The Lufkin DaVita Bleach Murder Trial: Is HemoDoc a Reporter?

By Peter Laird, MD

As the Lufkin DaVita murder trial winds down to its conclusion, it is interesting to follow the news reports as well as all of the comments at the end of most of KTRE's articles. In the last couple of days, there has been a bit of a debate over how accurate my "reporting" of the case has been.  I would like to make a few clarifications. First, I am not a reporter. I am a medical doctor with a blog where I voice my own individual opinions of various issues. If you are looking for both sides of an issue as an unbiased news reporter, you will likely be disappointed since my opinions are mine alone. I do strive for accuracy and presenting the discussion clearly, but in the end, these are my opinions based on an extensive review of the medical issues involved in this case and should not be mistaken for news reports of any kind. Instead of viewing this as a news report, think of it instead as an opinion page since that is exactly what it is. In such I hope it is an informed opinion of not only the Lufkin DaVita murder trial as reported in the news to date, but all the issues that I comment about on HemoDoc.

Defense rests in bleaching deaths Trial

J: Like I said before, unless you have sat through every session and heard evidence/testimony yourself, you really have no idea of the specifics of this trial. The jury will do it's job and whether we like it or not, we have to respect it. As far as hemodoc reporter, reading evidence and hearing/seeing evidence is two different things. I am sure he is a well educated man, however, his accounts of testimony and credibility of witnesses on stand cannot be accurate if he is not in the courtroom. The evidence is detailed, lengthy, scientific, confusing at times. All I am asking is that you respect the job the jury has to do, no matter what the outcome, based on what they have witnessed and not what is reported on this site. 

Another issue is whether I have been in the court room and the answer is no, I have not gone to the Lufkin DaVita courtroom. Instead, I have reviewed the daily news accounts and during the course of the trial, I have limited my opinions only to that which has been publicly reported in the news. I did not during the trial venture beyond news reports to remain within the bounds of the information I already possessed but may not yet have been brought up in court. Obviously, being limited to the information available in the news is not the best way to comment on a trial, but it was all that was available during the trial and it was also all that was appropriate to comment on as well.

That being stated, the news reporting of this case from KTRE and Lufkin Daily News in my opinion was very biased against Kimberly Saenz. In addition, I have added sources to my opinion many of which were not included in the testimony but are well documented in the medical literature and easily found on the internet. I am not sure why that is not a valid manner in which to formulate an opinion of the medical issues discussed in this trial.

Unfortunately, the CDC did not in my opinion complete their task by establishing 3-chlorotyrosine levels in dialysis patients with heart attacks, pneumonia and cardiac arrest or sepsis nor in separating other causes of chlorine sources. Nor did they consider or discover the abnormal chlorine levels in the water that Deaton brought to light. So just sitting in the courtroom didn't give you all of the evidence of this case either. There is much more to this story that can't be told yet in part because of what the judge has disallowed. Hopefully same day that will be known as well.

59th Annual EIS Conference (page 24 of pdf flyer)

DONALD C. MACKEL MEMORIAL AWARD 

Cardiac Events and Deaths in a Dialysis Facility Associated with a HealthcareProvider — Texas, 2008 

Melissa K. Schaefer, C. Lucero, M. Sochaski, R. Kleiman, J. Su, M. Arduino, A.Kallen, M. Schwartz, P. Patel for the Texas Dialysis Investigation Team 

I believe that the CDC has failed especially since they had over four years to prepare for this case. I do believe that Ryan Deaton has been able to elucidate the issues well and I believe that the jury will have the credible information to make an informed decision. I also believe that if Kimberly Saenz is innocent of all charges, then we must ask the question, who is responsible? I believe that the medical evidence provides that answer as well but that will be for the jury to determine. 

For now, it is the jury's time to reflect on the evidence and then speak of their opinions of this case. Their opinion in the conclusion of this whole matter is all that will be relevant anyway. I believe that the trial has brought out the most important information for them to make an informed decision and that is sufficient for the task at hand.  We await that judgement. How the jury will respond is impossible to predict at this time.  There are many on boths sides of the equation hoping for the verdict they believe is correct. Once again, may God be the judge.

Comments

[Kris]

Dear Dr. Laird

I have been following your commentary of this case with great interest. It is obvious that you are not a reporter (at least to anyone who reads the blog) and this is really what makes your commentary interesting.

I am not sure that I agree with your opinion of the innocence of the defendant in this case though. That there was no "intent" does not take away from the fact that she is as guilty as her peers to performing sub-standard care and routinely braking treatment protocol.

It is easy to pass this responsibility on to the health care provider (In this case DaVita) but considering that the staff are all medically trained with years of experience it could (and I believe should) be claimed that they had ample time to bring to light, through watchdog organizations or other means, the state of the care at the clinic.

But if you can not collectively punish the staff for malpractice then neither should the defendant be singled out.

I guess this is why the focus in the end gets put on the provider.

[Peter Laird, MD]

Dear Kris, this clinic was run with poor supervision for sure. The state had inspected this clinic and found severe deficiencies that were cited on more than one occasion. The judge in this case did not allow that evidence. That is one of the reasons why I mentioned above that even if you have gone to the trial every day, you still don't have the entire picture.

Yes, you have made some valid points that I can't really address until the jury has spoken.

Thank you,

Peter

[R]

Dr. Laird:

I have followed KTRE & Lufkin Daily News reports from inception. I have gained much insight into following your blog as well.

I have some questions that hopefully you will be able to point me in the right direction for - is it possible to review the CDC investigation and/or FDA investigation reports? Shouldn't these be available to the public? I have searched the CDC website and found nothing.

Where can I read this article "Cardiac Events and Deaths in a Dialysis Facility Associated with a HealthcareProvider — Texas, 2008"?

My most annoying question is this - early on it was reported that some 19 individuals died during a six month time frame; however, the case at hand only deals with the deaths of 5 patiens. What happened to the other 14 patients? Likewise, something in the neighborhood of 30 paramedic calls were made in the month of April, 2008 but Ms. Saenz is alleged to have caused injurty to a total of 10 patients in a broader time frame. The differences in numbers alone are troubling me.

I have bounced around in my thoughts of what went wrong - I am coming to the conclusion that this is no smoking gun. These patients were already ill and their health deteriorated greatly while undergoing treatment at this clinic. I would assume that fatalies are somewhat common given the illnesses requiring dialysis; however, we have not heard similar events occuring at the other dialysis clinic in our community which would be supplied by the same water system. I believe that the clinic as a whole, policies and practies, cleanliness, medication and equipment are to blame. No one person at fault but the clinic as an organization failed to treat these delicate patients delicately.

Lastly, early reporting also indicated that contaminated heparin may have been to blame. Does this possiblity fit the patient illnesses?

Thank you for your daily upates!

[Peter Laird, MD]

Dear R, with the case going to the jury tomorrow most likely, I will have to wait a couple of more days to address some of those issues. Contaminated heparin does not appear to be a factor in this case. The CDC report is not available online anywhere that I have been able to find to date as well.

I am under the impression that Dr. Melissa Schaefer did present her evidence for the Mackel Award as well as a copy of a paper she has written about the investigation. In addition, there is a CDC report primarily authored by Dr. Schaefer that the prosecution originally planned to feature. I am not sure if these are open to the public or will be released to the public once the trial is resolved. I was quite surprised that the prosecution never called her to the stand or presented her data. It is one of the great surprises about this case.

[R]

Would you agree that if the Lufkin water supply alone is to blame (alternate theory presented by defense) that the other dialysis clinic would have also seen a spike in occurances during the same time frame? Do you know of any such occurances?

[Cassandra]

Your comments are far from "informed".  You admit your bias (you are employed by the defense lawyer); you admit your ignorance (you have not heard a single minute of testimony or reviewed personally the evidence admitted before the jury apart from whatever your employer has supplied you); you admit your lack of qualification (you are years of training shy of being a board-certified nephrologist).  Yet, you openly declare your intention to snipe at the jury if you disagree with their verdict (as an internal medicine doc, not even licensed in the forum state, with zero experience as an attending nephrologist) and worse, attempt to pollute the trial while it is still in progress before an unsequestered jury.  It is publicly reported that the judge issued a gag order that applies to the state and the defense, as well as their witnesses, consultants, or anyone else connected with the case. Yet, you have apparently chosen to ignore and violate that order by schilling here for your employer, Mr. Deaton.  So, either he failed to inform you or, despite being instructed, you chose to violate the gag order on your own. At a minimum, your behavior is crass self-promotion through exploitation of others' misery. 

[Peter Laird, MD]

Dear R, if you follow the news reports, the elevated chlorine levels in this case were from a malfunctioning carbon filter. The elevated chlorine levels were AFTER it had been processed in the carbon filter meaning that the Lufkin DaVita carbon filter did not work properly. The levels that were 15 times higher was after it left the filter and went into the patients. Please remember that 3-chlorotyrosine is not specific for bleach exposure, only some source of chlorine, but not limited to bleach. The elevated chlorine in the "treated" water is sufficient for that occurrence.

I believe that the 3-chlorotyrosine levels in this case were caused by the malfunctioning carbon filter. DaVita changed this carbon filter after the unit closed. These are the so called "ghost" carbon tanks that was confirmed under testimony during the trial and reported several times in the news outlets.

Dr. Gruszecki and Dr. Germain both testified for the defense that they found no evidence of bleach infusion nor did patients experience the immediate type of reactions you would expect from bleach infusion. I find it very unusual that the prosecution did not have a hematologist testify about hemolysis. LDH alone is not diagnostic of hemolysis.

I believe that the evidence is compelling that no murders by bleach occurred at all. I truly do not believe that the prosecution proved it's case for one reason only, the evidence for that conclusion simply does not exist in my opinion.

[R]

I am not emotionally attached to this case in any way. I am simply confused about what actually happened at DaVita, Lufkin Clinic. Has there been any speculation that the illness could have been caused by accumlative exposure to excessive chlorine? Again, I am leaning in the direction that this particular clinic's practices are at fault. If Ms. Saenz's is at fault then so are her co-workers and employers. The only question from there is whether the employees should have know better or were they so poorly trained that they did not? I look forward to reading more of your information following the verdict. In my opinion, I don't belive the jury will about long on this, perhaps we will know the outcome tomorrw.
R

[Peter Laird, MD]

Dear Casandra, first of all, I am not employed by anyone let alone Ryan Deaton. Any reviews I performed were without charge at all. Secondly, dialysis is only prescribed by nephrologists. Even though I am quite well versed in all aspects of dialysis, after all, I perform home hemodialysis on myself nearly every day, from a legal point of view, since I do not have nephrology credentials, the judge would not have allowed me to testify as an expert in dialysis making my participation in this case quite limited.

As far as the gag order, that was for those testifying in the case. I was not on the expert witness list. Others who have reviewed parts of this case have likewise discussed it openly, one even on national TV. In addition, I only gave my opinions of the news accounts and did not present any direct evidence on this blog that the jury had not already heard or that was not already openly reported in the news reports.

Lastly, I would point out that I am also a sufferer of dialysis and renal disease in a common bond with all of those people at the Lufkin DaVita unit. After reviewing much but not all of the case, my own personal conclusion is that there were no murders. After dialyzing in 10 different dialysis units in 7 different states in the last 5 years, I will testify to you that what happened in Lufkin DaVita in my opinion, is only a small microcosm of what is happening across America. That is and has been my only motivation since entering dialysis advocacy in 2008.

No matter the outcome of the jury, they shall never be a target for me to "snipe" at whatsoever. In my opinion, DaVita is the guilty party in this case and that will be the focus of elucidating what happened at this clinic from my perspective as a doctor and a fellow renal patient suffering the daily effects as many of these patients likewise suffered. That is and will be my only motivation.

Thank you.

[Peter Laird, MD]

Dear R, when it comes to jury decisions, how many trials have we all expected a certain outcome only to have the jury come back at us 180 degrees in a complete surprise. This is such a complex case, I am not sure at all how the jury will deal with that complexity and the emotionally charged allegations. The defense has always been at a decided disadvantage in this case with a small law firm up against the state and the power of the Federal government with not only the CDC expert witnesses, but a Federal prosecutor as well assisting the local DA.

I have my own opinion of this matter which I have not held back, but in the end, the jury is the only one that will matter. We will all have to just wait and see at this point. Really nothing further to state until they have rendered their verdict. Don't be surprised if this takes longer than we think it will. I suspect that they are going to wrestle with all of the conflicting testimony and evidence. Very hard case to get a grasp upon all of the facts. In such a complex case, the likelihood of a hung jury remains very high. Once again, we will all have to just sit back and wait for their decision.

[Roberta Mikles BA RN]

Peter, for some reason, I must have missed this post and see that it was when I was out of town with no internet access. You opinion/comments -- WELL STATED

Of course, the jury now has spoken and truly sad, as far as I am concerned because I believe there was enough evidence brought forth to show this nurse was a scapegoat for Davita and I hope that Davita takes resonsiblity and is held accountable.. Truly, other aspects were revealed during the trial that showed problems in this unit and again I send people to www.qualitysafepatientcare.com to read California Davita surveys (inspection reports)
opinions above from --

Roberta Mikles
www.qualitysafepatientcare.com

[Angie Hardison]

I just found out about this case today, so I am new and dont have alot of information about it. I would like to ask 2 questions though and see if you could fill me in. #1 were the cargivers given a constant set of patients to serve. If not, all of the patients who were affected should not have been traced back to one caregiver if it were indeed a faulty filter. #2 personal question, not related to this case, when my mom was going through dialysis her blood pressure would drop and they would have to stand her on her head. Why does this happen and is it normal?

[Peter Laird, MD]

Actually, there is a CDC epidemiology report which I believe is flawed and that was supported by a ruling against admitting it into evidence it appears by the judge that showed association with several care takers, but Saenz had the most but it was not 100% association at all. Once again, the evidence was flawed and not allowed into testimony. I can't really say more at this time while her appeals are pending.

I am still very troubled by this case and wait for news of the appeal. I am hopeful she will get a chance at a new trial but that is a long shot to say the least.

As far as dropping blood pressure that you appear to be describing, that is unfortunately very common in dialysis. Usually it is related to taking fluid off too rapidly, but it can be a complex issue with multiple causes.