Colorado Dialysis Technician Training hearing February 1st

Hi,

I’m a father with a daughter who now has a kidney transplant. She was on dialysis for less than a year and has had her transplant since 2000. I’ve read a great deal and heard from many about the conditions that exist in this field of medicine - let’s just say I’m very concerned.

A group of us have been hard at work trying to improve conditions and have put together a state bill for hemodialysis technician training standards for the state of Colorado. I would like to post the bill and ask for help with our hearing on February 1st.

I just wanted to say things are happening much quicker than I anticipated. We are due to give testimony February 1st at 1:30pm in front of the Health and Human Services Committee concerning the need for hemodialysis technician training standards. Other bills are on the agenda but 1:30pm is the earliest we could be starting.

We very much would like to have testimony from those receiving dialysis in Colorado, those Coloradoans with a kidney transplant who care to comment on the need for technician training standards, staff, and any former staff would also be welcome. The committee would very much like to hear from those directly involved in the treatments. If there isn’t enough testimony the committee might assume there aren’t any problems and allow things to continue the way they have been.

I asked about phone-in testimony and my state rep said no; the only testimony we can have is testimony that can be written then read by another and testimony given by those who show up. I should add anonymous testimony will be allowed.

Also if you want to talk to my state representative directly, he is very open to listening to people about this issue and is even willing to be contacted at home - the following is his contact information:

Colorado State Representative John Kefalas, District 52

email: john.kefalas.house@state.co.us

State Capitol phone: (303)866-4569
home phone: 970-221-1135

Mailing address:
Rep. John Kefalas, District 52
c/o Colorado State Capitol
200 East Colfax
Denver CO 80203

plugger

P.S. I have worked with John since his 2004 campaign and he is one of the most trustworthy individuals I’ve ever met - and not just for a politician.

Here is a link to the bill and the bill:

Colorado HB1131

REDRAFT
1.12.07
Double underlining
denotes changes from
prior draft
SHORT TITLE: “Hemodialysis Technicians Training Stds”
DEADLINES: Finalize by: 01.09.07 File by: 01.15.07
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters indicate new material to be added to existing statute.
Dashes through the words indicate deletions from existing statute.
First Regular Session
Sixty-sixth General Assembly
STATE OF COLORADO
DRAFT
LLS NO. 07-0435.01 Christy Chase HOUSE BILL
House Committees Senate Committees
A BILL FOR AN ACT
101 CONCERNING STANDARDS FOR HEMODIALYSIS TECHNICIANS AS PART
102 OF THE STATE REGULATION OF DIALYSIS TREATMENT CLINICS.
Bill Summary
(Note: This summary applies to this bill as introduced and does
not necessarily reflect any amendments that may be subsequently
adopted.)
Requires the state board of health (state board) to adopt rules
specifying the minimum training and competency standards for
hemodialysis technicians. Prohibits a person from performing the
functions of a hemodialysis technician if the person has not satisfied the
training and competency requirements. Prohibits a dialysis treatment
clinic from allowing a person to perform hemodialysis technician
functions if the person has not satisfied the training and competency
HOUSE SPONSORSHIP
Kefalas,
SENATE SPONSORSHIP
Bacon,
REDRAFT
1.12.07
Double underlining
denotes changes from
prior draft
-2- DRAFT
standards developed by the state board. Conditions licensure of a dialysis
treatment clinic by the department of public health and environment
(department) on compliance with this requirement. Further requires a
dialysis treatment clinic to post a notice in its facility specifying that it is
regulated by the department and the method by which consumers may
provide feedback to the clinic or the department.
1 Be it enacted by the General Assembly of the State of Colorado:
2 SECTION 1. Part 1 of article 1.5 of title 25, Colorado Revised
3 Statutes, is amended BY THE ADDITION OF A NEW SECTION to
4 read:
5 25-1.5-107. Regulation of dialysis treatment clinics - training
6 for hemodialysis technicians - state board of health rules - definitions
7 - repeal. (1) AS USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE
8 REQUIRES:
9 (a) “DIALYSIS TREATMENT CLINIC” MEANS A HEALTH FACILITY OR
10 A DEPARTMENT OR UNIT OF A LICENSED HOSPITAL THAT IS PLANNED,
11 ORGANIZED, OPERATED, AND MAINTAINED TO PROVIDE OUTPATIENT
12 HEMODIALYSIS TREATMENT TO, OR HEMODIALYSIS TRAINING FOR HOME
13 USE OF HEMODIALYSIS EQUIPMENT BY, END-STAGE RENAL DISEASE
14 PATIENTS.
15 (b) “END-STAGE RENAL DISEASE” MEANS THE STAGE OF RENAL
16 IMPAIRMENT THAT APPEARS IRREVERSIBLE AND PERMANENT AND THAT
17 REQUIRES A REGULAR COURSE OF DIALYSIS OR A KIDNEY TRANSPLANT TO
18 MAINTAIN LIFE.
19 © “HEMODIALYSIS TECHNICIAN” MEANS A PERSON WHO IS NOT A
20 PHYSICIAN OR A REGISTERED NURSE AND WHO PROVIDES DIALYSIS CARE.
21 (2) THE STATE BOARD OF HEALTH SHALL ADOPT RULES TO
22 ESTABLISH THE FOLLOWING:
REDRAFT
1.12.07
Double underlining
denotes changes from
prior draft
-3- DRAFT
1 (a) MINIMUM STANDARDS FOR THE CURRICULA AND INSTRUCTORS
2 USED TO TRAIN INDIVIDUALS TO PERFORM THE DUTIES AND FUNCTIONS OF
3 A HEMODIALYSIS TECHNICIAN;
4 (b) MINIMUM STANDARDS FOR THE DETERMINATION OF THE
5 COMPETENCY OF INDIVIDUALS WHO HAVE TRAINED AS HEMODIALYSIS
6 TECHNICIANS;
