Why Do Dialysis Patients in U.S. Die More Frequently than in Other Countries?

[The Straight Story]

Why Do Dialysis Patients in U.S. Die More Frequently than in Other Countries?

Hemodialysis Machine (photo: Wikipedia) Medicare spends more than $20 billion a year to provide dialysis to patients with kidney disorders—about $77,000 per patient. This expenditure is higher than what any other country in the world spends on dialysis, and yet the United States owns one of the highest mortality rates for dialysis care among developed countries. Why?

For starters, Medicare often covers dialysis treatment in clinics with “shockingly poor” conditions, writes Robin Fields of ProPublica. Of the 1,500 clinics from across the nation that were inspected over a seven-year period, almost half were found to have “filthy or unsafe” facilities. Problems discovered included blood-stained chairs, walls, floors or ceilings.

At one clinic in North Carolina, a staff member handed a patient a can of bug spray after the patient complained about the prevalence of ants.

“Hundreds of clinics were cited for infection-control breaches that exposed patients to hepatitis, staph, tuberculosis, and HIV,” wrote ProPublica.

In many cases, patients died or were hospitalized after they began to hemorrhage because staffers failed to follow safety guidelines involving dialysis needles or tubing.

http://www.allgov.com/Controversies/ViewNews/Why_Do_Dialysis_Patients_in_US_Die_More_Frequently_than_in_Other_Countries_101209

[liberal N proud]

1. But we have the best health care money can buy

:sarcasm:

[Ganja Ninja]

2. At least we don't have Socialism.

:banghead:

[Erose999]

3. Because we don't have the Osama Bin Laden dialysis program.

Seriously, how does the son-of-a-bitch do it? I've never heard of anyone surviving on dialysis for so long.

[Horse with no Name]

6. Especially having to drag the damned equipment in and out of

caves and mountains while hiding from the US!:sarcasm:

[we can do it]

20. Because Its Bull Shit Just Like Everything Else Our Corporate News Feeds Us

[RKP5637]

4. Because we're the best place to live in the world! Ain't it great! Go USA! Go USA! Go USA! n/t

[Horse with no Name]

5. I worked with a nurse that worked at one of the strip center dialysis clinics

She mistakenly ran cleaning fluid (bleach) through the arm of a patient (that died).
She is still working as an RN today.
The corporations that run these fast food dialysis clinics have no desire to do better. They aren't forced to. It is ALL about the profit baby!

[sweetapogee]

9. ok

since the nurse didn't conform to protocols, wy wasn't she (or he) given a date with the medical board? Was the center sued out of existence?

[Horse with no Name]

10. Nope.

She is still working.
Never a reprimand.
Texas has tort reform.
IF you aren't wealthy then you can't sue for malpractice.
Your worth is established by an actuary and you can't sue for more than your potential lifetime earnings.
I would guess that someone that is on dialysis probably doesn't have a lot of expendable income.

[sweetapogee]

12. with all due respect...

something in the form of details is missing from your story.

On edit: may I add that my BS detector is going wild.

[Horse with no Name]

14. With all due respect (that's a nice way to call someone a liar btw)

there isn't.

Research what tort reform has done for malpractice cases in Texas and to the poor and middle class who have been affected.
http://www.tortdeform.com/archives/2007/07/the_detrimental_effects_of_cap.html
>>>snip
The reporters state that the law has made it economically unfeasible for lawyers to pursue many of the cases brought in by injured patients. Too often, lawyers say, even the best possible outcome in an open-and-shut case won’t cover their costs, let alone provide anything for plaintiffs. That’s particularly true for elderly patients and the working poor, who lose little or no earnings as a result of their injuries or death, leaving the limited pain-and-suffering damages as the bulk of any potential award.

“It’s the insurance companies that are profiting here,” said Paula Sweeney, a Dallas attorney whose sole practice is medical liability. In fact, insurers are profiting, after years of losses from malpractice policies in Texas. In 2004, as a result of having fewer claims to pay out, the state’s insurers reported their first profit directly from malpractice premiums since the Texas Department of Insurance began tracking the information in 1992.




In order for something to go in front of the State Board of Nursing, it has to be taken there. The Board has an allowance for employers to utilize "peer review" in the discipline of their own nurses. If the facility does not feel that the nurse is a threat to public safety, it won't go any further and the nurse won't be reprimanded by the board. An individual is allowed to take a complaint to the Board where it will be investigated--but generally, if an in-house peer review has already been done, the Board will defer to that.

