Posted on: Friday, December 6, 2002

Patients' dialysis time cut during strike

By Mike Leidemann
Advertiser Staff Writer

Striking nurses meet a bus carrying replacement nurses to The Queen's Medical Center. Nearly 1,400 nurses at three O'ahu medical centers — St. Francis, Queen's and Kuakini — remained off the job yesterday. Richard Ambo • The Honolulu Advertiser

Cutbacks in dialysis treatment caused by a nurses strike are having a potentially life-threatening impact on patients, a doctor at St. Francis Medical Center said yesterday.

Because of the strike, the center has reduced the dialysis time of some patients by up to one-third, a situation in which the "health of the patients could be in jeopardy," said Dr. Jared Sugihara, medical director for the Renal Institute of the Pacific at St. Francis.

"If this goes on for a long time, there is a potential someone could die," he said.

St. Francis has asked some striking nurses in a "patients first" committee to return to work in critical areas. Through talks with the nurses and in a court case, it is seeking the return of up to 16 nurses in the renal institute, four in the critical care unit, and seven to work during transplant operations.

The Hawai'i Nurses Association said yesterday it would honor the request only in the case of critically ill patients or to assist in a transplant operation for a limited time.

"In the event somebody gets critically ill, we would certainly go in, do whatever is necessary, and get out," said Blaine Southward, a striking St. Francis nurse who works in the dialysis center.

Sugihara said patients shouldn't have to wait until they are critically ill to receive treatment.

"Does something really bad have to happen before it's called critical?" he said.

The nurses complained that St. Francis waited almost two weeks before raising the issue and does not need to be cutting dialysis time.

"There's no way they need to do that," said Sue Scheider, executive director of the nurses association. "They've still got an adequate number of nurses and other staff to provide the service. They are trying to manufacture a crisis."

Scheider also said the hospital should have done a better job of preparing for the strike. "We could have made arrangements in that time, but they didn't indicate they were interested," she said.

Southward said the hospital should have used a 10-day notice period before the strike to hire replacement nurses or make other preparations.

Nearly 1,400 nurses at three O'ahu medical centers — St. Francis, Queen's and Kuakini — remained off the job yesterday. St. Francis is the only one of the hospitals that has not hired replacement nurses.

No new negotiations were scheduled at any of the hospitals, which are negotiating separately with the nurses.

Sugihara said the prolonged reduction in dialysis service is unprecedented in the nation.

"As far as we know, nobody has ever been in a situation where they have to restrict dialysis treatments for more than a few days in an emergency situation such as a hurricane," he said. "If we go beyond the short term, there is serious concern about the physical and psychological impact it could have on our patients."

The national Kidney Foundation of Hawai'i estimates that 1,500 patients statewide rely on regular dialysis treatment to stay alive. Three times a week, they spend three to five hours hooked up to a dialysis machine that cleans their blood, doing the work normally done by a healthy kidney.

The foundation estimates that kidney failure in Hawai'i is 30 percent above the national average and is especially high among Native Hawaiian, Japanese and Filipino ethnic groups.

Because of nursing staff shortages, St. Francis is cutting as much as one hour from the regular treatment of most patients, Sugihara said.

Much of the treatment is handled by nonstriking technicians, but a nurse needs to be present during the dialysis, Sugihara said. "The supervising nurses are working 16 hours a day with no relief," he said.

The only other company in O'ahu that provides dialysis treatment, Fresenius Medical Care, is operating at capacity and cannot accommodate any St. Francis patients, Sugihara said.

He said he also was worried about the pyschological effect the reduced treatment has on patients.

"For years, we've been telling them they have to have four hours of treatment. Now, suddenly we are giving them a lot less. That's got to be a concern," he said.

The strike is also putting patients awaiting organ transplants at risk, he said. If an organ suddenly became available for transplant, a Hawai'i resident who might have been waiting five to 10 years for a transplant would not be able to receive it under current conditions.

"The organ probably would be sent to the Mainland instead," said St. Francis spokeswoman Maggie Jarrett.

Last night, the nurses association accused St. Francis of trying to mislead the public about its willingness to bring in some nurses in the "patients first" committee, which was established to offer emergency care when the hospital cannot otherwise provide it.

The committee, formed before the nurses went on strike, was never meant to cover dialysis patients, said Claudine Tomasa, the chief nurses negotiator for St. Francis contract talks.

"We never implied we would consider care for patients who are not admitted to the hospital as in-patients," she said in a letter to the hospital. "It is our belief that St. Francis has ample qualified, skilled care already available to care for its dialysis patients, or that such patients could safely be transferred elsewhere."

Tomasa said no nurses would return until the hospital meets all conditions agreed to by the "patients first" committee, including an assurance that nurses would be indemnified from personal liability.

St. Francis and Kuakini have responded to the strike by reducing their patient load and some other services. Queen's, however, says it is operating on a "business as usual" basis, providing a full range of services that have the hospital operating at peak capacity, from 350 to 408 acute patients during the week, said spokeswoman Lynn Kenton.

The hospital, which on Tuesday said it was using 250 nurses is now using about 300 contract nurses, Kenton said.

"I know the level of care being given is receiving positive responses, hospitalwide," she said.

Advertiser staff writer Mike Gordon contributed to this report.