Ten September 11ths a year, that is approximately 30,000 people.
That is the number of unnecessary deaths we estimate is happening here
in the U.S. in one particular field of medicine. This field of medicine
is little regulated and has become more interested in profit than patient
well-being. That field of medicine is kidney dialysis.
I’m the father of a kidney patient (transplant now) who is shocked
by the conditions kidney dialysis patients suffer under. I’m writing
this as an introduction to the problems of dialysis and as a way to get
more people involved and educated. How can you help? You can
help by informing your congregation of what is going on in this field
of medicine and asking them to write, or you can allow me to ask.
I imagine my first job is to convince you there is a problem.
The government’s own statistics show this. On page 3 of this write
up I’ve included the overall death rate for patients on hemodialysis (the
most prevalent form of kidney dialysis). This is from the Renal Data
System organization which was given the task by the U.S. government to
keep statistics on the kidney treatment industry. They show a mortality
rate of about 23% for the year 2001 (last year statistics were compiled).
Now compare this to other countries (International Comparisons pg. 4).
This country has the highest mortality rate in the industrialized world!
I’ve also included a couple of internet postings to show you the kinds
of conditions staff are forced to work under (pages 5 and 6). I’ve
also included some bulleted items which outline many of the problems that
plague this industry (page 7). Separately I’ve included a flyer as
an example of what I might hand out.
More stories and information can also be found on my website.
I’ve already spoken at one congregation here in town and feel compelled
to get the word out about this as much as possible.
http://sky.prohosting.com/cschwab/
Figure 1 The bottom right number shows an annual death rate1
of 234.6 people per 1000 patients or 23.46% for the year 2001 (last year
stats are available)
1 Taken from U.S. Renal Data System Annual Data Report for the year
2003 (http://www.usrds.org/) page 479
International Comparisons
2Limitations of Prevailing Treatment Methods
Outpatient hemodialysis has produced relatively poor clinical outcomes,
high total treatment costs and low quality of life for dialysis patients.
These clinical outcomes are reflected in the mortality rates of dialysis
patients which, according to the USRDS, in 2000 were 24.0% in the United
States as compared to 11.0% in France and 9.7% in Japan. Although mortality
rates are influenced by many factors, including the relative risk of death
determined by considering age, overall health and other variables, a study
published in 1994 indicates that, even after adjusting for relative risk
of death, the mortality rate in the United States was twice that of Japan.
While the exact cause of this difference in mortality rates has not been
established, the USRDS has determined that mortality in patients is highly
correlated to the dose of dialysis delivered to patients. In general, the
dose of dialysis depends on the performance of the artificial kidney, patient
size and the duration of treatment.
2 http://aksys.com/therapy/esrd.asp 7th paragraph down, Aksys is a manufacturer
of home dialysis machines. I have also seen the international comparisons
in a Dr. Kjellstrand speech (recipient of Lifetime Achievement award in
Hemodialysis) http://sky.prohosting.com/cschwab/ under Other Voices section.
Internet Posting 1
(http://www.dialysisethics.org DuhVita Budget Cutting in Michigan topic
under Discussion September 18,2003)
“Earlier this year the DuhVita (DaVita) Michigan Region began cost cutting
measures by getting rid of facility administrators, who, always acted above
board and ran their centers with a patient-first quality, and always asked
the regional director to explain her namby-pamby directives. She then replaced
these fine administrators with others that don't question her directives.
Now it seems that the 2 Michigan regions are in a "budget retreat"
formulating new cost cutting programs for 2004. These include running centers
with 80+ hemo patients with 1 RN on duty all day, 5:1 patient to staff
ratios for PCT's, and a Nazi approach to running the business. By that
I mean that the entire staffs are feeling threatened by the "My way or
the highway" management style. Michigan is a growing DuhVita region, but
they are only growing by buying out money-losing programs, not by the doctors
increasing their patients. They have many doctors that only round on their
patients once a month and even then if it weren't for the RN's leading
the doc's around by the hand these doctors wouldn't even know who their
patients are.
We the staff, or "TEAMMATES" as the call us are sick and tired of the
unsafe conditions that are administered in these facilities on a regular
daily basis.
DaVita (DuhVita): He/She Gives Life, is just a grand shell-game marketing
approach that is making a few top level execs very rich at patients and
staff expense.
