Doctors here pioneered access to dialysis

The Journal of Business
From Our Special Reports
The issue dated August 30, 2007

Doctors here pioneered access to dialysis

Three Spokane physicians launched U.S.’s first non-research site for treating chronic disease

By Emily Proffitt

Kidney dialysis centers are commonplace today, but they weren’t in 1962, when three pioneering Spokane physicians opened here the first U.S. dialysis center outside of a research setting that treated chronic kidney disease.

The three doctors, Tom Marr, Loren Gothberg, and Richard Steury established their groundbreaking center in a small, four-bed unit at what was then called Sacred Heart Hospital. Critics said the country wasn’t ready for such treatments to be done in smaller cities, but the trio forged ahead with their work. As a result, thousands of patients across the region have been able to live with what once was fatal disease.

“We were doing something that had never been done before,” Marr says. “The big centers on the East Coast didn’t think smaller communities were ready for something like this, but the Spokane community was really supportive.”

Kidney dialysis is a method of removing waste from the blood when the kidneys are unable to do so. By the 1960s, doctors had been using dialysis to treat acute kidney disease for years, but treatment of chronic kidney disease was less common, for several reasons, Gothberg says. Different methods of dialysis had to be used for chronic cases, the costs of repeated treatment were enormous, and physicians questioned the ethics of keeping patients alive through repeated dialysis treatments, rather than letting kidney failure take its natural course, he says. Instead of keeping patients on a permanent regimen of dialysis treatments, however, the three doctors’ goal was to keep their patients alive until they could get kidney transplants.

“There was this attitude that you’re supposed to die,” Gothberg says. “We thought otherwise.”

The dialysis center here brought advancements to Spokane that had been made at the University of Washington, in Seattle, where Dr. Belding Scribner developed in 1960 a device that made long-term kidney dialysis possible, the UW’s Web site says. The device, a U-shaped Teflon tube called the Scribner shunt, was inserted between an artery and a vein in a patient’s forearm, and could be used for repeat dialysis sessions so that patients didn’t have to have frequent new incisions. During dialysis, the artery-vein connection was hooked up to an artificial kidney, so that the patient’s blood could be pumped into the machine, cleansed, and then returned to the body. Teflon’s non-stick properties made the shunt less likely to cause blood clots, which occurred with materials used in dialysis technology earlier, preventing patients from receiving more than a few dialysis treatments, the UW says.

In 1959, Marr, who was working as a research fellow with Scribner at the UW, decided to move to Spokane, where he took a job at Rockwood Clinic, he says. Meanwhile, Gothberg, who had worked with Scribner at the UW in the early 1950s, had set up a private practice here in 1954 and was doing some work with acute kidney dialysis treatment.

Marr and Gothberg, along with Steury, who also was running a private practice and doing work with acute kidney dialysis treatment, wanted to bring to Spokane Scribner’s work in chronic kidney disease treatment, but knew they couldn’t do it individually. So, they teamed up and opened the Spokane & Inland Empire Artificial Kidney Center in Sacred Heart’s old cafeteria space, Gothberg says. They started out with three employees, Marr says.

“Scribner’s work was really paramount to everything we were doing,” Steury says, adding that all three physicians were internal medicine doctors who became self-trained nephrologists. “It was all a seat-of-the-pants kind of thing for us.”

Gothberg remembers the opposition the three faced from members of the medical community when they set out on their mission.

“It was about fighting for turf. Members of the establishment said, ‘What does this fly-by-night little place mean by doing this?’” Gothberg says. “We thought that the need was there. People were dying of kidney disease.”

In the early years of the center, the physicians and staff contended with big, cumbersome dialysis machines that rumbled across the rickety floors of the old Sacred Heart hospital building, located south of the medical center’s main tower today. The machines made such a commotion that a heart surgeon asked the hospital’s administrator to get rid of them because he worried they’d crash through the floor of the intensive-care unit, Marr recalls.

Dialysis was a time-consuming process. Treatments took up to 12 hours, with patients typically receiving three treatments a week, often overnight, Gothberg says. Thanks to improvements in technology over the years, kidney dialysis now is a three- to four-hour procedure, he says.

