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Tillamook dialysis closure has patients fearing the worst

Sudden closure of rural Oregon facility by Texas firm leaves patients lacking options for crucial life-saving care
Sterling Hanakahi, 73, and Anita Hanakahi, 70, of Tillamook say they were blindsided when Texas-based U.S. Renal Care executives announced they would close their kidney dialysis center in the coastal community Feb. 23. Anita has relied on the center for the past nine years. For her and 10 other local patients, she said, local dialysis treatment is a matter of life and death. | COURTESY OF ANITA HANAKAHI
February 7, 2024

When U.S. Renal Care closes its Tillamook clinic later this month, 11 kidney patients will no longer be able to receive dialysis treatment in the Oregon coastal community.

Anita Hanakahi, who has received dialysis treatment for the past nine years, predicts that number will dwindle rapidly.

“Two or three people have said they're just going to call it a day, stop dialysis, and go home to be with the Lord in a couple of days,” the 70-year-old Tillamook resident told Oggys Online.

Death seems a viable option when other options are so limited, Hanakahi said.

There are other dialysis centers along the coast, but they are all more than an hour away from Tillamook. Newport is 70 miles away, Lincoln City is 60 miles away, and Astoria is 65 miles away.

Hanakahi said they all have formidable waiting lists. Coastal roads are also often treacherous, especially in winter months, she added, especially for older drivers already experiencing impaired vision and other health conditions.

“We pray before we go on the road,” said Hanakahi.

John Hay, the marketing and communication manager at Adventist Health in Tillamook, echoed Hanakahi’s concerns.

“There are other places, but you also have to be on the lists,” Hay told Oggys Online. “Just because you are on the list doesn't mean there is a space. It's going to be tough on those patients.”

Late last month executives for Texas-based U.S. Renal Care announced the plan to close their facility at Adventist Health's Tillamook campus Feb. 23. The closure comes as demand for end-stage-renal-disease care continues to grow, but dialysis providers have protested federal reimbursement changes

 Ali Leventhal, vice president of communications, refused to answer questions such as how many people would be affected by the company’s plan — a number later shared with Oggys Online by state officials. She emailed a prepared statement blaming Medicare reimbursements and describing the decision as a last resort.

According to Oregon Health Authority spokesperson Jonathan Modie, any dialysis facility that's closing must submit plans to the state "for orderly transfer of patients so that patients can continue to receive regular treatment.”

On Jan. 24 the company sent the Oregon Health Authority a brief notice of its intent to close the facility. A copy obtained under Oregon Public Records Law included no specific plans. 

“Fortunately, there is room at other clinics in the surrounding areas that can accommodate the facility's patient population,” said the letter, which was unsigned. “We are committed to working with each patient and his/her physician to facilitate transfers to a center that can offer the same level of quality care our patients have come to expect.”

In 2019 a group of private equity investors including Bain Capital acquired the company. Last year it refinanced its debt to invest more than $300 million, with an executive quoted saying "these transactions advance our commitment to invest in the future and improve the lives of patients who access kidney care through our more than 400 clinics and 200 home programs."

Facility faced challenges

Records obtained by Oggys Online show that inspectors from the Oregon State Fire Marshal and the Oregon Health Authority visited the facility last August to check its compliance with state fire codes and federal health standards.

“The dialysis facility must be designed, constructed, equipped and maintained to provide dialysis patients, staff and the public with a safe, functional and comfortable environment,” the inspection report concluded. “This standard is not met.”

Specific problems cited by inspectors included:

  • Test solutions for the glucometer were expired.

  •  Floors in the facility were stained. Caulked seams had black stains, with sections of caulk missing, chipping or peeling.

  •  Areas around the wall connector boxes showed signs of water damage.

  •  The countertop of one of the treatment stations showed chips and gouges.

  •  The facility failed to properly identify exits, resulting in “potential for panic and confusion during an evacuation.”

  •  The facility failed to provide fire drills.

Hanakahi said the company's announcement struck her and her fellow patients out of the blue when it was announced last month.

“They were thinking about closing down a year and a half to two years ago,” she said. “They had all that time. Surely, they could have given us more than 30 days in the dead of winter when all the roads are icy. If it had been handled differently, we could have prepared better instead of making rash decisions. It's a bad time to be dropping a bomb like that.”

Public records show U.S. Renal Care had just renewed the facility's license on Oct. 17, 2023. 

Maggie MacKenzie, the marketing manager for the Portland-based advocacy group Northwest Kidney Kids, told Oggys Online the demand for dialysis is increasing.

“We've definitely seen a shift in how many patients there are and how many health-care workers and dialysis techs we have now, and it's just a whole different ball game,” MacKenzie said.

“They can't find dialysis techs who want to do it anymore, and there's just too many patients for them to handle,” she said.

 COVID contributed to the growing dialysis demand, MacKenzie added.

“A lot of people are seeing the repercussions of COVID, even though they may not have the symptoms anymore,” she said. “It does more damage to your organs than people realized in the beginning.”

Increased demand for dialysis treatment will be keenly felt in rural areas outside Portland and the Willamette Valley, she added. “There aren't that many clinics on the Coast, so having one close is definitely not helpful for people who need it.”

Hanakahi said life in rural Oregon is tough enough. "In this community, it's hard to get an electrician or a plumber," she said. “I'm on a waiting list to get a plumber. It just seems that they had a year and a half to mull things over.”

Adventist Health Tillamook President Eric Swanson issued a formal statement of his own on the closure. “It is disappointing that U.S. Renal Care was unable to sustain its business model in Tillamook County, a region where the need for regular dialysis care is critical,” he said in the statement.

He added that hospital officials are looking for long-term solutions to bring dialysis treatment back to the community.

Long-term solutions sound great, Hanakahi said, but short-term solutions are a matter of life and death. She and her husband, a minister and disabled Vietnam veteran, might be able to perform dialysis treatment in their own home, she said, but even that alternative is too long term.

“It takes about a month of training,” Hanakahi said, but the closure happens in weeks. "How are they going to do that?”

She and other soon-to-be displaced patients have been meeting regularly, she added. “We're trying to see what resources we have,” she said. “We're thinking of getting an attorney.”

There is no way to overstate the seriousness of the problem, Hanakahi said. “For two, maybe three, people to say it's time to die is scary.”

Tom Henderson can be reached at [email protected].