lysis center began this week, city officials said.

City Manager Dave Martin said Thursday the Kansas Department of Health and Environment has started an inspection of the Fresenius Medical Care Dialysis Service center located at 2526 S. Main St., which, due to lack of an appropriate inspection, has not been able to serve patients with Medicaid or Medicare, which are federal programs.

The facility has been operating since late 2014 after construction on the new facility was completed but has only been serving patients with private insurance.

"It has been open to patients not covered by Medicare or Medicaid," Martin said. "It's been open but under a survey, it has to get inspected to serve (patients with Medicare or Medicaid.)"

Martin said KDHE officials have said the certification inspection had been moved up on the priority list.

"We were notified by KDHE they had moved it up," he said. "I'm not sure how long it takes and the exact process. If it passed a survey, Medicaid and Medicare patients can start going there."

Martin said he has been told a survey takes two weeks to complete.

Martin explained the reasons behind the delay in the center's inspection, citing financial and personnel issues as factors in the delay.

"There are four tiers of dialysis centers being inspected across the U.S.," he said. "We fell in tier 3 and it wasn't considered, maybe because of the location with a (dialysis) center in Pittsburg. It was not a priority center to be looked at.

"There are two factors behind it in getting inspected. Because of government cutbacks there were not enough people, and for them to be inspected, you have to have a lot of medical knowledge ... they were not able to get enough inspectors."

Martin said he appreciates all of the support from local, state and federal government officials, as well as local citizens, in getting the inspection moved up the priority list.

"People have been driving past it to go out of town to other facilities," he said.

Martin said city commissioners and others have written letters and he has personally taken phone calls on the issue.

"I appreciate all the calls from everyone," he said.

Martin said he has been told that if the center passes the survey, it could be open "toward the end of the year or early next year."

During a February city commission meeting, Martin said he had recently spoke with Pam Henderson, a representative for U.S. Sen. Jerry Moran, and Moran had been working on getting certification inspection completed for the center. Martin also thanked Kansas Senators Caryn Tyson and Jacob LaTurner for their assistance in support of the issue.

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Named as defendants are Utah Department of Corrections Warden Scott Crowther; Richard Garden, the department's Clinical Services Bureau director; medical workers at the prison; University of Utah Health Care, which provides dialysis at the prison through the South Valley Dialysis Center; and clinic employees, including two technicians who allegedly were involved in a scheduling mix-up.

Brooke Adams, spokeswoman for the Department of Corrections, said Thursday that she could not comment.

"We have not officially received nor had a chance to review the filing since we just learned about it tonight," Adams said. "In addition, our internal investigation is still ongoing."

Ramon Estrada, 62, died April 5 of apparent cardiac arrest due to renal failure, according to a statement by the Department of Corrections.

The inmate, who missed scheduled dialysis, was just weeks away from being released on parole after nearly a decade in prison on a rape conviction."

He talked about the importance of his dialysis treatments in a 2008 parole hearing.

"I'm getting very sick and very ill," Estrada said, "and if I hadn't gotten into that program, I wouldn't be here right now."

Six other inmates also missed their on-site dialysis treatments and were taken to a hospital for evaluation. One was hospitalized overnight, three received dialysis and returned to the prison, and two were found to not need dialysis immediately.

A University of Utah Health Care investigation found that a technician had agreed to switch shifts with a co-worker and take the April 3 and 4 appointments. But although the techs both noted the change on a communications log at the prison, the tech who agreed to cover the shifts failed to note the change on his personal calendar, investigators found, and did not go to the prison.

Then, prison nurses apparently did not try to contact the dialysis center for at least two days after the tech began missing appointments, according to the investigation.

University of Utah Health Care did not have a comment on the law suit but has previously said that it deeply regrets the scheduling error and that the relationship between the missed dialysis session and Estrada's death is under investigation.

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Twitter: @PamelaMansonSLC

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As someone who needs dialysis every other day, Don McLaren has learned to make the best of an inconvenient situation.

Now helping him through those four-hour dialysis sessions at the Flin Flon General Hospital is a brand new TV with headphones.

“It’d be a long time in here without them,” McLaren said last week from his dialysis chair.

