LIHU‘E — The County of Kaua‘i is facing a “growing crisis” in dialysis placement, according to the island’s only kidney doctor.
In a county council meeting on Wednesday, Dr. Raymond Petrillo, who runs Island Kidney Care in Lihu‘e, explained he is struggling to provide necessary dialysis treatment for his patients due to the lack of dialysis units, medical staffing shortages and insufficient public transportation for patients.
“Dialysis is needed, necessary, vital for life when patients develop chronic kidney disease and they come down to a percent of kidney function that is in the single digits,” said Petrillo to council members.
During dialysis, excess fluids and toxins are removed from the blood of people whose kidneys are no longer properly functioning.
Petrillo noted he is the only kidney doctor on the island, and he has roughly 500 chronic kidney disease patients.
“It’s a high frequency and those patients are in different phases of their approach to the ultimate dialysis,” he said.
He stated roughly 150 of those patients currently require dialysis, and 30 of them are waiting for treatment.
“There is no room for 30 patients. And so, we wait,” he said.
“When they do develop symptoms, they’re going to require hospitalization, and then we’re going to have to find some solution for them. It’s unclear to me what solution we might get for these folks, so their health is in some jeopardy.”
There are currently two dialysis centers in the county, totaling 18 dialysis chairs. Liberty Dialysis has 10 dialysis chairs at their center in Lihu‘e, as well as eight chairs at their center in Waimea. Ten chairs can serve roughly 60 patients, and patients are usually required to go in for treatment three days a week, said Petrillo.
He stated that the county is in need of an additional 20 dialysis chairs to fit the current need and allow for an expected increase in demand due to the aging population.
Petrillo, who said he inherited the crisis when he moved to the island in November 2022, also noted transportation difficulties add to the problem.
He explained patients in ill health are being tasked with traveling to inconvenient locations to receive dialysis treatment overnight. He described an 85-year-old patient that lives in Kapahi with vision problems, terrible health and no options for transportation.
“Her dialysis chair time would be 8:30 p.m. to 12:30 a.m. the next day. That is untenable,” he said.
Petrillo also described a 45-year-old patient with minor mental health issues who is unable to travel at night.
”Many patients have said, ‘I am not going to be confined to this travel time, these odd hour shifts,’ and they choose not to do dialysis and ultimately they have six months to live at that point roughly,” Petrillo said.
Petrillo was joined by nurse managers Melissa Ann Souza and Stephanie Smith, who noted medical staffing issues also make it difficult to provide treatment.
“Medical people are burnt out, they’ve been burnt out from COVID,” said Smith.
Melissa Ann Souza added that 30 percent of the nursing workforce throughout the country quit their jobs during the pandemic, and so the county is working to rebuild its staff.
‘We need to step up’
All three medical professionals at the meeting advocated for increasing home dialysis options due to the limited number of dialysis units, as well as its increased efficiency.
“It’s just better outcomes. You feel better,” said Smith, largely because home modalities are more frequent than the three days per week available to patients in dialysis centers.
Smith said increasing home dialysis treatment has been a challenge due to the lack of trained dialysis providers.
“We need trained caregivers and a lot of people don’t have the financial luxuries to put the time into it,” she said.
She explained that a five-week certification process is required to perform the treatment, and the training can be completed by nurses, family members, other caregivers and even patients who have enough aptitude.
Bill De Costa and other council members discussed a variety of potential solutions to address the problem, including adding dialysis chairs at other medical locations in the county, implementing a tax break for residential homes that conduct dialysis, as well as creating a certified dialysis program at Kaua‘i Community College for recent nursing graduates struggling to find jobs.
“Let’s get them a job in this area so they can run their (dialysis) machines,” said De Costa. “I’m pretty sure it’s really simple to get some kind of professional instructor to create a class and Wilcox (hospital) is going to give them a certification,” he added.
County Council Chair Mel Rapozo was also a fan of the idea of a certification program at Kaua‘i Community College and noted he had been unaware of the crisis.
“It’s an emergency. It’s a health care crisis. And I think we need to step up and deliver for our local residents,” he said.
Rapozo said that plans to convert the former Big Save Value Center in Lihu‘e to a day care center should be replaced with a health center for dialysis treatment. He stated lieutenant governor Sylvia Luke is already planning on building a day care center near the Safeway grocery store.
“Why in the world are we going to have two day care centers in Lihue. Let the state do the day care, and let us use this wonderful building here to put in some beds. It’s a perfect place. That’s an ideal location,” said Rapozo, noting the building’s short distance from the bus stop.
All council members agreed to hold further discussions on the issue.
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Emma Grunwald, reporter, can be reached 808-652-0638 or egrunwald@thegardenisland.com.
