McCleary MRSA Prevention

I recently underwent an emergency ureteral stent placement at Eastern Maine Medical Center here in Bangor, Maine.  My care and my outcome have been excellent.

But

I felt like a hawkeye during my care.  Although I knew some of the nurses and I appreciated everyone’s  kindness and skills, I did not appreciate the dirty floor that I walked across in my Pre Anesthesia cubicle.  The floor had some sort of spill on it and I commented.  I mentioned that I am a stickler for infection prevention because I lost my father to a hospital acquired infection.   The nurse said the floor was stained, which I found unlikely since it was tile.  What REALLY bothered me was that after I walked across whatever had spilled on that floor, I got onto my stretcher and swung my feet up with whatever crud I had picked up on that floor.  YUK!

I gave that some thought.  When I was asked to undress, I removed everything and donned a jonny, pants and hospital slippers…like footies with non slip stuff on the bottom.  Then I was escorted to the Pre anesthesia area, about 50 feet away…through a hallway and a couple of doors to my cubicle with the dirty floor.
So, I picked up whatever was on that floor all the way to my stretcher.

When I lifted my feet and slippers onto the stretcher, my stretcher was automatically contaminated.  Then….to add more concern, I wore those same slippers with whatever living organisms were on them, when I transferred onto the OR table.  The slippers were never removed until I dressed to go home.

I have an idea.  Why not let the patients wear their own shoes until it is time to get onto the stretcher, then put the new clean slippers on….OR, change the contaminated slippers before the feet are lifted up onto the stretcher?

This could be a simple precaution to prevent awful HAIs and Surgical site infections.

Being mindful of what is brought onto our beds or stretchers as patients is so important.  Sometimes it only takes a simple fix to help prevent infections.    I sent off an email to my Infection Control nurse friend at EMMC.  Maybe we can change one small thing to reduce HAIs.

And maybe, just maybe EMMC should invest more into cleaning those cruddy floors!!  Housekeepers are an essential part of the Infection prevention team.

Kidney Stone

X-ray similar to mine

 

 

 

 

 

 

5/15/15

My husband Mike and I were sitting in a roomful of nurses, one of my favorite groups to be with.  We were attending the lovely annual dinner that was sandwiched between two full days of meetings with the Maine State Nurses Association.  I was so happy to be there.  I basically dragged Mike along, but he was pretty happy when they served up a beautiful prime rib.   Then during dessert,  ZING…. flank pain…not bad yet, but there.  I turned to Mike and said “I don’t know if I am getting a kidney stone or what!”   We left shortly after that.  We were camped in our travel trailer at Blackwoods Campground in beautiful Acadia National Park.  The meetings were in Bar Harbor, Maine, the nicest setting I could imagine.  Before getting stoned, we had enjoyed 2 gorgeous days of camping and touring around.

All night, I labored with the unrelenting horrid flank pain.  The camper was cold..no electric hook ups there. No cell phone service either!   Although our RV is 30 feet long, that little middle space wasn’t much of a place to pace with kidney stone pain, nausea, shakes, and clammy skin.  In hindsight, I should have gone to the Bar Harbor ER.  But, my first 2 kidney stones only caused me a single day of pain and eventually they passed on their own.  I was being stoic and thinking, I can handle this on my own.

Not this time.

If I had gone to the ER that night, maybe I could have skipped the next several days of misery.  I made a stupid choice.

5/16/15

We, or HE packed up our stuff and we drove home in the morning.  I was loaded up with ibuprofen and so the pain wasn’t bad, but I felt like shit warmed over.  I hated to miss the second day of meetings because a Facebook friend was going to speak about Patient Advocacy for Nurses.     I got home and started drinking water like a camel.  That night, the pain was back, in my back, in the black night.   UGH.   No doubt, I had to be seen by someone who knew more  about kidney stones than I did.

5/17/15

Sunday we trooped off to  St Joseph’s ER, where I got a cursory tap on both kidneys (this was my physical exam), a urinalysis and culture, antibiotics and 4 Oxycontin pills.   Yup, you have blood and Nitrites in  your urine Kathy.  Advice, follow up with your primary care and a urologist and drink tons of liquids. mmmmhmmmm.    No xray or CT scan done.  I was actually ok with that until the next round of unrelenting pain.  I am into Choosing Wisely, until wise choices are not made.  In this case, they probably should have done at least an xray. This was partially my fault because I never want more tests or medicines than necessary.

