Harvey pushes dialysis staff to the edge

For almost a week, it was about doing the impossible in South Texas. Like tracking down 33 children across a flooded city who hadn’t received a dialysis treatment in three days. It was about staff and patients staying huddled in a clinic overnight because flood waters cut off access to roads and they couldn’t get out. It was about a dialysis company buying boats, amphibious vehicles––anything that could plow through water—to help transport patients and staff to clinics, and bringing in hard-to-find tankers of gas to keep clinic generators running and to fill employee’s cars so they could get home or to a hotel room, because their own home had been flooded.

All that human kindness came to the surface last week after Hurricane Harvey slammed coastal towns and Houston with 50 inches of rain in three days. The renal community grabbed the national spotlight as television cameras and newspaper reporters focused on the broken lifeline between patients desperately trying to get treatments, an overwhelmed and exhausted staff putting their own personal lives and families on hold as they worked days without a break, and dialysis companies trying to reopen clinics and build a transportation system of any means possible to get patients in for treatment, and to ferry fresh staff members from all over the country into the clinics to provide relief.

Even the Centers for Medicare & Medicaid Services agreed to speedily certified six Fresenius Medical Care dialysis facilities that had waited more than a year in Houston for an initial survey, so they could open their doors and allow patients to be treated.

The storm, which hit coast towns like Rockport and Corpus Christi first on Aug. 25 and hovered over Houston—the nation’s fourth largest city—for five days before bouncing over to Louisiana, Tennessee, and Alabama, was blamed for more than 50 deaths and caused an estimated $125 billion in damage to homes, businesses, and marinas. Oil production grinded to a halt, sending gas prices upward around the country. The Texas National Guard activated 14,000 troops in addition to 10,000 troops from other states to help in the ongoing recovery.

Fresenius, DaVita Kidney Care, US Renal Care, and American Renal Associates all have clinics in South Texas. At the height of the storm on Saturday, Aug. 26, more than 57 clinics were closed in Houston alone, according to the Texas ESRD Emergency Coalition. By Friday, Sept. 1, 12 clinics were still closed in Houston, and another 12 in coastal cities, including Rockport and hard-hit Port Arthur and Beaumont—where the city lost its water supply. “Closed due to hurricane damage; will not open for a few months,” read a comment from one of the closed facilities on the TEEC’s list.

At press time, company officials said many of the clinics had reopened and were being assessed for flood damage

Harvey’s timeline of destruction

Wednesday, Aug. 23: Harvey begins circulating in the Gulf of Mexico

Thursday, Aug. 24: National Weather Center changes Harvey from a tropical storm to a Category 4 hurricane

Friday, Aug. 25: Storm makes landfall in South Texas, hitting coastal towns Rockport and Corpus Christi

Saturday, Aug. 26 to Monday, Aug. 28: Harvey pounds Houston and surrounding areas, overflowing bayous, flooding homes and streets. Over 50 inches of rain in three days sends 35,000 people to shelters set up in school gymnasiums and convention centers.

Tuesday, Aug. 29-Wednesday, August 30: Harvey hits Port Arthur and Beaumont hard; Beaumont loses its fresh water supply.

Wednesday, Sept. 1: Clinics in Houston, Corpus Christi began to reopen

Flooded out

Keeping dialysis machines humming wasn’t the problem in many facilities having to close, dialysis companies told NN&I.

“Accessibility due to flood waters was the main issue for not being able to open centers,” said Chakilla Robinson White, Group Vice President for DaVita Kidney Care. “Additionally we had many teammates who were unable to get out of their neighborhoods due to flooding.”

At the height of the storm, she sent a companywide email with the subject line "Rally For Help in Texas," appealing to staff in other places to travel to Houston to help. To ease the personnel shortage, some patients were transferred to San Antonio, Brownsville, Austin and the Rio Grande Valley to get treatments.

DaVita spokesperson Ashley Henson said that approximately 150 clinics were in the storm’s path, with more than 7,500 patients and 2,000 staff members impacted.

“We have taken actions to communicate evacuation orders with patients, obtained updated patient contact information, tracked where patients will be transferred and held regular scheduled check-ins with local teams,” she said. “All patients have been provided with medical information (prescription, dietary instructions and fluid restrictions) so that they can share this with their new treatment teams.”

Preparing for Harvey

Some dialysis clinics started taking steps a week prior to prepare for the storm, which knocked out power to over 300,000 customers, and saw emergency personnel rescue more than 2,000 people from flooded homes. FMCNA spokesperson Kate Dobbs said clinic personnel in Corpus Christie, Houston, and in the Lake Charles, Louisiana area began holding emergency preparedness calls twice daily a week before the storm hit.

By Friday, Aug. 25, three clinics were closed in Corpus Christie, Dobbs told NN&I, and 25 clinics were closed north of there up through Houston by Saturday. “We dialyzed as many patients as possible before closing those clinics, and all patients had been given their emergency packets,” she said. “We prepared our clinics outside of the impact zone for an influx of transient patients.” At the peak, Fresenius had 39 clinics closed during the storm; all but five of those have re-opened, said Dobbs.

Power outages for home dialysis patients

Fresenius was able to track patients transported to other FMC clinics who received treatment, said Bob Loeper, vice president of operations support and business continuity/disaster response for Fresenius. The provider also tracked the status of home dialysis patients.

“We alerted power companies where we have home patients in the area that they need power restored as soon as possible,” he told NN&I.

The company also sent extra home dialysis supplies to patients ahead of the storm, knowing that delivery routes might be compromised later.

Many patients who could not find access to dialysis clinics went instead to hospital emergency rooms. But Loeper said FMC worked with hospital personnel to divert those patients to open dialysis clinics when possible

Steve Fadem, medical director for DaVita’s Med Dialysis Center in downtown Houston, said flood waters trapped patients and staff. “By Sunday, people had lost power. There was no way anything could be open.” One day later, several units were reopened, but DaVita staff couldn’t get to them, said Fadem.

“Many of our nurses are locked in, flooded out of their homes, and they're either somewhere else, or they can't get out of the neighborhoods," Fadem said in an interview with NPR. "As a consequence, we don't have enough nurses to dialyze the numbers of patients that are coming here.

A team from Baton Rouge, La., showed up with boats to ferry both patients and nurses from their flooded homes to the center. "This is surreal. I've never seen anything like this ever in my career,” Fadem told NPR.

Major providers with clinics in Texas (as of May 2017) and those impacted by Harvey

DaVita Kidney Care: 240 (150 in Houston and surrounding towns)

Fresenius Medical Care NA: 194 (48 in Houston; 20 in Corpus Christi, Rockport, Beaumont)

US Renal Care: 102 (11 in Houston, Corpus Christi)

American Renal Associates: 22 (8 clinics in South Texas; 5 had “intermittent evacuations”)

Dialysis Clinic Inc.: 3 (none impacted, but DCI provided support to pediatric patients at Texas Children’s Hospital, some of whom had participated in DCI’s summer camp)

Satellite Healthcare: 12 (1 Wellbound clinic in Houston was closed due to flooding)