DaVita's Lufkin Dialysis Center in 2007 did not have the required number of properly trained personnel present to meet the needs of patients, according to a state health survey conducted nearly a year ago.

An expansion survey conducted by the Texas Department of Health and Human Services on July 18, 2007, indicated the DaVita clinic at 700 S. John Redditt Drive had not adequately staffed its facility and had not given patients the correct prescribed treatments as ordered by a physician. The report was one of several documents released by the state in response to an open records request from The Lufkin Daily News.

A Davita spokesman did not immediately comment on the reports. The spokesman, Michael Chee, has said the company's staffing model has "never deviated from state-mandated staffing requirements."

A recent spike in patient deaths prompted the facility to close its doors April 28. It remained closed Monday pending the outcome of investigations by the Texas Department of State Health Services, Lufkin Police Department and the federal Centers for Disease Control and Prevention.

In the survey conducted in 2007, two clinic employees told a state surveyor they were administering treatments against a physician's order, under the order of a supervisor.

"Both employees said they were instructed to do so by the charge nurse," the report stated.

A charge nurse told the surveyor the facility administrator made the recommendation.

The state surveyor also noted that while she was present, the center ran out of a mix used to treat water before administering dialysis to patients, the report stated. An employee told state health surveyors the only person who knew how to properly mix chemicals to treat water at the facility was also responsible for another facility in Livingston, and was not in Lufkin that day.

The facility administrator was notified of the problem and recommended that patient treatments be altered, the report stated.

"Surveyor informed employee No. 8 around 12:15 p.m. of the concern for patients being placed on the 1K acid instead of the prescribed (amount)," stated the report, which includes patient information withheld by state officials. "The interview with the Charge Nurse revealed that after the surveyors concerns, the facility had some individual jugs of (info withheld) and they began switching patients at about 12:40 p.m. back to the prescribed (amount)."

"A review of the list of patients found 22 (out of 22) patients were being dialyzed with the incorrect dialysate," the report stated.

The surveyor also noted the facility was administering treatment at 32 of its stations — an expansion which had not yet been approved, the report stated.

An exit interview between the state surveyor and a facility administrator stated the staff had been made aware of the problems, the report stated. The report listed a corrective plan of action to be taken, and the plan was accepted by the state Aug. 1, 2007.

State health department spokeswoman Carrie Williams said a surveyor stayed on site July 17 until all corrections were made. The surveyor returned to the facility Aug. 22 and noted that the company's corrective plan had been implemented.

"She went in and all of the items had been corrected," Williams said Monday.

The state considers the deficiencies in the 2007 report as serious, the spokeswoman added.

Roberta Mikles, a patient health care advocate and registered nurse based in California, looked over the surveys Monday at the request of The Lufkin Daily News. She said the type of deficiencies the surveyor found at DaVita's Lufkin facility in 2007 are "very serious infractions."

"I'm just blown away by this. It is just absolutely, positively deplorable," Mikles said.

"When such safety concerns as this are found where patients' lives are placed in jeopardy — especially if their blood potassium level does not warrant a 1K dialysis — it places a patient in jeopardy of having cardiac problems," she said. "Right there you've got a charge nurse that does not have the judgment to know a 1K could kill patients. There should not be any RN in any unit that does not have good judgment when it comes to a situation like this."

Surveys conducted in 2003 and 2006 stated the facility was also non-compliant with state health standards.

"While touring the reuse area of the facility and observing the reuse process, it was determined that the reuse technician did not reprocess used dialyzers according to AAMI standards and the company's own reuse procedure," stated a report conducted April 8, 2003.

The report from that date also stated staff did not have proper training and competency.

A follow-up survey of the facility conducted two months later, on June 2, 2003, noted the center had not corrected infection control problems previously documented.

Williams said the state revisited the facility in July and determined all of the deficiencies had been corrected.

A document made by the surveyor during a revisit to the facility was not included in the open records request for copies of original surveys.

A survey conducted May 23, 2006, stated the facility did not properly document test results for water or a discharge summary of a patient who died. The date of the patient's death was withheld from the survey, but the survey did state that the discharge summary on that patient did not include cause of death or place of death.

Information on several pages of the documents provided to the paper was blacked out because of a pending ruling from the Attorney General's Office on open records rules. Portions of the report, which are said to include medical records, names and quality of care information, are being withheld from the public.

Williams said the state conducts regular surveys of dialysis facilities in compliance with state and federal rules and regulations.

"We look closely at everything from paperwork to patient care. We survey these facilities every three years as well as conduct on-site complaint investigations," she said.

A state health report is expected to be released in the coming weeks regarding a recent investigation into regulatory compliance at the facility.