This stone is different from my other ones.

5/18/15

Monday I crawled around my house thinking this bitch of a stone will pass.  It HAS to.  I’m feeling sick, constipated, and very miserable with pain.  I have drunk gallons of water and strained the gallons of pee.  Nothing..  And when old women are crabby AND constipated, they take Milk of Magnesia.  No need to discuss this further because not everyone reading this will be a nurse or doctor.

5/19/15

I called St Joes for my urine culture results.  Negative.  I asked if I needed to take the rest of the Bactrim.  She said “yes”, and “no further follow up needed”.   Apparently she didn’t know about me, and my pain and  my kidney stone.  Then I called the urologist that the  St Joes doctor recommended, thinking that I could skip right to the expert and avoid another visit with my Primary Care in between.   They would not give me an appointment until I had blood work and a CT scan and I would have to get those ordered by my primary care doctor.  My stone and I were being held hostage for more tests.  Finally, I called my primary care doctor.  They got me in within a few hours.  He is my fave!!  He got my history and ordered, not a CT, but an abdominal film and blood work. Then he gave me Flomax. It did help to reduce the pain, but it didn’t go away.    I tossed and turned all night again with that stabbing constant  pain.  There was a pattern…when I wanted to lie down and sleep, that made the pain worse.

5/20/15

I called for my blood results and was told that my parathryoid hormone level was elevated but my blood calcium was not.  How about the xray? (by biggest concern)   No result on that yet, and the doctor is running 45 minutes late, and he might not  get to it today, but we will let you know as soon as we get the reading….that’s what I was told.  I waited all day long thinking maybe he would get to it, but they never got the reading of my xray from EMMC imaging  that day, and in the busy-ness of the day, nobody called to get it.   Another night of misery coming right up.

5/21/15

First thing in the morning I called the primary care office again.  Before I got my question out, the med tech said, “I am going to call over there (EMMC)  right now”.  And so she did.  I have a 1.5 cm or about a 3/4 inch kidney stone, one that will not pass on it’s own.  The radiologist apparently did not think this was a significant clinical reading and didn’t share this information with my doctor after he read my film.   I saw the xray myself, and I knew that the stone was at least 1cm….twice as big as my last one.  I assumed because this stone was large, and would not pass on it’s own,  that the reading and report out would be called to my doctor very quickly.

Now the fun really begins.

I really needed  a urologist. My PC faxed a referral to a urologist we had discussed during my office visit. This was not the same one that St Joes recommended.    When I spoke with that GU office these were their comments “We can’t give you an appointment until the doctor sees your lab and xrays.  He is in surgery until this afternoon.  I have to talk to my supervisor about this and she is out of town.”  And then the kicker, “he only does procedures at Bar Harbor or Blue Hill Hospitals.”  NO WAY am I circling back to Bar Harbor. I am too sick and miserable.  And we have two hospitals right here in Bangor.  So, my PC (primary care) called Urology Surgery, an affiliate of Eastern Maine Medical Center.   At first they said I had to jump through the EMMC ER hoop (one of many so far)….I must go to the ER to get the urologist on call.  OK, so now I am both sick and pissed off (get it?).  I asked for the phone number and I called them myself.  I firmly told them that I have a diagnosis..with X-rays, urinalysis and blood work to match, and I have visited an ER and my PC already.  NO WAY am I going to add EMMC ER chaos, cost, and time to this.  And I need to be taken care of.  Guess what.  That did it…I had to blow up just a little bit first, but I got into that office within 2 and half hours and I got the nicest, kindest, sweetest, most talented GU surgeon ever.  He almost made me cry with gratitude.  He knew I was sick by looking at me. My struggling kidney had already caused a rise in my creatinine level. By 5pm I was being wheeled into the EMMC OR for a ureteral stent placement, step one of two to rid myself of this stone.  Everyone from the GU office, to the EMMC registration, to Patient intake, to preop, to OR to recovery room, anesthesia….all kind, caring and skilled.  These are the names I remember..Courtney, Bev, Paula, Sue, and of course Jonas, my surgeon.   They met my needs before I knew I had a need.  Paula, my recovery nurse, helped me to the bathroom to pee for the first time after the procedure.  She said…”you probably won’t pee yet, you just feel like you have to.”  Her colleague said, “if she pees, Paula, you have to do a pee dance.”  Paula did a pee dance..because, although it felt like I was passing glass…I peed!!!  YAHOO

 

 

.