Have a nice day.:hi:

[sweetapogee]

18. a few definitions:

When a health care professional acts in a manner inconsistent with what would be considered established reasonable care for a practitioner with like credentials under like circumstances, this health care professional becomes a candidate for a malpractice lawsuit.

When a health care professionals actions result in the injury or death of a patient, this is called depending on the state definition either manslaughter or homicide.

A patient sues in civil court to recover a monetary settlement in malpractice cases. The health care professional suspected of homicide is tried in the criminal court system.

A Dr. or Nurse can be sued for malpractice without ever being arrested. A Dr. or Nurse can be arrested for manslaughter without ever being sued for malpractice.

Malpractice is generally handled as a civil complaint, manslaughter is generally considered a prosecutable crime through the criminal court system.

Tort generally refers to the legal ability of a patient to sue a health care professional for pain and suffering as the result of that professional committing malpractice. It does not have anything to do with the patients ability to sue for actual damages as the result of a health care providers negligence.

What is being described here is negligent manslaughter/homicide. It is impossible for a health care professional anywhere in North America to commit a gross act of negligence resulting in the death of a patient without having to face a disciplinary hearing before the state medical board. Impossible, totally totally impossible. Let me repeat, impossible.

I'm calling BS on this one. Unless of course, details are missing.

[Horse with no Name]

22. And I call BS on you

You are obviously ill-informed regarding how the process works in Texas. Oh, and by the way, I have been a nurse in Texas for over 20 years. I know how it works.


But really, do have a nice day. :hi:

[sweetapogee]

25. Oh ok

where do you practice? RN, LPN, NA? Anyway, dispute what I have said instead of trying to discredit me. Should be easy given your 20 years.

I'm still in BS mode

[Horse with no Name]

26. I disputed it 2 posts ago

but you are too full of yourself to see it. As far as telling you where I practice? Sorry, not in a million years.

I'm done trying to educate you about how things work in my state regarding a topic I am very informed on.
I don't routinely argue with brick walls and I am not going to continue to argue with you.

I put forward facts regarding OUR state. You put forward general legalese (sorta). Sorry, it didn't float.

[sweetapogee]

27. I can say the same thing about

you. Anyway, why are you confusing tort with malpractice and medical ethics oversight? If anyone should know better it should be you. Are you doing this on purpose or just trying to confuse people who don't have any insights into this subject?

I'm not, as I said earlier defending anyone or anybody. Bad things do happen. But the system isn't in shambles, you should know this. You are, by your own admission part of the system. And you should know that Medicare insists on certain standards for their providers. Your argument is not any comfort to anyone who is expecting good things from a universal government run health insurance program. So what are you trying to accomplish?


Likewise, have a good day.

[Dappleganger]

28. She DID dispute what you said

and cited TX tort reform law.

You can say BS all you want but you've not proven her otherwise. The fact that you're saying this to another DU'er is ridiculous.

[sweetapogee]

29. sorry

if I offend but I like to keep to facts. I happen to be one of those neat orderly persons.

As a point of fact, the poster (nice as she is) did not cite TX law, rather the poster cut and pasted from an opinion article which makes vague reference to law. Big difference.

If you think that a nurse in the USA poisoned a dialysis patient during treatment and nothing happened then there is no sense trying to talk to you. Do you really think this happened as described or do you just want to believe it happened, i mean with respect to nothing happening to the nurse or the clinic management? Do you think the funeral home just pulled the hearse up to the back door of the clinic, loaded up the body and everyone went back to work as if nothing unusual happened? No, again, impossible.

And again, I'm not defending anyone or anything. I'm not trying to make a case against government intervention into the health care industry. What I'm doing is reading a story about a medical mistake that has BS written all over it and questioning it. If I offend you sorry but I like facts.

Now, if it would make you feel better and keep up family DU harmony I will now proceed to agree with you and everyone else, and yes, we must burn those devils in TX in the tar pit. Are we good now?

[Dappleganger]

32. And she gave you facts.

You chose to reject them.

[sweetapogee]

35. my first reaction

is to say where?

But in the interest of peace, love and DU harmony, I say "you are so right".

[sweetapogee]

24. In addition

Everyone professionally certified as a provider in the health care industry has, depending on their actual certification, has what is called their "scope of practice". At the low end of the scale is the medical First Responder who has about 50 hours of advanced first aid up to and including Dr. Kildare and Dr. Frankenstein who are legally able to perform brain surgery. Anyone who exceeds their scope of practice is probably (like in 99.9% of the time) going to lose their license. In that .1% of the time that they don't, well, they lose all their hair and a good portion of their nerves anyway.

