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  1. #1
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    Default The Abuse Just Keeps On Coming.....................

    I would suggest if any of you are being abused by your dialysis clinic, that you take a recorder of some type to record the abuse and then take the recording to the local prosecutor. In most states, this action is legal. However, it is not legal in some states, check with a local health care attorney or criminal attorney. Most attorneys will write a letter for around a fee of $50 or they will give a free first appointment. Many times, the actions of the dialysis industry, if taken place in a domestic relationship, would result in fines and jail time. No, the social worker is there to collect money for the company, they are not there to help you deal with an abuser. Yes, I do have personal experience with that issue and that is one of the reasons why Davita was fired by me. I am happy to help anyone of you deal with an abusive dialysis clinic, I have worn the badge. I would be happy to speak with any local law enforcement or prosecutor about abuse in dialysis clinics on your behalf. If anyone is curious, witness intimidation in a criminal case, is a FELONY. The courts do not take too kindly to witness intimidation or contempt of court. It is time for these abusers to see the inside of a county jail or state penitentiary.

    1. Jail is where the offender will be temporarily detained prior to receiving the final verdict of his case. It is also where offenders of minor crimes are placed. Most detainees are those who will serve detention for less than a year.

    ND: This means they have committed a misdemeanor, meaning M1-M5.

    2. Penitentiary is a detention unit for more serious type of offenders. It is also a place where reformatory discipline and or punishment is done. ND: This means they have committed felonies.

    3. Jail is synonymous to shorter detention whereas penitentiary suggests longer detention.

    4. Jail is maintained by smaller jurisdiction units like counties and cities while penitentiaries are maintained by the state or the federal government.

    5. Jails have fewer amenities and are also smaller in size compared to penitentiaries.


    Attachment 87

    ND:

    Someone who has been found guilty of witness intimidation would be sent to a jail such as
    Lebanon Correctional Institution in Lebanon, Ohio. They will have no freedom and they will be subject to search and roll call, 24/7. These places are He!! on earth. So, I would suggest if some of these workers know what is good for them, they will not abuse dialysis patients.

    http://www.drc.ohio.gov/Public/leci.htm

  2. #2
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    Default Re: The Abuse Just Keeps On Coming.....................

    I don't know what kind of abuse you experienced or whether a prosecutor would have taken your case to court. Patients can also file a grievance with the ESRD Network and the State Survey Agency. If you file a grievance with the State Survey Agency, it will take the information you provide and conduct a complaint investigation at the facility. During that survey the surveyor(s) will observe care and interactions between patients and staff looking for whether there is a "culture of safety" (patients being encouraged to ask questions and report problems without fear of reprisal), interview patients and staff, and look at medical records of multiple patients in order to keep the complainant confidential. Patients can report anonymously, but that limits the ability of the surveyor to check back with the person who reported to find out more information or report what happened. Surveyors maintain patients' confidentiality.

    Every dialysis facility should have posted phone numbers for a patient to contact the ESRD Network and State Survey Agency. The Network doesn't have the same enforcement power as the State Survey Agency. Serious uncorrected problems can lead to a facility closure. That doesn't happen often, but it has happened.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  3. #3
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    Default Re: The Abuse Just Keeps On Coming.....................

    Quote Originally Posted by Beth Witten MSW ACSW View Post
    I don't know what kind of abuse you experienced or whether a prosecutor would have taken your case to court. Patients can also file a grievance with the ESRD Network and the State Survey Agency. If you file a grievance with the State Survey Agency, it will take the information you provide and conduct a complaint investigation at the facility. During that survey the surveyor(s) will observe care and interactions between patients and staff looking for whether there is a "culture of safety" (patients being encouraged to ask questions and report problems without fear of reprisal), interview patients and staff, and look at medical records of multiple patients in order to keep the complainant confidential. Patients can report anonymously, but that limits the ability of the surveyor to check back with the person who reported to find out more information or report what happened. Surveyors maintain patients' confidentiality.

    Every dialysis facility should have posted phone numbers for a patient to contact the ESRD Network and State Survey Agency. The Network doesn't have the same enforcement power as the State Survey Agency. Serious uncorrected problems can lead to a facility closure. That doesn't happen often, but it has happened.
    ND:

    Why is it that individuals in dialysis think they know everything? You do not know more about prosecution than I do, I am a former county police officer. In addition, I know many in the county prosecutor's office. I had a social worker act like she knew more about the law than me, my friend who has been an attorney for 16 years and my best friend from childhood, who is a partner at a blue chip law firm, representing many major corporations, making $300 per hour. I have read many of these "behavior" contracts, the vast majority which will not stand up in court with a decent attorney. In addition, many of these contracts threaten criminal prosecution when the issue at hand is a civil complaint, not a criminal issue. Moreover, most prosecutors office simply do not have the time and resources to deal with such nonsense. If our friends in dialysis had any knowledge of the current state of the criminal justice system, the jails are full with courts issuing release orders from overcrowded jails.

