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The Time Has Come “Big Dialysis” Must Be UNDONE!

Warning!!! Danger!!!

“When you see something that is not right, not fair, not just, you have to speak up.
You have to say something; you have to do something.”

                                                                                                           – Rep. John Lewis

– Rep. John Lewis

“The care of human life and happiness, and not their destruction, is the first and only object of good government.”

                                                                                                             – Thomas Jefferson

– Thomas Jefferson

“Patients with housing insecurity, lack of insurance, and low income have a higher risk of kidney failure, or death.”

                                                                                                                             – U.S. News & World Report

– U.S. News & World Report

Healthy DC & Me Leadership Coalition, “Blow the Whistle” Grassroots Leaders, & Dialysis Advocates Inc. CEO, Arlene Mullin
at the Whistleblower “Dialysis” Summit on Capitol Hill, Washington DC July 28 2023

Big dialysis

Healthy DC Leaders and Supporters of Dialysis Reform, “Go To Congress” To Deliver a Black History Month
“Congressional Call For Action”. (Feb. 29, 2024)

Dr. Hamilton at SEIU-UHW, Union Workers, and Supporters of Dialysis “Labor Practices” Reform “Congressional Call For Action”,
Press Conference on Capitol Hill, Featuring Investigative Journalist, & Author Tom Mueller. (Jan. 30, 2024) )

Did you know?

  • Many researchers have reported that the algorithm used to assess kidney function, was incorrectly adjusted for race in a way that artificially increased the eGFR, thereby reducing the perceived need for kidney care and eligibility for a transplant, which significantly harmed African Americans. 
  • In 2021, The National Kidney Foundation, after a lengthy scientific reassessment of the eGFR algorithm (estimated glomerular filtration rate used to access kidney function), recommended the immediate removal of the race modifier from the algorithm in all laboratories in the U.S.
  • Recent research shows that involuntary discharges from for-profit long-term care hospitals are not only on the rise, but also target African American patients disproportionately.
  • Since the June 2000 Senate hearings, where witnesses told Sen. Chuck Grassley about the flawed regulation of the Dialysis industry, neither Congress, nor CMS, the Dept. of Justice, the judiciary, nor anyone else has improved industry oversight.
    For more info. Reference provided by:
  • Cass Gualvez, SEIU-UHW union’s executive board member says, “Dialysis clinic business models are built to cut corners in order to get folks in & out of the clinics as fast as possible. Which is a problem.” Slower & gentler Dialysis care helps patient live better & survive longer.
  • CMS has refused to disclose an “Outcomes List”, which identifies the 5% worst Dialysis clinics in the nation with the highest numbers of death, hospitalizations, septicemia (life threatening complication of an infection) cases, even under FOIA requests.
  • Under former DaVita board member, and now head of CMS, Thomas Scully, Dialysis companies were exempted from supplying data from their operations, with the networks, as was historically done in the past; this has hindered the ability to collect local data for quality.
  • Former ESRD Network executives, on record, strongly question CMS’s lack of transparency regarding “missing” Dialysis funds, derived from the $0.50 aggregate tax per Dialysis treatment facility which is meant to fund the Networks; their claims of malfeasance remain.
  • In the past 5 years SEIU-UHW has fought a highly publicized battle against destructive “Big Dialysis” practices to include documenting unsanitary clinic conditions in California, such as the presence of flies, cockroaches, mice, crusts of blood on Dialysis stations, and defective water purification systems.
  • The SEIU-UHW has garnered the support of Governor Gavin Newsom while a bipartisan group of 17 House members, all of whom have received campaign donations from DaVita’s PAC since January 2021, introduced the “Restore Protections for Dialysis Patients Act”, which would forbid any group health plan from limiting, restricting, or conditioning its reimbursement of Dialysis services.
  • NIH says, psychological distress, depression, and anxiety negatively impact the quality of life and well-being of chronic renal failure patients. Depression has been well documented as a common extra-renal comorbidity in approximately 30-40% ESRD patients and is associated with increased mortality risk. Body image damage as well as physical, functional, metabolic, social and mental fragility also affect the quality of life of patients. #mentalhealthmatters!

“How to Make A Killing, Blood, Death, and Dollars in American Medicine: Author: Tom Mueller, 2023 ©
(Author Tom Mueller is credited for the information referenced in the above text.) For more info.

Dialysis Patient Mr. Justin Charles Evans is feeling the “ABCs” of his Dialysis!

