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September 17, 2008

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Roberta Mikles, Health Care Patient Advocate

Anna, I understand all that you mentioned. Training and education is a major problem as well as unit supervision to ensure effective practices are being implemented. As an advocate, I have been attempting to bring concerns such as these (lack of oversight) not only to CMS, NKF, but other organizations and elected officials. As we are well aware, many states, can not meet the CMS request to survey facilities every three years. Much can happen in three years, let alone one year. Therefore, how does one know if the facility is in compliance. There is more to quality safe care than that which is noted on Dialysis Facility Compare. With infection continuing to be the number two cause of death, among this vulnerable population, one must ask who is overseeing to ensure effective practices are being conducted. As Dr. David Nash, of Jefferson Medical School, Health Care Policy Division, stated in reference to infection (to recall) 'it is the process of care'. This situation is most disturbing. Basic practices not being conducted!!! Is there understanding, by staff, of the patient consequences for lack of implementing effective practices. You said this is a Davita unit, then my question is what happened as Davita was awarded some recognition for their training program, to recall. Yes, Davita needs to take responsibility. However, our elected officials must understand the realities that occur in some units. I, once again, state the following "In spite of the newly revised ESRD COnditions, additional Clinical Performance Measures, as well as the Patient Safety Program, without an effective oversight and enforcement program (CMS) many quality care and patient safety areas will continue. It is the survey process that often identifies ineffective practices ie lack of implementing effective infection controls, lack of monitoring patients, lack of following facility policies/procedures. These aforementioned, as evidenced in many surveys, including Lufkin Davita, were and went apparently unnoticed by facility staff and facility management. What will have to happen before someone realizes that our oversight and enforcement program is greatly in need of repair. Should Medicare treat dialysis facilities as they do hospitals and withhold reimbursement for certain avoidable events/outcomes? Would this instill more thought to that which occurs in some facilities related to delivery of care? Roberta Mikles RN Health Care Patient Advocate RMiklesRN@aol.com

Kathy Alter

Bill - Just wanted you to know I'm alive and back blogging minus my right leg below the knee. Just thought you'd like to know.

Kathy Alter
Stayin' Alive

Brian Steele-Sierk

I am amazed that Da Vita has been able to keep it's name out of the news reports. Do you have any good documentation or links that will definitively show that Da Vita was running Life Care?

Zach

If you are concerned that the NYT reporter did not mention DaVita, then send her an eMail with some facts.

I've updated Anna's post with a screen shot from CMS's Dialysis Facility Compare site (comments don't allow images) which list the corporate ownership of the Life Care center as DaVita.

Anna Bennett

Thanks for adding the screen shot. Due to NY State ownership laws, DaVita was only the "Manager" of Life Care. The NY Times is aware of this, as is the NY State Department of Health (who failed to mention DaVita in their press release)

All of my equipment is branded DaVita, all if the posters in the Unit were DaVita, all of my legal forms are branded DaVita. The name tags of the staff, and the business cards of the social worker and dietitians are DaVita. My home hemo Nurse had a DaVita e-mail address.

The FA who was brought in during the week that the State was inspecting was introduced to me as a DaVita FA. (she then promptly boldface lied to me about what was going on) Life Care was a DaVita unit in it's staffing, policies and procedures. Don't let semantics and bypassing NY State law lead you astray.

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