UC Davis Health becomes Mendocino County’s kidney care lifeline

(SACRAMENTO)

When kidney patients at the small community hospital in Ukiah need a nephrologist, he rolls in on a cart - his image beamed to life on a video screen from UC Davis Medical Center in Sacramento, three hours away.

Nurses wheel the cart from room to room at Adventist Health Ukiah Valley, the 50-bed hospital in a rural and scenic region where rolling vineyards fade into redwood forests.

Mendocino County, northwest of Sacramento, lacked access to a nephrology specialist until UC Davis Health partnered with Adventist Health Ukiah Valley to offer kidney care through video consultations.

Mendocino County has long struggled with a shortage of medical specialists. The closest nephrologist is at least an hour's drive away. So patients who need kidney care face long trips for treatment or consultations - even farther if their insurance is limited.

UC Davis Health fills the gap in access with its telenephrology program, a critical link that extends specialty care into hospitals that don't have it onsite.

"The best part of living in rural communities is the fact that you get to live away from the big, urban areas," said Kristen Marin, the director of critical care and trauma services at Adventist Health Ukiah Valley. "However," she added, "it comes with its challenges, and part of that is access to care."

She describes the UC Davis telehealth program as "the next best option" to in-person care.

"This partnership is not only valued by the patients and their families," she said, "but also, from a care provider, it's exactly what you want to see in a rural community or in a rural hospital where Adventist Health is committed to caring for patients close to home."

Chronic kidney disease on the rise

UC Davis has been a leader in telehealth since the 1990s, connecting with more than 200 clinics and hospitals across a 33-county coverage area. The real-time consultations on video or phone involve nearly 50 specialties.

Nephrology is a newer specialty for telehealth, due to the deepening shortage of nephrologists, especially in rural settings where chronic kidney disease is on the rise.

And because many local residents here lack primary care providers, kidney disease may go undetected until a serious medical event occurs.

"That means patients find out about end-stage renal disease on a trip to the emergency department," said Clay Martin, who manages the busy Dialysis Clinic, Inc. (DCI), in Ukiah. "They have no idea their kidneys are failing. They'll just start feeling the effects of kidney failure without understanding what's really going on."

Those are the life-changing moments when UC Davis Health nephrologists Nandakishor Kapa and José Morfín enter the scene.

Morfín, the telenephrology medical director, is often the first care provider to meet with newly hospitalized patients who are shocked to learn of their condition.

José Morfín, shown on the left screen, is one of two UC Davis Health nephrologists who offer video consultations to nurses, doctors and patients at Adventist Health Ukiah Valley, located in a rural region without kidney specialists.

He explains what kidney disease is: when the two bean-shaped organs in the lower back can't filter blood as well as they should.

He helps patients understand what may have contributed to it, often high blood pressure or diabetes, and sometimes trauma or genetic factors.

He recommends ways to manage their health, from nutrition guidance to dialysis treatment and, when appropriate, kidney transplants.

Much of what Morfín does is educate people about a disease they don't fully understand.

He leans into the video camera to speak with compassion.

"People will hear this news, 'you need dialysis,' as if it's cancer, it's paralyzing for them."

But he stresses that kidney disease is manageable and that going on dialysis is a temporary "bridge" before more lasting treatment such as a transplant. He then connects them with resources such as UC Davis Health educational videos and hospital staff who can help patients navigate disability insurance.

A partnership with multiple benefits

UC Davis Health has provided telenephrology to Mendocino County patients since 2021, when Adventist Health requested the program.

It was a win-win-proposal, Morfín said: "The ask was in alignment with our core mission values."

The program provides round-the-clock video consults, remote dialysis oversight, real-time support for primary care physicians in the hospital and continuity of care for complex cases.

UC Davis Health offers nephrology video consultations for kidney patients in Ukiah and surrounding communities so they no longer have to travel outside Mendocino County to seek specialty care.

So far, the program has helped deliver more than 1,000 dialysis treatments at Adventist Health Ukiah Valley. That alone has saved the hospital money by not having to transfer patients to dialysis clinics or medical centers in places such as Santa Rosa, St. Helena, San Francisco and Sacramento.

The dialysis treatments at Adventist Health Ukiah Valley mostly take place in the eight-bed intensive care unit (ICU), when patients are sick enough to need it. Critical care nurses are specially trained to operate the portable dialysis machines, with UC Davis Health specialists available on demand.

Nephrologists appear on screen for any nurse, physician or patient who needs them.

