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CASPER, Wyo. — Two people who work at U.S. Renal Care’s location in Casper told the Casper City Council on Tuesday that the clinic is experiencing problems involving patients being forced to miss dialysis treatments or be taken off dialysis too early due to the city’s door-to-door transportation service schedule, known as “Casper ASSIST.”

U.S. Renal Care Administrator Linda Smith and Social Worker Cathy Cywinski asked the city council if anything can be done to help ensure dialysis patients are able to make it to the clinic and stay through the end of their treatments once there.

Cywinski told the city council that since May 2021, the clinic has been asked to take patients off of dialysis treatment early 18 times in order for those patients to be able to get a ride back from ASSIST. She said there were four times that ASSIST dropped patients off late, causing them to miss dialysis treatments, and five times that patients had been unable to make their appointment at all due to ASSIST being closed.

She said that ASSIST’s inability to go to Mills, to go to the west end of town, and to provide service on Saturdays has left patients struggling to find transportation.

Cywinski said that she and Smith have reached out to ASSIST to see if anything can be done, but have been told that the transportation service is forced to stick to the operating budget they have been given by the city.

Dialysis is a treatment people rely on when their kidneys are not functioning properly. The treatment removes waste products and excess fluid from the body. Cywinski said that the treatments typically last 3-4 hours and patients typically receive those three days per week.

“Missed treatment and shortened treatments, even by 15 minutes, are devastating to these patients,” she added. “They become weak and tired, have poor appetite, nausea, they can have the taste of ammonia in their mouth and have swelling of the heart. Even one missed treatment or one shortened treatment can cause the individual to wind up in the hospital or even die.”

Cywinski added that U.S. Renal Care tries to ensure that patients are finished with their treatments in time to get transportation service from ASSIST, but that there are times when it is not possible to finish treatments without delays, such as a patient who is having a difficult time stopping bleeding.

“Transportation should never be a reason that people are not getting their prescribed treatment,” Cywinski said, adding that if the problem is impacting the U.S. Renal Care clinic, it is probably impacting other places that provide services to people in the community.

Council member Kyle Gamroth asked whether the clinic has noticed a change in patients’ ability to get to appointments since the City of Casper took over operation of the transportation services from CATC in May 2021.

Smith and Cywinski said that they only joined U.S. Renal Care in early 2021 and did not have data prior to May 2021 regarding the number of patients missing appointments or being forced to leave early.

Gamroth asked whether they were aware of any reimbursement programs the city could participate in in order to help cover the cost of providing transportation to patients outside of the hours and areas the ASSIST service currently offers.

Cywinski said that she was not aware of such programs. She said that U.S. Renal Care had reached out to churches to help provide transportation. She said that churches have expressed a desire to help but that their ability is limited as they are providing care to people in other ways.

Council member Bruce Knell asked whether the clinic could reschedule patients who rely on ASSIST to ensure they can rely on the transportation service to get to their appointments and have those fully completed before needing a ride home.

Cywinski said that the clinic tries to schedule people as Knell suggested but that there is still the problem, which is sometimes unavoidable, of people getting off of dialysis treatment late and it being too late for the bus to take them home in time.

“I apologize if I come off without a heart here, because that is certainly not the case,” Knell said. “This is a taxpayer-funded, government-funded entity that only has so many dollars. … I know for a fact that our budget is stretched to the limit.”

Knell said that he “appreciates the plight,” but said he thinks the council’s ability to help address the problem may be limited due to budgetary constraints at the city level.

“At some point we may have to put some responsibility on the people that are getting the care themselves,” Knell said. “I’m sorry to have to say that, but it is literally the truth.”

Council member Jai-Ayla Southerland asked for clarification about what adjustments could help ensure patients can make it to appointments and stay until they are finished with dialysis treatments. She asked whether the request was to have ASSIST offer extended hours, service on Saturdays and expanded access to Mills and the west side of town.

Cywinski said that extended hours is part of the request, but that even the ability for ASSIST to wait 15 minutes at the end of the day could help. She added that the expansion of service area and offering service on Saturdays would also help.

Mayor Ray Pacheco said that he thinks the city council should discuss the matter further and see if there is something that can be done, adding that he doesn’t think the experience of U.S. Renal Care patients having trouble finding transportation is unique to that clinic.

“I would say come budget time, I think the city needs to figure this out,” Pacheco said.