3 U. of C. kidney patients die

5 others have allergic reactions to dialysis treatment

By Jerry Crimmins, Tribune Staff Writer.

Chicago Tribune, Saturday, July 17, 1993.

Three women died Friday after they received kidney dialysis treatments at an outpatient facility operated by the University of Chicago Hospitals, and patients who undergo dialysis there have been told to use other sites, hospital officials said.

Five other patients, out of a total of 20 who underwent kidney dialysis Friday at the same outpatient center, at 1161 E. 55th St., suffered an allergic reaction described as itching and hives. They were admitted to the U. of C. Hospitals for observation, said Susan Phillips hospital vice president.

"We ... will be working around the clock to determine the cause of this tragedy," said Ralph Muller, president of the U. of C. Hospitals.

The names of the women who died were not released pending notification of family. The Cook County medical examiner's office is Investigating the deaths.

A hospital statement said all three patients who died "suffered from end-stage kidney disease and had multiple. additional complex medical conditions, including advanced heart disease."

Two of the women who died received their dialysis treatments between 6 and 9 a.m. and the third between 9:30 a.m. and 1:15 p.m., the statement said.
The first woman. age 78, died in the waiting room at the 55th Street dialysis renter at 10 a.m.

The second, age 56, returned home before she began to feel ill and was taken to Jackson Park Hospital, where she died.

The third, age 80, went into heart fibrillation In the ambulance that takes her to and from dialysis. She was pronounced dead at 4 p.m. in the emergency room at Bernard Mitchell Hospital, part of the U. of C. complex, hospital officials said.

People whose kidneys have slopped working undergo dialysis about three times a week to remove accumulated toxins from their blood. In the process, Phillips said, a patient's blood is run through a series of fillers in the dialysis machine, and the blood "is essentially washed and goes back into the patient."

Fluoride blamed in dialysis deaths

By Jerry Crimmins, Tribune Staff Writer.

Chicago Tribune, Saturday, July 31, 1993.

The deaths of three kidney dialysis patients who used the same dialysis center operated by the University of Chicago Hospitals July 16 were caused by "acute exposure to excess fluoride in the water" used for the treatment, a preliminary investigation has determined.

U. of C. officials announced that finding Friday in the midst of their investigation being conducted in cooperation with officials from the Centers for Disease Control and the Illinois Department of Public Health.

Three women died and six other kidney patients suffered an allergic reaction after they underwent dialysis July 16 at the U. of C. dialysis center at 1164 E. 55th St.

The levels of fluoride found in the dialysis water system at the center were "very high," much higher than that found in Chicago's drinking water, hospital officials said. They said the system used to filter fluoride out of the tap water used for dialysis apparently had failed.

The excess fluoride caused heart failure in the three who died because it interfered with the body's electrical system, which makes the heart beat, said Susan Phillips, hospital vice president.

Those who suffered an allergic reaction were admitted for observation to the U. of C. Hospitals and subsequently released.

Phillips said Chicago area residents who drink tap water with a small amount of fluoride added to prevent tooth cavities have no reason to worry.

A person who drinks a lot of water might drink about two quarts a day, she said, or 3½ gallons of water per week. In contrast, kidney dialysis patients use about 300 gallons of water per week. she said.

"Because dialysis patients are exposed to high volumes of water, these patients can accumulate potentially harmful amounts of fluoride if the water is left untreated. Consequently, dialysis water systems have special equipment to filter out fluoride," said the hospital's statement.

But at the dialysis center on 55th Street, the filtering process for some reason did not work, and instead high concentrations of fluoride were released into the water used by the patients, the statement said.

"This tragedy has deeply affected every one of us at the hospitals, and our hearts go out to the families of those patients who died," said Ralph Muller, president of the U. of C. Hospitals.

Fluoride blamed in 3 Deaths

Traces Found in Blood of U. of C. Dialysis Patients

By Gary Wisby, Staff writer.

CHICAGO SUN-TIMES, SATURDAY, JULY 31, 1993.

Fluoride poisoning was blamed Friday in the July 16 deaths of three dialysis patients at the University of Chicago Hospitals.

Hospital spokeswoman Susan Phillips said symptoms suffered by the victims - and by six other dialysis patients who developed symptoms similar to allergic reactions - "were consistent with fluoride exposure."

Traces of the chemical were found in patient' blood serum and in water samples taken at the treatment center at 1164 E. 55th. Phillips said.

Small amounts of fluoride are added to city water to help prevent tooth decay. A series of devices used to purify the water used fur dialysis somehow failed to do so, Phillips said.

Hospital president Ralph Muller said, "We will continue our investigation."

The finding was confirmed by the federal Centers for Disease Control in Atlanta, which is assisting in the investigation along with the Illinois Public Health Department. In addition, samples were tested by laboratories from around the country, Phillips said.

The victims were Beulah Wynn, 56, of the 1400 block of East 69th Street; Ardelle Bell, 78, of the 6200 block of South King Drive, and Mattie Lee, 80, of the 7200 block of South Euclid Avenue.

All Suffered from advanced heart disease in addition to the kidney disease that necessitated the blood-cleansing dialysis process.

Exposure to high fluoride levels is rare. But because large volumes of water are used in dialyzing kidney patients, they can accumulate harmful amounts of fluoride if the water is untreated.

Water cleanliness standards are based on exposure by healthy people to 14 liters a week. Dialysis patients use more than 300 liters a week.

'I'he U. of C. Hospitals' water purification system uses deionizers, reverse osmosis, water softeners and three filtration methods. "We're looking at the entire system," Phillips said.

The 55th Street facility will lie closed until the investigation it completed. Until then, its patients will be treated at the hospital, which has a separate filtration system, or a second off-site dialysis center.

Phillips said none of the hospital's 250 dialysis patients, who undergo the process three times a week, have cancelled appointments since the deaths occurred.

The death rate for dialysis patients is 26 percent a year in Illinois. The rote al the U. of C. Hospitals fell from 17 percent in 1989 to 11 percent last year, officials said.