on this one case, you can easily realize that hundreds of farmworkers in Florida alone are dying because of lack of access to care,” said Swain. “We need to figure out how others can get access without this kind of intervention. Lots of hospitals and clinics and agencies are not talking to one another. We know there is a problem. As law professors, we are training our students to answer the question: How can we make this system work?”
But throughout Florida, says Newman, the process is “locked in a drawer somewhere…We took this one case to test whether the system created in 2010 was working,” said Newman. “We learned it wasn’t. This is an enormous and life-threatening hole in our public health safety net that needs to be plugged.”