Dialysis Patient Mr. Justin Charles Evans is feeling the “ABCs” of his Dialysis!



1. We must protect dialysis patients in America, who need regular treatments just to stay alive, from the predation of big dialysis corporations.

2. We must guarantee that dialysis patients in America receive state of the art medicine, including low ultrafiltration rates (UFR) and longer treatment times, to ensure they live longer, better lives.

3. We must protect patients from infections, heart damage, organ stunning and other predictable harm caused by aggressive, high-speed dialysis — the treatment model used by major dialysis companies.

4. We demand an end to involuntary discharge. Patients must never be thrown out of their clinics on arbitrary or invented charges.

5. We demand an end to blackballing — patients who, after being shut out of their clinics, are denied care at other area clinics, and are forced to dialyze in a local ER.

6. We demand real oversight for this industry: serious regulations enforced by independent regulators at the state and federal level, not by the current captured, conflicted regulators who often defend the interests of corporations over those of patients.

7. We demand that Congress hold hearings to uncover and fix the deadly, long-term problems in this industry.

8. We must safeguard dialysis workers, who are also victims of this industry: overstaffing, low wages and high stress make their work lives brutally hard, and prevent them from taking proper care of their patients.

9. We must de-monopolize Big Dialysis, where two multi-billion-dollar firms have achieved an 80% stranglehold on the market, hurting both dialysis patients and dialysis workers.

10. We demand an organ donor and transplant system that works faster and more transparently, with transplant waitlists that are free from racial bias.


       Economically many Americans are dependent on the federal government. Systemic barriers involving racism, and discrimination have preyed upon the ignorance, emotions, habits, communities, and mental health of marginalized citizens with damning effects on generations of Americans. The “Huffington Post” says that “racism is a mental health crisis”.

       “Government of the people, by the people, and for the people shall not perish from the earth”, yet 160 years since Abraham Lincoln’s “Gettysburg Address”, many brave and courageous individuals have come forward to detail unscrupulous Dialysis practices that are threatening the ideals of America’s democracy, and constitutional foundation.

       It is important to address the needs of voiceless Americans and to work towards equitable lawmaking. “The way to right wrongs is to turn the light of truth upon them”. Ida B. Wells

       The time to act is now. Washington, DC has one of the highest rates of kidney failure in the U.S. The Healthy DC & Me Leadership Coalition “Dialysis” Grassroots NEEDS YOU TO ACT!



1. Stark Law Reform-Nephrologists must have accountable measures, mandates, & enforced oversights.

2. Mandatory Mental Health established services at each treatment center.

3. Dialysis “Community-Run” Resilience Hubs-CMS Grant Funded. (Details included.)

4. Financial Cap on profits made from Dialysis treatment and care. (Tax impositions, etc.)

5. Reform industry’s allowance of current corporate duopolies, etc.
(i.e., Scaled tax imposition for corporations or physician ownership with more than 5 centers. Implement closure of centers that have egregious health department fines, repeated violations, etc.)

6. Circulate and make visible on CMS website the annual “Outcomes List”, as well as list all centers, physicians, and medical agencies that have settled negligent, legal, financial, or fraudulent claims.

7. Mandatory “bi-annual” Congressional hearings to observe compliance issues, community oversight concerns, governmental spending, enforcement, and areas needing improvement.

8. Automatic Justice Department investigations for centers or physicians with more than 5 reported discriminatory complaints, patient retaliatory findings, or unresolved recommended equity-lens implementations.

9. Discounted service fees, taxes, or costs for patients of home dialysis.

10. Mandatory funded, “in-home” partial nursing services for home dialysis patients.

11. Mandatory physician, and senior medical personnel “bi-annual” certification/CE for advanced industry study, via “summits” to be hosted by global, national, and research professionals under a newly established Medicare-sponsored, “Road to Reduction of Lives Lost, & Dialysis Cure Seeking” initiative.

12. Transparent code of ethics mandated for congressional, federal, and state elected, officials regarding lobbyists, physician, and care center professional relationships. (Automatic financial penalties and fines to be assessed and paid into a fund set-up to benefit the “Community-Run resilience hubs”, via a grant or adopted contribution structure.)



