Dialysis Danger: Why Location Matters for Some Kidney Patients

Theresa Gaytan, 65, walked into a Fresenius Medical Care center in Berwyn in March 2009 for a routine dialysis appointment.

Gaytan never returned home from her visit.  The Gaytan family’s attorney said a technician at the clinic who was involved in her care had performed a reversal of lines. He was not authorized to do the complicated procedure and it went badly, said Mark Parts.

"There were many, many mistakes," said Parts, the Gaytan family attorney. "The tube had become disconnected. There was a large pool of blood under the chair, so it came down onto her clothes.  She had a massive hemorrhage from the dialysis circuit."

Gaytan lasted a while after the episode, hooked up to another machine.

"On March ninth, we ended up taking her off life support," said Theresa's daughter, Angela Gaytan.

Patients whose kidneys fail face countless hours hooked up to dialysis machines. The technology takes the blood from their body, cleans it of waste, and then cycles it back. 

It’s complex, and carries some risk.
 
Unit 5 and our partners at ProPublica.com have uncovered new data showing that the decision on where you get your treatment plays an important role. ProPublica arranged the data to make it possible for you to search and find information like a clinic’s mortality and infection rates.

Fresenius -- the corporation that owns the clinic Teresa went to and dozens of other clinics in the Chicago area -- has some centers where death and infection rates are extremely low and others where those rates are much higher.

Fresenius would not comment on the Gaytan case, citing privacy concerns.

The data alone aren't enough. A doctor is a patient’s first line of defense in sorting out how to decide where to go, and in understanding the data.

David Goldman, a dialysis patient who needs a new kidney, spends three days a week hooked up to a machine for four hours at a time. His sessions take place at a Highland Park Hospital clinic he swears by.

"I’ve been to others when I’ve travelled, and this is far and away the best," said Goldman.

Nephrologist Nancy Nora, who works at the Highland Park clinic, says being in a hospital setting makes a big difference. The location means she can get quick turnaround on lab results -- within one day -- if something is wrong; she has proximity to other medical specialists and access to detailed electronic medical records.

"This is a unique environment, …  being a hospital-based unit," Nora said.

The division between clinic-based centers and stand-alone centers is not black and white.  A Fresenius Dialysis Center in Garfield produces different results from the one in Berwyn, just a few miles away.

"In our practice we have our offices in the dialysis unit," said Dr. Brian Duffy, the medical director of Fresenius Dialysis Center in Garfield.  The proximity allows him to see his patients often, sometimes up to 12 times a month.

"These are the things that we are going to look at, and every month we’re going to get the labs, and we’re going to go over that; the dietician’s going to come and answer your questions," he said.

Duffy also said family members play a role and should have similar conversations with their loved ones about their treatment.

Angela Gaytan couldn’t agree more. Looking back, Gaytan said she would now tell dialysis patients and their families to study up.

"Just do your homework," she said. "Don’t rush."

ProPublica: Dialysis Facility Tracker
 
Map: Chicagoland Dialysis Centers:

View Cook, Lake, DuPage, Will, Kane and McHenry County Dialysis Centers in a larger map

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