Im very upset by the course of actions by our current owner FMC. They have purchased us several years ago and have lately been writing us letters, emailing us and having meetings with there Area Directors trying to strong arm us into using there products. FMC is a vertically integrated company as we all know. They have a supply side of there business, but they are also on the provider side as well. We are very happy with our PD and HD products we are getting from Baxter. HD side, their dialyzers perform wonderfully and the patients KT/V are all doing quited well. They are competively priced and we could not be happier. On the PD Side, we also have been using Baxter products, and our infection rates are very low 1:105 and the patients as well as our staff absolutely love the service and the responsiveness of our representatives.

Recently we have been bombarded by emails, letters, etc, strongly encouraging us to use Fresenius products, and after doing extensive research with regards to the PD products, the Fresenius products seem to be inferior to the Baxter products. Higher infection rates (1:10. 1:7) at some of the other units that I have talked to.

There has to be some type of conflict of interest here and Im looking for some advice. We are getting very tired of the constant letters and emails, and quite frankly have had it.

What is sad is that the patients are the ones that are suffering here. Who is looking out for the patients best interest? It looks like to me that Fresenius is looking out for their own best interest finacially, and that is very SAD.

I have been fighting with them tooth and nail regarding this, and I want to be able to offer the best system or dialyzers to my patients. Why would I knowingly allow my patients to use an inferior product? I couldn't live with myself.

What if any are my course of actions here. We still have three years left on our contract with them and if I had it my way I would have the Dr pull all of his patients and go elsewhere. This was the worst move we have ever made.

Last Question and I would like someone to answer is. A hemodialysis or PD prescription is a prescription right. There is no difference in writing a script for that then a script for a Ansaid or whatever medication. Its a CLINICAL decision right??? IF its a clinical decision than how can a company demand that you use their products??

Thank you for your time.....

Very upset and getting more upset as time goes forward

Dear Very Concerned:

There is no legal requirement that the very best supplies and equipment be used on any patients. However, the equipment/supplies that is used must be fit for the purpose for which it is being used.

A company that owns (or manages) a clinic will naturally want to use it's own equipment and supplies. I think that you would agree that this would be the approach that most companies would take, believing that it would make economical sense. Hopefully a company that encourages it's facilities to use it's products, is producing a quality product.

However, if you feel that another company's products may be more appropriate for use, then you should approach your doctors or administrator about using (or continuing to use) them. However, be prepared to state and defend your case, backing it up with the facts, from which you draw your conclusions.

A personal opinion that one product is superior over another will be insufficient unless it is backed up by facts. Look to your Q.A. data to back up your opinion that the patients do well using one product and not as well using another product.

You have a tall mountain to climb, if you are going to convince a company that owns or manages a facility that it's products should not be used. However, if you can back up your position that it's product is inferior to other products and therefore the patients are adversely impacted, that the company would listen and investigate your claims.

Good luck,
Mary

Report this to your network. Report this to your congressional representative. If its not illegal it's immoral and unethical to the core. Any company be it Gambro,FMC or any of the others that puts patient rights and safety behind corporate profits should have its Medicare licenses revoked! I guarantee the "right" politician will JUMP all over this!

"Patient Advocate": What is your definition of ethics and morality and therefore unethical and immoral acts? I would be most interested in hearing further from you about your use and your interpretation of those terms. Perhaps you could call me at your convenience. I can be reached at 1-800-371-3114.

Thank you,
Mary Rau-Foster

Thanks patient advocate and Mary for your posts. Mary, if you look at the Morality and Ethical ways of doing business, one has to consider how one Does business. It already proven that the said company has been sited for many unethical practices through their past. But if you look at my first post and then re-read Patient Advocates post they both come together. I have asked for documentation and infection rates From both of my Represenatives, and only one has provided me with the appropriate Documenation. It appears that Fresenius cannot provide me with their infection rates across the board.

I think Patient Advocate feels like I do, that if a company willingly strong arms you into using their product, knowing full well that their product is inferior to the health and saftey of ones patients for increasing ones profits, that is indeed unethical and immoral.

