|Dialysis dilemma: Patients frustrated by lack of local services|
|Written by Jane Stebbins, Pilot staff writer|
|June 05, 2012 08:23 pm|
Bob Meunier purchased his retirement home in Brookings in 2002, but has yet to be able to move into it.
“I love it up there; it’s beautiful,” he said. “We spend as much time as we can up there.”
Not these days.
The Pittsburg, Calif., man underwent heart-valve replacement surgery – a procedure doctors said he might not survive. But survive he did, only to develop kidney failure three years ago.
And until there is a dialysis center in Brookings, the 60-year-old can’t relocate to the town he wants to call home.
“I can’t afford to sit up there and go (to a center) four times a week,” he said. “I can’t drive myself, and I can’t tie down someone else ... the gas and everything else is too much.”
He’s not the only one who’s frustrated.
Rod Rush of Brookings was diagnosed with kidney failure brought on in part by high blood pressure in 2001 and had to make the two-hour trek to Eureka and back three times a week while awaiting a transplant.
Lloyd Costa of Brookings makes the drive as well, and has for the past two years.
These three and six others met in Brookings recently to discuss their challenges and options, which appear to be few and far between – much like the centers to which they must travel.
The closest centers are all two hours away: in Eureka, Calif., or Coos Bay, Grants Pass and Medford.
Once there, patients sit in a chair while machines draw and filter their blood and pump the clean blood back into their system. The procedure takes four hours. And then it’s back in the car for another two-hour drive home.
Some are arguably more fortunate, and can have the procedure done at home. But even that machine takes 15 to 20 minutes – and up to five times a day, according to DaVita Dialysis Centers officials.
It’s either that or drive to a center two to three times a week.
It’s tough on all involved, and not just the older set, either.
Karla Richardson of Crescent City, Calif., was en route to a dialysis treatment in Eureka, Calif., in 2007 when her transplanted kidney failed and she died. She received her new kidney at the age of 19 and died at 37.
Some kidney failure patients were promised a dialysis center would open in the Brookings area – one as early as this past April – and time and time again, have run against what they believe are merely excuses.
They say it’s like “fighting city hall,” “the good ol’ boys,” and that the “medical industry is only interested in the almighty dollar.”
“Brookings is a retirement community,” Meunier said. “This has to be a major issue.”
No one denies that: not nephrologists – kidney specialists – dialysis medical suppliers nor hospital officials.
They were told dialysis suppliers DaVita and Fresenius Medical Care were, at varying times, willing to provide the services.
“We have been in contact with the Curry County Hospital District and plan to reopen our discussions regarding their effort to bring nephrologists to the area to oversee dialysis patient care,” said Fresenius’ Jon Stone in an email to the Pilot.
Bill McMillan, CEO of Curry General Hospital in Gold Beach is frustrated, as well, especially since the population is growing – and graying.
Scott Nichols, regional director for DaVita has been in contact with Costa’s wife, Judi Klein.
Last month she asked Nichols if it would be possible to get a dialysis center without hospital involvement.
“I can only tell you that it depends,” he wrote her in an email. “And even with hospital involvement – which would certainly help – it would still depend.”
He said that’s the only answer he has until he can put together a “model” for Brookings to “estimate how it would look.”
Brookings is the largest city in Oregon without a hospital, much less a dialysis center.
“This is a frail, vulnerable population,” McMillan said. “I don’t know how they do it. If you have a critical health need and live in a rural area, something’s got to give.”
Rush knows that first hand. Although hale and hearty now, his wife used to tell him he looked like a walking ghost.
“I’d be in the dialysis center and be in there month after month and see the same people,” he said. “And then you wouldn’t see someone and you’d have to ask. Someone would say, ‘Oh, they passed.’ And I’d think, ‘Is this for me?’ It’s really bad.”
They’re tired of promises, too.
“Fresenius said if we build it, they (the firm) will come,” McMillan said.
At one point, officials at Curry Health District identified a building in Brookings that could have been used for a dialysis center. But that deal fell through.
Some thought the unallocated 3,000 square feet in the new hospital could be used, but McMillan said they need three times that.
There are a number of hurdles, Nichols said.
“There has to be the right lease, the community need – it’s hard to say. But we want to be everywhere there are patients.”
And then, of course, there’s the money.