"It's like a little rolling cart, we just bring it and introduce him: This is Dr. Morfín, he's our nephrologist, he works out of UC Davis," explained Erin Ford, an Adventist Health nurse for 20 years.

"What he's been able to provide is super helpful because, even though he's not quite here in person, it almost seems like he is," Ford said. "I think we're super lucky to be partnered with UC Davis."

Kristen Marin, the ICU director, said Adventist Health Ukiah Valley is the only hospital in Mendocino County with inpatient dialysis. And that, she added, means patients can promptly get the treatment they need and heal near their family.

"Dr. Morfín has brought services to this hospital, to this county, that would otherwise have to go out of county and that is huge," Marin said.

"This is allowing us to care for our community here, and that's important. We know that patients do better when their families are close to them. We're focused on family and patient-centered care - that's important to us in rural Ukiah."

A day-in-the-life of a telenephrology doctor

Dr. Morfín has been with UC Davis Health since his nephrology fellowship in 2006. He's drawn to the mission of expanding access, advancing health equity and improving the health of medically underserved residents throughout northern and central California.

"The whole reason I went into nephrology is to work with marginalized communities," he said. "There's a workforce gap between patients and providers, and rural communities are especially impacted."

Morfín typically sees in-person patients at the Folsom Medical Care Clinic and the Ellison Ambulatory Care Center on the UC Davis Health Sacramento campus. He also frequently visits patients at a dozen dialysis clinics in greater Sacramento.

But he'll take the Mendocino County video calls from anywhere, anytime. Sometimes it happens in the middle of workouts and twice it happened while he was on vacation in Mexico.

In addition, he drives to Ukiah every three months to meet with hospital staff and patients at the DCI clinic down the street. He chats in Spanish and English with men and women of all ages who sit in large medical chairs and who are tethered for a few hours by catheters and tubes to dialysis machines in a large room full of them.

On a recent visit to DCI, where hemodialysis machines perform the work of kidneys - filtering waste, excess fluid and toxins from the blood - Morfín stops to greet people he normally sees on a screen.

A woman bundled in two blankets tells Morfín that she leaves dialysis sessions heavier than when she arrives. Morfín opens her medical record and instructs clinic staff to extend her treatment time so the machine can remove more fluid.

A middle-aged man wants a kidney transplant. Morfín advises he needs to be more consistent with his appointments and medication.

Jesús Andrade, 46, a nephrology telehealth patient from Ukiah, meets with his kidney doctor José Morfín during a post-transplant appointment at the UC Davis Health 48x Complex in Sacramento.

UC Davis gives new life to a kidney patient

There are many success stories from the past five years of how telenephrology has improved patients' lives. Perhaps few as compelling as that of Jesús Andrade, a 46-year-old landscaper who learned of his kidney problems when he offered to donate a kidney to his wife.

Andrade, who lives in Ukiah, was visiting his wife in Mexico and undergoing evaluation to determine if he'd be the ideal candidate for her transplant.

"During the screening they discovered that I, myself, had kidney disease and couldn't be a donor," Andrade said. "It was very difficult news - we learned that both of us were facing serious problems with our kidneys."

He went on dialysis for more than two months in Mexico, until doctors deemed him stable enough to return to California.

Once in Ukiah, Andrade continued thrice-weekly treatments while Morfín referred him to the transplant team at UC Davis Health. Social workers, meanwhile, worked to fix a glitch in Andrade's Medi-Cal insurance.

On March 16, Andrade was wheeled into an operating room at UC Davis Medical Center where he received a donated kidney from his sister.

"My life since the transplant has completely changed," Andrade said. "I feel good, I feel normal."

During his recuperation phase, Andrade is focused on a strict, to-the-minute medication regimen. He's very careful about hygiene, eating the right foods, and he gets regular lab work to allow his body to adapt to the kidney.

He recently reflected on his experience following a post-transplant appointment in the UC Davis Health 48X Surgery Complex. He sat on a tall chair outside the specialty clinic to share an experience he said he will never forget:

A couple of weeks after the transplant, Morfín stopped by DCI to round on patients. When he noticed Andrade's chair sitting empty, he worried that something might be wrong. "He called and asked how I was doing," Andrade said. "I explained that I got the transplant and I was home recuperating. He was so happy to hear the news. That really moved me because it reflected the genuine interest that he always had for me."

Andrade said he's "deeply grateful" to his entire UC Davis Health care team because he feels cared for and supported. "They are a group of professionals committed to helping people when they need it most."

He continued: "Thanks to them, I received a second chance. They gave me my health, my hope, and the opportunity to continue moving forward with my life."