Lessons learned.

1. Don’t self diagnose.  When your body is screaming at you with pain, pay attention.  Do something about it right away.

2. Always bring an advocate, whenever and wherever you can.  I am still unclear about how my stone will be removed, because I was so sick when I went to the Urologist’s office.  I do remember something about lasers.  It was a mistake not to bring Mike to the exam room with me. He is my trusted partner and extra pair of ears.

3. Don’t take no for an answer when you are getting dismissed, delayed or disregarded…and it won’t matter how good your people are…there is always some excuse or reason why your needs can’t or won’t be met when you need them met.   Be persistent and advocate for yourself/your loved one.

4. Say thank you, frequently and sincerely.  I thanked everyone over and over.  I thanked my surgeon immediately when we very first met and we were shaking hands.  I will write notes of thanks for the excellent care I received at EMMC and in the surgeon’s office.

I am two days with my spanking new ureteral stent.   This has allowed my brutalized left kidney to pass urine, despite my big stone.  I am pain free.  I have taken only 2 advil since my surgery.  I am eternally grateful to my surgeon for pushing his scheduler to get me into surgery in 3 hours rather than in days.  Her response to his request “are you kidding me?”   She was obviously annoyed , but he didn’t back down.  He was advocating for ME!  She could steam about it all she wanted and she did, but she got me in.

I don’t share my story to get sympathy….I share it hoping to help patients to advocate for themselves and to be persistent when healthcare needs are not being met.

I also share in  hopes that my caregivers, throughout this ordeal, will learn to simply do what’s right for their patients.  Take care of them.   Sick, miserable patients don’t want to hear excuses or be delayed.   Patients want the right care, at the right time and in the right place.

My relief from pain and sickness came after almost a full week of battle, fighting for myself.   I am still facing another GU procedure to remove the stone and the stent.  Then maybe..just maybe… .a parathyroidectomy.  I don’t anticipate any more battles, but my husband and I will be on alert and advocating for me.

 

 

 

 

 

 

 

 

I was seen a month or so ago for floaters and flashers in my left eye, in  Bangor, Maine.    I walked out of EMMC ER without being seen,  because of a very poor  and unprofessional reception, watching a suffering young woman being ignored, and a very long wait time.  I went across town to St Joes.  I was nicely welcomed, quickly and efficiently triaged, waited an hour in an exam room, and was seen by a competent and nice nurse practitioner for about 5 minutes, maybe less.  I had no medicines, no sterile instruments, no diagnostics, no treatments,   and nothing extra.  I walked out with instructions and an appointment with an ophthalmologist the next day.  I had a good experience of care.

Grand total   $1313.85.  HOLY CRAP!

I looked up St Joe’s list of usual ER charges online.  My charges, on my itemized bill were way out of whack.  So, even though my copay will not change ($125), I called St Joe’s billing inquiry line.  The lady was very nice until I asked to participate in the weekly inquiry meeting where they will discuss my bill.  I want to know what they have to say about my bill and be part of the discussion.   It was obvious that this was really really weird for them to deal with someone who actually wants transparency and details about how they came to this wild price for my visit.  She finally relented and said she would tell the supervisor who participates in their billing inquiry meetings that I want to be there.

I asked the billing lady if she has ever heard of the concept of “nothing about me without me”.  I know that this generally pertains to collaboration and communications about our actual care and plans for it, but why not billing and costs.

After reading Rosmary Gibson’s new book. Medicare Meltdown, I fully realize how important it is for healthcare consumers to fully engage in all aspects of quality and cost in healthcare.  We need to protect our ability to access and afford healthcare, because Hospitals, providers, medical device and pharmaceutical companies, for profit companies and others are usurping all of the cream..off the top of the fresh milk bucket of healthcare. They do this with predatory pricing and charging of all patients, and getting what they can from all payers, public and private.      If we do not engage, our existing systems will not survive.

$1313.85 for a 5 minute visit is outrageous and unexplainable….and I want to know details about how they came to that astronomical price.  We all need to become inquiring minds when it comes to healthcare costs and quality.

