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Utah Inmate Dies when Dialysis Tech Doesn’t Show

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Source: Deseret News

Inmate dies after dialysis tech doesn't show

Ramon C. Estrada, 62, died Sunday, April 5, 2015, at the Utah State Prison.

UTAH STATE PRISON — An inmate scheduled to be paroled in two weeks died Sunday after a medical contractor responsible for performing his dialysis treatments failed to show up at the prison on Friday and Saturday.

Ramon C. Estrada, 62, died from apparent cardiac arrest that was the result of kidney failure, according to a statement from the Utah Department of Corrections. His body was sent to the state medical examiner to determine an exact cause of death.

“A preliminary review indicates that the lack of dialysis treatment could be a contributing factor in Estrada’s death,” said Department of Corrections spokeswoman Brooke Adams.

Richard Garden, the clinical services bureau director for the Department of Corrections, was placed on administrative leave while the circumstances leading to Estrada’s death are investigated.

A dialysis technician who works for University of Utah South Valley Dialysis Center, based in Sandy, “failed to show up as anticipated” at the Utah State Prison on both Friday and Saturday to provide dialysis treatment for inmates, Adams said. Estrada was to receive kidney dialysis on Friday. He died Sunday night while prison staff and others were preparing to take him to University Hospital to be treated.

Six other inmates, all men, also went without their scheduled dialysis and were taken to the hospital Sunday night. Four were admitted for an overnight stay. One man remained hospitalized Tuesday.

Adams would not comment on why the technician failed to show up or why it took prison officials until Sunday night to get treatment for the inmates.

“Obviously, we are aware that he didn’t (show up),” Adams said, but she would not say when prison officials discovered that the inmates hadn’t received their scheduled treatment.

The spokeswoman also declined to comment on the circumstances surrounding Garden being placed on leave. An internal investigation is underway.

“The delayed response in ensuring that the inmates received needed medical care is unacceptable,” Adams said.

Estrada’s parole date was just two weeks away, on April 21. He was sent to prison in August of 2005 after being convicted of rape. Estrada was a citizen of Mexico.

Aside from the Department of Corrections’ internal investigation, the Unified Police Department is also investigating Estrada’s death, which is standard procedure. Lt. Justin Hoyal said his department is primarily interested in finding out Estrada’s cause of death from his autopsy.

“(Criminal culpability in Estrada’s death) is one of the things that could play into this and one of the things we will look into,” Hoyal said. “But as far as the investigation as to what took place there at the prison, as far as his medical care and what may or may not have been taken care of, is being conducted internally by prison officials.”

A spokeswoman for the University of Utah Health Care said it would also investigate the “unacceptable mistake.”

“We are saddened to learn of this prisoner’s death and are concerned about the scheduling error for dialysis services provided at the prison by University of Utah technicians. We have a responsibility to provide quality care for patients. We will now conduct a thorough review of the circumstances that led to this unacceptable mistake and will take whatever steps are necessary to improve communications and procedures,” Kathy Wilets said in a prepared statement.

Adams said several changes will be put in place at the prison “to improve communication with and oversight of the dialysis contract provider.”

“Those steps include getting a schedule calendar with contact telephone numbers for dialysis technicians; requiring nursing staff assigned to the Olympus (prison) facility to make contact with and receive post-treatment reports from the on-duty technician on dialysis days; improving chart notes about each inmate’s status and condition; and requiring timely notification to the charge nurse when the dialysis schedule changes or a technician fails to show up,” she said.

Choices for Dialysis Patients at the End of Life

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When kidney dialysis was introduced in the 1940s it was originally intended as a life saving treatment.  It was mainly used for young patients with acute renal failure and helped them until their kidneys could function without the therapy.  Since then the use and frequency of dialysis has changed.  Today the average dialysis patient is 65 years old and is used as a maintenance treatment just as often as it is for acute episodes.