    Most dialysis patients are too sick to be in a county jail and the county system does not want to pay costs over $100,000 per year for that patient to be given dialysis in the county or state jail. The vast majority of dialysis patients would be eaten alive in the corrections system, they are not healthy enough to defend themselves against a much healthier and much younger criminal population.

    I have had experience with the Renal Network and I am aware that many dialysis workers are scared of the network. I am really not sure why...... They do not punish the clinics, nor do they move against the clinics or to protect patients against abuse. In a nutshell, they work against patients, they help industry blackball patients from getting into other clinics when they have made false accusations against patients. In one case, they claimed that a patient brought a firearm to a clinic and threatened the staff. Normally, in that case, at the very bare minimum, the person or group complaining would file a criminal complaint with the local police department. Yet, in that case, the paper trail of a bare minimum criminal complaint, unlawful possession of a firearm, had not been filed with the local police department. Given how afraid most in dialysis are of people who ask questions or challenge them, I find it very difficult to believe that they did not call 911 or the general number of the local police department. In other words, I think someone is lying and they were simply looking for a way to easily get rid of the person in question, it could be for a million different reasons.

    A word to the wise is that if you work in dialysis and do not have any law enforcement experience, let the local jurisdiction handle the people that you think are violent. Many years ago, a social worker was very abusive to one of the clients in the county assistance building in my metro area. The client simply brought a firearm to that county building in question and blew that social worker away. Sooner or later, I see it happening in a dialysis clinic. The current generation will not tolerate or put up with such abuse and arrogance. They will not tolerate being told how to live when it is very clear by the number of dialysis workers that I have viewed, that are grossly overweight. Honestly, I could care less. What do you think goes thru the mind of a dialysis patient, who is being loudly lectured by a grossly overweight dialysis worker, who is shoving pizza in their mouth and slurping a 32 oz BIG GULP drink??? After awhile, that dialysis patient in question is going to hate that worker and will seek ways to get even in the clinic or on the streets. The patient is being blamed for being a diabetic, when the cause of diabetes is truly unknown(Cleveland Clinic). Adults do not like being treated like children.

    Dialysis patients pass away because they are not being given enough dialysis which causes serious heart problems Any dialysis worker who thinks a diabetic on dialysis can only drink 32 oz of fluid per day, while being thirsty 24/7 is a drunken fool who needs to put down the bottle and sober up, coming back to reality. If you are curious, Dr. Agar would agree with my statement about fluid and diabetics.

    Since the late 1960's, we have run the dialysis industry with "professionals." Honestly their policies and their need to think well of themselves, has lead to over 1.3 million people to pass away on the kidney transplant list and over 100,000 current people waiting on the kidney transplant list and that list is constantly growing. It is perfectly ok for them to profit to the tune of billions and to give Kent Thiry a bonus of $68 million, yet, they claim that they do not have enough money. Yet, the one donor is not to receive one cent of profit, say the professionals with their trust funds and massive stock accounts. If it were not so sad, it is one of the most humorous things I have heard in my life. Yes, it is ok to treat dialysis patients like cattle as long as those summer homes are getting bigger, they drink as they please, and those stock accounts are exploding with money for a retirement of luxury. Yes, they will have a chance to work when they want, go on vacation a few times per year to Europe on a care-free vacations, no dialysis or hassle for them, you see.......

    It is because of our sickness and outrageous suffering that they have a swanky and comfortable life. It has been said that we cannot blame them. Well, guess who is in control, guess who runs the clinics, guess who is charge? Frankly, the buck stops with them and not anyone else. Instead of serving the truly sick, they only serve themselves. When a vendor screws up, somehow the home dialysis patient is to blame. The dialysis clinic never, ever confronts the real guilty party. I have never met so many wimps in my adult life. When they meet their maker, the ability to make excuses and blame the patient or the home patient will be over, they will have to account for their actions in abusing the very least among us. I do not think the maker's verdict will be a very pleasant one.

  4. #4
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    Default Re: The Abuse Just Keeps On Coming.....................