It would cost about $150,000 to $200,000 to get a clinic up and running, McMillan said. But with an estimated patient pool of 25, it’s “barely feasible.” Fifty patients, he said, would make it “feasible.”
Vince Hancock of DaVita said 10 percent of its company’s centers are running in the red.
“If you have private insurance, they’ll pay for dialysis for 33 months,” he said. “Then it automatically switches to Medicare – at a loss. There has to be a reasonable mix. To close down those centers in the red would be hugely burdensome to our patients.”
There isn’t an exact number, either, of how many people could use the services. The number could be much higher, particularly if the number of people needing dialysis and wanting to move to Brookings were included.
And more people moving here would result in more business for the dialysis center.
McMillan said it would be at least a couple of years before the district could invest in a new service.
“There’s no way to put a good face on this; it’s a horrible situation,” he said. “We hear the stories. People say they’re too tired, they’re too sick, they’re just going to die. It’s heart-wrenching.”
And ultimately, there must be a nephrologist. Several have expressed interest, but need a clinic.
Allen Mathew, a nephrologist in Eureka, Calif., was interested in opening a nocturnal unit in Brookings, where patients could receive treatment during the night and have their days free.
But that requires clinic space, a partner to assist, staff and a medical director responsible for the operation.
He doesn’t put all the blame on medical officials and politicians.
Some of it belongs to the patients themselves, he said.
Many decided decades ago they would retire in Brookings. But by the time they arrived, some were unhealthy.
“Seventy-five percent of these patients are obese, diabetic, they have cardiovascular hypertension,” he said. “Others did all the right things, but they hit retirement and they’re sick and didn’t know it. They go to live there, and there’s no support for them.”
He is particularly frustrated by those who apparently don’t care about their health.
Mathew has a 27-year-old patient whose kidneys failed, in part, due to her addiction to methamphetamine.
The young woman received a transplant from her best friend – and returned to a life of drug abuse. Her new kidney, he said, is failing.
Some patients here would like to see a traveling nurse, but Mathew said – and they agreed – that oftentimes, such a person doesn’t have a vested interest in the community, much less the patient.
“To get someone to come here is costly,” Mathew said. “Enticing people to this area, it takes a special person. You can’t do this out of fellowship. As hungry as they may be, it won’t function here.”
That leave all involved back at the proverbial drawing board.
Local officials have tried other tacks.
“We put a letter of intent with Fresenius and a financial analysis said it was doable with 25 people,” McMillan said. “But they’re a for-profit company and the profit margin is too low.”
“We have to be fiscally responsible,” Hancock said. “We’d love to bring it there, if we could make it work.”
“We’d love to have a center in Brookings,” he said. “We want to do the right things for patients.”
He said they’ve looked at Brookings before, and reached out to hospital officials again earlier this year but haven’t heard back.
Those involved have tossed around the idea of a joint-venture partnership, which also has failed to come to fruition. There’s even been talk of fundraisers.
And don’t forget the politics involved.
Brookings isn’t part of the Curry Health District, which was established in 1984 and runs from just south of Port Orford to the Pistol River area.
Brookings wasn’t included because, at the time, it had its own health district, which has since disbanded.
The board, McMillan said, has indicated it doesn’t want to extend services to areas outside the district, even though half its money is generated from Brookings residents.
Some have proposed to include Brookings in the district.
“The people in the north part said, ‘We’d be happy to have Brookings in the district,’” McMillan said. “But the people in Brookings-Harbor said, ‘Hell no, we don’t want to pay the tax.’ It’s like the old north/south split in this county. It’s such a political hot potato.”
“I don’t know what the problem is here in Brookings,” Rush said. “It’s got to be monetary, or the egos of doctors. We live in a country where we could afford this. It’s a real shame.”
Some believe a dialysis center could even benefit the town in many ways.
Stacy Bergstedt of Brookings said dialysis patients on vacation might know there is not a center here and merely pass through – taking their potential tourism dollars with them.
“The lack of a center will continue to keep people away from Curry County,” she wrote to the Pilot. “How could they really stay?”
“People would come out of the woodwork,” Klein added. “What if they could stop here? Then maybe they’d buy property. Maybe they’d spend money. It would be good for Brookings.”
This group is not giving up, either.
“All these people passing away,” Klein said. “Or moving, or giving up. But we’re not t