"People need dialysis to survive. They have no choice," Grassley said. "Some dialysis patients fear for their lives when they're hooked up to the machine. That's wrong, and it's intolerable, especially when taxpayers are footing the bill."
Grassley's comments came after a hearing, "Kidney Dialysis Patients: A Population at Undue Risk?", at which auditors detailed the federal government's inadequate oversight of dialysis facilities. Medicare pays for kidney dialysis. As a result, the federal Health Care Financing Administration is charged with ensuring that dialysis patients receive good quality of care.
Two new reports from the General Accounting Office (GAO) and the Health and Human Services Office of Inspector General (HHS OIG) document the lapses in federal oversight. According to the reports:
»Unannounced inspections of dialysis facilities occurred at only 11 percent of dialysis facilities in 1999. That number was 52 percent in 1993. (GAO)
»When inspections were conducted, they found problems. In 1999, 15 percent of inspected facilities had problems severe enough to warrant termination from Medicare. (GAO)
»In 1998, 44 percent of all dialysis facilities had not been inspected within three years. By the end of 1998, 10 percent of facilities had not been inspected in six years or more. (HHS OIG)
Grassley said the infrequency of inspections and the consequent lack of patient data make it impossible to quantify how much patients are suffering, yet the known instances of poor care are disturbing. The HHS OIG report describes documented cases of patient harm, including:
»a patient who received another patient's blood dialyzer, putting him at risk for bloodborne diseases;
»a patient in cardiac arrest who was put at risk as facility staff searched for a misplaced code cart;
»a patient who was exposed to a toxic disinfectant through his bloodstream when hooked up to a reused blood dialyzer that had not been rinsed properly
»and a patient who received a drug overdose that resulted in prolonged bleeding and subsequent hospitalization.
Last November, a former nurse in a Miami, Fla., Veterans Administration hospital was sentenced to 10 years' probation because a dialysis patient had bled to death while she talked on the phone, according to media reports.
Two witnesses testified about the poor quality of care they received in dialysis facilities. One patient, a 72-year-old retired dentist from Pelham, Ga., described how he suffered "the pain of being ?roto-rooted' with needles the size of a ten-penny nail by untrained personnel with no medical background," which he said made him a "nervous wreck."
Another longtime dialysis patient said he suffered cardiac arrest because an attending technician did not recognize his low potassium level. The patient called the incident "completely preventable."
Grassley said the incidents are alarming, especially in light of the growth of the dialysis population. More than 360,000 patients received dialysis in 1998, costing more than $11.4 billion, according to the GAO. Experts expect the number of dialysis patients to double in the next 10 years as the population ages.
Grassley said he plans to take a series of steps to help ensure that dialysis patients receive better treatment. He said he will:
>»ask the Health Care Financing Administration for a plan of action within 30 days to address the issues raised at the hearing;
»ask the HHS OIG to look into how Medicare pays for dialyzers and whether payment rates reflect the re-use of dialyzers, a common practice;
»look into whether HCFA has enough resources to fund adequate inspections of dialysis facilities;
»and explore the GAO's recommendation that Congress should authorize HCFA to assess monetary penalties on dialysis facilities, as it can with problem nursing homes.
"It's a blessing that Americans are living longer," Grassley said. "We have to make sure they're also living well. As a nation, we can't leave kidney dialysis patients behind."