Immigrant fights for transplant from Clinic Politicians help her in quest for new liver

The Plain Dealer Cleveland, OH
Friday, July 19, 2002

Metro

Michael O'Malley, Diane Solov and Eddy Ramirez; Plain Dealer Reporters

Distribution zones: All

A Cleveland woman admitted to the Cleveland Clinic in need of a life-saving liver transplant was turned away when Clinic officials discovered she was an illegal immigrant with no ability to pay, her family said.

In a panic, the woman's family called a lawyer, who appealed to local politicians, who in turn got the Clinic to re-admit her.

Now Orilda Gramajo, 31, a Guatemala native who has lived here 10 years and has two small children, is expected to know today whether the Clinic will put her on its transplant waiting list.

"More than anything, I want the transplant," said Gramajo, her eyes and skin yellowed by her disease. "I want to live longer. I want to see my children grow."

The Clinic transplant team is evaluating her to see whether she meets the strict criteria for the operation.

Even if she makes the waiting list, there is no guarantee that a liver will become available in time to help her.

Gramajo, who speaks little English, suffers from end-stage liver disease, the result of complications from an operation she had years ago in Guatemala, members of her family said.

She was admitted last month to MetroHealth Medical Center and told by doctors there that without a liver transplant she had only weeks to live, the family said.

MetroHealth does not perform transplants, so she was referred to the Clinic to be assessed for its transplant program.

The Clinic performed diagnostic tests, raising the family's hope that she would soon be placed on the transplant list.

But that hope was soon shattered.

"They told us no illegals were operated on," said Gramajo's sister Dalida Gramajo, speaking in Spanish.

"First, it [the reason for not doing the transplant] was because she was an illegal. Then it was the insurance. They placed a lot of obstacles."

The Clinic has admitted in a letter that her immigrant status had made them uncertain whether Gramajo would be accepted for the transplant list.

Last night, Clinic spokeswoman Angela Calman said the only considerations now are medical. "We understand her family's desire to lobby on her behalf, however, she has and continues to be evaluated by the same set of standards that apply to all patients in need of a liver transplant."

The Gramajos, a tightly knit family on Cleveland's West Side, say they offered to cash in certificates of deposit and sell land in Guatemala to pay for the transplant. Clinic bills already have reached $17,000. The operation could cost $150,000, plus tens of thousands in follow-up care and medicines.

But the Clinic dismissed the family's offer to raise money and talked about referring her to transplant hospitals in California and Florida that have more experience with immigrants, the family said. Gramajo ended up back at MetroHealth.

Last week, worried family members packed the downtown office of Cleveland immigration lawyer Richard Herman. He contacted Cleveland Councilman Nelson Cintron Jr., whose ward includes much of Cleveland's Hispanic community.

Cintron and 12 council members wrote to the Clinic, pleading Gramajo's case.

"We strongly agree that this upstanding Cleveland resident whose children are U.S. citizens should not be denied an urgently needed life-saving liver transplant on grounds of immigration status," the letter, dated July 11, said. "We urgently request reconsideration of this case."

That same day, she was transferred back to the Clinic from MetroHealth, where she had spent the last six days.

Besides City Council, the Cuyahoga County commissioners and U.S. Rep. Dennis Kucinich got involved. And, according to family members, Clinic chief executive Dr. Floyd Loop received a call from a civic leader about Gramajo's plight.

Five days after Gramajo had returned to the Clinic, Dr. John Clough, chairman of the Clinic's health affairs, sent a letter to the county saying she would have the same access to the waiting list as anyone else in the Clinic system.

"There was initial concern that the patient's undocumented- immigrant status, because of policies of the United Network for Organ Sharing, might interfere with her ability to be considered for transplantation," Clough wrote July 16. "This was resolved last week when she was found to be eligible for Medicaid. There is no financial issue standing in the way of placing this patient on the transplant list."

Herman said the national organ network has no prohibition on transplants for immigrants, but caps the number performed because of the scarcity of organs.

"This is a civil rights issue," said Herman. "Immigrants, regardless of legal status, should not be excluded."