Today, I spent my morning volunteering at a flu shot clinic at the brand new Brewer, Maine Community School.  My name is on a list with the State of Maine called Maine Responds.  My name landed on that list a few years ago when we had massive flu shot clinics in Bangor because of the Swine Flu scare and epidemic.  I love volunteering and doing this work to help preserve public health in my area.

The new school in Brewer impressed me.  I met and talked  with the school nurse, Carol.   She offered a tour of their school health clinic.  Jeesh, I remember my school nurse’s office and it was the size of a closet.  When I substituted for a regular school nurse in a different bedroom community outside of Bangor, same thing….a closet size room with a cot for sick children that needed to lie down.   Carols office was so exciting. She had her own space with supplies, records and medications.  There was a separate exam room with 2 cots…but what really floored me was the  in-school  medical clinic with dental services and regular medical services.  Two days a week a Family Nurse Practitioner visits from Penobscot Community Health Services up the road.   The children are seen by appointment and a sliding scale fee is arranged.  In other words, children in need can get care for free.  Wow…we have come a long way.  This is a community oriented and patient centered way to meet the needs of all children, no matter the financial circumstances at home.

I remember small  children coming into Walk in Care at Eastern Maine Medical Center, where I worked in the 90s.   Too many of them had horrible cavities. Some of their teeth were just stubs and they were infected and in pain.  Some of these children had never sat in a dentist’s chair and of course they had not been taught proper flossing and brushing.  Diet was another problem.  Now, these kids can be cared for  and educated about their health AND their teeth right in the school in Brewer.   This needs to happen everywhere.  No child should be ‘different’ than another when it comes to physical and dental health.

I felt so good coming home from my little excursion today.  I learned that in places, there is progress in healthcare education and maintenance…..and what better place to start than in our children’s schools?

http://www.cnn.com/video/#/video/bestoftv/2012/11/29/ac-griffin-medicare-fraud-investigation.cnn

On November 28, Wolfe Blitzer, CNN,  reported that a whistlblower lawsuit against Davita Corporation for major medicare fraud is impending.  If the allegations in this video are found to be true, then this lawsuit has the potential to be the biggest case of Medicare fraud in US history (according to Blitzer).  Davita recently was approved by the Maine DHHS Certificate of Need office,  to purchase (for $17,000,000)  and operate  the Dialysis assets of Eastern Maine Medical Center in Bangor, Lincoln and Ellsworth Maine.  Davit, EMMC and the Maine CON office were aware of this an other lawsuits against Davita at the time of approval.

When I read a letter,  written by a Davita lawyer and submitted as public document to the Maine Certificate of Need officials, I was stunned.  His letter seemed to be an attempt to belittle my work, my reputation and to silence me, and in turn the patients’ voice.

After I consulted with trusted and wise colleagues in Patient Safety, I decided not to write a rebuttal letter.   Instead, my colleagues wrote a strong letter of support to my State officals.  I can’t express how this made me feel.  That virtual group embrace was overwhelming.   We all work very hard to engage and empower patients, to give them a voice, and to help keep them safe.  Each of us has had an impact in our own communities and States, and we also work as a cohesive unit  in a Nationwide network to tackle Patient Safety issues together.  We are unstoppable and our collective  voice will not be silenced. 

The following letter of support was sent yesterday to Maine State officials,  and others.  This letter is a collective effort that brought many of my colleagues together to demonstrate our unified and solid stand for safer patients everywhere.  It was signed by 27 Patient Safety Advocate/Activists.

Without my nationwide Patient Safety network , including Roberta Mikles RN, who put me in touch with Advocate Arlene Mullin, and 5 very brave patients, Maine State Nurses Association, Maine People’s Alliance and Carl Ginsburgh,  this Patient Safety campaign in Bangor, ME,  would never have happened.

 There is power in the truth.

 

Date:    August 17, 2012

 To:       Phyllis Powell

Assistant Director

Planning, Development and Quality

Division of Licensing and Regulatory Services

Department of Health and Human Services

State House Station #11

 41 Anthony Avenue

Augusta, ME 04333-0011

 

Re: Letter in support of patient safety activist Kathy Day, RN concerning proposed

 July 12, 2012 

 The debate over the sale of EMMC dialysis patients to Davita is not a Union vs EMMC issue, as some choose to say.   It is a Patient Safety issue.  Patient safety is an issue for every single Maine resident who uses our healthcare systems. This Davita issue is also about relinquishing local control and governance over the quality and safety of care provided to local Maine patients.  Unforeseen illness, injury or medication complications could put any one of us in a dialysis chair some day.  This should frighten every single one of us.