    I recognize that it's not easy being on dialysis. When you're on standard in-center dialysis diet and fluids are severely limited. It's worse for people who are diabetic and whose blood sugars are not in control because they are thirsty. Staff may not always pay attention to other things that can cause a patient to gain more fluid weight. Some prescribed medications cause thirst. Wringing patients dry to the point that their BP crashes and then having to bring their BP up with saline works against helping them stick with their fluid limits as they go home thirsty. Doing home dialysis--PD or more frequent HD--makes the diet and fluids somewhat less limited and it puts the patient in more control of his/her own treatment, which makes it less likely that patients experience conflict with staff.

    So far as what you say about people working in dialysis, although we all know there are some bad apples that I wish would leave to find other work that fits them better, there are many other good people in dialysis clinics of all disciplines, most of whom don't live "swanky lives," who go to work every day with the one goal to keep their patients as happy and healthy as possible. The more that dialysis patients and staff can work together on that goal of making patients lives better, the fewer patients will feel like you do.

    I have a friend who was a long-time dialysis patient and who has had a kidney transplant now for a long time. She lives with multiple health problems. She said several years ago she started keeping a journal of small things every day that she's grateful for. She calls it her "be-gratitudes." She said that noticing the simple things and writing them down has helped her turn her attitude around and she believes it's helped to lessen pain and other symptoms. I don't know if it would help you, but it might be worth a try.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  5. #5
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    Default Re: The Abuse Just Keeps On Coming.....................

    Quote Originally Posted by Beth Witten MSW ACSW View Post
    I recognize that it's not easy being on dialysis. When you're on standard in-center dialysis diet and fluids are severely limited. It's worse for people who are diabetic and whose blood sugars are not in control because they are thirsty. Staff may not always pay attention to other things that can cause a patient to gain more fluid weight. Some prescribed medications cause thirst. Wringing patients dry to the point that their BP crashes and then having to bring their BP up with saline works against helping them stick with their fluid limits as they go home thirsty. Doing home dialysis--PD or more frequent HD--makes the diet and fluids somewhat less limited and it puts the patient in more control of his/her own treatment, which makes it less likely that patients experience conflict with staff.

    So far as what you say about people working in dialysis, although we all know there are some bad apples that I wish would leave to find other work that fits them better, there are many other good people in dialysis clinics of all disciplines, most of whom don't live "swanky lives," who go to work every day with the one goal to keep their patients as happy and healthy as possible. The more that dialysis patients and staff can work together on that goal of making patients lives better, the fewer patients will feel like you do.

    I have a friend who was a long-time dialysis patient and who has had a kidney transplant now for a long time. She lives with multiple health problems. She said several years ago she started keeping a journal of small things every day that she's grateful for. She calls it her "be-gratitudes." She said that noticing the simple things and writing them down has helped her turn her attitude around and she believes it's helped to lessen pain and other symptoms. I don't know if it would help you, but it might be worth a try.
    ND:

    My point to you is that the kidney transplant policy is not working and has not worked only to benefit and enrich the professional kidney community, it does not work for the patient, who should be front and center of the benefits. The time has come for dialysis patients to stand up and say, "Enough is enough." I have a right to do with my body as I please, unless my body belongs to the government. The paternalism has to stop. I challenge you to live as a dialysis patient for at least a month. I hate to shake your world, but, if someone has enough money, they will travel to other nations, buy a transplant, and come home to the United States.

    "For almost three years, Ms Pascual’s health has been steadily deteriorating as she waits on dialysis. The 40-year-old and her fiance, Brent Jones, who are getting married in November, fear if they don’t take drastic steps she will become too sick for a transplant or die.
    They are planning to go to the Philippines, where it is legal to buy human organs – unlike in Australia. The couple are researching Filipino hospitals and doctors, who will find a paid donor who is a good match and perform the transplant."

    Why should this woman have to die so that "professionals" in the renal community can think highly of themselves? If the professional renal community looked at dialysis like Dr. Agar, many of the current problems would not exist.

  6. #6
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    Default Re: The Abuse Just Keeps On Coming.....................

    Anyone can take their chances on buying an organ from someone in another country. However, understand that those kidneys may not be screened as well so it may not last as long and may carry some diseases that could make him/her sick or die. Even in the US, some people have gotten hepatitis C, HIV, CMV, and other diseases from transplanted organs. Also, it's important to know when someone goes outside the US to get a kidney, Medicare Part B won't pay for immunosuppressants like it would if the person got the transplant in the US. Medicare Part D may cover the drugs, but because Congress was trying to protect insurance plans this will be a coverage gap which could make out-of-pocket costs for those costly drugs higher than if covered by Part B and a Medigap plan.

    Instead of blogging about how unfair things are, why don't you write a petition on Change.org and see if that spurs legislation that overturns Title III of the National Organ Transplant Act that states, “it shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.” The penalty of breaking this law is a fine of $50,000 or up to five years in prison, or both.

