I am delighted to submit this recommendation for Megan Whaley, BSN, RN for the DAISY Health Equity Award. Megan has demonstrated exceptional commitment and innovation in advancing health equity, making a significant impact on the lives of undocumented and uninsured patients receiving hemodialysis.  Throughout her time as the Nurse Manager, Megan has been a staunch advocate for equitable healthcare for the undocumented and uninsured patient population with end-stage renal disease, requiring hemodialysis.  This patient population is especially challenging, as they have a disease that often has a treatable cause if caught early.  Dialysis is a life-saving treatment for individuals with end-stage renal disease, but access to this treatment poses unique challenges for undocumented patients in the United States. While legal residents and U.S. citizens generally have access to dialysis through Medicare, Medicaid, or private insurance, undocumented immigrants face significant barriers to accessing the same level of care. These patients are often directed to seek emergent care in their nearest emergency department on an as needed basis.  Undocumented patients often lack access to health insurance. While emergency medical care, including dialysis, is mandated by the Emergency Medical Treatment and Labor Act (EMTALA), this does not guarantee coverage for the full range of treatment or follow-up care needed for the end stage renal disease.  Megan has actively engaged in addressing disparities in health outcomes through working with providers to ensure patients have access to primary care through charitable resources, access to medications that can lower phosphorus and blood pressure, and to education regarding health promotion and nutrition management.  This work has been instrumental in improving access to quality care for this vulnerable group.  Megan meets with each of the patients and works with her team and her leaders to establish a schedule, evaluate the efficacy of treatment, and educate the patient on their disease state.  This work has allowed patients to progress to the ability to work and obtain a TIN, allowing two patients to be listed for a transplant, the standard of care for end-stage renal failure.  

The cost of dialysis is prohibitively expensive. Without insurance, undocumented patients may face substantial out-of-pocket expenses, which can be a significant barrier to accessing necessary treatment.  Megan is cognizant of identifying patients who can demonstrate compliance with medication, nutrition, and disease management, who would benefit from outpatient dialysis.  She works with her providers to refer patients to charitable care resources locally.  Many healthcare providers are reluctant to treat undocumented patients due to fear of financial instability or legal repercussions. This can limit the availability of care, especially for routine and preventive dialysis services.

Undocumented patients may encounter difficulties navigating the healthcare system due to language barriers, fear of deportation, or lack of knowledge about available resources.  Megan has also worked with her team of staff and Nephrology providers to ensure this work is standard for all undocumented and uninsured patients with end-stage renal disease requiring hemodialysis and seeking care at the University of Kansas Hospital.   

Megan's support in this work has led her to advocate for policy changes at the state level to improve access to dialysis for undocumented patients, such as expanding emergency Medicaid or creating programs specifically designed to cover undocumented immigrants.  Megan has had to work to strengthen partnerships between healthcare providers and community organizations to improve access to resources and support for undocumented patients, including navigation assistance and working with community resources to support these patients.  Megan strives to provide cultural competency training for her team and the healthcare providers to ensure they are equipped to address the unique needs of undocumented patients and can offer care in a supportive and non-discriminatory manner. The work that has been done on behalf of these patients has been shared at the National Nephrology Conference level and at the local legislative level, to increase public awareness about the challenges faced by undocumented patients in accessing dialysis and other healthcare services to foster a more compassionate and informed approach to healthcare policy.

This work is a testament to Megan's dedication to ensuring that every patient receives compassionate, respectful, and equitable treatment. Megan has consistently demonstrated exceptional dedication to improving patient care by collaborating with a diverse range of stakeholders. Her work has intersected with administrators, Emergency Department providers, Interventional Radiology teams, internal medicine providers, and lobbyists from the Kansas Department of Health and Environment (KDHE). Through these partnerships, Megan has effectively advocated for the essential resources and support needed to enhance patient care and address the complex challenges faced by her staff. Her relentless efforts in securing vital resources and fostering cross-departmental collaboration underscore her commitment to advancing the care of a challenging patient population.