  I asked for a tour of the EMMC (BOYD) dialysis services the other day. The clinic supervisor seated me in the waiting room for about 10 minutes while he made the necessary calls to EMMC bosses to address my request. That gave me the opportunity to talk with the spouses of 3 local dialysis patients.  They were uncertain and fearful of Davita coming to Bangor.  One dedicated husband said he wished he had known about the hearing because he would have attended.  It’s a shame they didn’t know. Patients and families would have benefited more than anyone from the DHHS Certificate of Need  hearing. It seems that EMMC staff should have posted the hearing information in a dominant spot for all to see…especially patients and their families.  Sadly, the patient’s voice is left out of decisions that are most important to them.

 I was denied a tour of the facility.  Apparently, my concern for the safety of EMMC dialysis patients was not a good enough reason to be allowed to see it. Before I left, I had a brief conversation with the clinic supervisor.  He said he had done research on Davita.   I asked if he had read about how Davita has sued doctors because they resigned and left to work elsewhere because they believed Davita policies were not safe for patients. They bucked Davita policies.   Yes, the young supervisor had read about that.  “How did that make you feel?” I asked.  He said with a very non expressive face “indifferent”.  Wow.  I didn’t have anything else to discuss with this man.  His indifference over something this damning of Davita was alarming. He was responsible for every patient who was hidden behind those securely locked EMMC clinic doors.  Even though his response floored me, I realize that EMMC and Davita have wedged him into the middle of a situation that he has absolutely no control over.  If Davita comes, he and every other person, including doctors on staff at our dialysis clinics had better get use to not having control over anything in the “business” of Davita.

 

I am extremely concerned for EMMC dialysis patients if this financial deal goes through.  At the July 10 Certificate of Need hearing, I displayed  3 posters. Two of them had the real life stories of 5 patients from Davita clinics from across the US. The patient heroes (whose photos and stories were displayed) wrote their own testimonials about personal harm from their Davita clinics.  Most of them had been dismissed from their clinics, simply because they were vocal about their concerns and harm.  These 5 people were just a tiny sample of thousands of patients who have experienced the exact same thing.  I didn’t observe one single Davita rep, EMMC manager or dialysis staff person reading those stories, even after repeated welcomes to all to do so.  Could it be that they don’t care about patient harm?  Dr Razcek, EMMC vice CMO described the patients’ experiences  as anecdotal.  It’s odd that he would describe the stories of real life dialysis patients anecdotal, but swallow the stories or “so called” evidence of Davita whole. Dr R’s comment was insulting to the integrity of those 5 people who have suffered through harm, retaliation, segregation, bullying, physical and mental abuse, and now someone is questioning their honesty?   I have spoken with each and every one of those patients and they are real, their suffering is real and their stories are real.  I offered to put EMMC leaders in touch with those patients and that offer was refused.  These patients’ stories are the absolute and dangerous  truth about Davita.  

 

 “The right care, at the right time, in the right place” was in bold print in the half page EMHS ad in today’s BDN. .  Apparently, that promise is made to everyone except dialysis patients.  EMMC/EMHS  will have no control over Davita policies or the quality of care that our Maine citizens receive in Davita managed dialysis clinics.  There will be no local governance. Davita skewered the EMMC dialysis care  outcome reports during the public hearing.  If I had been an EMMC manager, that would have made me very angry. In fact, although I am no longer employed by EMMC, I do remain loyal, and it made ME angry. My family and I receive some of our healthcare services from EMHS and EMMC.  Who validated Davita’s data?  Davita did.  Conspicuously missing were Davita’s records of dismissals and patient harm.  Records of their care outcomes, patient safety measures,  and regulatory violations in California are available online.   The 5 patient stories I displayed were just a sample of many who have been harmed and dismissed by Davita.  As a Mainer, a retired nurse and as a former employee of EMMC, I was insulted by Davita leaders and their condescending presentation. 

