| Mr. Chairman and Members of the Committee. Thank you for inviting me to testify today. My name is Brent Smith. My exposure to the dialysis industry began in 1973, two weeks before my 18th birthday. A year later, I received my first transplant which was from my mother. Two months later, the kidney failed due to infection, and I returned to dialysis. In 1977, I received a second transplant from my grandmother. That transplant succumbed to complications in 1990. I returned to dialysis in the fall of that year. Soon after, it became all too clear that the entity providing treatment, its administration, the support staff, and many of the standard procedures with which I was familiar had changed drastically. Over the last ten years, as a patient, I have witnessed the gradual decline in competency of those given the responsibility of my care. In my view, efficiencies intended to enhance the financial position of the providing companies expose patients to great risk and may even hasten their demise. This trend continues and worsens each years as providing companies focus on bottom line management and not patient care. The major concerns of dialysis patients fall within the following five interrelated components. I have provided more detail in a longer statement submitted for the record. They are the following: Adequacy of dialysis Competency of patient care technicians Knowledgeable and disciplined nursing staff Facilities and technology (machines) Accountability Adequacy of Dialysis The adequacy of my prescribed treatment relies heavily on me, my discipline with regard to diet and fluid restrictions, and my oversight of my dialysis treatment. Because I am very disciplined in my care, I can allow the dialysis machines to do their work. I have worked to become very knowledgeable in what is needed for my care. Other patients who are less familiar with the dialysis process are very vulnerable. One of the areas that needs to be addressed by research is adequacy of dialysis. I can only tell you my personal experience with the amount of time I dialyze. When I dialyze four hours each session, I feel better. When treatments have been shortened in the past, over time my energy levels are depleted. In addition, complications appear from fluid retention, such as higher blood pressure and shortness of breath. I, and other patients, feel lethargic and have little appetite. So, I can only conclude that the amount of time on dialysis is a factor. Competency of Patient Care Technicians Second, in the year I started dialysis, the care givers were mainly nurses from the top graduating classes, as well as medical students, and other medical technicians. Almost every technician had a college degree, and every technician had previous medical experience. Today, I see technicians with only a high school diploma. In Arizona, a manicurist is subject to more licensing than a dialysis technician. When I first returned to dialysis, I had technicians handle my blood and my life who were convicted criminals, strippers, and refrigerator technicians. The ratio of patients to technicians, at times, is now 5 or 6 patients to every technician. This is not safe, and it doesn't work. A main worry for dialysis patients is vascular access. A patient told me recently of a treatment where it took eight attempts by technicians to initiate her treatment - eight sticks by 16 gauge needle! Not only is this painful, it increases the risk of infection and could destroy that access. There are limits to vascular access with each patient. When vascular access runs out, a patient can no longer dialyze and can die. Many other patients have told me of similar occurrences. These examples, involving poorly trained, unsupervised technicians include the following: target weight miscalculations that could cause blood pressure decline. On one occasion, staff miscalculated the projected amount of fluid to remove from me by a significant margin. When this happens, a patient feels extremely weak and lightheaded at best. At worst, a patient can severely crash, losing consciousness with a blood pressure far lower than levels needed to maintain life. Also, patients experience excruciatingly painful cramping, and treatments will be shortened because the patients cannot withstand additional treatment. too much or too little heparin, the blood thinning agent. Too much heparin thins the blood and could lead to the patient's inability to clot blood; so they could bleed to death. Too little heparin allows the blood to clot in the machine and stop the flow of blood back to the patient. placement of a dialyzer on the wrong machine for the wrong patient. This is a potentially fatal error. Disregard for the Universal Antiseptic Code, the protocol that protects both patient and technician alike from infectious germs, viruses, and bacteria. This is one of the largest and most common reasons patients are hospitalized. |