7 © MINIMUM REQUIREMENTS FOR CERTIFICATION THAT AN
8 INDIVIDUAL HAS BEEN TRAINED AND DETERMINED TO BE COMPETENT TO
9 PERFORM THE TASKS OF A HEMODIALYSIS TECHNICIAN;
10 (d) REQUIREMENTS FOR THE ACCEPTANCE OF THE
11 DOCUMENTATION SPECIFIED PURSUANT TO PARAGRAPH © OF THIS
12 SUBSECTION (2) BY ANOTHER DIALYSIS TREATMENT CLINIC THAT MAY
13 LATER EMPLOY THE INDIVIDUAL; AND
14 (e) THE ACTS AND PRACTICES THAT ARE ALLOWED OR PROHIBITED
15 FOR HEMODIALYSIS TECHNICIANS.
16 (3) (a) A PERSON SHALL NOT ACT AS, OR PERFORM THE DUTIES AND
17 FUNCTIONS OF, A HEMODIALYSIS TECHNICIAN UNLESS THE PERSON IS:
18 (I) TRAINED AND DETERMINED COMPETENT IN ACCORDANCE WITH
19 STATE BOARD RULES ADOPTED PURSUANT TO SUBSECTION (2) OF THIS
20 SECTION; AND
21 (II) UNDER THE SUPERVISION OF A PHYSICIAN OR REGISTERED
22 NURSE.
23 (b) A DIALYSIS TREATMENT CLINIC LICENSED BY THE DEPARTMENT
24 SHALL NOT ALLOW A PERSON TO PERFORM THE DUTIES AND
25 FUNCTIONS OF A HEMODIALYSIS TECHNICIAN AT OR FOR THE DIALYSIS
26 TREATMENT CLINIC IF THE PERSON IS NOT TRAINED AND DETERMINED
27 COMPETENT PURSUANT TO STATE BOARD RULES.
REDRAFT
1.12.07
Double underlining
denotes changes from
prior draft
-4- DRAFT
1 (4) IN CONNECTION WITH ITS REGULATION OF DIALYSIS
2 TREATMENT CLINICS PURSUANT TO SECTION 25-1.5-103 (1) (a) (I) AND
3 25-3-101 (1), THE DEPARTMENT SHALL VERIFY THAT A DIALYSIS
4 TREATMENT CLINIC ONLY EMPLOYS HEMODIALYSIS TECHNICIANS WHO
5 HAVE BEEN TRAINED AND DETERMINED COMPETENT IN ACCORDANCE WITH
6 STATE BOARD RULES. COMPLIANCE BY A DIALYSIS TREATMENT CLINIC
7 WITH THIS SECTION SHALL BE A CONDITION OF LICENSURE BY THE
8 DEPARTMENT.
9 (5) EACH DIALYSIS TREATMENT CLINIC LICENSED BY THE
10 DEPARTMENT AND OPERATING IN THIS STATE SHALL POST A CLEAR AND
11 UNAMBIGUOUS NOTICE IN A PUBLIC LOCATION IN THE CLINIC SPECIFYING
12 THAT THE CLINIC IS LICENSED, REGULATED, AND SUBJECT TO INSPECTION
13 BY THE COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT.
14 THE NOTICE SHALL ALSO INFORM CONSUMERS ABOUT THE ABILITY TO
15 PROVIDE FEEDBACK TO THE CLINIC AND TO THE DEPARTMENT AND SHALL
16 DETAIL THE METHOD BY WHICH CONSUMERS CAN PROVIDE FEEDBACK.
17 THE STATE BOARD MAY ADOPT RULES, AS NECESSARY, TO SPECIFY THE
18 CONTENTS OF THE NOTICE REQUIRED BY THIS SUBSECTION (5).
19 (6) THIS SECTION IS REPEALED, EFFECTIVE JULY 1, 2017. PRIOR TO
20 SAID REPEAL, THE FUNCTIONS OF THE STATE BOARD OF HEALTH AND THE
21 DEPARTMENT REGARDING HEMODIALYSIS TECHNICIANS SHALL BE
22 REVIEWED AS PROVIDED IN SECTION 24-34-104, C.R.S.
23 SECTION 2. 24-34-104 , Colorado Revised Statutes, is
24 amended BY THE ADDITION OF A NEW SUBSECTION to read:
25 24-34-104. General assembly review of regulatory agencies
26 and functions for termination, continuation, or reestablishment.
27 (48) THE FOLLOWING AGENCIES, FUNCTIONS, OR BOTH, SHALL TERMINATE
REDRAFT
1.12.07
Double underlining
denotes changes from
prior draft
-5- DRAFT
1 ON JULY 1, 2017: THE FUNCTIONS OF THE STATE BOARD OF HEALTH
2 AND THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT REGARDING
3 HEMODIALYSIS TECHNICIANS PURSUANT TO SECTION 25-1.5-107, C.R.S.
4 SECTION 3. Effective date. This act shall take effect July 1,
5 2007.
6 SECTION 4. Safety clause. The general assembly hereby finds,
7 determines, and declares that this act is necessary for the immediate
8 preservation of the public peace, health, and safety

