What is dialysis exactly?

Dialysis is a dangerous but life-saving procedure in which a patient’s blood is taken out, cleaned, and then put back into their body. Dialysis must be done three times a week with each session lasting three to four hours. For people with end-stage renal disease it must be done for the rest of their lives or until they get a kidney transplant.

Why should I care about dialysis?

More than 80,000 Californians receive dialysis treatment in clinics every month. The chance that you or someone you love will need dialysis is growing in California as people live longer and more people have underlying diseases like hypertension, coronavirus, or diabetes that can lead to kidney problems. In some cases, COVID-19 can lead to kidney problems.

The Dialysis Industry

How many dialysis clinics are there and who owns them?

There are more than 650 dialysis clinics in California. Two large corporations — DaVita and Fresenius — monopolize the dialysis market in the United States and in California as well, where they own 73% of the clinics.

Where are these clinics located?

Most of them are located in strip malls or other remote locations, often nowhere near a hospital.

So, they must be low-profit operations, right?

Actually, the clinics are making huge profits. The operating margin for the dialysis industry in California is more than ten times higher than the hospital industry in California. In 2021, DaVita and Fresenius, the two corporations that own 73% of dialysis clinics in California, made combined profits of $415 million from their clinics in the state. 

Who actually takes care of patients during their treatment?

The primary patient care is performed by Patient Care Technicians (PCTs) who are generally paid little more than minimum wage. Clinics also have at least one Dialysis Nurse overseeing the care of the patients, but with no minimum staffing regulations for PCTs, the caregivers are often overwhelmed providing care for multiple patients at a time.

Dialysis Clinic Safety

Do clinics have doctors on site?

While every clinic has a medical director, they are not required to be on site. Nephrologists (doctors who specialize in kidney care) are only required to see their patients at the clinic once per month. Clinics are required to have a Registered Nurse on site.

Why does having a doctor, nurse practitioner, or physician assistant on site matter?

A doctor, nurse practitioner, or physician assistant on site will be able to respond to emergencies such as cardiac arrest, bleeding, dangerous fluctuations in blood pressure, and other common problems associated with dialysis treatment. They will also oversee the quality of care, make sure procedures are followed, consistently assess the overall condition of the patients, and watch for signs of potential problems.

Most dialysis patients are medically fragile and often have other health issues. Currently, when serious problems occur most clinics just call 911, which puts patients at risk and contributes to ER overcrowding.

Can clinics afford to have a doctor, nurse practitioner, or physician assistant on site?

Two big dialysis corporations dominate the industry, and clinics have operating margins more than 10 times higher than hospitals in California. They could invest in better care and safety — like having a doctor, nurse practitioner, or physician assistant in the clinic whenever patients are being treated — and still make large profits.

Are clinics currently required to report infections or other problems with sanitation or hygiene to the state?

No, right now they don’t have to. Patients have reported seeing bloodstains, cockroaches, and other sanitation problems in their clinics. Problems with sanitation and hygiene could put patients at risk of infections.

Why does reporting matter?

The public has a right to know about infection rates at clinics. Patients and their family members have a right to know if they will be safe getting treatment in a dialysis clinic and to make informed choices about where to receive care if there is more than one clinic available to them.

Ending Unequal Treatment

How are dialysis patients treated unfairly?

Many dialysis patients have reported unequal treatment if they have Medicare instead of private insurance. They sometimes have to wait longer for treatment while patients with private insurance are treated first.

Why do clinics give priority to patients on private insurance?

It’s simple: clinics make more profit off patients on private insurance — a lot more. It’s estimated that clinics mark up the cost of care by 350% for patients on private insurance. That markup boosts their profits and ends up raising premiums for the rest of us who are on private insurance.

Who’s for Prop 29? Who’s against it?

Who’s supporting Prop 29?

In 2016 dialysis patients and clinic workers came together to try to make improvements to patient care and safety in dialysis clinics. They worked to increase staffing, ensure more recovery time for patients, and end profit-increasing schemes to move patients from public to private health insurance. The patients and clinic workers are supported by the 97,000 healthcare workers in SEIU – United Healthcare Workers West.

Who’s behind the “No on Prop 29” campaign?

The two corporations that dominate the industry — DaVita and Fresenius — have done everything possible to keep their huge profits flowing by stopping patients and workers from making improvements to dialysis care. In 2020 the “Big Dialysis” corporations spent over $100 million just to defeat Proposition 23, which like Prop 29 would have implemented better protections for dialysis patients in California. Those same corporations are fighting Prop 29 and have already put $36 million into defeating the initiative.