McCleary MRSA Prevention

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.

I am now well into my third year in Patient Safety Activism.  My father’s preventable death because of a hospital acquired infection continues to drive my passion.  Although he was old and he had health problems, the infection that took away his independence, his strength, his appetite and his ability walk and to live out his remaining days with my mother should not have happened.    Nobody except  hospital insiders and the grieving family and friends of the other 2 deceased victims of that MRSA outbreak knew about it.  So, my father was not only a victim of MRSA, a deadly superbug, he was also a victim of hospital secrecy. Hospitals generally sweep hospital harm under the rug and schmooz patients and families into believing it is part of doing business.  I do see a gradual change in this, but it is taking way too long.

Yet, when victims or their loved ones become patient safety activists we are expected to be kind, polite, and above all calm.  Many of us have been characterized as angry whiners. I’m sure we have been called worse behind closed doors.   Imaging that!  Let me just say, I am angry.   My anger is completely  justified.   But, when I testify anywhere, or when I share my father’s tragic story, or I work with anyone on patient safety, I remain polite, and I restrain that roaring lion inside me.  I am a professional, and I use the manners that my parents taught me.  This brings me to healthcare industry push back.  I knew when I stood up to fight for patients and patient safety, that I would be exposing the underbelly and preventable horrors of healthcare…the infections, the errors, the short staffing, the disrespect and paternalism,  the ‘toxic hierarchy’, the big bad truth of what happens inside hospitals and other healthcare facilities.  I knew it would not make me popular with the “industry”, but of course that was not the reason for my work.  Patients and their safety were my priority, much like when I practiced as an RN for over 30 years.  I saw so much during that time, but I had bosses…in fact, I layers upon layers of bosses and my family depended on me for that paycheck.  How far could I realistically go with my advocacy during my employment.  This is why I find retirement so liberating.

Healthcare industry push back is alive and well.  My first bitter taste of that was in my very first meeting with Hospital people about MRSA. A contentious doctor  proclaimed that the new Maine law to screen high risk patients for MRSA on hospital admission was  “irrelevent”.  I had just run a patient safety campaign and spent about 4 months writing and rewriting a very involved and detailed legislative proposal for MRSA prevention for the Maine HHS committee, to end up with a tiny part of it in Maine law.  That big old lion was roaring inside my head and I wanted to let him out to attack that doctor.  But, being the lady that I am, I  kept my cool, and moved  beyond that arrogance, because we were all in that room to do a job, and that was to make patients safer.   The rule making work continued in that committee for months, and his attitude never changed. If I said white, he said black.  So much for collaboration.  Interestingly, the rest of the group was mostly nurses and none would contradict that doctor.  Perhaps I am a little biased, but I love nurses and the herioc work they do, but those nurses ’just went along’.    “Toxic hierarchy” is a new term I recently learned and it describes this group’s behavior perfectly.

This summer, I spent most of my time working on a campaign to stop the acquisition of my local dialysis clinic services by a large for profit dialysis corporation.  My reasons for this action are described in an earlier blog, but the greatest concern over this is patient safety and access to care.  I talked with experts, dialysis patient advocates and former patients and employees of that corporation.  I worked with the Maine State Nurses Association, the Maine Peoples alliance and other local socially responsible groups.  I did my homework and research and compiled resources and documents. Most importantly, I collected stories of patients who said they were harmed and dismissed.  I took all of this and carefully prepared testimony for the Maine Certificate of Need hearing on July 10.  In August, I came upon a letter that the corporation had written to Maine officials. The letter was almost entirely about me!  It contained misleading and downright dishonest comments about my work, how I go about it, and my character.  It was apparently an attempt to discredit me, and my work and to silience me and the patient’s voices. It appeared that the letter was also written to pander to the current pro business and anti union sentiments in our State governement. This guy covered it all, and if one didn’t know me, and saw that letter, they would  think that I am a monster!   This carefully crafted letter and  packet of “evidence” against a  retired RN volunteer, who is now an honest hard working patient safety activist  was  the biggest and longest piece of push back rherotic I have experienced yet!    And, it is now an offical State document!     My first thought was, if they treat me this way, imagine how they treat patients.  Oh my, those poor vulnerable patients.  The good thing about this letter is that it validated my beliefs about how ‘small’ this corporation really is.

I didn’t expect to make new friends or win over the healthcare industry with my work.  I did expect to help save lives, make patients safer, and to be treated with respect while I am doing it.  All of us who do this work have the same expectation. Because we have chosen to lead in Patient Safety because of personal tragedies, instead of waiting for the industry to do it all on their own or even to invite us in, we are sometimes criticized and disrespected.    I have watched two of my passionate colleagues experience push back when we were included in industry leaned events.  One was a nurse who tried to talk about her mothers tragic healthcare debacle in a federal DHHS HAI meeting a  few years ago. The physician moderator of the group rudely cut her off mid story and she was terribly upset by that.  The second one was a presenter at the recent Patient Safety Academy in Portland, ME.  He was doing a detailed and well prepared presentation on C Diff.  His beautiful and healthy middle aged mother died of the horrible infection and he has done tremedous work on awareness and prevention.   A very rude crabby infection nurse, cut him off and ‘told him a thing or two’.  She was obviously in denial of the imperfections in hospitals, and took my colleague’s accurate and non accusatory presentation as a personal affront.  Her actions were embarrasing to her two coworkers and to everyone else in the room.  This was my colleagues first time doing a presentation at such an event.

Civility.  Is there any such thing in patient safety advocates’ conversations with the healthcare industry?  I think so, but it isn’t consistent.  All of us need to take a deep breath and think about who really matters in our discussions.  We need to put away the egos, denial and the defensiveness. Al Gore would advise us to put the anger in a lock box, and I really do make an effort to do that.  We all need to consider what and who our conversations are about.  They are about patients, suffering, hurting human beings, who need all of us to survive, heal safely and live.  Come on….let’s get along, and have these conversations without push back.  

Backbone.  That is what it takes to do this patient safety activism job and do it well.  The industry has a lot to learn from us, and perhaps the first thing they need to learn is manners.   I have never seen any of my patient safety colleagues be impolite during patient safety events or conversations.

 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.