If you have a problem with Davita or any other diaylsis facility why not use the posted procedure.
1 talk to the person(s) involved with the problem
2 Then the Facility Administrator
4 Then the Regional Kidney Council
From experience this works
Charles
Hi Charles,
By “regional kidney council,” do you mean the End-stage Renal Disease Networks? Your list is absolutely right. The “Rights & Responsibilities” module of Kidney School (http://www.kidneyschool.org gives a lot of detail about how to advocate for yourself if you have a dispute with a center.
Hi Folks
Wow why didn’t I think of that ???
[QUOTE=cehill;16745]If you have a problem with Davita or any other diaylsis facility why not use the posted procedure.
1 talk to the person(s) involved with the problem
2 Then the Facility Administrator
4 Then the Regional Kidney Council
From experience this works
Charles[/QUOTE]
Thanks
bob obrien
[QUOTE=Dori Schatell;16746]Hi Charles,
By “regional kidney council,” do you mean the End-stage Renal Disease Networks? Your list is absolutely right. The “Rights & Responsibilities” module of Kidney School (http://www.kidneyschool.org gives a lot of detail about how to advocate for yourself if you have a dispute with a center.[/QUOTE]
Dori,
Can you sum up what is advised in Kidney School? Because the list Cehill provided and which is stated over and over again on the net is not realistic. Oh sure, it should be the way to proceed, but when one is dealing with corrupt individuals, it will cause a patient to be marked and might get one kicked out of a clinic with no place to dialyze… and we all know what that means. It really upsets me every time I see this advice given. And most dialysis patients instinctively don’t trust it, because they know all so well the position it could put them in. I don’t know why it is so hard for those, usually not on dialysis, to understand that following such advice could put lives in danger. Nope, there are dishonest ppl in many of the clinic management/ownerships and even in some of the networks. What patients need is fair mediation and representation that protects their rights when they must report the clinic. The list mentioned is nothing but a trap. Who in their right mind would go up this ladder without any assurances that they would not be ostracized or have their life-support level treatments yanked away from them? Only the naive or foolish would attempt to go up this broken ladder. As I have been saying for years, this problem, and it is the most major problem for the dialysis population, needs a real solution like state advocacy organizations that assure that patients filing grievances will not be taken advantage of.
Hi Jane,
The summary is kind of the bullet points that Charles gave–it’s the detail that’s important, about how to talk to people and how to keep a conflict from escalating, You’re really best off reading it. 
Hi Folks
Sorry to cehill, I know you meant well. I should not have posted what I did, but the times are a changeing.
Dori, It still won’t matter if you , me , Jane , read and reread the rights. It boils down to the center and if they are a good center or a bad center. My first two I worked very hard to "“PLAY THE GAME” as I was told to do by the dr, nurse , soc. worker and network people. But in order to play a fair game ,it takes both sides playing with the same respect for each other. How much money will it cost to get people who have the upper hand to show and give respect to the people who are ill?
Once more to cehill, I’m sorry to have posted the way I did.
[QUOTE=Dori Schatell;16749]Hi Jane,
The summary is kind of the bullet points that Charles gave–it’s the detail that’s important, about how to talk to people and how to keep a conflict from escalating, You’re really best off reading it. :-)[/QUOTE]
thanks
Bob O’Brien
[QUOTE=Dori Schatell;16749]Hi Jane,
The summary is kind of the bullet points that Charles gave–it’s the detail that’s important, about how to talk to people and how to keep a conflict from escalating, You’re really best off reading it. :-)[/QUOTE
Hi Dori,
I read the module and my opinion is still the same. Just as Bob stated, one can speak and act respectfully and go through all the hoops yet be given the royal runaround when clinic personnel are not honest. It has nothing to do with speaking to clinic personnel in a way that keeps conflict from escalating. Because it is not the patients, but the clinic personnel that act and respond unprofessionally.
So, then the module provides more stringent steps to take. But the problem is, a patient’s life may be in danger, because the clinic may “dump” him before he has even had the opportunity to take steps to protect his rights. If a patient is “dumped” there is no guarantee that he can find another clinic in short order to give him txs, thus keep him alive. This is why none of the measures listed will work in many instances. Patients know this and avoid even getting in this position.
