Mobile dialysis centers urged for next catastrophe
Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services, arrived in Houston on Monday not only to gather tales of Hurricane Harvey but also, and perhaps more importantly, to contemplate any hard lessons learned before the next disaster strikes.
“I wanted to come and say thank you,” she told a packed meeting room of employees and officials at a dialysis center near Brays Bayou. She then added she was sent by the Trump Administration to ask, “How can we do better?”
U.S. Health and Human Services Secretary Dr. Tom Price made a similar mission trip to Florida on Monday as that state also continues to right itself after Hurricane Irma.
In addition to the Dialyspa center, Verma was scheduled to visit a nursing home later in the day as part of the larger national discussion on how best to ensure medical access to care during and after a major storm.
The topic has taken on heightened national urgency and scrutiny after eight elderly patients died in oven-like conditions at a Hollywood, Fla., nursing home whose air conditioning had failed following Irma’s landfall.
In the flooded Houston region, the scramble was to get care to an estimated 7,000, people who needed every-other-day dialysis treatment.
“If they don’t get treatment, they can die and they do,” Dialyspa CEO Dr. Jeff Kalina told Verma.
One recommendation offered Monday would be to have mobile dialysis centers at evacuation centers. During Harvey, there were no such mobile units at the George R. Brown Convention Center after it began sheltering people fleeing the storm.
Also at the Monday morning meeting was U.S. Rep. Michael Burgess, R-Denton, and Dr. David Teuscher, a Health and Human Services Department regional director.
Kalina, an emergency room doctor during Hurricane Ike in 2008, said he watched several patients perish because treatment was delayed. It is not something he can easily forget.
This time across the city many dialysis centers were closed by Harvey. Hospital emergency rooms were overburdened and sometimes unreachable. Finding and caring for the region’s widely scattered kidney patients became a race against the clock, Kalina said.
Still, none of the 70-plus who lost their lives during and after Harvey’s historic flooding are believed to have died from not receiving dialysis, officials said Monday.
That does not mean things didn’t get dicey.
Many patients who were evacuated from flooded homes ended up among the thousands of evacuees crowded into the convention center. If their condition was seen as dire they were then loaded onto buses and shuttled to the few open dialysis centers, often traversing flooded streets.
Teuscher questioned why it had come to that.
Patients dependent on electricity for ventilators are known to officials and often urged to make early evacuations. He wondered why the same could not be done for those needing dialysis. Maybe a master list of patients could be compiled so they could be moved out of a storm’s projected path in order to keep care seamless, he suggested.
Dr. Horacio E. Adrogue, Dialyspa’s medical director, said it was not that easy. Individual dialysis centers sometimes reluctant to reveal client lists to competitors, he said, and patients who refuse to leave their homes cannot be forced to do so.
Instead of trying to move a large number of fragile patients, he suggested it would be more efficient to establish mobile dialysis centers at evacuation centers before a storm hits.
Not having them in place during Harvey meant that patients, already in distress, had to be moved by bus to centers.
Charles Willie was one of them. At age 80, in failing health, he was evacuated from his nursing home, first to a Holiday Inn and later to the convention center, where he spent one night. Confused and weak he called that night “pretty horrible.”
His usual dialysis treatment comes on Monday and he missed it during the storm. By the time he got care, he was on a downward slide.
Two weeks later he was much improved, and his regular Monday treatment was back on schedule as Verma stopped by. Noting the Korean War cap perched on his head she thanked him for his service. She also asked if there was anything she could do for him or if he had any message she could take back with her to Washington, D.C.
Willie smiled and shook his head. He closed his eyes and leaned back in his chair to let the machine work its magic.