Stand-Alone, Comprehensive, Community-Based Mental Health & Dialysis Resilience Hub



Stand-Alone, Comprehensive, Community-Based Mental Health & Dialysis Resilience Hub

Our organization, with your support and endorsement, would like to explore the implementation and management of a Dialysis “resilience hub” to help advance educational, oversight, and service protocols for existing Medicare Dialysis patients. The “resilience hub” would be housed in an established “Dialysis” wing of the Capital City Emergency “Level II” Trauma & Wellness Center, (est. 2025).

The hub would be augmented to support dialysis patients through a coordination of:

    • resource distribution and services that would be able to provide emergency services when needed,
    • provide patients a place to gain education and outreach regarding “home dialysis”,
    • submit confidential patient complaints,
    • requests for advocacy representation,
    • provide supplies (to include refrigerated medical supplies),
    • access to mental health & social service case management services,
    • nephrology service, & Dialysis treatment center linkage,
    • legal support referrals,
    • support groups,
    • cafeteria, and internet access capabilities,
    • dialysis industry support personnel training and staffing recruitment capabilities,
    • healthcare enrollment issues,
    • medical records requests,
    • established children’s dialysis specialists,
    • nephrology research and holistic professionals coordinated research “training” facility to highlight work around stem cell, bioartificial, and pig kidney transplant research, as well as other pharmaceutical medicine discoveries, or advancements.

Our organization would also like to establish a community-physician-advocacy “CPA” task force to implement:

    • external “pop-up” treatment facility inspections,
    • quarterly employee surveys,
    • monthly mandated report audits regarding kidney allocations, safe patient operating ratios, and an equity lens evaluation.
    • other duties as assigned.

The task force would have policing power to implement official warnings with a Medicare backed intent to “fine, enforce compliance, or close” centers and practices with repeated or egregious failures as determined by an established “report card” mechanism which would obviously have to be drafted and approved.

The “resilience hub” would allow for the hiring of community members which would help to create administrative, and “entry-level” occupational opportunities for citizens in under-served communities, where the majority of current existing Dialysis centers are located.

This in our opinion would provide an automatic built-in oversight on the community level, assuming that we are successful at getting Medicare to implement mandatory parameters, requiring that existing “Dialysis” centers, and nephrologists establish relationships with centers such as ours, that includes enforceability for any violations found.

A projected date of implementation, and an acceptable plan for funding are areas that we would further like to explore with Congressional members and senior Medicare personnel. Our organization envisions an automatic “service charge” which would cut into the current profit margins of industry giants.

Our organization’s “stand-alone” trauma center model introduces a “solid” framework for beginning the process of implementing a Dialysis “resilience hub” to service Medicare financed services through an “exploratory” measure/initiative, which would allow time for measured outcomes, impact, and observation.

The nation’s capital is the perfect place to create a model such as this, which could be adopted across the nation. Existing “Dialysis” centers and Nephrologists that choose not to adopt these practices; should face reduced Medicare reimbursement rates. Additionally, “CPA” task force committee inspections, reports, etc. where documented violations are found would deem the applicable treatment centers, and Nephrologists subject to “higher” imposed fines, and enforcements.

Mr. George Bernard Shaw once remarked that, “progress is impossible without change, and those who cannot change their minds cannot change anything.”

It has been 51 years since Congress enacted legislation to support“Dialysis” care for all. At the 2000 Senate hearings on Dialysis Congress was made aware of several “pitfalls” concerning the current Dialysis industry practices that continue to this date, to negatively and disproportionately impact American citizens of color and other ethnicities.

The Healthy DC & Me Leadership Coalition’s “Dialysis” grassroot members would like to schedule time to further address your motivation with helping to “undo” the dangers that “Big Dialysis”, industry practices are imposing on far too many American citizens.

“In closing, please note “the difference between equity and equality is that equality is when everyone
gets the same thing, and equity is when everyone gets the things they deserve.”

“In closing, please note “the difference between equity and equality is that equality is when everyone gets the same thing, and equity is when everyone gets the things they deserve.”

                                                                                                           – DeRay Mckesson

– DeRay Mckesson

“When listening hard to dialysis patients in America, caring for them honorably and well, is a way to regain
our collective homeostasis. Being more like them is a path to finding our better selves.

“When listening hard to dialysis patients in America, caring for them honorably and well, is a way to regain our collective homeostasis. Being more like them is a path to finding our better selves.

                                                                                                    – Tom Mueller

– Tom Mueller

Thank you,
Dr. Rhonda L. Hamilton,
(240) 274-9436
Contact Dr. Hamilton


Thank you,
Dr. Rhonda L. Hamilton,
(240) 274-9436

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