The only way they can afford to take such steps is if their right to uninterrupted, safe care is protected. At present, even though this right is on the books, it is not enforced. And this in a nutshell is the problem -no patient wants to fall through this unprotected crack. It is not good enough to have rights on the books if rights are not enforced. Also, patients fear any possible whiplash of abuse they will get from clinic personnel if they file a complaint. This could include anything from ostracism such as staff refusal to take care of patients’ needs in a timely way, or speaking and acting unprofessionally to patients all the way to fear of staff giving the wrong medications or even putting something harmful in a patient’s lines.
Dialysis patients will never be free to stand up for their rights until they can be assured that their tx can not be yanked away from them while they are in the midst of advocating for themselves. This must be a given, not a ??? in the mind of every dialysis patient. Regulations are nothing without enforcement. If just this one point was fully enforced, patients would come out of the woodworks to self-advocate for the first time. As a patient, myself, this is the issue I most care about and work towards seeing become a reality for the dialysis population, as what could be more essential than this first most foundational right?
Here is an 8-page document put together by the ESRD Networks about when it is and is not permitted to involuntarily discharge a patient from a dialysis facility: http://www.esrdnetwork8.org/assets/pdf/DPCPositionStatement06.pdf.
I don’t believe that these situations are so common that patients are afraid to say anything for fear that they risk losing their dialysis clinic. Years ago, I heard of this happening in small, rural towns, but not so much in big cities where there are many clinics and they are not all owned by the same companies. I’m aware of more than one case where patients were involuntarily discharged for various reasons and died–mainly because those cases were extensively discussed at an ESRD Network meeting, to try to figure out how to make sure it never happened again. Even that was probably 4 years ago now.
Certainly patients may fear that this could happen, but that doesn’t mean it actually does any more.
[QUOTE=Jane;16753][QUOTE=Dori Schatell;16749]Hi Jane,
The summary is kind of the bullet points that Charles gave–it’s the detail that’s important, about how to talk to people and how to keep a conflict from escalating, You’re really best off reading it. :-)[/QUOTE
Hi Dori,
I read the module and my opinion is still the same. Just as Bob stated, one can speak and act respectfully and go through all the hoops yet be given the royal runaround when clinic personnel are not honest. It has nothing to do with speaking to clinic personnel in a way that keeps conflict from escalating. Because it is not the patients, but the clinic personnel that act and respond unprofessionally.
So, then the module provides more stringent steps to take. But the problem is, a patient’s life may be in danger, because the clinic may “dump” him before he has even had the opportunity to take steps to protect his rights. If a patient is “dumped” there is no guarantee that he can find another clinic in short order to give him txs, thus keep him alive. This is why none of the measures listed will work in many instances. Patients know this and avoid even getting in this position.
The only way they can afford to take such steps is if their right to uninterrupted, safe care is protected. At present, even though this right is on the books, it is not enforced. And this in a nutshell is the problem -no patient wants to fall through this unprotected crack. It is not good enough to have rights on the books if rights are not enforced. Also, patients fear any possible whiplash of abuse they will get from clinic personnel if they file a complaint. This could include anything from ostracism such as staff refusal to take care of patients’ needs in a timely way, or speaking and acting unprofessionally to patients all the way to fear of staff giving the wrong medications or even putting something harmful in a patient’s lines.
Dialysis patients will never be free to stand up for their rights until they can be assured that their tx can not be yanked away from them while they are in the midst of advocating for themselves. This must be a given, not a ??? in the mind of every dialysis patient. Regulations are nothing without enforcement. If just this one point was fully enforced, patients would come out of the woodworks to self-advocate for the first time. As a patient, myself, this is the issue I most care about and work towards seeing become a reality for the dialysis population, as what could be more essential than this first most foundational right?[/QUOTE]
I eliminated the foolishness by going home, they can stuff it! More of the “Do as I say, Not as I do.”
Hi NDXUFan – Jane did, too–she just wants to help the folks who still are in-center. I agree with you that the more folks we can get home, the more folks who can advocate for themselves more freely.
Jane, the Kidney School module did suggest things like going to the press or hiring an attorney if things escalate beyond where the “usual” channels can help. Never underestimate the power of a newspaper story…
Hi Folks
Beth or Dori
Is there a message board that you could say is set up for people with disabilitys that is on par with this one ?
Thanks
Bob OBrien
Hi Bob,
Not that I know of, but if you look on Google, you might find something.
