The state health department will require a Lufkin dialysis center to appoint four staff monitors to its facility before it can be approved for reopening, according to a letter from the state to the facility.

In a May 16 letter to a division vice president of DaVita, the Texas Department of State Health Services said a licensing survey conducted May 13 found the facility had potentially serious or life-threatening risks to patients — requiring the highest level of corrective action to be carried out for reopening. The letter was released Tuesday in response to an open records request from The Lufkin Daily News two weeks ago.

DaVita has 10 days from May 28 to submit a corrective plan of action to the state for it to approve the facility reopening, said state spokeswoman Carrie Williams.

The letter from the state recommended two nurses, a physician and dialysis technician, by name, that the Lufkin facility should appoint to monitor its staff. The letter also included a list of consulting groups approved by the state to monitor the facility.

DaVita has been working "quite aggressively" with the state since the letter was sent to the facility in mid-May, said company spokesman Michael Chee.

The company has retained all four monitors the state required and is now working toward a re-open date with the state, Chee said. The facility has not yet been approved to be open.

"As we clearly interpret this letter, the state obviously allows us to reopen at a date that we hope is in the near future," Chee said. "We view this as very positive because if the state had any concerns they obviously would not express their intentions about allowing us to reopen."

The center at 700 S. John Redditt Drive voluntarily closed its doors April 28 and contacted officials about a spike in patient deaths and complications, Chee said. The number of patient deaths has not been released by the state, local police or any other investigating department.

Lufkin police on Friday arrested a nurse who had worked at the facility and charged her with injecting two patients with bleach the day the center closed. DaVita fired Kimberly Clark Saenz, a 34 year-old licensed vocational nurse from Pollok, April 29, and also suspects she is connected to four patient deaths that month, Chee said. Police have not filed any charges against Saenz in connection with any patient deaths at the facility. DaVita has turned over all its physical evidence to police in order to make that determination, Chee said. Police have said they are continuing to investigate.

Saenz was arrested Friday on two counts of aggravated assault for allegedly injecting two patients with bleach. She bonded out of Angelina County Jail Monday night on a reduced bond of $100,000, according to a jailer. Her nursing license has been temporarily suspended by the Texas Board of Nursing, and bond restrictions prohibit her from working with patients and administering medication.

Attempts to reach Saenz's attorney for comment Tuesday were unsuccessful.

In the state's letter to DaVita, the monitoring physician, among several things, will be required to oversee facility operations and staff qualifications, training and practices, "including ongoing education and verification of competency." That monitoring physician will also conduct a thorough facility mortality review "to evaluate the statistically significant high Standard Mortality Rate," the letter stated.

A two-person team of monitoring nurses will be required on site, including one nurse there for five days a week during the first month, to "ensure patient safety."

A technician monitor will be required to review the facility's existing water treatment system, dialysate delivery system and machine maintenance practices in addition to other policies, the letter stated. DaVita will pay for the monitors at its facility, Williams said, and none of the monitors has previously worked at the company.

An evaluation of the center within that first month will determine if further on-site presence is needed, the letter stated. The facility will be required by the state to file written monthly reports until the completion of the corrective action plan is fulfilled by state standards. The state is also requiring DaVita to send a copy of the survey report conducted in May, when it is made public, to all of its patients.

"We don't know what determinations the state is ultimately going to make," Chee said. "We have a mutual interest regardless of the findings in ensuring that when the facility reopens we are all comfortable that the issues have been addressed, patients will be safe, and we can begin providing dialysis care again."

The center has had a history of being non-compliant with state standards, according to state surveys obtained by The Lufkin Daily News through open records.

A survey conducted in July 2007 at the Lufkin center stated staff had administered treatments to patients against doctors' orders. The surveyor noted she discovered the errors and told the facility administrator. She remained at the facility for the day until patient treatments were corrected, a state spokeswoman said. The surveyor returned a month later and documented that the facility was in compliance with its corrective plan of action.

Surveys conducted in 2003 and 2006 showed reuse technicians were not properly reprocessing used dialyzers according to AAMI standards and the company's own reuse policy. A follow-up survey to the 2003 report found the center had not corrected infection control problems. Another follow-up survey conducted a month later found the center was in compliance, a spokeswoman said. A follow-up report to the 2006 survey also found the center had complied.

Chee has called those survey reports isolated incidents, saying there is no connection between those reports and the current investigations.