Some of the biggest challenges in getting the center off the ground were financial, he says. Few insurance companies would pay for the treatment, Marr says. The center received a private grant in 1962 that helped offset the cost of care significantly, but as patient volumes grew, the doctors knew they needed public funding as well.

Soon after the kidney center in Spokane opened, the doctors invited U.S. Sen. Henry Jackson, his aide, the future U.S. Rep. Tom Foley, and U.S. Sen. Warren Magnuson to tour the center and see the work they were doing, Marr says. Eventually, Congress passed a law to extend Medicare coverage to kidney dialysis.

Marr, who also traveled to Washington, D.C., to meet with members of Congress, traveled to Olympia with former Sacred Heart CEO Gerry Leahy and several patients to lobby the Legislature, which resulted in some key state funding, he says.

The center also received federal funds for home dialysis in the mid-1960s, and used part of that money to hire Florence Hansen, a social worker who became the center’s first director. Hansen raised funding and organized support services for the center, which was key to being able to treat every patient who was medically eligible for the program, she says. At that time, most centers across the U.S. had to subject patients to a rigorous screening process, due to high patient volumes and lack of funding, Hansen says.

Demand grows

Word about the center grew quickly, and it drew patients from across the region and Canada, Marr says. The doctors wanted patients eventually to be able to complete dialysis treatments at home, rather than at the center, to cut costs and make the treatments more convenient for patients. They trained patients’ caregivers to use the dialysis equipment and sold them machines to take home. The training process usually took several months, Gothberg says.

“The caretakers were the real heroes,” Steury says. “Most didn’t know the difference between a syringe and a needle when they first came to us.”

The center’s first home dialysis patient was an Associated Press newsman, Burl Osborne, who was suffering from end-stage kidney failure, and moved to Spokane from the East Coast to undergo treatment here, Gothberg says. Osborne completed his first home dialysis in 1965. He dialyzed at home and while he traveled for assignments until he received a kidney transplant, Marr says.

Osborne, who later became chairman of the AP and publisher of the Dallas Morning News, wrote an article about his experiences in Spokane. Shortly thereafter, Gothberg started receiving letters from people across the globe who suffered from various diseases and wanted to know more about their treatment program, he says.

Transplants

Until the 1980s, the center referred its patients elsewhere for kidney transplants, Hansen says. It also ran a kidney retrieval program that rivaled those in larger cities such as Seattle, she says. At the forefront of bringing kidney transplant services here, the physicians at the kidney center recruited two transplant surgeons from the University of Oregon in the early 1980s, Marr says. In 1981, the first kidney transplant in Spokane was performed at Sacred Heart, he says. By 1987, 100 kidney transplants had been performed here, he says.

Eventually, home dialysis waned in popularity as more centers cropped up, increasing the convenience of in-center dialysis for patients, Gothberg says. Meanwhile, Medicare began giving patients a choice between in-center and at-home dialysis, and many patients started choosing in-center treatments, Steury says. The center here had encouraged at-home treatments, because they cost significantly less money, and the doctors wanted to be able to treat as many patients as they could, he says.

“The real killer of home dialysis was when patients could choose; we didn’t give them a choice because we were so hard up for money,” Steury says. “Private companies also started seeing in-center dialysis as a real gold mine, which shot home dialysis down in the air.”

Marr, Gothberg, and Steury have retired, but their work lives on through the center they started decades ago. Now called the Inland Northwest Renal Care Group, the center operates 10 dialysis units across the region, Gothberg says. It has roughly 650 patients currently, about 10 percent of whom dialyze at home, he says.

“Our goal was to restore life and the ability to function for patients, and I think we’ve proved that,” Gothberg says.

Contact Emily Proffitt at (509) 344-1265 or via e-mail at emilyp@spokanejournal.com.

http://www.spokanejournal.com/spokane_id=article&sub=3299

PHOTO: From left, Drs. Tom Marr, Loren Gothberg, and Richard Steury founded the kidney center here in 1962. Florence Hansen, right, was the center's first director.