Public Employee Press

HHC dialysis policy:
Contracting OUT patients' lives

By DIANE S. WILLAMS

Blasting HHC's plan to outsource inpatient and outpatient dialysis, DC 37 and a coalition of community boards, health-care advocates and politicians are warning the public hospital system: When lives are at stake, don't compromise patient care or sell off critical services to profiteers!

"We urge the Health and Hospitals Corporation to meet with the unions and devise alternatives to contracting out dialysis services," said DC 37 Executive Director Lillian Roberts. HHC will vote June 28 on a nine-year contract with Atlantic Dialysis LLC to privatize services at nine hospitals.

Under Section 11 of the economic contract, which lets the union bid on work that an agency may contract out, DC 37 has submitted an alternate proposal to keep dialysis in-house with an efficient staffing model that uses Hemodialysis Patient Care Technicians, Clerical Associates, Social Workers and others in DC 37 locals 420, 768 and 1549. HHC had not responded by mid-May.

DC 37 has reminded HHC of its mission to provide quality care regardless of patients' ability to pay and urged the corporation to respect the contract and not erode bargaining units of direct patient care staff.

Higher mortality

HHC already has outsourced dialysis at Bellevue, Elmhurst and Jacobi hospitals. Bellevue's clinic, run privately by River Renal, does not give homeless and uninsured patients the same high-level care they received from unionized HHC staff. "Under the private model, patients get two treatments a week instead of three under HHC's care," said Assistant Director Moira Dolan of DC 37's Research and Negotiations Dept.

"River Renal does not have access to Bellevue's computers, so patients have no one to advocate on their behalf," said Rosetta Liburd, a Local 1549 Clerical Associate who worked 15 years at Bellevue's clinic. "We used to make patients' medical appointments, arrange their transportation, and check on their well-being." Bellevue's team of doctors, nurses, Clerical Associates, Attendants, a Dietitian, a Social Worker and a Housekeeper were all bumped when River Renal took over, cut staff and offered lower salaries with fewer benefits.

"It's painful to see patients' health deteriorate under private care," Liburd said. "I worry about the quality of care dialysis patients are getting."

Patient survival rates are "worse than expected" at two Atlantic Dialysis clinics in the Bronx and Brooklyn, according to Medicare.gov, and some patients have left River Renal for dialysis services at HHC-run facilities even if they have to travel further.

Currently nine HHC facilities provide either acute or chronic outpatient dialysis to uninsured and Medicaid patients, who are often very fragile, Dolan said. "How would a private, for-profit vendor treat these patients?" she asked.

Clive Davis, who worked in a private dialysis clinic for 17 years, says he is disgusted to see patient care sacrificed for bigger profits. He quit in 2007 and is now a Biomed Tech at HHC's Jacobi Hospital.

"Private dialysis companies are about profits. The uninsured cannot pay and, I believe, are of no interest to them," said Davis, who does not want to see HHC clinics privatized.

Dialysis is big business. Medicaid and Medicare pay hospitals up to five times more for dialysis than they pay separate clinics, making contracts to run hospital dialysis services extremely lucrative deals where owners pocket vast profits. For example, two of the largest dialysis companies, DaVita Inc., whose net worth is $7 billion, and Fresenius Medical Care, whose net worth is $17 billion, treat two-thirds of dialysis patients in the United States. DaVita's CEO, Ken Thiry, earns about $12 million a year.

DaVita is under city, state and federal investigation for abuses such as tripling drug doses and charging the padded bills to Medicaid and Medicare. Fresenius has paid $486 million to settle a federal medical fraud case, including $101 million for criminal charges.

Private dialysis companies cut costs by hiring less experienced, non-union employees, sometimes assigning one Registered Nurse to 15 or more patients and one Hemodialysis Technician to treat four or more patients at a time, with only 15 to 20 minutes to clean machines and equipment between patients. When state inspectors come around, they beef up staff.

HHC claims its deal for Atlantic to run dialysis clinics at Queens, Woodhull, Coney Island, North Central Bronx, Kings County, Harlem, Jacobi, Metropolitan and Lincoln hospitals could save $178.5 million over nine years.

"That's no real savings if patient care is compromised," Roberts said. DC 37 has enlisted political allies, community and faith-based coalitions and union activists to petition and phone bank against the shortsighted plan.