A person who performs within their scope of practice but disregards proper protocols is going to face a hearing to explain their actions. There isn't like a "maybe" in the equation. It is possible that a health care professional may breech protocol and get away with it because no one knows about it. I mean you could rob a bank but if no one knows about it you suffer no negative effects from the law. But in the case described we have an actual human being who was poisoned while being treated. How do you explain away a body in a clinic? This nurse either exceeded his/her scope of practice or broke protocol, either way a hearing.

The fact that it is claimed that the cause of death was poisoning means that there was both an autopsy and investigation into the procedures and equipment used on this patient. Where was the county medical examiner and county prosecutor on this case? And do you realize that any information obtained in this case by health care professionals made public but not provided by court transcripts are violations of Hipaa laws?

[social_critic]

7. The US dyalisis system is designed wrong

It was designed by Congress without realizing what a mess they were creating. The payments to providers encourage patient mistreatment. It is so bad, if I were an elderly patient with a kidney problem, I would move out of the US to a country where the treatments cost less and have better quality, to improve the chances of survival. And if I were a smaller country near the USA I would develop an industry to do that, provide retirement communities and health care to US patients, with improved quality and lower cost. When I think of it, this could be one hell of a business line for Cuba after the communist regime changes and the embargo is dropped.

[sweetapogee]

8. from the article...

"In many cases, patients died or were hospitalized after they began to hemorrhage because staffers failed to follow safety guidelines involving dialysis needles or tubing."

While I'm no means a doctor, I'm a volunteer EMT and run patients to and from dialysis and also respond to several dialysis clinics for 911 calls. The above quote troubles me because there isn't any data given to back it up or make comparisons.

I'm not saying that all clinics are run properly nor am I saying that there isn't room for improvement. The clinics I have exposure to are clean and professional and full of medicare patients. Most of the 911 calls we get to the clinics are for AMIs, CHF issues, TIAs, COPD, diabetes and other things that are not necessarily related to the actual dialysis treatment.

One of the things that strikes me about some dialysis Pt's that I have contact with is the general disregard that they have for their overall health in general.

Again, not defending anyone and I'm sure someone will come back with clinic horror stories to counter my claim but to make a judgment on this based on the supplied story isn't fair to anyone. Let's see the data.

[social_critic]

11. The data were published recently

I've read an article recently with the data - it was a paper magazine I get, and I forget which one it was, but the numbers were there, and it did show the US record isn't nearly as good as it is in other nations. And they spend less for the care. Sometimes these things need re-engineering, but it takes an act from god to re-engineer a process dictated by law which is controlled by large bureaucracies and has so many hidden special interests.

[sweetapogee]

13. If you

find it, let me know. I checked the CDC website and didn't see anything. It is easy to say this operation or that system is better than that one and so forth but there has to be a professional baseline to make comparisons.

People who are being treated for kidney problems many times have other medical issues that cloud things. The Hipaa laws in this country while good for patient privacy make collecting data and sharing information difficult.

[Hannah Bell]

30. the mcdonalds-style dialysis operations are known for having a high rate of problems.

they're for-profit clincs & they started to pop up around the time hmo's started to be the preferred model for health care, around the 90s.

there is positive reinforcement for cutting costs.

[delightfulstar]

15. The medical community isn't proactive enough.

You'd think they would realize that these patients have suppressed immune systems - it's the nature of the disease.

My mom has ESRF, and there were all kinds of red flags popping up years ago that her doctor should have caught - high potassium, high calcium, elevated BP, elevated sugar. She was otherwise in good health, but had two ticking time bombs in her, in the form of failing kidneys, and didn't know it. She became seriously ill in 2006, and had we not put two and two together, she wouldn't be with us at all. When she started to retain fluid, they didn't look at dietary issues or adjusting her meds - they just threw her into another treatment, which brought her to four a week. She is 84, and they're reluctant to let her get a transplant, even though she would probably live 5-10 years with it, given her genetics. Though she hasn't driven since having cataract surgery, she still lives independently, and has no intention of doing otherwise until she absolutely has to. She's a fighter, and an inspiration to me.

[Contrary1]

16. Aside from all the reasons listed in the article...

I believe one of the main reasons for the high mortality rate is despair. Understaffed clinics, nurses that were too busy to act like they cared, and a few that really didn't. Infrequent visits to the center by a doctor.

I witnessed it three days a week for the two years my mother endured dialysis. Several were brought in by ambulance from surrounding nursing homes. Others were dumped off at the door, which seemed to be the extent of their family's involvement.

Many patients cried every time they were hooked up. Some stared into space for the entire four hours.

