Friday, 12 November 2010

Health Problems in Dialysis Clinics?

A research report produced by ProPublica, which has been discussed on many news sites, suggests that there are some serious health issues attached to dialysis - not that dialysis itself is bad for you, but the clinic you receive treatment at may be very bad for you.

To quote from the report
"Nearly 40 years after Congress created a unique entitlement for patients with kidney failure, U.S. death rates and per-patient costs are among the world's highest while the biggest for-profit providers flourish."

ProPublica examined thousands of clinic inspection reports and interviewed many patients and others involved in dialysis, and came to a shocking conclusion - at clinics all over America, it is quite common for patients to receive their live-giving treatment in unsanitary conditions, where lapses in the quality of care can endanger their life. In a health care clinic!

The report describes some pretty scary events that have occurred, including some which have lead to the patient's death, and claims that medical care supervision is minimal in some clinics. That care is often administered by young under-qualified technicians. That staff to patient ratios are not prescribed by the authorities. That some clinics (note that it says some, not most) are run like a factory systems, with technicians stretched to their limits by monitoring too many patients simultaneously.

According to the report, the clinic inspections that they examined revealed that almost half of those checked were described as filthy or unsafe, and many exposed patients to hepatitis, staph, tuberculosis and HIV. Prescription errors were common.

And remember, in America, Medicare funds these clinics, and running clinics is big business. According to the report, the government's payment policies for dialysis have created financial incentives that, in some ways, have worked against better patient care, while enabling for-profit corporations to dominate the business.

But if you come from a poor background in the US and have kidney failure, where can you go for treatment? To a Medicare funded clinic. It's highly unlikely that the less well-off will get private care for their dialysis.

Italy has one of the lowest mortality rates for dialysis care -- about one in nine patients dies each year, compared with one in five in the US! And yet Italy spends about one third less on patients than the Medicare system, according to the report.

Italy has doctors and nurses present at all stages of treatment, not technicians whose general medical knowledge will, by definition, be more limited. Fistulas are used in preference to catheters - catheters can be used immediately they are inserted, but are more prone to infection and clotting than fistulas, which must be allowed to "settle in" before being used.

Overall the report paints a pretty poor picture of health care at some clinics, and advocates reform in the way dialysis patients are treated. The obvious answers include (but are not limited to) having better staffing ratios, with doctors and nurses present to check patients, not just technicians.

It's not as if there's much of a choice in having dialysis or saying no thanks, not today.

You just don't expect to be at risk by saying yes to treatment!