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ATLANTA — Thirty-eight end-stage renal patients, most of them illegal immigrants, would receive the dialysis they need to stay alive at no cost under a rough agreement brokered Tuesday among local dialysis providers and Atlanta’s safety-net hospital, Grady Memorial.
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The deal will be too late for Fidelia Perez Garcia, left, who left for Mexico and died.
The deal, if completed, would end a yearlong impasse that has come to symbolize the health care plight of the country’s uninsured immigrants and the taxpayer-supported hospitals that end up caring for them. The problem remains unaddressed by the new health care law, which maintains the federal ban on government health insurance for illegal immigrants.

Grady, which receives direct appropriations from Fulton and DeKalb Counties, ultimately agreed on Tuesday to help pay for continuing dialysis for most of the immigrants. Others would be distributed among local dialysis providers as charity cases.

Last fall, Grady’s new management closed its money-losing outpatient dialysis clinic in a move intended to demonstrate fiscal toughness to the city’s philanthropic community. The closing displaced about 60 uninsured illegal immigrants who depended on free thrice-weekly treatments at the clinic to survive.

Illegal immigrants, and legal immigrants newly in the country, are not eligible for Medicare, the federal program that covers most dialysis costs for American citizens with end-stage renal disease.

Grady volunteered to transport the patients to other states or their home countries and pay for three months of treatment. Thirteen accepted the offer. But in response to a patient lawsuit and news media scrutiny, the hospital eventually contracted with a commercial dialysis provider to treat the others in Atlanta for one transitional year.

That contract, with Fresenius Medical Services, expired on Tuesday.

Vital details of the agreement remain to be negotiated, including precisely how the patients will be distributed, how much Grady will pay and whether the arrangement will extend for patients’ lifetimes. But all parties said after meeting Tuesday morning that they were optimistic that they would reach an understanding and that patients would see no lapse in treatment.

“That would make me feel real happy because continuing with my dialysis, I need it to live,” said Ignacio Godinez Lopez, 24, who crossed into the United States illegally as a teenager and has been treated at Grady’s expense for four years. “I’m young, and without dialysis it would be taking my life.”

The patients in Atlanta have gambled that American generosity, even at a time of hostility toward illegal immigrants, would prove a surer bet than uncertain care in their home countries. Several said that the fates of those who returned home had reinforced their fears about leaving Atlanta.

Five of the 13 patients who left for Mexico with assistance from Grady or the Mexican government have died, according to Matt Gove, a Grady senior vice president. Most died while still receiving dialysis, although not always as regularly as recommended.

One patient, Fidelia Perez Garcia, 32, apparently succumbed in April to complications from renal failure after running out of Grady-sponsored treatments in Mexico. Patients with end-stage renal disease can die in as little as two weeks without dialysis, which filters toxins from their blood.

Ms. Perez’s mother, Graciela Garcia Padilla, said by telephone that her family was able to raise money for three additional dialysis sessions, at a cost of about $100 each. Ms. Perez then went 12 days without dialysis and persuaded a hospital to treat her only when she was close to death, Ms. Garcia said.

“They sent her to me just to die,” Ms. Garcia said. “Here, they let people die.”

At the same time, regular treatment in Atlanta has not guaranteed survival. Four of the 45 patients who were receiving dialysis at Fresenius clinics have also died, Mr. Gove said.

Nationally, about one in five dialysis patients die within a year of starting treatment, and about two in three die within five years, according to government figures.

The hospital, which has recently begun a financial turnaround after years of multimillion-dollar losses, has spent more than $2 million on repatriation and dialysis since closing its clinic, Mr. Gove said. As the expiration of Grady’s contract with Fresenius loomed, each sought to shift responsibility to the other. Larry L. Johnson, a DeKalb County commissioner who prodded and mediated the negotiations, said there was movement only when Grady agreed to contribute financially to the patients’ care.

Under the broad outlines of the agreement provided by Mr. Johnson and other participants, Fresenius, DaVita Inc. and Emory University’s health system would each treat a small number of patients — most likely three to five — as charity cases. Fresenius would care for the rest with financial assistance from Grady.

Fresenius and DaVita are the country’s largest commercial dialysis providers, with combined net income of more than $1.3 billion last year.

The agreement would not address the broader concern of how to care for illegal immigrants in the region who have developed renal disease since the Grady clinic’s closing, or those who will do so in the future. At the moment, their only option may be to wait until they are in distress and then visit hospital emergency rooms, which are required by law to provide dialysis to patients who are deemed in serious jeopardy.

Kevin Sack reported from Atlanta, and Catrin Einhorn from New York.