Scotland Dialysis Unit Improves Treatment While Saving Money

Monday, April 29, 2019 - 9:00am

The walls are white, the counters are antiseptic and the recliners are set comfortably next to treatment stations.

It looks like a typical medical outpatient clinic.

But this dialysis unit sits on the other side of barbed wire and heavy, steel electronically-controlled locked doors. The waiting room is occupied by a uniformed officer.

It’s in a prison.

The long-planned new kidney dialysis unit at Scotland Correctional Institution opened today (April 29), and will be able to handle up to 72 male dialysis patients a week.

With two shifts a day, Monday through Saturday, the unit will become the main dialysis treatment center in the state prison system. Until now, dialysis was performed at Central Prison, North Carolina Correctional Institution for Women and Hoke Correctional Institution in Raeford.

Treatment for 62 male offenders now will be consolidated at the prison in Scotland County, and those qualifying offenders will be transferred to that prison. Some dialysis treatments will continue at the NCCIW for female patients and for a few patients at Central Prison.

Consolidating the bulk of dialysis treatments at the Scotland facility will save taxpayers more than $400,000 a year, said William “Bill” Lucas, a business officer in the state prison’s health services section.

Doing most of the treatments at one prison facility saves on training time and transportation costs. It is substantially less expensive than providing dialysis for offenders at private medical clinics. And this way is safer for the community because offenders do not have to be transported to outside clinics for dialysis.

“This is quite a challenge,” said Scotland CI Assistant Superintendent Dean Locklear. “This is very specialized treatment.”

With 36,000 incarcerated offenders, the state prison system is equipped to handle most medical issues that arise from the population of a small city, albeit one scattered throughout the state in 55 prison facilities.

Appendixes and tonsils are removed, bones are set, surgeries are performed, teeth are extracted, diseases are diagnosed and medicines are dispensed. Mental health therapy is conducted and end-of-life hospice care is provided.

More than 2,000 doctors, specialists and nurses are either on staff or on-call throughout the prison system. This level of treatment, known as the community standard of care, is required by federal law and the U.S. Constitution. 

Kidney dialysis is one of the most specialized, detail-oriented of medical treatments, becoming more common as the state’s prison population ages and offenders in greater numbers arrive with, or develop, chronic kidney disease from hypertension, diabetes, congenital/hereditary causes or a history of drug abuse.

Treatment options are limited for patients with end-stage renal disease.

“At that point, the options are dialysis, a kidney transplant or death,” said Rebecca “Becky” Kennison, a health care contractor with NaphCare who works at the Scotland unit and has 33 years of experience in dialysis. “They need treatment three times a week for the rest of their lives or until they get a new kidney.”

The new dialysis unit was designed by medical professionals to meet treatment needs with flexibility to handle a few almost a dozen additional patients if necessary.

The unit is staffed with dialysis-trained doctors and nurses. In addition, a nephrologist, who specializes in kidney diseases, sees each patient at least once every two weeks. 

Each treatment lasts roughly five hours. Nurses closely watch for infections. Patient blood pressure is tracked by a state-of-the-art electronic monitoring system.

A charcoal-filtered, 250-gallon purification tank removes chlorine and impurities from the water used in the procedures. A computerized reverse osmosis device provides final filtration before the extremely pure, pressurized water is pumped to the dialysis machines at the treatment stations.

The machines combine bicarbonate and acid solutions to reach the levels of calcium, magnesium and potassium tailored to meet the treatment needs of each patient.

The process is high-tech, detail-oriented and carefully calibrated to remove impurities from the blood and flush them from the body in an antiseptic, controlled environment.

Because prison is another controlled environment, patients are escorted to and from dialysis treatment through layers of locked doors by correctional officers, and one is stationed in the waiting room. 

Restraints are sometimes necessary to maintain control.

While this is a medical treatment unit, all needles are counted (and accounted for) at least twice a day. This is, after all, also a prison. Safety first.

“We are constantly striving for efficiencies and cost savings while fulfilling our primary mission of protecting the public,” said Director of Prisons Kenneth Lassiter. “Our staff works diligently to provide community standard of care and I’m proud of the work they do day in and day out.”

John Bull