Kidney doc says he keeps too busy

Kidney doc says he keeps too busy

By The Associated Press
CASPER - About 100 people in Wyoming rely on Dr. James Rupp and his staff to keep them alive.

Rupp is the lone nephrologist, or kidney doctor, in Casper and one of only about four in the state. He provides dialysis care to about 60 patients at Wyoming Kidney Center in Casper and manages about another 40 patients' dialysis care in outreach centers in Lander, Gillette and Rock Springs.

Over the past 15 years, Rupp has seen the number of dialysis centers grow from two to eight or nine. He visits the outreach clinics several times a month while the other nephrologists in Wyoming and the surrounding states cover other communities.

Access to dialysis in the state has increased dramatically, and patient outcomes in the state have improved to better than the national average. However, Rupp said some dialysis patients could be at risk of losing this great coverage because of the lack of nephrologists in the state.

People with end-stage kidney failure need dialysis regularly or they will die within a few days or weeks.

Dialysis becomes necessary when a person loses 85 to 90 percent of his or her kidney function. Dialysis does the same things a healthy kidney does, such as removing waste from the body, balancing certain chemicals in the body and helping control blood pressure.

When Rupp first moved to Casper in 1995, there was already an outpatient dialysis center, but it was managed by a doctor in Colorado and soon closed.

Cheyenne was the only other place people could go to get outpatient dialysis services.

"People had to move out of state," Rupp said. "I knew a woman who had to move to South Dakota, and these are people who have lived in Wyoming all their lives."

Rupp decided to open his own outpatient center because he saw a need. The Wyoming Kidney Center opened in March 1999.

Rob Catellier said he was beginning to think about leaving his home in Casper in the early 1990s because he was not receiving the care he needed. Catellier has been on dialysis for more than 17 years after an autoimmune disease destroyed his kidneys.

He did not like having a doctor manage his care from Colorado and said he was spending a lot of time in the hospital. It upset him that he was missing his son's birthday every year.

"Then, (Rupp) came and got me all tuned up," Catellier said. "I've got time now. I don't have those medical emergencies."

He said he could count on his fingers the numbers of times he has been hospitalized since Rupp started working with him.

The statistics support this personal anecdote. The Centers for Medicare and Medicaid release reports on each dialysis facility in the country every year.

Fewer people at the Wyoming Kidney Center die than are expected to. According to the most recent report, there was an 18 percent annual death rate among patients at the center from 2003 to 2006, while a rate of 28 percent would be expected based on the types of patients served. During that period, 39 patients died of the 61 who were expected to.

"This lower mortality is unlikely to be due to random chance and probably represents a real difference," the report said.

Also demonstrating the center's success is its low infection rate. From 2003 to 2005, 4 percent of patients from the center were hospitalized because of septicemia, a blood infection, while more than 11 percent of dialysis patients nationwide were hospitalized for this infection.

Rupp is not sure how long he can keep up these outcomes and still manage all his outreach clinics and take calls at the hospital 24 hours a day without any help.

"There are not many of us," Rupp said. "It puts a big strain on me. Some days I am really busy and others, not so much. It's very hard to do it every day."

Rupp's help, Dr. Vera Nelson, another nephrologist, left his practice in April to pursue other career opportunities after working with him since about 2001.

Marsha Johnson, administrative nursing director for Wyoming Kidney Center, said based on the dialysis population in Casper, the city needs about 1½ nephrologists.

"The biggest thing for the nephrologist is that person has to cover what is going on at the hospital every day, every holiday," Johnson said. "There are not many nights that go by without some calls."

Luckily, Rupp has had some help recently with a temporary nephrologist hired by the Wyoming Medical Center, said Julie Cann-Taylor, director of critical care services at the hospital.

Cann-Taylor said she understands that the hospital plans to have a temporary nephrologist for the rest of the year.

This helps Rupp in the immediate future, because he does not have to be on call about 24 hours a day, but Johnson said it is a temporary solution that is expensive, and temporary people are not as familiar with the patients.

The Wyoming Medical Center has been trying to recruit a nephrologist since Nelson left in April, said Shauna VanderLinden, spokeswoman for the hospital. She said they are working with Rupp on this.

"We've had a few candidates here, but none of them were the right fit," she said. "There is a shortage of everyone in health care."

Without help, Rupp said, "I am more likely to give up my outreach clinics if I am too stressed. It puts the population at risk."

However, at this point Rupp is not thinking about leaving these communities, and Catellier said this is a good thing.

"I am really glad to have him as a doctor," Catellier said. "My family is, too."

http://www.billingsgazette.net/articles/2007/10/25/news/wyoming/25-nephrologist.txt