Gaps in disaster preparedness leave patients at risk

Blalock Dialysis Center had a generator ready when a massive winter storm swept across Texas in mid-February. But the stand-alone facility didn't expect to need a backup water supply.

Blalock's water pipes buckled in the unseasonable cold, which meant that its more than two dozen patients had to find dialysis treatment elsewhere. It took about two days and $10,000 to truck in water, said Dr. Ritu Patel, a nephrologist at the Houston-based center, calling it "extortion at its finest."

In the meantime, staff scrambled to find providers willing to take their patients. Some of the large dialysis chains said they weren't taking new patients, and a hospital chief medical officer yelled at Patel for sending patients to their already crowded emergency department, Patel said.

"It was the worst week of any nephrologist's life. We never thought in a million years we would not have water," she said, adding that the state should prioritize centers like Blalock when a crisis hits. "Now we're creating our own backup water and making sure the problem doesn't happen again."

Without a nationwide network or a health system to fall back on, smaller dialysis centers are often left to find resources for patients. It's a scenario that's played out before across the nation. And it has renewed a call by health systems for dialysis centers to bulk up their disaster preparedness.

Increasing CMS funding in the Kidney Community Emergency Response network, which helps providers boost their disaster plans, could be a good start, said Nicolette Louissaint, executive director of Healthcare Ready.

DaVita and Fresenius said in statements that they were able to accommodate some additional patients during the storms, but many of their sites were at capacity. Quality Dialysis, which offers in-home dialysis care for Houston-area residents, said DaVita and Fresenius took on some of its patients when their water or power went out.

At Houston Methodist, about 20% of the patients in the system's emergency departments during the storm were ones who were overdue for dialysis, CEO Dr. Marc Boom said, adding that it was the third major disaster in recent years in which hospitals saw an influx of patients from stand-alone centers.

"I don't think the industry has collaborated enough to prevent endangering patient lives," Boom said, calling on the large dialysis chains to be accountable.

Likewise, Harris Health saw 81 patients for emergency dialysis at its hospitals during the storm, only about 10% of whom were the system's patients, according to a spokesperson. Medical staff also coached patients on emergency diets to help reduce the waste that builds up in their blood and allow them to postpone treatment while centers were shut down.

More than 760 dialysis centers closed across Texas when the storm hit, displacing around 54,000 patients, according to Dialyspa, which has seven centers in the Houston area. Most dialysis patients can only go four or five days without treatment.

Under federal guidelines, disaster plans for end-stage renal disease facilities must be tested and updated every two years. They must have a plan to collaborate with local, state and federal emergency preparedness officials and check with them annually to review dialysis facilities' needs.

"We often increase requirements in preparedness without funding," Louissaint said.

A New Jersey law that took hold after Superstorm Sandy in 2012, requires certain healthcare facilities, including dialysis centers, to have emergency generators, log use and regularly test them. The state created a low-interest loan program for financial assistance.

In New York, a bill in the state Senate would require facilities that offer dialysis services to have enough generators to support the site during an emergency.

Two bills moving through the Texas Legislature would require dialysis centers to adopt an emergency operation plan and facilitate collaboration across local and state organizations. Power and water restoration would also be prioritized.

Overall, there is a tendency to shortchange emergency planning. A disaster strikes, and preparedness and infrastructure funding increases for a few years, Louissaint said. After that, the aid and political will often run dry.

"One-time investments, or ones that last a few years and drop off, are not enough," she said. "There has to be sustained, ongoing investment."