 If EMMC continues to pursue this $10,000,000 sale, and dialysis patients are harmed by Davita, EMMC becomes complicit in any resulting harm and sickness that our local dialysis patients my encounter.

 Keep the control and funds for dialysis services in Bangor, ME.  Use any revenue to address perceived defects  in our local clinics. Keep the dialysis business-related revenue in the local pharmacies, laboratories,  and supportive services.  Keep the  safety of Maine patients in Mainer’s hands.  Davita cannot do one single thing better than EMMC except make money and pay stockholders.

My third display poster for the hearing , showed photos of the CEO of Davita in a Three Musketeer Costume and quotes from him  saying “It is not about the patients, it is about the teammates”.  These photos, quotes and articles are available to anyone online.   This poster should have made it perfectly clear that money intended for high quality dialysis care is siphoed off by Davita and goes to glitzy rich booze soaked  parties, huge new $100,000,000 Denver, CO headquarters, a $22,000,000 annually compensated CEO,  and most importantly to them,  into stockholders hands.  Davita is even banking on boomers!  I posted that article on this board as well.

Mainers, demand that the control of our local dialysis clinics stay in local hands.  Cheapened care, cookie cutter treatments, and Walmartesque  services from Davita will not benefit Maine dialysis patients.

 The State of Vermont rejected Fresenius (Davita’s biggest competitor) because citizens declared that For profit dialysis services were not for the public good of Vermonters.

 Davita services are not for the public good of Mainers.

 

Kathy Day RN Patient Safety Activist

I pray to God that I never go into End Stage Renal Disease.

When I read in the Bangor Daily News that Eastern Maine Medical Center was going to sell their Dialysis services (patients at average $70,000 annually each in 2008) to DaVita Dialysis Corporation, I was shocked. http://bangordailynews.com/2012/04/24/health/eastern-maine-medical-center-to-sell-dialysis-clinics-to-national-chain/  It is my understanding that EMMC offers a fine service already, just as they have promised their charitable donors they would.  Charitable donors have given money toward a beautiful 4 year old facility on the West Side of Bangor, ME, and I have never heard anyone complain about their treatment.  Information about bad care often trickles down to me because I am a patient safety activist and advocate.

The BDN news article went on to describe 3 concurrent investigations into Davita  by regulatory agencies.  One is for fraud in overcharging for a common medication given to dialysis patients, Epogen.  These investigations were fluffed over by EMMC  and we, the BDN readership were assured that these investigations are no big deal…..really?  Apparently the investigations are not as big a deal as a check for over $10.000,000 for the purchase of EMMC dialysis.   A fellow activist from California contacted me about  Davita.  She warned that Northern Maine does not want or need them here.  She in turn connected me with Arlene Mullin Tinker.  Arlene and her team of legal advisors  have advocated for thousands of harmed dialysis patients.  Many of them have been Davita patients.  Her experience is that Davita is #1 for dismissals. During my 42 years as an RN,  I had never heard of dismissing dialysis patients.  Wouldn’t that be a death sentence??  A death sentence usually involves a judge and a  jury of our peers.  Not so for dialysis patients.

As it turns out, Davita clinics nationwide have repeatedly dismissed dialysis patients without cause or notice.  These patients have generally been patients who were vocal. They complained about unsafe care, complications of their care, poorly trained staff or poor infection prevention techniques.  All of these complaints sound reasonable to me.  I would certainly complain if I was on the receiving end of poor care.  Dialysis patients are captive to  their illness and to the treatment for it, dialysis.  Without regular high quality  treatments, they will die.  So, even if their care is substandard, they generally have no choice about where to get their treatments.  Their only option is to continue care, often times  from the same people who may have harmed them.  My research revealed that the only reason to “dismiss” or fire a dialysis patient is violence.

At EMMC Dialysis services, the hierarchy beyond the director of the clinic, is EMMC management, and then Eastern Maine Health Services management, and finally we have 2 local Boards of Directors.  Managers and Board members are Bangor  and EMMC service area residents.  They live, shop, go to church and social  functions  in the same places that the patients do.  Our local Hospital hierarchy coexists in the same community as the patients and they are accountable to them.