I would often go around and chat with some of the patients. More than one confided to me that they had a lethal dose of various drugs stashed away if the day ever came that they had had enough.

On my mother's final day at the center, she told the staff how terrible she was feeling. Her stomach hurt, she couldn't keep anything down. She felt very weak. They informed he that she most likely had a mild case of stomach flu, and that she needed to get hooked up anyway. She cried, and was told that if she went to the hospital, the very first thing they would do would be to stick her on the machine anyway.

She asked me to take her to the hospital the following morning, and she never came home. She had suffered a stroke that had cut off the blood supply to her bowel.

In all fairness to the clinic, getting to the hospital earlier would not have changed the outcome.

My mother was weary of her life as it had become. For those with no hope of a transplant, dialysis can be a slow miserable death.

[lunamagica]

21. How horrific. It's so sad that medicine seems to be so efficient

in creating slow and painful ways to die....

[sweetapogee]

34. In spite of

some who think I'm some sort of jerk, your story is a good story. I'm sorry about your mom and while I have no idea how you must feel about your loss i can sort of relate since both of my parents didn't make it to age 60 due to cancer.

Anyway, a good cause for those who think the system is broken would be to volunteer their time to give comfort to those in this treatment. As mentioned I volunteer to transport both 911 emergencies and transport interfacility 12 to 24 hours per week and few things are more depressing than a dialysis clinic. When I'm with a patient regardless of the reason, I give that patient my complete 100% attention. Sometimes it is very hard as they can be difficult to be around but one of the reasons I volunteer EMS is for the fact that I can limit my time with a patient to the actual transport time, then i'm off to do another task. But it is very rewarding in many ways. But I will admit that my preference is 911 trauma emergencies. We all have our niches in life.

Your story is good in that you have discovered this issue, people are lonely in that situation and want to know that someone cares. Paid professional staff can be frustrated in that they care but don't have the time. This is were we laymen need to step in.

Take care Contrary1

[leeroysphitz]

17. I think that the dialysis machines were designed to work most efficiently in caves. n/t

[Overseas]

19. Medical care for profit. Quarterly profits are most important.

Too much blind obedience to the myth that the private sector can do better.

[Recursion]

23. All patients who need dialysis for renal failure or disease are eligible for Medicare

That is, they have a public option.

This is why I think we should focus more on provider costs and quality and worry less about the particular funding and insurance mechanism we use to pay for it: concentrate on the care itself, not its provisioning.

This does bring up the question: how does the VA do with dialysis? Actual socialization rather than socialized provisioning might improve things.

[Hannah Bell]

31. all eligible for medicare? cite?

[Horse with no Name]

33. It's true

I will find the link.

Socialized medicine that nobody hears about.
https://www.cms.gov/ESRDGeneralInformation/
http://kidney.niddk.nih.gov/kudiseases/pubs/financialhelp/
>>>snip
In 1972, Congress passed legislation making people of any age with permanent kidney failure eligible for Medicare, a program that helps people age 65 or older and people with disabilities pay for medical care, usually up to 80 percent. The remaining 20 percent can still pose a significant financial burden on patients. Fortunately, other public and private resources can help. Anyone with permanent kidney failure who does not have adequate insurance coverage should seek the help of a certified or licensed social worker. Every dialysis and transplant center has a social worker who can help people with kidney failure locate and apply for financial assistance. Social workers who specialize in helping kidney patients are called nephrology social workers.

[Hannah Bell]

36. that explains a lot.

[Horse with no Name]

37. Like why it isn't done in a non-profit setting?

Like a VA or something and why so many PRIVATE companies have their thumbs in the pie?

[sweetapogee]

39. a better question to ask is

why isn't it done in the patients own home?

[Hannah Bell]

41. some is.

[Hannah Bell]

40. yes.

[Recursion]

43. Agreed

Dialysis sounds like a textbook example of a public good. IMO this should be handled through the FQHC system rather than Medicare.

[Contrary1]

38. Then there's this:

Who is Eligible?

You can get Medicare no matter how old you are if your kidneys no longer work, and you need regular dialysis or a kidney transplant, and you have met the following conditions:

You have worked long enough to earn a minimum amount of credits toward retirement under Social Security, the Railroad Retirement Board, or as a government employee.

You’re already getting or are eligible for Social Security, or Railroad Retirement benefits.

You’re the spouse or dependent child of a person who meets either of the requirements listed above.

http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf

It seems to me that the above conditions would exclude some. :shrug:

[Hannah Bell]

42. yes, that's sheds additional light. it's part of the social security system, then.