    Another option is to use social media to find a living donor willing to donate to you. Because there are paired donors and donor chains the person wouldn't even have to match your tissue type. One of the sites where people have registered to find a living kidney donor is this one.
    http://www.matchingdonors.com/life/index.cfm
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  7. #7
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    Default Re: The Abuse Just Keeps On Coming.....................

    Just thinking...have you been evaluated for a transplant and are you on the transplant list? If there are barriers to get on the list, are there any resources that you need to complete the evaluation and get listed?
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  8. #8
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    Default Re: The Abuse Just Keeps On Coming.....................

    Quote Originally Posted by Beth Witten MSW ACSW View Post
    Just thinking...have you been evaluated for a transplant and are you on the transplant list? If there are barriers to get on the list, are there any resources that you need to complete the evaluation and get listed?
    ND:

    If there was that serious of an issue, would have called Johns Hopkins, Mayo, or Cedars Sinai in LA.

  9. #9
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    Default Re: The Abuse Just Keeps On Coming.....................

    Quote Originally Posted by Beth Witten MSW ACSW View Post
    Just thinking...have you been evaluated for a transplant and are you on the transplant list? If there are barriers to get on the list, are there any resources that you need to complete the evaluation and get listed?
    ND:

    Medicare’s perverse incentive to keep patients on dialysis

    Natasha Deonarain, MD, MBA | Policy | December 2, 2014


    One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.

    I began to understand this paradox clearly when I listened to my friend’s anguish.



    She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town and serves a regional population for the last 25 years. It’s approximately 90 percent Medicare beneficiaries.

    Every month or so, I’d call her to see how she was doing. And each month, I’d listen to an earful. There was always an escalating amount of work to be done amidst health insurance and Medicare game playing: begging for medication approvals, fighting against denials for procedures, image tests or post-transplant drugs, dealing with arguing between pharmacists, insurance authorization reps and the practice’s doctors, implementing a new electronic health record that had more down time then up, and struggling to collect practice revenue. The clinic even hired a third-party business and billing company at great expense to help. Needless to say, tensions ran high.

    A few months ago, my friend confessed that she had a stack of sympathy cards on her desk to send out, a pile that kept getting higher every month.

    “My doctors really don’t want their patients to go for dialysis,” she told me proudly. “In fact, one of them said the more he could delay dialysis, the healthier his patients would stay.”

    Medical practice for these small town doctors has gotten difficult. They’re trying to stay abreast of rising business cost, families and houses. They work harder and harder every week, with new Medicare or insurance policies and regulations to face first thing Monday morning. Now, their struggling with their militant practice management company that seems to take away their professional autonomy on a daily basis.

    Things have become so tight that despite my friend’s above and beyond work ethic (she used to work for me) she’s been told recently that she’ll get fired if she spends 7 minutes or more overtime per week.

    Medicare is at bare bones payments these days, with other insurance companies paying below Medicare, a phenomena that traditionally didn’t happen. One of the only procedures however, that these doctors can still capitalize upon is dialysis.

    One night over dinner, I asked her a few questions.

    “What do your doctors want to do with their lives?” I asked.

    She snorted. “I can tell you right now what each one of them would rather be doing, and it isn’t working inside this clinic anymore!”

    “So why don’t they leave?”

    “Are you kidding me? They can’t stop now. They’re miserable but they can’t quit. They like the money too much.”

    “So they’re doing same things again and again, working harder and harder to make ends meet, playing more and more games and feeling miserable, frustrated and angry … and they feel they have no choice? What about their patients?”

    “Well, they still get paid OK on the dialysis. In fact, they own part of the local clinic in town,” she replied. “They weren’t too happy when a competitor came in right next door.”

    “So dialysis pays the best right now of all the things you guys do?

    “That’s right,” she said.

    “So what are they going to do if Medicare drastically cuts all reimbursements for ongoing pre- and post-renal transplant management, but is still willing to pay decently for dialysis?”

    “I don’t know,” she sighed.

    “Do they have any incentive to wish their patients healthy and not recommend dialysis, given their current practice situation?”

    She stared at me. “Well, no,” she said hesitantly.

    “Tell me this. When they still can’t meet their bottom line, what will they do to keep up their reimbursements?”

    She laughed. “They’ll send them for peritoneal or hemodialysis!”

    “So let me ask you this. Do these doctors really want to keep their patients healthy, or do they have to keep them sick?”

    Natasha N. Deonarain is CEO and founder, Conscious Health Solutions. She is the author of The 7 Principles of Health and can be reached on Twitter @HealthMovement.

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