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Wednesday, May 31, 2017

Too much power in too few hands - in dialysis clinics as well as our government.

Much of what is wrong with this country right now is due to too much power being in the hands of too few people - or companies.  Companies are free to be more merciless than actual people because, of course, there is no one person (with a conscience we hope) to place responsibility on. So if you complain, or sue, it's "policy" set by the "shareholders" or some "committee" and there is no recourse.  

Corporations wield a disproportionate amount of power in our government.  Their money, one way or another, purchases the representation they want.

Two corporations, DaVita and Fresenius, between them, provide 70% of the dialysis in the United States. 

Back in the 70s a group of physicians, tired of watching their kidney failure patients die for lack of money for dialysis, went to Congress.  Medicaid was expanded to cover dialysis 100%.  I think this needs to be done for every chronic disease, from cancer to fibromyalgia, but please do not hate people with ESRD simply because they do have the near universal medical coverage every single American ought to have. Because there's a dark side to it that I'm about to tell you about.

So - dialysis is big business.  We (via our government) pay about three times as much per treatment in the United States as in any other developed country. The same treatment, with the same machine, the same supplies, as they get in the other countries - generally even from the same two corporations; DaVita and Fresenius.

The care we receive for that big payment is dismal. I am thoroughly disliked at my husband's dialysis clinic, because we monitor every treatment, every change, every prescription.  We ask questions, and we do not hesitate to call the ESRD Network with complaints.  And, of course, you can see there are many blog posts here about the poor care he receives. When I spoke to other medical professionals, other patients and their caretakers, I am told that pretty much all dialysis clinics are the same - or worse.

Part of the reason for that dismal care is that dialysis patients are being treated by people with a high school diploma and a few weeks in clinic training.  They are getting a little bit over minimum wage. They have (maybe) one RN on duty and that one highly trained person is responsible for watching over, well, I don't know how many - 20 or more patients at a time I suspect.  (Yes, it's true that some of the technicians have far more than that basic training, or have come to dialysis from other specialties.  Some of them care deeply about doing their job with respect, compassion and kindness.  Some of them are there for a paycheck.)

Those dialysis technicians work ridiculous shifts.  Most recently, I was given to understand that our techs were scheduled for three 17 hour shifts in a row so that the company would not have to pay them any overtime.  Over the Memorial Day weekend. So we are talking about people who haven't seen their family for three days, who have eaten their meals at the break room table, who have clearly had less than eight hours of sleep - watching over a machine that sucks the blood out of someone and puts it back in - watching over half a dozen or more patients at a time. Sure, they got several days off afterwards - after all, they can't make any overtime! This holiday weekend aside, many times I've been told technicians are work 12 hours or more in a single shift.  They work until 10 pm and then are expected back at 4 am to open for a new day, a new 12 hour shift. In six months, we have seen an incredible turnover rate.  The best techs give out and quit first. This is not a quality lifestyle for anyone!

Not surprisingly, during this holiday weekend, a mistake was made in my husbands treatment.  I complained.  It was corrected at the next treatment.  How many other mistakes were made?  For people whose families don't monitor their treatments as closely?  These mistakes take days off that patients life expectancy.  They cause untold misery.

California has a state bill in process to address some of these concerns.  It would force the clinics to be reasonable about the hours their employees work.  To improve the patient: technician ratio so patients get more of the attention they need. And for more frequent inspections of the dialysis clinics.  Right now, dialysis clinics are inspected less often than nursing homes.

Fresenius and DaVita claim this bill endangers patient care.  How, pray tell, can a more alert, well trained, less stressed out medical technician taking care of fewer patients at one time going to endanger anyone?  Far the opposite I would think.

I tell you what it does endanger.  It endangers the enormous profits these companies are making.  Take a look at their financial reports.  Glance at any stock market website and see what a great investment dialysis companies are.

DaVita has FIRED four employees for speaking out in favor of this bill.  Oh, they claim that these four employees - one of them considered a model employee of 16 years - all suddenly, on the same day, committed something so egregious they had to be fired immediately.  They sure did - they spoke out about what goes on in those clinics.

The patients are afraid to speak out.  They are afraid of in-clinic retaliation.  I can tell you I, personally, have been retaliated against for my constant complaints. My husband lives in fear that the people who stab him with two large needles every other day, who suck all the blood out of his body and put it back - might retaliate against him.

And now the employees themselves will be afraid to speak out.  They see what's going to happen if they do.  They will be fired. Like all of us - they need that job.  Some of them, the best of them, have a great deal of time put into specialized training for their job.  And if they get fired from a DaVita clinic for speaking out, do you think a Fresenius clinic will hire them? Do you think any dialysis clinic will hire them again? So what do they do with all that education - go to work at McDonalds and hope that will cover their bills? No doubt they have a family to support, too.

This is because there is too much power, in too few hands. And the motivation is not care, compassion, or improving lives.  The motivation is the highest profit possible from people's suffering and desperate need.

Speaking as a family member of someone on dialysis - if California passes that bill, we may move to California.

But, really, that bill needs to be in Congress.  That law needs to be a national law.

Adequate medical care is not too much to ask for in this most rich and developed nation.

Nuff said.

Blessedbe

Summer Foovay


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