There are some medical professionals that believe dialysis is simply prolonging an inevitable conclusion of this patient population: death.  “Many of these patients don’t realize they are in the final phase of life because no one has talked forthrightly with them,” said Mildred Z. Solomon, EdD, president of The Hastings Center. A 2013 analysis published in the Journal of General Internal Medicine (2013;28:1511-1516) found that patients with end stage renal disease (ESRD) reported they did not know their medical prognosis and couldn’t recall being offered dialysis alternatives.  Another report in Medical Anthropology Quarterly (2005;24:297-324), found that of all the patients researchers spoke with at two Californian dialysis clinics, only 4 confirmed they initiated dialysis treatments by choice.

Give People a Choice, It Might Be Their Last Chance to Make One

There is a growing movement of physicians and bioethics organizations that believe such patients should be given more information about their illness and more choices about how they want to spend their final years alive.  “We haven’t had a grown-up conversation that this is a stage of life patients are in and death may not be that far away,” Dr. Solomon said. “People want to have that sort of conversation and are expecting it from their doctors, but physicians aren’t initiating it.”  Patients are surrounded by medical staff all the time, including nurses and dialysis technicians.  But these staff are not necessarily trained or equipped to have these types of conversations with patients.  It’s important that the primary physicians and specialists step up and take lead.

It’s a difficult job, but somebody has to be straightforward with patients and give them the choice of how they want to end their lives.  “Everything we know about patients suggests that most of them want to have the conversation,” said Lewis Cohen, MD, professor of psychology at Tufts School of Medicine in Boston. “And patients want doctors to be the ones to broach the subject.”  Dr. Cohen recommended the following guidelines for having such a conversation with ESRD patients:

  • Identify patient preferences. What kind of care do they want? Who should speak with them if they are unable to communicate?
  • Ascertain if the patient is even willing to hear about dialysis alternatives.
  • Ascertain what the patient already knows about their medical condition. Many patients want to get the issue of death out in the open and would rather have the discussion with medical professionals than family or friends.
  • Provide as much information to patients as possible.
  • Give the patient a specific estimate of prognosis.
  • Inquire about the patient’s goals and expectations of treatment.

Patients should hear about their options and receive thorough thoughtful recommendations from practitioners.  By exploring their thoughts, beliefs, ideas and expectations, you can help dialysis patients make the best choices for their unique situation.

Race and Income Potentially Increase Risk of Death in Dialysis Patients

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NEW YORK CITY, NY – A recent study released by Dr. Tanya Johns and her colleagues at Albert Einstein College of Medicine in New York City indicates that young black adult dialysis patients who live in poor neighborhoods are much more likely to die than their white counterparts.

In higher income areas racial differences were not such a pronounced factor. This indicates that the correlation is more closely related to economic status than race. “In our study, young black patients’ risk of death was worse when they lived in poor neighborhoods. We need to better understand how the wealth of someone’s neighborhood affects patients’ health while on dialysis,” said Johns. The study that was published in the Journal of the American Society of Nephrology states that among dialysis patients between the age 18 and 30, blacks are nearly twice as likely to die at a young age.

The study analyzed data from more than 11,000 young white and black adults with kidney failure. All patients began dialysis between 2006 and 2009. After a 23-month follow up, the study identified a higher risk of death in young black adults in poor neighborhoods. They found that black dialysis patients were 1.5 times more likely to die than whites.

Dialysis and Poverty in the United States

Poverty in the United StatesIt is well known that minority groups in the United States in general have higher poverty rates. According to the U.S. Census Bureau the highest national poverty rates were for American Indians and Alaska Natives (27.0 percent) and Blacks or African Americans (25.8 percent). The 2007–2011 national poverty rate for Whites was 11.6 percent, and most states (43) as well as the District of Columbia had poverty rates lower than 14.0 percent for this group. Knowing this could explain why young black adult dialysis patients have higher risk of death.

The study did was not explained in terms of medical factors. It also did indicate additional medical conditions such as blood pressure, to generate the results.