Mary, thats like me coming into your office (My company owns your unit) and selling you syringes that I know are not as good as what your using and I know they may cause high infections due to their design. Just because I own your unit does that make it moral and ethically right for me to sell those products to you. More importantly, like in my case, is it ethically and morally correct for you to use them on your patients just because the company owns you? The company that you buy from right now, has shown you the difference in infection rates and you know there is a possibility of having higher infection rates with using the other products?? As a RN, I ask you, how can you use the inferior product and sleep at night??? As for myself, I can't. Like I said before, the patient is the one that is effected and Im the one who has to look at for my patients, because I took that oath when I graduated from RN school. If I don't look at for my patients, who will?? The patient? No, because they are reling on me, and putting their trust into me that I will do the very best job that I can to help them maintain or prolong their lives. Will the Company who owns my unit look out for my patients?? At this point and time, it does not look like they are looking out for my patients best interest and that is what has me boiling mad right now. They are looking out for their own self interest, which is their botom line. Money and greed has made the Medical Industry the horrific, and irreversable mess that it is in right now.

I shall right my congressmen, and anyone else who I can right. I will also be meeting with my DRs to see if we their some type of legal action that can be implemented in this case.

Mary, if the facts that I have in front of me are true, which I no reason to believe them to be false, then there has to be some type of legal action. My owners have to know these facts as well since they are competitors, and yet they continue to push their products. Yet another sleepness night.

This is simply PUTIRD!!!!

Dear Very Concerned,

Are you aware that Mary is both a nurse and an attorney?

I think you should look very carefully at the data you are quoting. When marketing and data meet, some funny things can happen.

When people who are highly knowledgable in a specialized field and its research look at the same data, they often can point out how data was tweaked to include or exclude variables that will make one product look better than another. If the data shows a true health hazard exists, these people tend to call it to the attention of the FDA.

Sales people know if they show the data to someone who doesn't know what to look for, they can get strong, emotional responses.

Ka-ching $$$$$ !!!

I have worked in this industry for many years both on the provider and manufacturing side. Manufacturers try to differentiate there products through marketing. You have to be very careful when you read marketing materials. Small differences will be highlited and used to sell products. The question I have is who is determining the better product? Based on what criteria? Where is your scientific evidence of a better product? I am extrenely interested in what the product in question is. The ultimate decision in what product is used lies with the physician. You should be having this discussion with that person. Bring him evidence to support your claims.

Dear Very Concerned: Thanks for your initial and follow up posting. I can tell that you are really struggling with this issue. I applaud your concern for the patient and your desire to be an advocate for the patients.

I see my role as an advisory one-- that is to ask questions that will help you find a proper solution to your situation. My role is also one to raise questions of claims that certain actions (or inactions) are illegal or unethical. It is important to truly understand the difference in the terms and what they mean.

I think I may have pushed your button when I questioned the person who signed in as "patient advocate" about her definition of ethics and moral and unethical and immoral practices. Is she one who works with you and is therefore very familiar with the situation you are describing? I suspect that she is not.That being the case, perhaps she was reacting to your perceptions and concerns...and not having first hand knowledge, it is not very helpful to you, or anyone to pronounce judgment on that for which first hand knowledge may be lacking.

Too often, I see people like yourself who are attempting to try and understand a situation or to seek help in correcting a situation, and who attract "well intentioned" but ineffective people who use a situation for their own personal needs and reasons. That does little to help the situation. We are either part of the problem or part of the solution.

As with any of the questions in this forum, like yours, to which I respond, I do not have sufficient information to confirm or deny that your allegations are correct or incorrect. I do have sufficient knowledge about what constitutes unethical and immoral business practices. The fact that one may disagree with marketing practices, including an aggressive campaign to ENCOURAGE facilties to use company owned products, does not give rise to a "credible" claim that this practice, as described above, is unethical.

As an effective patient advocate, it is important to maintain your passion while maintaining your composure. If Ican't get heard because I am shouting or threatening rather than presenting my concerns in a professional and persistent way, I lose the opportunity to truly advocate for the patient. It is the message that needs to be heard and focused upon, not the messenger and his or her delivery of the message.

The question that should be posed is "how can I get someone to listen and respond to my concerns?" The way to make that happen is to present (and I am quoting Sgt Joe Friday from Dragnet) "just the facts".


When you feel as passionate about a situation, as you do, it is easy to let those concerns interfere with the ability to reason things out and choose the best course of action. Anyone, to whom you direct your concerns, be it a congressal representative, the network, or a lawyer (such as myself) will ask you questions to which you must be prepared to respond. That is why I encouraged you to be prepared to back up your claims.