Wake up renal patients...Ask questions, demand answers, demand QUALITY.
Remember, It's YOUR Life they hold in the balance!!!!!!!”
Internet Posting 2 (http://www.dialysisethics.org Discussion section)
“I have worked for both for-profit and non-profit. My experience has been that the non-profits staff better and appear to give their techs better training than the for-profits. In fact, the reason I left the last for-profit that I worked at was because of the RN to patient ratio. I felt that my license as an RN was in jeopardy when I was the lone RN with 16-22 patients. The techs worked at a 4:1 ratio and took turns dong the reuse on top of their patient load. Add in all the paperwork, care plans, meds, emergencies, anemia management, etc., all for 1 lone RN to do and it is no wonder that no one wants to work like a horse for next to nothing.
The PCT's do put on cath patients, but RN's must do dressing changes,
the cath off packs and check all machine settings, baths, etc against the
treatment RX.
The state I work in also requires that the pct's be state certified.
In my area, the for profit companies are having a very difficult time attracting and retaining adequate staff ( as in actual bodies) as word has gotten around about the working conditions. Those who do stay in dialysis usually go to a staffing agency and work through them for much higher wages and can pick and choose their own work schedule.
Dialysis is such a specialty that I doubt that any RN just off the street would even know much about it, what they learn all depends on the education they are given by the for-profit companies and from what I have seen, it is poor at best. As for the patients and their families, this is where education comes in, something the for-profits don't seem to want to pay for. Much easier to label someone as non-compliant than to educate them about their disease and treatment options.
I don't see the nursing shortage as creating an atmosphere of arrogance
for RN's. Instead I see the
nursing shortage as finally giving RN's the ability to pick and choose
where they want to work. They are no longer so desperate for jobs that
they have to take what they can get. Some Administrations are treating
RN's with more respect and thinking very hard as to what they can do to
retain the RN's they have. Something the dialysis companies are not willing
to do because they have such a big obligation to their stockholders. That
obligation outweighs their obligation to the very patients who are the
ones generating all the $$$$$ for the stockholders.
Yes it is frustrating. But until you and the staff make a stand, it
will continue to be that way. These companies only understand when it hits
them in the pocket book. And as long as you and the others are willing
to put up with the current conditions, then as far as the administration
is concerned and the money keeps rolling in, everything is just fine. It
is after all your license.”
• The death rate on dialysis in the U.S. is over 22% a year (higher
than the death rate in combat in Vietnam). This compares with under 10%
a year in other industrialized countries with a variety of health-care
systems. Canada, the U.K., Germany, France, Japan, etc. all have much lower
mortality rates than the U.S.
• The difference can not be accounted for by the fact that we dialysize
more patients with complicaitons.
• The extra deaths each year amount to about 30,000. This is more than
the US homicide rate of 18,000.
• The average dialysis patient lives less than four years.
• A disproportionately large number of dialysis patients are African-American.
• Americans are underdialyzed. Dialysis is strictly rationed to three
days a week. Other countries provide more dialysis.
• Legislation (HR 1004) has been proposed to correct this situation.
It was stymied in committee. (there recently has been an effort to
revive it)
• The impact of the rationing is that many patients are being treated
against medical advice (AMA) as their doctors would like to prescribe more
frequent treatments.
• There is little oversight of dialysis centers. Some centers have
had mortality rates as high as 50% a year without being closed.
• There is reuse of dialyzers, which is a procedure that has not been
approved by the FDA. It is potentially dangerous, as toxic chemicals are
used in the cleaning of dialyzers between treatrment.
• There are inadequate grievance and complaint procedures to ensure
the confidentiality of patients and to protect them from retaliation.
• There are no national standards for the training of dialysis staff.
Technicians have the most contact with patients and often begin work with
inadequate education and sporadic training, support and supervision.
• There are conflicts of interest throughout the system - with leading
regulators, for example, having served on dialysis corporations.
• There is little support for rehabilitation of patients - almost no
effort to keep them working or getting them back to work; no reward or
funds for rehabilitation.
Likewise, there is very little effort spent on helping patients
and their families adjust to dialysis. They
often begin treatment with little or no orientation on how to cope with
the process.