Davita, now that is a different story. They are a Fortune 500, for profit company headquartered in Colorado.  They are buying up Dialysis clinics all over the World.   Davita people  ”from away” came to Bangor on May 25 to do a slick sales pitch at a State of Maine DHHS Certificate of Need hearing.   They presented  an almost religious mission and presentation.  They explained their trilogy of care. 1. We care for the World 2. We care for each other.  Last and finally,  3. We care for patients.   I immediately figured it out.  Patients are last on the list.  But, the money that patients bring in, mostly from taxpayers  in the form of Medicare/Medicaid dollars, is really #1.  The “world” is their stockholders.  ”Each other” are the so called citizens of the Governors community(will explain in a moment).  And finally at the bottom of the pit are the patients…..who get the dribs and drabs of whatever  remains of the healthcare dollars after the coffers are filled.   I looked into Davita leadership. Their CEO, Kent Thiry is quite a guy.  He likes to be called “Governor”, which seems  kind of egomaniacal.   Employees are called “citizens” of his community.  He runs RAH RAH rallies for his cult like “followers’ and dresses up like a Muskateer.  He leads loud Nazi like rants/chants.  He does somersaults on the stage.  He hired a bull for a ritzy Las Vegas meeting to prove that he can ride one.  What does any of this have to do with Patient Safety and high quality of care.  Dialysis funding (through Medicare patients)  pays for all of these Davita variety shows! http://www.youtube.com/watch?v=JowmBdx4nFw

Davita is a perfect example of everything that is wrong with Healthcare today.  Taxpayers pay into Medicare and Medicaid services.  Coverage for dialysis treatment in guaranteed to every US citizen regardless of income. Around $70,000 to $100,000 is paid annually  for every medicare dialysis patient.  EMMC was offered over $10,000,000 by Davita for their dialysis services.  Kent Thiry ‘s 6 year average yearly compensation was over $22,000,000, http://www.forbes.com/lists/2012/12/ceo-compensation-12_Kent-J-Thiry_IPFN.html,  more than all of the  dialysis services of EMMC is worth.  All of these  figures prove that there is HUGE money in corporate dialysis services.   My concern is …How much is spent on safe, high quality dialysis care?  If the profits in this for profit  ”business”  are any indication, not much actually goes to patient care.

The slick sales people at this CON meeting also bragged about Walmart-like “one stop shopping” for patients.  They are proud that they offer their own  mail order pharmaceuticals for their patients.  Most dialysis patients are on at least 8 prescription drugs.  Staff are trained to be sales people and to encourage their patients to purchase their medications through Davita mail order services.  Then they will deliver them directly to the patient, at the bedside.  WOW, it’s a miracle. Bill Miller of Miller Drug on State St in Bangor has been doing that for free for years…same day, home delivery for free.  And Bill’s profits stay in Bangor, and help the local economy. Bills neighbors and friends can also borrow certain medical equipment for free. I borrowed a wheelchair from Bill a few years back to help my father get around at the American Folk Festival….no charge!  What does Davita do for free?   What else will Davita sell their patients?  They are starting to buy up employee health clinics, nursing homes and other practices.   This is a company with outside policies and controls, and with inside sales.  This is a company that will profit off our local dialysis patients, and bring nothing to our local or State economy.  The money will go to the corporation/stockholders.  Living, breathing, suffering and captive Patients become cash cows for Wall Street Commodities.

Where do patients fit into the Davita scheme?  Good question.  If they are harmed or have issues with their care or safety, the complaint process is complex, and my understanding is that complaints often go into a black hole.    The End Stage Renal Disease Network fields these complaints.  Davita has representation on that network, so complaints essentially go to the people who are being complained about.  If a complaint somehow reaches a state health department, they might do an investigation, but generally the investigators are nursing home inspectors, and they do not know the specialty of dialysis.  If CMS (Centers for Medicare Services)  is brought in and they make recommendations, Davita may or may not comply.  Since there are no sanctions, there is no accountability and no incentive for Davita to fix problems. Then if a Davita clinic does not like the patient, because they have asserted themselves about substandard care or complications, Davita may just dismiss them. Some  patients that have been both harmed and dismissed by Davita clinics were also blackballed from other dialysis services.  Since Davita will purchase 3 dialysis clinics business, in Bangor, Ellsworth and Lincoln, ME, all inpatient EMMC services and home dialysis services, this leaves local dismissed pateints out on a limb….facing either death or horrible long commutes to distant clinics.    None of this bodes well for patients.