I am not minimizing your feelings nor making light of your concerns. If you believe that there is a problem, and it is reasonably based upon information that you can use to back up your claims,speak out but you will have a better chance of being heard than you will if that information is not being provided by you.

In your example, you indicated that you (as the the owner of the company) were "coming into my office" and selling me syringes that I know are defective and cause infections. You questioned whether that was ethically or morally right. In your first posting, you did not indicate that this was the problem-- is this the case-- if so, have you brought this to any one's attention? You indicated that the company that you are currently purchasing your supplies from has shown you the difference in the infection rates and that they are significant. Have you brought this to the attention of the owners of your company?

In conclusion, you must do what you believe is the right thing to do and for the right reasons. It is important to refrain from allowing your feelings regarding the purchase and/or ownership of your facility to color, interfere or impact your evaluation and judgment of a situation (if that is indeed happening).

As always, attempting to seek assistance or to respond to that request for information in written form is never
the most effective way. I would be happy to talk with you further. Again, I may be reached at 1-800-371-3114.

Take care,
Mary

In response to the comments from "Buyer Beware" and to support comments from Very Concerned, the information which supports the clinical benefits of the product Very Concerned knows is better for the patients has been proven time and time again. It has been proven not only by published in-vitro studies but, by several published independent studies across the country. In addition, after speaking with MANY PD nurses across the country it is a daily reality. It has very much to do with how safe the patient is should the system be contaminated regardless of any "disconnect" features. The sales people are not showing data to people "who do not know what to look for" they are showing it to doctors and nurses who know exactly what the data represents and that data is clear! The fact is, there is a PD system out there designed to be clinically beneficial to the patients and it has been clinically proven to reduce the risk of exit site infection and peritonitis and if it weren't there wouldn't be FMC patients on the system and more going on everyday. So now the question is, if their PD product fails doesn't that mean more patients on hemo for a company who has a large number of dialysis centers, hemo patients, machines and products in the market?? At the end of the day, we are supposed to be doing what's best for the patient and the patient does have a right to some say in that.

Mary: I know a RN at national chain that recently had her performance evaluation. She was downgraded and not given a raise because she was not using enough of the chains product. She has clinical evidence to support her use and her doctors have backed her. Would she have a case under Ohio's brand new RN/Patient Care whistleblower law that was signed 1/9 by the governor. Does she have any recourse with the Attorney General of Ohio?

MAry,

I too am very frustrated. Im being strong armed into using product that I find inferior. The poster before me (interesting party ) has brought up a good point.... Is there anything we as RN's can do? Is the whistle blower legislation onlu in Ohio? I thought this was a clinical decision and not an economic decision. Who is taking care of who?

Was reading thru these posting and would love your opinion on the Ohio RN whistleblower law? Can it apply to a situation where the RN believes the company is putting patient care 2ndary to use of its products? Seems to fit. I believe this is one of the reason that RN's are leaving dialysis in droves. They did not sign up to sign off on their patients......

I just wondered what the final outcome was for Very Concerned. Is FMC still signing your check, are you at the same facility, are you using Fres. or Baxter? If you switched to Fres, has your documentated CQI shown any difference for your facility as opposed to your previous CQI data with Baxter?

Honey,

I did switch a few patients due to the threats of me losing my job and geting a poor evaluation. Those patients who switched almost immediately had peritonitis... I went to my Medical Director and demanded that we switch back to our original provider.....

Make a long story short, we since have pulled away from that National chain, and are using the products and services that we want. Infection rates are back where they should be and everyone is happy!!!!!!!

BRAVO!!!! It's refreshing to see some one stick to their guns and principles. As you read alot of the posting in various discussion boards many of our patients complain about lack of care, inadequate care, and a general lackluster staff. Unfortunately that is what is happening in the industry. As chains continue to roll over the independants the care becomes (sadly) assembly line. I have worked for independants, chains, and hospital based units (bio med) and there is nothing worse than the attitude that we do it this way because "we always have" or someone higher up told us we had to. As professionals and patient care providers we should question not only the products we use, but the service we provide. I hear people talk of continous quality improvement and when I examine their program it is simply QA under another name. I'm glad to see that there are others in the industry that are concerned about the reasons we are here (it's supposed to be about service and care remember). While it is possible to balance quality care and profitability, quality should NEVER be compromised in "name" of profitability.