Hi Folks
Thanks Dori. I did do a search and came up with message boards, that to me are not on par with this board. I was looking for a board that dealt with issues people with disability deal with in day to day life. . But the most if not all had to deal with getting SSDI etc. Not that it isn’t important, but I was looking for bus serivce, shopping, everyday life issues. That people take for granted. And how there coped or found answers.
VOTE VOTE VOTE Please people Vote. I have for yrs tried to get people I meet who don’t vote, to get out and VOTE
Thanks
Bob O’Brien
I agree, Bob. I can’t even imagine anyone not using their right to vote, when it makes so much difference to our day-to-day lives.
Hi all,
I had something to reply to this thread, but have been busy of late and haven’t had a chance. So, will save for the future. But jumping ahead to something I got wind of today, a nurse at my clinic told me that they now have to do an 11 page annual report in which they document that they advised patients where they can get home hemo. He said there is a big push towards home txs. If that is the case, we can thank all the advocates who worked for this. Does anyone know anything more about this report and what it includes?
Hi Jane,
I don’t know about the 11 pages, but we were able to successfully advocate (with the help of lots of others in what we call the “renal community”) for a change in Medicare’s Conditions for Coverage for Dialysis Facilities–the rules clinics have to follow if they want Medicare funding. Now the Conditions require centers to educate patients about ALL of their options–including PD and home HD. When the CMS Surveyors come by (not as often as most of us would like), centers will have to prove that they have made folks aware of all of their choices.
The American Nephrology Nurses’ Association and National Kidney Foundation (nurses, technicians, social workers, dietitians) developed an assessment tool that is an optional tool for clinic staff to use to do initial assessments and follow-up reassessments required by Medicare under the new Conditions for Coverage that became effective 10/14/08. The Comprehensive Multidisciplinary Patient Assessment is 35 pages long and can be found here:
http://www.kidney.org/professionals/pdf/ComprehensiveMultidisciplinaryPatientAssessmentFrm.pdf
The new Conditions for Coverage require that dialysis facilities educate patients about all treatment options including dialysis at home and transplant. If the facility doesn’t offer a specific type of treatment, it has to inform patients where that treatment is offered.
Back the original topic of this message which related to grievances, the new regulation states:
I Be informed of his or her right to file internal grievances or external grievances or both without reprisal or denial of services; and
(17) Be informed that he or she may file internal or external grievances, personally, anonymously or through a representative of the patient’s choosing.[/I]
The interpretive guidance that is written to explain the regulation to surveyors states:
[I]Every patient must be free to file a complaint or grievance within the facility or externally with the ESRD Network or State survey agency. Facility staff should inform patients that they can file a grievance anonymously or through a representative without being afraid that they will be treated differently or denied services.
“Reprisal” would include retaliation or revenge and could include perceived punishment, isolation, the intentional infliction of physical pain or emotional distress or involuntary discharge from the facility.[/I]
Further the regulation goes on to say:
I Standard: Internal grievance process. The facility’s internal grievance process must be implemented so that the patient may file an oral or written grievance with the facility without reprisal or denial of services.
The grievance process must include—
(1) A clearly explained procedure for the submission of grievances.
(2) Timeframes for reviewing the grievance.
(3) A description of how the patient or the patient’s designated representative will be informed of steps taken to resolve the grievance.[/I]
And the interpretive guidance for this part of the regulation states:
[I]The facility’s policies and procedures must describe all available grievance procedures to the patient. The facility must inform the patient and/or the patient’s designated representative (also called “designee”) of its internal grievance process. Refer to the requirement at V465 under the Condition for Patients’ rights.
Each facility must implement a process to ensure that there will be no reprisal or denial of services for any patient who files an internal grievance and the grievance procedure will be clearly explained to patients. The existence of grievances should not be viewed negatively, as this would be an indication that patients understand the internal grievance process and believe that filing a grievance will not result in reprisal or denial of services. Lack of grievances does not indicate a lack of an internal grievance process [emphasis added].
The facility’s grievance process should assure those grievances involving situations or practices that place patients or staff members in immediate danger (e.g. the patient’s grievance brings attention to hazardous environmental conditions) are resolved immediately.
The facility’s process must include clearly defined timeframes for a grievance to be acknowledged, investigated, and addressed. Timeframes should be sufficient to conduct an investigation yet ensure that the grievance is addressed in a timely manner.
The patient/designee should be informed of the status of the investigation periodically, and when resolution is attained or considered attained by the facility. Each grievance should demonstrate a completed cycle of reviewing the grievance and reporting back to the patient.[/I]