Davita answers to their stock holders, not to their patients and as importantly, not to our community or service area.  It is very clear what this company’s priorities are.  Patients bring money to the company, and by cheapening dialysis care, they make their stockholders happy.   Ask Warren Buffett.

Maine does not need Davita. They are exactly what is wrong with Healthcare today. Davita is a prime example of why healthcare is bankrupting this country and our States.    The fact that EMMC service area patients may recieve cheaper and lower quality care is reason enough to escort them out of State. We need to tell them “Thanks anyway, but we value our citizens too much to invite you in.”   Maine welcomes business..there is a sign near the New Hampshire border saying “Maine is open for Business”.  If that business has potential to harm our citizens or suck money out of our economy, we do not welcome them.  I look forward to seeing the back side of Davita going over the NH border….headed back to Colorado.

Addendum  http://bangordailynews.com/2012/05/27/business/who-makes-the-most-50-highest-paid-ceos/

check out who is #46 on the list of the highest paid CEOs in the US…all made on some of the sickest patients in our country, and on Taxpayer dollars to care for them.

I have learned that although I am a smartie pants patient safety activist, and I know all the correct questions to ask and who to ask, the answers are hard to come by.  The most transparent places I called were Maine Medical Center and Eastern Maine Medical Center.  The hospital I called in Boston had attitude.  I asked their infection control nurse what the infection rate was for robotic assisted hysterectomies, and all hysterectomies and I was told “well, I know they are below the National average”.   Exactly what does that mean?  I have no clue.  She also said that they are not required to report those numbers to the public, but in a year, they would be doing that.  I told her I have cancer now and I need surgery, so that report in a year would do me no good.  Then she went on to tell me she did not have the authority to give me that information.  When Iasked for someone who did have the authority, she said I would have to wait until Tuesday(this was the previous Thursday) and call back, but she was not certain I could get that information.  I did not call back.  I was completely turned off by their lack of transparency.

Both of the Maine Hospitals I called gave me the information they had on infection rates for hysterectomies, and EMMC even had it broken down for robotic assisted hysterectomies.   Both were concerned compassionate and friendly.  It might be because I know both of them from my MRSA work.  Even so, I appreciated their honesty and candor.   The only problem I had was finding out about other complications of their robotic assisted surgery cases.   I think if I had persued it further, I could have found out, but sometimes there is such a thing as TMI….too much information.  TMI can be kind of frightening.

So, although the original plan was to go to Boston and engage the doctor who did the first robotic assisted hysterectomy in New England, I have changed my mind.  That is the perogative of patients/healthcare consumers.  I did my homework.  I also asked my personal local doctor her opinion.  She was  very candid.  Her own husband died of melanoma this past June.  She basically said that given the choice of going to Boston or Portland (she and her husband went to both places), she would choose Portland.  Her comments were that the Boston teaching hospitals are world class but they love having you come there to learn ‘on’ you.   She went on to say that Maine Hosptials have the focus of Patient Safety.   This was reassuring to me.  She is a wise doctor.

So, after all my struggles and conflicts with Maine Hospitals and the Maine Hospital Association over MRSA, I will put my trust in Maine Medical Center and a GYN/oncologist there to take care of me. I am hoping that my activism has made Maine Hospitals safer places.   I have the expectation of a very safe, infection free experience.  I am scared enough about the risks of anesthesia, complications, post op pain,  recovery and beyond…..I really don’t want the added concern of preventable harm.  Eastern Maine Medical Center would have been an option if they had a GYN/oncologist, but they do not.  MMC does and that is where I will go.

I encourage all potential patients to call the hosptials they are considering and ask about their infection and complication rates.  Look the Hospitals and Doctors up on Healthgrades.com, or Why Not the Best. com websites to see their ‘grades’.  Ask around, talk to your doctor.  Ask him or her “if this was you or your mother, with exactly the same risk factors, where would you go for care?”    No question is a stupid question and all the answers (or lack of answers) are important in making your best healthcare choices.

So, my first lesson in my personal Healthcare journey  has been that although one can know the right questions, we can’t expect to get all the answers…and in some cases we can’t expect any answers at all!  But, the answers we do get and the way they are delivered can have a huge impact on your decision.