Article - April 11, 2008 - Arizona Republic

Poorly kept dialysis unit is cleaned up

By Yvonne Wingett and Amanda J. Crawford

Inside a small, quiet room of the Maricopa Integrated Health Systems' Phoenix kidney dialysis unit, patients are hooked up to machines that drain blood from their bodies, cleansing it of poisons and toxins.

Because kidney-dialysis centers deal so extensively with bodily fluids, health officials emphasize the importance of maintaining sanitary conditions to prevent blood contamination and other health threats.

But nine months ago, conditions in the center were not as safe and sanitary as they are today. State health surveyors found dried blood on chairs, walls and the floor. Dialysis machines, parts still wet with blood, were not appropriately checked for contamination after treatments. Ants infested the treatment area and crawled on patients.

State health officials were so concerned about the conditions in the dialysis unit in July, the most recent inspection by state surveyors, that they considered it an "immediate threat" to patients' safety. Inspectors refused to leave the facility until the most serious deficiencies were addressed.

The problems at the Phoenix unit, identified in a report by the Arizona Department of Health Services, were so severe that the center was at risk of losing its Medicare funding within 90 days. MIHS immediately began to correct the problems and developed a plan to avert similar problems in the future. The facility now is in full compliance. No Medicare funding was affected, and MIHS staff continues to monitor the unit closely.

"Many of these things were corrected before the first day (of the survey) ended," said Karen Ford, chief nursing officer for MIHS.

Still, the report provides a glimpse into operations of one unit of the taxpayer-funded county health system. Over the past three years, only one other dialysis center out of about 100 inspected throughout Arizona warranted the same "immediate jeopardy" rating by state health officials, they said.

Overall review

The problems at the center were not the only ones MIHS needed to address.

The system received a preliminary denial of accreditation in a review of its overall operation by a private accrediting organization, the Joint Commission.

That inspection has not been released to the public. After MIHS appealed the rating, the commission dropped several of its initial findings and upgraded the rating to conditional accreditation. MIHS officials continue working to correct problems and hope to earn full accreditation.

The kidney-dialysis center is one of two MIHS units inspected by the state health department on behalf of the federal Centers for Medicare and Medicaid Services.

In July 2005, less than a year after a newly elected board took over operations of MIHS, state officials also found deficiencies at the Phoenix center. Those findings were far less significant than last year's review, according to state health officials and survey documents.

Growing industry

Kidney dialysis is a growing health industry in Arizona. There are approximately 100 Medicare-accredited dialysis centers in the state, which are inspected by state health surveyors about every three years.

Over the past three years, 21 of those centers were under threat of losing Medicare funding within 90 days because of problems found by state surveyors, said Kathryn McCanna, licensing-program manager for the DHS. None of the centers lost Medicare funding.

Only one other dialysis center, the Chinle Dialysis Facility on the Navajo Reservation, was also found to pose immediate jeopardy to patients, like the MIHS unit.

McCanna said the dried blood on the dialysis chairs and equipment and ant infestation at the MIHS unit in Phoenix triggered the immediate-jeopardy finding, but the poor contamination controls on the dialysis machines posed the potential for serious harm to patients. The controls ensure that blood from patients is not transmitted to others.

"Infection control in dialysis is an area focused on because of the potential transmission of blood-borne diseases," McCanna said. "It is extremely important that good infection-control practices be done: wearing the gloves, cleaning between patients."

McCanna praised MIHS administrators for working to address problems immediately.

"I believe the organization took this issue very seriously," she said.

In response to the survey, MIHS officials immediately cleaned up the facility, called in exterminators and bought new chairs.

They made personnel changes, assigned additional leadership to help oversee the facility and implemented a self-monitoring system. They also hired an outside consultant, which continues to do unannounced surveys of the unit to make sure it remains in compliance with federal and state regulations.

"We have a new administrator," Ford said. "We have new chairs. We went through extensive retraining of staff. We put in different types of monitoring and checks and balances."

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