HOLY COW!!!!

[plugger]

I was just going along and doing my civic duty.  We decided at DialysisEthics it would be a good idea to put state_inspections_and_lawsuits on the website as a way for staff and those on dialysis to see what can go wrong at a clinic.  Things were going along as I would have expected, when I came upon Colorado's El Paso county!

If I was davita I would consider giving up on reuse, their TWO incidents in just ONE county sure seemed to upset the state of Colorado and the press (see related articles in inspection reports).  Makes me wonder how many incidents go unreported.  El Paso sure looked like an epicenter of trouble there for awhile:

http://www.dialysisethics2.org/index.php/State-Inspections-Colorado-Counties/colorado-el-paso-county-state-inspections.html

[MooseMom]

Well done, and thank you!  Perhaps we will have to use shame as a tool for getting the treatment that we need.

I'm already mentally drafting my letter to my Congressman...he is one of the new crop of GOP congressional freshman who will be taking his position in the New Year.  He replaces a Democrat who I really happened to like, so this new guy is going to have to prove himself to me.  He campaigned on the standard Republican platform, ie personal responsibility and the reduction of federal spending.  That sounds good, so I plan to tell him that the current policy of throwing the VAST majority of dialysis patients into a modality that is illustrative of neither concept is, frankly, unAmerican.  We should be able to have more choice, and that means putting more emphasis on home dialysis and more frequent in-clinic dialysis if home dialysis is not an option for a particular patient.  Thrice weekly in center dialysis raises the risk of cardiovascular incidents, resulting on more federal money spent in hospitalizations.  Adding more dialysis results in healthier patients and less cost to American taxpayers. 

If you are a believer in "personal responsibility", then you would think that encouraging patients to dialyze at home if at all possible would just make sense.  But our current system treats the dialyzor like a pack of lemmings, and too many patients aren't given the information or support needed to be able to exercise this hallowed "personal responsibility".

If I thought I could prove it, I'd sue my mother's clinic to kingdom come.  They brought in a guy specifically to set up a nocturnal unit in the clinic, and he approached my mom to see if she might be interested.  I told her that nocturnal in-clinic would be ideal for her, and I explained why.  She finally asked the head nurse about it and was told, basically, "No way."  I never could find out why.  Now that I know more about nocturnal and the benefits of longer, slower and more frequent dialysis, I am furious that this treatment was withheld from my mother.  I know she developed chronic heart failure as a result of her dialysis.  I refuse to allow the same thing to happen to me.

My congressman is going to be hearing from me as soon as his butt hits his new congressional chair.

[Riki]

January 5th is the first day of Congress, MM.. *G*

I agree with you totally, MM.  I was given a choice when I started dialysis, of which type I wanted.  At the time, in-centre hemo and PD was all that was available.  I chose PD, and did that for nearly 5 years, looking after all the dialysis myself, with my mom's help.  I don't have a choice anymore, unfortunately.

They're just beginning to offer home hemo, and if I had better eyesight, I'd totally sign up.

[MooseMom]

Thanks for that!  I wasn't sure if maybe the new session started on Monday the 3rd.

I don't see why optimal dialysis can't be offered in clinic.  Home hemo is not for everyone, but that should not mean that if you are not a candidate, then optimal dialysis is not an option for you.  Why can't people have longer and more frequent sessions in clinic?  If your answer is "cost", then I'd tell you that shorter and less frequent dialysis means more hospitalizations and more complications, and THAT's where you really run into higher costs.  If extra dialysis keeps people out of the very expensive hospital ERs, then you end up SAVING money.  But that makes entirely too much sense...

[mogee]

In Toronto one major centre, St. Michael's Hospital has in-unit nocturnal hemo.  Perfect for people who need a bit of help or whose homes are unsuitable for home hemo.

[MooseMom]

In Toronto one major centre, St. Michael's Hospital has in-unit nocturnal hemo.  Perfect for people who need a bit of help or whose homes are unsuitable for home hemo.

I guess that's great if you live in Toronto.

Can you do short daily hemo in clinic in Canada?  If not, why not?  Not everyone can do in-unit nocturnal hemo...a patient might have small children or a night job.

[mogee]

I know people who have had short daily in-centre treatments, but I don't know how difficult it is to make such an arrangement.  I can't say whether it is available to anyone who wishes.  I will ask about it.

[sullidog]

I've sent letters to everyone in my area and gotten replies back that they will consider our concerns.

[RenalSurvivorDotCA]

I don't see why optimal dialysis can't be offered in clinic.  Home hemo is not for everyone, but that should not mean that if you are not a candidate, then optimal dialysis is not an option for you.  Why can't people have longer and more frequent sessions in clinic?  If your answer is "cost", then I'd tell you that shorter and less frequent dialysis means more hospitalizations and more complications, and THAT's where you really run into higher costs.  If extra dialysis keeps people out of the very expensive hospital ERs, then you end up SAVING money.  But that makes entirely too much sense...

Less frequent dialysis will eventually lead to more cost in the overall health system; but more dialysis will lead to more immediate cost and time in the dialysis system.

My unit is a large unit. We have 50 chairs in the main unit and also 15 chairs in two satelite units. The main unit has about 100 patients Mon/Wed/Fri and the same on Tue/Thur/Sat and is closed on Sunday. The average on-time is 4 hours...some are only 3 hours and some others like myself are 5 hours. The nurses already work 12 hour shifts. If they were to be open another shift  (say, at night) they would need to double the staff and would only house one more shift per day...not enough space or time for every patient to get daily dialysis. I'm not even sure if all the patients could even survive daily dialysis. Some I know get sick after dialysis and are sickly for the next day too and only start to feel good on the thrird day when it is time to go back to dialysis again.

