Dialysis treatment, risks, and medical malpractice
According to the current U.S. Renal Data System Annual Data Report, 468,000 people in America are dialysis patients being treated for kidney failure.
The National Kidney Foundation gives a simple definition of dialysis. Dialysis is a treatment that does some of the things done by healthy kidneys. Kidneys are critical organs that play an important role in preserving life. They remove waste, salt, and extra water, balance certain chemicals electrolytes in the bloodstream, and help regulate blood pressure.
There are two types of dialysis, hemodialysis and peritoneal dialysis. An easy way to understand the difference is that in hemodialysis, the blood is cleaned outside the body, while in peritoneal dialysis, it is filtered inside the body. Hemodialysis treatments are commonly about four hours in length and are done three times a week. Peritoneal dialysis treatments are often done at home, sometimes during the night while patients are asleep.
Kidney specialists, called nephrologists, usually order dialysis when a patient develops end stage renal disease (ESRD), which usually means the patient has lost at least 85% of kidney function. Even in early chronic kidney disease, many people have no signs and symptoms, but as the disease progresses into ESRD, noticeable problems might include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, differences in urination, decreased mental performance, muscle cramping or twitches, feet and ankle swelling, persistent itching, chest pain, shortness of breath, and hypertension.
Quality of care concerns
As a Houston, Texas medical malpractice attorney, I have represented several patients and wrongful death beneficiaries in lawsuits involving poor dialysis care.
In my experience, some dialysis clinics are poorly staffed.
For example, I handled a medical malpractice lawsuit involving a patient receiving a hemodialysis treatment at the downtown Houston outpatient dialysis facility. She became unresponsive and coded in the dialysis chair, but no one noticed for at least 20 minutes. Considering that she was not breathing for much or all of that time, she sustained a permanent brain injury that led to her death.
I am currently working on another case where a patient was hospitalized and required dialysis because of unexpected injuries related to the surgery. Unfortunately, the hospital did not offer dialysis services and relied on an off-site vendor to come in, as needed. This led to some delays in the patient receiving dialysis treatments, which contributed to her rapid deterioration and ultimate death.
Hemodialysis patients also face a higher risk of bloodstream infections. According to the Centers for Disease Control and Prevention (CDC), about 75,000 people currently receive hemodialysis through a central line, which makes the risk of infection even greater because of direct access to the bloodstream. Further, hemodialysis patients have treatments multiple times a week, exposing them to potential infections through their interactions with healthcare workers and facilities. Then, of course, dialysis patients already often have weakened immune systems.
To increase awareness and the healthcare community of these risks, the CDC and The Joint Commission, which accredits hospitals and healthcare facilities, have joined together in a project called Making Dialysis Safer for Patients Coalition.
The coalition recommends six tips to prevent dialysis infections for patients with catheters.
First, they encourage patients to get a fistula or graft, to allow easy access to the bloodstream for dialysis treatments, rather than relying on catheters. Catheters have a higher risk of infection.
Second, patients using catheters at home should learn how to use them properly and, for example, should not get them wet.
Third, patients and healthcare providers should wash their hands often, especially before and after dialysis treatments.
Fourth, patients should familiarize themselves with the safety steps that healthcare providers should follow when using a catheter for treatment. This allows patients to speak up if they notice a step being skipped.
Fifth, patients should be aware of the signs and symptoms of infection and what to do if they suspect an infection. In my experience as a medical malpractice attorney, this is an important point. Often, healthcare providers may be dismissive of patient concerns about infection. It pays to speak up and be persistent.
Sixth, and finally, patients should know what to do if they had any problem with a catheter.
For dialysis patients with fistulas or graft in place, the tips are the same, except the first one. The first tip is to avoid scratching or picking of the dialysis access site.
We are here to help
If you or a loved one have been seriously injured by poor dialysis or kidney care, our experienced medical negligence attorneys can help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine