By Peter Laird, MD
The Lufkin DaVita bleach murder trial will enter its final phase as the defense provides expert witnesses on the clinical aspects of the individual cases. The CDC presented evidence last week by Michael Schwartz that surely will be contested. According to news reports, Dr. Schwartz alleged that 100% of bleach would have been removed by one pass through the artificial kidney which completely ignores the fractional solute removal that renal dialysis is based upon. Diffusion of solutes is not nearly 100% efficient in four hours of dialysis let alone one pass through the system.
Dr. Schwartz assertion that all of the bleach would clear in only one pass through the machine as noted in news reports and thus serving as his explanation for why the autopsies in the two patients showed no evidence of bleach infusion is beyond absurd in my opinion. The allegation it would be removed is in my opinion farcical and not defensible by any evidence based medical literature. If this is the level of CDC evidence, then the prosecution may have built their entire case on a house of cards.
In addition, Dr. Schwartz reportedly alleged that epinephrine would mask elevated potassium levels from hemolyzed blood from bleach. Studies likewise do not show epinephrine having that type of ability. Epinephrine does drive potassium into the cells, but it is a very modest and only temporary affect. In my opinion, I believe that Dr. Schwartz did not testify factually on these two issues and perhaps more that cannot stand up to the scrutiny of evidence based medicine.
Witness describes Yahoo! search for 'bleach poisoning'
Schwartz said that he found the autopsies to be uninformative. The autopsies weren't able to effectively explain what Schwartz says his research on the effects of sodium hydrochloride have taught him.
"Epinephrine was given to all the cardiac arrest victims between the time they were at the Lufkin Davita Clinic and the time they got to the emergency room," said Schwartz.
Schwartz said these epinephrine were meant to restart patients' hearts, but perhaps had an adverse effect because of the presence of sodium hydrochloride.
Schwartz talked about the way bleach probably came into contact with patients.
"It went into the dialysis bath, it didn't go into the bloodstream of the patients," said Schwartz.
The most pressing issue is that of the elevated 3-chlorotyrosine levels that the CDC has paraded before the world as proof of bleach infusion. However, the defense witness testifying today, Dr. Jonathan Niedigh of Loma Linda university, countered many of the tests performed by the CDC on the alleged victims bloodlines. One of the most important cases is that of Graciela Castaneda, an alleged victim that the CDC heralded as absolute proof of bleach infusion by the highest tested 3-chlorotyrosine levels, yet they have a problem, the CDC was not able to find any bleach residue in her bloodlines.
Witness in bleach trial says supervisor said 'I will not go down for this'
Deaton directed his attention to asking the witness about the bloodline of Graciela Castenada.
"This is one of the bloodlines in his reports, he did not list any positive evidence for bleach," said Neidigh.
The witness testified that Jackson was very thorough in looking at multiple sites on the bloodlines for bleach. He stated Jackson used several methods to test each blood line. In Castenada's blood, there was a positive finding for a bleach or chlorine content, but the bloodline did not reveal any content of bleach or chlorine.
"The logical conclusion was that bleach or chlorine did not come through the bloodline," said Neidigh.
The witness concluded that the bleach content found in blood would have had to most likely come through natural causes. The witness said this appeared to be the case for a couple of the patients tested.
The prosecution case has centered on the allegations of two elderly and potentially physicially compromised "eye witnesses" and the defense alleges it has the medical records where there is a paucity of evidence to date supporting bleach infusion manifested by hemolysis. For the eye witness accounts to be meaningful, explicit evidence of a murder must be found. For the prosecution, it doesn't appear that they ever found the smoking gun.
As the defense presents its final expert witnesses tomorrow, the unknown factor of this entire case is how will the jury adsorb difficult medical records, complex technical research evidence, and evidence that employees at DaVita may have acted inappropriately by delaying notification to the police, contaminating evidence, losing evidence, and potential internal supervisory misconduct according to the witness testimony today on top of clear evidence pointing to failures to adhere to the standards of dialysis care expected by this DaVita unit such as running the bleach cycle between the first and second shift as one employee testified recently.
How the jury will pull this entire case together remains the greatest mystery to both sides. I believe the complexity of this case could easily overwhelm the members of the jury. How the defense presents its case tomorrow in many ways may be the most important determinant of the final outcome. I look forward to hearing the other side of the story tomorrow as we will see in the news reports from KTRE and Lufkin Daily News. I suspect that the final day of testimony will be filled with surprises few could imagine in the midst of the prosecution case just one week ago today as Dr. Schwartz confidently declared Kimberly Saenz guilty. Since Ryan Deaton began his defense case, the news from the court room nearly every day is filled with revelation after revelation I had never heard about this case.
My only prayer is that the truth of this incredible saga may be fully known, and not just by a reasonable doubt without a satisfactory conclusion to anyone. I believe that the truth shall prevail. Those that have died and suffered at this DaVita unit deserve no less. After all, their story is the real story of this tragedy. I believe that there will be many answers for all that have followed this case over the last four years and especially for the survivors and the families of all involved. May God be the final judge in all things.
As I read through the most recent television coverage, once again, I am reminded of what I have been stating for seven years to dialysis providers, CMS (federal level government agency that oversees dialysis facilities), state and federal legislators and reporters --- (1) staff are not adequately trained, (2) staff are not adhering to facility policies and procedures and (3) there is a lack of effective unit-level supervision --- The below certainly supports such, from KTRE news -
"Quite a few things caused some concern," said Cartwright. One of the things that stood out to him specifically was the fact that DaVita employees were not meeting company policies.The requirements mandated by DaVita were not being met with daily readings," said Cartwright.
The witness also pointed out that in reviewing the files at the Lufkin DaVita Clinic, he did not find that employees had proper training in testing the water."
Peter, this trial, and all that is included, should send a message to our legislators who have NOT addressed effective oversight, in spite of numerous OIG reports, dating back to 1999, from recall, to ensure patients receive safe care. This trial should also send a message to the aforementioned that someone needs to take a look at the REAL care that this vulnerable population receive in many of the units I have been yelling about this for seven years with little attention. I use California as an example. Anyone can take a look at the inspection reports for California www.qualitysafepatientcare.com - Davita facilities are there -- inspection reports clearly support that there is a lack of training/education, supervision, non-adherence to facility policies, etc. Goodness.. what does it take for our government, legislators and all oversight agencies to realize that patients are not receiving quality safe care?
I was contacted at the beginning of this saga, referring the attorneys to many with more expertise than myself ,as I was not an expert in dialysis, but an advocate attempting at improving care for patients (because of what my father experienced)-- However, I reviewed many documents, and as a non-dialysis expert, could see that there was perhaps a coverup. It is frightening to know, or think, how many patients maybe have died from preventable errors in dialysis facilities, where, perhaps --- the situation was covered up. As I stated previously, I wish, whoever is aware of what really happened, would come forth... For those who work in dialysis facilities, this should send a message that you, too, could be arrested if you are accused of implementing an incorrect practice that results in a negative outcome for a patient.--My heart goes out to these families, as I have communicated with some of them, over the years and feel their pain of what they have gone through ... They deserve to know the truth ---- these were their loved ones --
I agree with Peter, "May God be the final judge in all things." and May the families finally have some peace ---
above are Opinions of
Roberta Mikles BA RN - Dialysis Patient Safety Advocate,
Posted by: Roberta Mikles BA RN | Friday, March 23, 2012 at 07:09 AM