The Flin Flon Health Auxiliary recently donated four ceiling-mounted television sets, complete with their own headphones, to the hospital’s dialysis room.

The TVs replace the room’s older models, while the headphones provide a newfound level of ease and privacy for patients.

The auxiliary’s Sheila Sproxton said patient comfort is a focus for the volunteer organization.

To that end, members sew “compassion bags” to hold hospital patients’ possessions and provide personal hygiene items to patients who arrive without them.

The auxiliary has also provided plush toys to be given to children who are having surgery or dental work done.

Prior to donating the TVs and headphones to the dialysis room, the auxiliary also put $5,000 toward the revamped ER to be built at the hospital.

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Recurrence scores based on a 16-gene assay accurately predicted clinical outcomes in patients with surgically treated clear cell renal cell carcinoma, according to study results.

Surgery or ablation represent curative options for patients with stage I to III clear cell renal cell carcinoma, but about 30% of patients with localized disease will relapse, according to study background. Clinicians frequently use clinical and pathological parameters to determine the probability of recurrence.

Brian Rini

“The current methods we use to assess recurrence can certainly be improved,” Brian Rini, MD,associate professor of medicine in the department of urology at the Cleveland Clinic and a HemOnc Today Editorial Board member, told HemOnc Today. “Researchers have utilized a similar testing method to predict breast cancer recurrence.”

Rini and colleagues conducted a developmental study to investigate the association between the clinical outcomes of 942 patients — who had stage I to III clear cell renal cell carcinoma and underwent nephrectomy at the Cleveland Clinic — and the expression of 732 genes. The cohort had a mean age of 62 years (range, 53-70) and was 63% male. Sixty-eight percent of patients had stage I disease.

Researchers identified 516 genes associated with recurrence-free intervals, from which they selected 11 genes for additional statistical analyses. The researchers added five reference genes to develop a 16-gene recurrence score algorithm.

Researchers then conducted a validation study using an independent cohort of 626 French patients. The median age of this cohort was 61 years (range, 53-71) and 71% were male. Sixty-four percent of patients had stage I disease.

Researchers sought to define an association between the recurrence score and the risk for recurrence and 5-year disease-specific survival, stratified by tumor stage (stage I vs. stage II vs. stage III) and adjusted by tumor size, grade or Leibovich score.

Median follow-up was 6.2 years (range, 5.1-8.4) in the developmental study and 5.5 years (range, 3.6-7.9) in the validation cohort.

Researchers observed a significant association between the continuous recurrence score (median = 37; interquartile range [IQR], 31-45) and recurrence-free interval (HR = 3.91; 95% CI, 2.63-5.79; based on a 25-unit increase in score). Analyses stratified by tumor stage indicated the continuous recurrence score was significantly associated with cancer-specific survival (HR = 5.55; 95% CI, 3.11-9.92), DFS (HR = 3.43; 95% CI, 2.45-4.7) and OS (HR = 3.55; 95% CI, 2.32-5.44).

Researchers conducted a multivariable analysis that demonstrated a significant link between recurrence score and the risk for recurrence (HR = 3.37; 95% CI, 2.23-5.08) when stratified by tumor stage.

In a model including Leibovich score and recurrence score, the recurrence score remained a significant predictor of recurrence (HR = 4.2; 95% CI, 2.76-6.4), whereas Leibovich score became insignificant.

Researchers also used the recurrence score to identify a clinically significant number of high-risk patients with stage I disease (n = 58) and low-risk patients with stage II or stage III disease (n = 43).

The researchers acknowledged several limitations of their study, including the use of different American Joint Committee on Cancer staging systems (2002 and 2010) for the developmental and validation cohorts. Further, follow-up could not be standardized.

“We have already seen genomic progress in other specialties,” Rini said. “One of our ultimate goals would be the ability to predict more overall outcomes using genetics.” – by Cameron Kelsall

For more information:

Brian Rini, MD,can be reached at the Cleveland Clinic Main Campus, Mail Code R35, 9500 Euclid Ave., Cleveland, OH 44195; e-mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Disclosure:The study was funded by Genomic Health and Pfizer. Researchers report employment with Genomic Health and Pfizer. Rini reports research funding from Genomic Health for the development study.

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