I’ll add the hearing length will be about a half hour. Rep. John Kefalas will speak for about 5 minutes, individual testimony will be 3 minutes. Even if you aren’t a Colorado resident, you might consider dropping a line to John on why technician training standards are important - the more the merrier!

Way to go Plugger! I’m having trouble with vision in my right eye - reading gives me a headache so please know I want to interact more than I can right now but I do want to say how much I appreciate your long efforts. Please continue to post developments.

Bill, good to hear from another old-timer again! I’m sorry to hear about your problems - hope you will get over it soon! It is always a pleasure to see one of your posts and have to thank you for some of the education you have given me over the years - I’ll try and put it to good use.

Let me just say, we have here a unique opportunity to positively affect thousands of lives. We already know one big thing the opposition is going to come back with is there are very few complaints, therefore everything must be fine! We can pull out stats, quote some rather distinguished people in the field, but it is going to be more difficult without enough people writing in or testifying - nothing tells the story like hearing from people who are directly affected.

A chance to do something like this without fear of reprisal doesn’t come around very often, I hope people will take advantage. Again you can contact:

Colorado State Representative John Kefalas, District 52

email: john.kefalas.house@state.co.us

State Capitol phone: (303)866-4569
home phone: 970-221-1135

Mailing address:
Rep. John Kefalas, District 52
c/o Colorado State Capitol
200 East Colfax
Denver CO 80203

hearing - time and place:

Hearing Room A
Legislative Services Bldg.
200 East 14th Street
Denver Colorado, 80203

Thursday, February 1st
Sign in: 2:30 to 3pm

If anyone cares to contact some reps on the committee we are going in front of and tell them to vote for this bill, here is the contact info (you don’t have to be a Colorado resident)

Health and Human Services Committee Members and Contact information

McGihon, Anne L., 303-866-2921 - anne.mcgihon.house@state.co.us
Chairman

Frangas, K.Jerry, 303-866-2954 - kjerry.frangas.house@state.co.us
Vice-chair

Gagliardi, Sara 303-866-2962 - sara.gagliardi.house@state.co.us

Green, Gwyn 303-866-2951 - gwyn.green.house@state.co.us

Kefalas, John, 303-866-4569 - john.kefalas.house@state.co.us
bill sponsor

Kerr, James 303-866-2939 - james.kerr.house@state.co.us

Primavera, Dianne 303-866-4667 - dianne.primavera.house@state.co.us

Riesberg, Jim 303-866-2929 - jim.riesberg.house@state.co.us

Roberts, Ellen 303-866-2914 - ellen.roberts.house@state.co.us

Stafford, Debbie 303-866-2944 - debbie.stafford.house@state.co.us

Swalm, Spencer 303-866-5510

Hey Plugger

I follow some your posts on another board. Glad your posting here.

Can I copy your bill and send on to house here in PA

bobeleanor

I think that would be a great idea!

Plugger I am glad you have found a lot of forums to post this and I am glad it is getting a lot of acceptance! I hope you get a lot of support!

[QUOTE=bobeleanor;12339]Hey Plugger

I follow some your posts on another board. Glad your posting here.

Can I copy your bill and send on to house here in PA

bobeleanor[/QUOTE]

I would be very happy if you did! Be aware this bill maybe amended along the way though.

Regards

[QUOTE=AngiesKidney;12343]I think that would be a great idea!

Plugger I am glad you have found a lot of forums to post this and I am glad it is getting a lot of acceptance! I hope you get a lot of support![/QUOTE]

Me too! Thanks!

It looks like there is internet access for those who want to follow the proceedings:

http://www.leg.state.co.us/clics/clics2007a/cslFrontPages.nsf/Audio?OpenForm
(click on “Hearing Room A”)

As for the details: HB1131 Hemodialysis Technician Training Standards hearing will start Thursday, February 1st some time after 3:00pm. A total of 5 bills will be heard that day with HB1131 being the fifth bill of the day. Total time of the hearing will be approximately one half hour – time may vary. Those giving testimony will have 3 minutes to present. Those wishing to give testimony are asked to sign in between 2:30pm to 3:00pm.

Hearing Room A
Legislative Services Bldg.
200 East 14th Street
Denver Colorado, 80203

This seems like a good time to list the organizations we have involved or are showing an interest:

ADA (Association of Dialysis Advocates)
ANNA (American Nephrology Nurses Association)
CNA (Colorado Nurses Association)
CNNT (Council of Nephrology Nurses and Technicians)
DialysisEthics/Health Care Patient Rights
Front Range Kidney Patients’ Association
HCAC (Health Care for All Colorado)
NANT (National Association of Nephrology Technicians)
NRAA (National Renal Administrators Association)

We also have some local groups others are working on.

