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July 10, 2008

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Jessica Savage

Hi Mr. Peckham,

I had the very same question you did when I looked at the report. How many deaths were in 2007? And how many since Jan. 1 - April 28 this year?
I'm not sure if you saw the updated report (it was posted online several hours after the story first broke), but I've pasted it below.

Thirty-two patient deaths occurred between Jan. 1 - Dec. 31, 2007, according to David Wright, spokesman for the Centers for Medicare and Medicaid Services (CMS) Region VI office. And since the start of the new year through the facility's closure date, 16 patients have died, Wright said, totalling the number of patient deaths at 48 for DaVita Lufkin Dialysis.

Bill Peckham

Jessica (please I'm Bill) I want to thank you for your excellent reporting on this story for over two months. It is only through your hard work that we know what we do. Great job.

No, I didn't see the update. Thank you, that is interesting. We still don't know the right denominator to calculate the mortality rate. However, 32 is a very big number for a unit with 20 stations, especially coming after a bad year on 2006.

In talking to your sources have they included people starting dialysis in these numbers? The Dialysis Facility Reports do not include deaths in the first 90 days of treatment. It is not clear if there is any other reporting requirements that would keep track of what is happening to this exquisitely vulnerable group.

Jessica these Dialysis Facility Reports (DFRs) are very informative and should in my estimation, be in the public record. Since the problems at the Lufkin unit predated the hiring of the arrested nurse it calls in to question conditions at units throughout Texas (indeed throughout the US). I think this tragedy should lead to a close look at what is happening in the nation's dialysis units.

Will the State of Texas release the DFRs they have on every dialysis facility in the state? Release them intact without redaction? Sunlight is the best disinfectant, these dialysis units need some sunlight. Releasing the DERs would be a good first step.

Roberta Mikles RN Patient Advocate

Bill, I support your statement "I think this tragedy should lead to a close look at what is happening in the nation's dialysis units." In fact, I HAVE BEEN TRYING TO DO THIS FOR SEVERAL YEARS. I have attempted to have some of our elected officials, as well as some organizations, realize, after my review of hundreds of facility survey reports, that there are facilities out there that do not provide quality safe care. Perhaps, and how sad, that this unfortunate tragedy might be what will change the system, only as a result of injury and harm to patients. As I have stated, over and over, there is more to quality safe care than clinical performance measures and other quality indicators. In fact, with the newly revised Conditions addressing CQI, what makes any one think that there will be compliance when this facility, for example, which already supposedly had a policy regarding QI was not implementing such. Without effective oversight/enforcement no one knows what is truly happening in many facilities. And as I have stated before, perhaps Medicare should consider dialysis facilities as they do hospitals and withhold payments for certain preventable negative outcomes. The need for increased oversight can be demonstrated in the simple fact of what happened between the 2007 survey and the recent survey. I am also wondering if the surveyors reviewed each patient record (hospital record) for those who were taken to the ER and/or admitted? Something is missing. True care, or lack thereof, in many facilities, is known by advocacy organizations (those supported by the industry, etc) as well as providers and government agencies. Therefore, one must ask why has no one addressed the ineffective oversight and enforcement program? One would think that providers would fully support increased inspections thereby using the findings as a tool to improve delivery of care. Just one example, is that of reuse, and in my review of surveys I was shocked at the numbers of facilities that had been cited for not following policies or even staff not being aware of such. This was the same for infection control, even in spite of facilities already having policies that address the newly revised Conditions. SOMETHING NEEDS TO BE DONE. One must also ask why is there such secretive aspects to dialysis. For example, if CMS can post nursing home deficiencies (surveys) on the nursing home compare website, why not do the same for dialysis facilites? If CMS can require nursing homes to post their survey in their facility for public viewing, why is this not done with dialysis facilities? Interesting!!! In fact, this was a suggestion when comments were being taken on the then proposed Condition language. Seems the bottom line and root of all evil is inadequate training/education of those providing care, unit supervision (various levels) and lack of staff being aware of facility policies and procedures. Thank God for the good dialysis facilities that are out there. Roberta Mikles RN, Director - Health Care Patient Advocates
RMiklesRN@aol.com

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