Inmates with kidney failure receive inadequate dialysis

Medical monitor finds inmates with kidney failure receive inadequate dialysis
by Pat Shellenbarger | The Grand Rapids Press
Wednesday September 10, 2008, 5:35 PM

The care of Michigan inmates on kidney dialysis is so inferior, it threatens their health and could cause some to die unnecessarily, a doctor appointed by a federal judge concluded.

The "serious, ongoing problems in the medical care" of patients in the Corrections Department's dialysis unit "have harmed or have the potential to harm the prisoners receiving dialysis there," Dr. Robert Cohen said in a report to U.S. District Judge Robert Jonker, who is hearing a lawsuit over health care of state prisoners.

Cohen, appointed as the court's independent medical monitor, said some of the inmates with end-state renal disease (or kidney failure) often do not receive dialysis treatments when medically required.

"This is not a trivial matter," Cohen wrote. "Inadequate dialysis results in substantial, but preventable, increases in morbidity (disease) and mortality (death)."

The Corrections Department has not kept the promises it made to increase staffing and build a permanent dialysis unit when it moved 63 kidney patients to the Ryan Correctional Facility in Detroit late last year after closing most of the Southern Michigan Correctional Facility in Jackson, Cohen claimed.

He faulted the Corrections Department for failing to keep adequate medical records and maintain sanitary conditions in the temporary dialysis unit at Ryan. Appointments for inmates needing to see an outside specialist often were delayed, further threatening their health, he reported to Jonker.

Cohen noted the May 1 death of a 51-year-old inmate, identified only as "patient A." The inmate had several serious health problems, including end-state renal disease, and was schizophrenic, Cohen wrote. Some of the many doctors who saw the patient failed to adequately treat him or coordinate his care, Cohen concluded.

"His death was premature, and his emergency care was unacceptable," he wrote, adding state officials refused to give him all the patient's medical records, despite a court order requiring them to do so.

Cohen urged the Corrections Department to change its policy denying inmates with end-state renal disease the right to be considered for kidney transplants. That policy establishes "a separate, unequal, and clearly inferior standard of care for prisoners," Cohen wrote, "which is substantially different from that available to all other persons in the United States."

Several other states and the Federal Bureau of Prisons allow inmates with end-stage renal disease to receive kidney transplants, which can improve the quality of their lives and add years to their lives, Cohen said, and it is cheaper than keeping them on dialysis.

Corrections Department spokesman Russ Marlan confirmed Corrections Director Patricia Caruso does not allow inmates to receive organ transplants.

"She is adamant she's not going to use tax dollars to steal organs from the citizens of this state," he said. "It does not say in the United States Constitution that we must provide organs."

Cohen, however, did not advocate giving inmates preferential treatment, only that they not be denied the right to be considered for kidney transplantation. He noted an increasing number of kidneys are donated by living relatives of the recipient and, therefore, do not delay other patients waiting for transplants.

In such cases, the Corrections Department would not deny an inmate the right to receive a transplant, Marlan said.

"We're continuously striving to create a health care system that's focused on improving quality and controlling cost," he said.

E-mail Pat Shellenbarger: pshellenbarger@grpress.com

http://www.mlive.com/grpress/news/index.ssf/2008/09/medical_monitor_finds_inmates.html