ASSOCIATED PRESS / FEBRUARY 2008 Hawaii is experiencing a shortage of dialysis care, doctors say. Here, a patient undergoes dialysis at Fresenius Medical Care North America Dialysis Clinic at Kapiolani Medical Center at Pali Momi.

Dearth of dialysis beds ‘serious’

A hospital limits care, bringing other facilities more kidney patients

Hawaii hospitals have been hit with an expected kidney dialysis crunch resulting in part from reduced service at Hawaii Medical Center-East in Liliha.

The hospital, formerly St. Francis Medical Center, usually had 20 to 30 dialysis patients in acute care at any one time but now has only five beds devoted to dialysis.

The change comes as Hawaii shows an increasing incidence of kidney disease related to high rates of diabetes and obesity, experts say. And patients often have costly complications.

"Dialysis patients have become disenfranchised, discriminated against," said Dr. Jared Sugihara, a kidney specialist. "No one wants to admit them."

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A limit of five beds at Hawaii Medical Center-East for patients needing kidney dialysis and acute care has hit Oahu's other hospitals with an unexpected surge of dialysis cases.

The situation highlights Hawaii's growing incidence of kidney disease, related to high rates of diabetes and obesity, and the Hawaii hospital system's ability to deal with it.

Liberty Dialysis Hawaii LLC and Fresenius Medical Care, which operate outpatient dialysis facilities, are providing acute dialysis services at most hospitals under contract. Most say they are at or over capacity.

The Queen's Medical Center has an acute dialysis inpatient center with 12 machines and staff to treat 26 patients, and it has been 30 percent over capacity with increased patients and treatments, said Cheryl Fallon, nurse manager. "But when patients show up in the emergency room, we can't turn them away."

Fallon said the staff is working overtime and on days off, and the unit is working with a local agency to help supplement the staff and trying to hire and train new staff.

A broader issue is Hawaii's growing number of kidney patients, said Cathy Young, Queen's vice president for cardiac medicine and geriatric services. "We don't have enough capacity in our state to take care of this growing incidence of kidney failure.

"It's only going to increase," she said, suggesting the state Department of Health and hospital providers "come up with a plan" to handle it.

Kim Hadden, vice president for operations and chief nurse executive at Straub Clinic & Hospital, which contracts with Fresenius for inpatient dialysis services, said the hospital is over capacity with four dialysis machines and 10 patients requiring treatment.

Donda Spiker at Kuakini Medical Center said it is able to treat three patients at one time in the hemodialysis department and that it has one portable machine. She said physicians have been informed "we have reached our capacity and want to make sure we can take care of patients we already have."

Oahu is often closed to dialysis patients from other islands, said Dr. Jim Jones, one of four nephrologists or kidney specialists on Maui. He said he has been called to take patients from the Big Island and Kauai when there was no place for them on Oahu. Kauai has one kidney specialist, and the Big Island has one in Hilo.

Dr. Jared Sugihara, a nephrologist who goes to the Big Island regularly to see patients with kidney disease, said the availability of beds for dialysis patients on Oahu has been a critical problem for North Hawaii and Kona.

"Quite honestly, it comes down to money, basically," said Sugihara, who was medical director of St. Francis' renal program.

Dialysis patients, often suffering from diabetes, heart disease, pneumonia and other serious conditions, require specialized equipment and staff and longer-than-average hospital stays, he said. Costs are higher and reimbursements are low, he said.

As a result, Sugihara said, "Dialysis patients have become disenfranchised, discriminated against. No one wants to admit them. It's been terribly frustrating for all nephrologists. At this point our concern is someone is going to have to die before something happens. We certainly don't want this to happen to our patients."

Dr. Eugene Wong, medical director for Liberty Dialysis-Hawaii LLC and Queen's dialysis inpatient unit, said he has obtained approval "to accept any emergency from the neighbor islands should they need nephrology services where there is no nephrologist."

But Queen's will put a limit on how many Oahu dialysis patients it will accept that are not emergencies, Wong said.

The former St. Francis Medical Center-Liliha (now Hawaii Medical Center-East) usually had 20 to 30 dialysis patients in acute care at any one time, kidney specialists said.

The nonprofit hospital operation was restructured to a for-profit business after purchase in January 2007 by CHA LLC (previously known as Cardiovascular Hospitals of America) and a Hawaii physicians group. Several waves of employee layoffs have occurred and beds reduced to increase profitability.

HMC-East had 140 acute care beds and 52 skilled nursing beds when the new owners took over, said Salim Hasham, a medical finance specialist from Canada hired in April to reverse the hospital's revenue losses. The hospital now has 80 acute beds and 36 skilled nursing beds, he said.

HMC-East's cap on dialysis patients earlier this year caught other hospitals by surprise.

"There wasn't any transition," said Sugihara. "It came suddenly."

Dialysis to remove waste and excess fluids from the body is the only treatment option aside from a kidney transplant for people with kidney failure. A delay in providing needed dialysis can be life-threatening.

Glen Hayashida, chief executive officer of the National Kidney Foundation of Hawaii, said "there was tremendous concern" about HMC-East's limit on dialysis patients and the hospital "provided reassurance that patients would be taken care of, although they were not formally admitted to the hospital side of things."

Wong said HMC-East will admit dialysis patients to the emergency room and keep them there for days as inpatients without taking them to a hospital bed.

Hospital executives have had meetings with state Health Director Chiyome Fukino about the latest problem plaguing the state's "broken" health care system, said Richard E. Meiers, Healthcare Association of Hawaii president and chief executive officer.

"We're very concerned about the lack of inpatient dialysis beds since HMC-East reduced the available beds," he said. "This is a serious issue for the citizens of Hawaii, and it's going to continue to get worse."