Safety risks in outpatient dialysis clinics
Many clinics have inadequate staffing to ensure patient safety
Peritoneal dialysis is a process where an external machine fills in for your kidneys when they are not working properly. The dialysis machine basically removes blood from your body, cleans out the waste, excess fluids, and salt from it, and then pumps it back into your body.
Dialysis is essentially the only treatment for end stage renal disease, which is now the ninth leading cause of death in the United States. In 1972, the federal government began paying for dialysis treatments, and at the time that benefited about 10,000 patients. Today, that number is 460,000, which is a 46 time increase, which is felt to be because of the rise of the percentage of the population with high blood pressure and diabetes.
Symptoms of kidney disease
Experts say that the one-year mortality (death) rate for patients on dialysis is 25%. That jumps to 65% after five years of dialysis treatment.
Clearly, the best thing to do it to try to prevent kidney disease in the first place, or to catch it early and get immediate treatment.
Be aware of these signs and symptoms of kidney disease, and see your doctor if your start to notice any of these on a regular basis: changes in the volume that you urinate, nausea, vomiting, loss of appetite, feeling weak or fatigued, sleep problems, decreased mental ability, muscle twitching and cramps, feet or ankle swelling, itching, hypertension (high blood pressure) that is not easy to control even with medications, chest pain, and shortness of breath.
I am sure that you noticed that many of these symptoms can be caused by a variety of conditions. The point is to pay attention to your body and see a doctor quick if you start to notice any of these problems.
There are non-profit and for-profit dialysis clinics
There are currently around 7,000 outpatient dialysis clinics all over America. Out of that total number, a whopping 70% of the clinics are owned by two large for-profit companies, Davita and Fresenius Medical Care.
With all the federal money available to fund dialysis treatments, it is a lucrative business. In 2016, Davita reported a net profit of $789 billion.
Studies have shown that for-profit clinics tend to have around one-third fewer nurses on duty than non-profit companies.
Some former employees of the large for-profit dialysis clinics claim that the staffing levels are inadequate. Megallan Handford, a former nurse at a Davita dialysis facility said that the priority was on transitioning patients—getting a patient on dialysis and then getting the next patient on the machine as soon as possible. He claimed that staff was only given 15-25 minutes to get the machine ready for the next patient, which was not enough time to clean and sanitize the machine properly. Davita denies those claims.
Medicare’s website contains a searchable database where you can research and compare dialysis clinics in your area.
Risks of dialysis clinics
As a Texas medical malpractice attorney, I have handled a number of cases where people suffered serious injuries or death because of poor care at dialysis clinics.
In my experience, staffing is a major issue.
I remember representing the spouse of a lovely lady who died in an outpatient dialysis chair some years ago. What shocked me was that it took around 20 minutes for anyone to release that she had passed away in the busy dialysis center.
But upon further investigation into the law, it is easy to see how this could happen. Federal regulations are surprising lax when it comes to staffing levels. 42 USC Section 494.180 only requires an outpatient dialysis clinic to have one registered nurse on site, and has no requirement for a medical doctor to be in the facility at any particular time.
The law leaves it up to facilities to ensure that there is adequate staffing of qualified personnel to provide a suitable staff to patient ratio. While some of the qualified personnel are licensed vocational nurses (LVNs), though handling dialysis malpractice cases, I have learned that some clinics basically hire people off the street with no skills, and then provide them with limited on-the-job training.
Regardless of the federal regulations, this is dangerous medicine.
Many patients have said that they feel like they are on an assembly line at a factory, with few nurses and no doctors around to help.
That is why I urge people who are going to have outpatient dialysis to take someone with them. Sure, it is a bit of a scheduling hardship, considering it typically is a significant commitment of time, three four-hour sessions per week. This provides much-needed safety net, so a loved one on friend can speak up and get help if something goes wrong.
Without a kidney transplant, dialysis if the only legitimate option for people with end stage kidney disease to stay alive.
Many people first learn of their kidney condition in the emergency room, and then are started on dialysis with little explanation or conversation.
While federal law requires dialysis clinics to educate patients about kidney transplantation, some people have received dialysis for years before knowing that getting a kidney transplant was even an option.
Getting a kidney transplant is cheaper than dialysis and is also much more likely to extend the patient’s life. That is why it is important for patients being placed on dialysis to talk with their doctor about getting on the kidney transplant list as soon as possible.
Dialysis malpractice attorneys here to help
If you or someone you care for has been seriously injured by shoddy care at a dialysis clinic, call the experienced Houston medical malpractice lawyers at Painter Law Firm for a free consultation. Our telephone number is 281-580-8800.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements [...]read more
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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