Hey Plugger

I sent out emails to the folks you had on the list. I got back some replys.

Having been on this site for the last yr. the one thing that is very clear. There needs to be a set of rules not just for techs. But for centers. Sometime ago I posted that when one walks into a center no matter where in the US. All center should have to abide by a set of rules not just for in center pts. ,but for home use pts. This would go a long way to try and end some of the questions on this site. Looking over some the post it seems like it each center has their own rules.

I know that some on this site will get the hair up on this, but set rules work in many areas of life.
bobeleanor (jpfm)

I totally agree that improving the consistency from one dialysis clinic to the next would be better as long as that consistency is for optimal and not mediocre care. I’d love to see highly qualified staff working in dialysis clinics with enough co-workers that they are not harried and stressed. I think this would reduce the number of patient-provider conflicts. In fact, I know a social worker who works in a dialysis clinic with all RN and LPN staff. She reports that conflicts rarely occur and staff turnover is very low with many staff members having worked at her facility for more than 10 years. This has to make patients feel safer.

So far as rules are concerned. There are federal (and in some states, state) regulations that dialysis facilities must abide by. When state surveyors survey a dialysis clinic, they check for issues related to patient health and safety, patient rights and more. The regulations govern in-center and home dialysis programs. These regulations are called the Conditions for Coverage of Suppliers of End Stage Renal Disease Services. You can find these at:
http://www.access.gpo.gov/nara/cfr/waisidx_05/42cfr405_05.html (see 405.2100-405.2184)

These regulations don’t cover every possible situation though. Therefore, dialysis clinics (or in some cases dialysis corporations) must have written policies and procedures. When a state surveyor comes into a clinic, he/she/they check to see if the clinic is abiding by federal, state, and local laws and regulations and by the policies and procedures written in the clinic’s policies and procedures manual. If not, the clinic would be found to be out of compliance. A dialysis clinic must develop a plan to correct the deficiency. The survey will return to see if the deficiency(ies) has been corrected. There can be severe sanctions if a clinic is not in compliance, including terminating a clinic from Medicare which means it can’t get Medicare reimbursement and/or closing clinic.

The policies that differ from clinic to clinic and upset patients seem to be things like visitor policies and whether a patient can eat or drink on the dialysis machine which apply to in-center patients only and what home equipment the dialysis clinic supports which applies to home patients.

Personally, I am concerned about policies related to involuntary discharge. I believe patients are discharged too often for things that are not specifically allowed under the ESRD regulations – the most common of which is “non-compliance,” often defined as frequent skipping or shortening of dialysis treatments.

What other policies do you think need to be standardized?

bobeleanor,

Thanks! One thing that is happening is it looks like we are tying this training in with the facilities’ license - we have high hopes it will give our health department more teeth.

The one major goal we may not accomplish at this point is getting the techs out from under the RN’s license. I pushed on my rep to put stronger language in for it and he pushed back and said he wanted to hear more from dialysis nurses - could be tough.

I’m licensed as a social worker and I’d certainly think twice before I let anyone practice under my license. I think it would be terrific to remove technicians from under an RNs license. I imagine that RNs would support that if they thought about how having a technician practice under their license places them at risk of losing their livelihood. How many RNs do you know who would be willing to sacrifice their career for anyone? I can’t imagine a dialysis clinic expecting that of their RNs?

I don’t know how they let this happen in the first place or why? Oh, I did see your previous post …and WOW! A clinic with nothing but RNs and LPNs, sounds like a dream, sounds like the-way-it-used-to-be. Not that all techs do a bad job, I’ve heard of some I would trust before some nurses. I don’t see it going back to those days though anytime soon.