I think the ultimate goal of in-center dialysis is not to make us feel better, it's to stave off death. We all know it is not a cure; only a stopgap solution until we can get transplanted. I guess what I'm saying is that we all cannot get "more" dialysis in the current system. The only way I can see is to go into the home hemo program if your unit offers it. That way you can get as much dialysis as you want and it won't cost the unit more in terms of staffing.

[plugger]

I've sent letters to everyone in my area and gotten replies back that they will consider our concerns.

Great to hear!  I started writing our politicians back in about 2004 and it led to passing a bill for the certification of hemodialysis techs in Colorado, never know what is going to come up when you plant some seeds.  (Also got more money for state inspections from facility license fees).

[Bill Peckham]

I don't see why optimal dialysis can't be offered in clinic.  Home hemo is not for everyone, but that should not mean that if you are not a candidate, then optimal dialysis is not an option for you.  Why can't people have longer and more frequent sessions in clinic?  If your answer is "cost", then I'd tell you that shorter and less frequent dialysis means more hospitalizations and more complications, and THAT's where you really run into higher costs.  If extra dialysis keeps people out of the very expensive hospital ERs, then you end up SAVING money.  But that makes entirely too much sense...

Less frequent dialysis will eventually lead to more cost in the overall health system; but more dialysis will lead to more immediate cost and time in the dialysis system.

My unit is a large unit. We have 50 chairs in the main unit and also 15 chairs in two satelite units. The main unit has about 100 patients Mon/Wed/Fri and the same on Tue/Thur/Sat and is closed on Sunday. The average on-time is 4 hours...some are only 3 hours and some others like myself are 5 hours. The nurses already work 12 hour shifts. If they were to be open another shift  (say, at night) they would need to double the staff and would only house one more shift per day...not enough space or time for every patient to get daily dialysis. I'm not even sure if all the patients could even survive daily dialysis. Some I know get sick after dialysis and are sickly for the next day too and only start to feel good on the thrird day when it is time to go back to dialysis again.

I think the ultimate goal of in-center dialysis is not to make us feel better, it's to stave off death. We all know it is not a cure; only a stopgap solution until we can get transplanted. I guess what I'm saying is that we all cannot get "more" dialysis in the current system. The only way I can see is to go into the home hemo program if your unit offers it. That way you can get as much dialysis as you want and it won't cost the unit more in terms of staffing.

The unit could offer every other day dialysis and stay open Sunday. It wouldn't be necessary for everyone to switch. Offering EOD dialysis would increase frequency 16.6% for those that switched but would increase the dose 33% going by the Scribner Dialysis Product (PDF). That's a great value!

[MooseMom]

Yes, we need to be thinking more in terms of value rather solely in terms of cost.  Healthier patients will have a better chance at keeping their jobs, and this is good for society as a whole.

[RenalSurvivorDotCA]

The unit could offer every other day dialysis and stay open Sunday. It wouldn't be necessary for everyone to switch. Offering EOD dialysis would increase frequency 16.6% for those that switched but would increase the dose 33% going by the Scribner Dialysis Product (PDF). That's a great value!

Thanks for the link. I'll check it out.

But isn't every-other-day dialysis what we do now (except for Sundays?) EOD would be a logistical nightmare; especially for those of us who work. You'd need M/W/F off one week and then T/Th/Sa the next week.

[RightSide]

In Toronto one major centre, St. Michael's Hospital has in-unit nocturnal hemo.  Perfect for people who need a bit of help or whose homes are unsuitable for home hemo.

That's a good idea.

I've never heard of any such modality being offered in my community in the States.

[mogee]

In Toronto one major centre, St. Michael's Hospital has in-unit nocturnal hemo.  Perfect for people who need a bit of help or whose homes are unsuitable for home hemo.

That's a good idea.

I've never heard of any such modality being offered in my community in the States.

Let's contrast that with Bill's assertion:    The critique of the Canadian system is that it is not entrepreneurial, it is good at doing what it has always done but it doesn't advance care in the same way the US system does.

Ever since the discovery of insulin in the 1920s, Canadians have been keen for medical advancement, and things did not change when universal health care arrived forty five years ago.  In practice, medicine is much more international and collaborative than anyone admits.  A nephrologist in New York has more professional common ground with a nephrologist in Cairo than to cosmetic surgeon around the corner.  This is why it is not surprising that discoveries are often made simultaneously in different countries by unrelated researchers.

[monrein]

In Toronto one major centre, St. Michael's Hospital has in-unit nocturnal hemo.  Perfect for people who need a bit of help or whose homes are unsuitable for home hemo.

I guess that's great if you live in Toronto.

Can you do short daily hemo in clinic in Canada?  If not, why not?  Not everyone can do in-unit nocturnal hemo...a patient might have small children or a night job.

I used to do short daily (2 1/2 hours) five days a week in Toronto, at a self-care clinic.  I wasn't doing well on 4 hours three times a week, so requested more and started on more days with a week or so.  Of course money is always an issue in healthcare and as the dialysis population grows our resources are increasingly squeezed.  I think that self care clinics in which patients provide as much of their own care as possible, with fewer nurses and medical personnel on site, are a great cost saving measure with the added bonus of patients feeling more empowered and independent.  I only really needed a nurse if I dropped my pen or if ever there had been an emergency.

[MooseMom]

That's a good point, monrein.  I don't mean to sound smug, and I apologize if I do, but one reason I am quite keen to dialyze at home is because I am confident that I can, and if I can, then I should.  I like the idea of being able to "give" that chair to someone who cannot dialyze at home.

I would love to see such self-care clinics around here.  That's a brilliant idea.