After talking to my rep though, it sounds like we will probably have testing of a tech’s practical skills, mainly cannulation

That sounds like a terrific starting point since dialysis access problems are costly and a very common reason for hospitalization.

[QUOTE=plugger_;12388]I don’t know how they let this happen in the first place or why? Oh, I did see your previous post …and WOW! A clinic with nothing but RNs and LPNs, sounds like a dream, sounds like the-way-it-used-to-be. Not that all techs do a bad job, I’ve heard of some I would trust before some nurses. I don’t see it going back to those days though anytime soon.

After talking to my rep though, it sounds like we will probably have testing of a tech’s practical skills, mainly cannulation[/QUOTE]

I am in a unit where there are more RNs and LPNs then techs. The care has been better than any of my previous units that did not have this ratio, because the nurses have more nursing education than the techs and understand what they’re doing in many respects and they also have a more professional attitude. As an educated patient, I can tell them how I’d like my tx to be and they are eager to assist me to get a good tx. Nevertheless, the nurses are still lacking in basic dialysis education as they are trained by the company and they don’t get complete training. So, they have blinders on so to speak. But the ones who are the most honest realize that their training is incomplete. I was on dialysis for a long time and never had one nurse admit this to me. But in my current unit I have had several own up to it.

Honest nurses are wonderful people. They are really dedicated to patient care and work so hard. They are better than medicine. But I see this thing all the time where they are unaware that they are lacking a complete dialysis education until they have a patient like me who is able to open their eyes. I’ve influenced quite a few that there is more to dialysis then how they were trained. But only a very few open their eyes and see it. And, yes, I’ve had some techs who were every bit as good as a nurse-they are really special people. Oh, and I’ve had some nurses who knew less and peformed their jobs worse than the worst tech.

In discussing cannulation above, when you say tech do you mean techs and nurses or just techs? Because I have also had techs who were better at cannulation than nurses. Some nurses have frightening cannulation skills! Their hands shake, they may have poor vision and it is so scary when they are coming toward you - they will hurt you!

My unit still has most of the core staff, but lately they have lost some and have put some techs in their place. It really surprised me to see them hire some individuals off the street who were so poorly educated. They hired this one lady who was really bad off. I would not allow her to cannulate me as she was so new and barely knew what she was doing. She took it personally although I tried to kindly explain to her that she was a nice person, but I don’t like anyone, nurse or tech, who is not experienced to cannulate me as we are talking about my lifeline. After her short, 2 wk training she thought she was Super Nurse! This is how these individuals think as they go from fast food or some such position to medical work. They have the medical uniform down pat, but have little idea what they are doing. I see them work on elderly and other patients who have no concept that these people are so inexperienced. As you can well imagine, this spells problems.

Maybe you can use this post with you rep. I applaud what you are doing and knew someone would come along with the guts and know- how to wage a campaign and get legislation. A good dad is going to protect his ESRD child . I knew one other father who tirelessly protected his child. Kept her safe on home txs for years and, ironically, he died prematurely from all the stress since he always had to battle the unit and the govt. He was in top physical shape, so it was a great shock and loss when he died, but that’s what stress can do. His daughter was strong like him and I have no doubt she will be fine.

I do as much as I can to fight for change in my own way. The Industry has had an advantage for years as they know patients are a captive audience and family members are so stressed taking care of their loved ones that there are few to fight the battle for patients’ rights. But what they didn’t figure on is the Baby Boomers. Baby Boomers are not the type to take unit abuses lying down. I believe this generation will wage a good fight. Congratulations on your efforts and courage, Plugger, and I hope all who see this thread will get off your duffs, for once, and email the reps. I really hope that this will be a significant turning point for improvements in ESRD care. GOD BLESS!

Plugger,
On your list of organizations is DialysisEthics the orignal organization-are they still active? KNow their board has not been active for a long time. Who is Front Range? And it looks like you have nurse, tech and renal administrators working with you?? They are for this bill?