The Strangest Show On Earth

(The whole article can be found at, the following are some quotes)

“Thiry is switched on from sunup until bedtime, an inscrutably upbeat carnival barker whose default expression is delight. He’s also the rare boss who regularly rewards people outside his cozy inner circle, particularly clinical technicians and their facility administrators (FAs). Most dialysis techs are modestly educated and paid hourly; burnout and turnover are common.”

“He (Thiry) says he’d apply the same philosophy if he were overseeing 41,000 employees at 1,800 Taco Bells. After two decades in the dialysis business, Thiry knows his teammates’ jobs—essentially keeping people on life support for wages they could earn slinging Gorditas—can be intense and depressing, and his naturally sunny managerial tactics palpably boost morale.”

“Beyond the walls of Casa del Mundo and DaVita’s 1,800-plus clinics, however, detractors abound. As DaVita’s profits swell, so too do the numbers of whistleblowers, plaintiffs, attorneys, former patients, and dialysis-industry observers who allege that the cheery DaVita ethos obscures something much more sinister. They rage at the company’s allegedly unethical and reckless behavior, seethe over its aggressive efforts to dominate a game that’s already rigged in its favor, and roll their eyes at Thiry’s showy antics. “My problem with DaVita is they lack integrity,” says Peter Laird, an M.D. in Lancaster, California, and a longtime dialysis patient and activist whose blog, “HemoDoc,” addresses dialysis industry issues. “They say, ‘All for one, and one for all.’ But they’re not talking about patients.” In Laird’s view—one echoed by virtually every DaVita critic I spoke to—too many DaVita nurses, techs, and administrators gobble up the hugs and high fives from their leader while neglecting their patients or jadedly herding them through the health-care system. All may be well for the citizens of DaVita Village, the critics say. The problem, they contend, is that the company’s patients comprise what Laird and others before him have called “the Village of the Damned.””

“Bill Peckham, a longtime dialysis patient turned activist blogger, goes a step further, saying the “all for one” DaVita Village concept simply doesn’t include patients. He likens the company to a village that mines coal. “We patients don’t have the voice of a citizenry; we’re just the coal.””

“Allegations of overbilling the government for drugs aren’t DaVita’s only purported infraction. Large dialysis companies routinely “buy up” groups of nephrologists, the M.D.s who diagnose and treat kidney disease. These doctors then refer patients needing dialysis to the companies with which they’re on contract. (DaVita also has begun creating “one-stop shops,” clinics that house DaVita-branded pharmacies and provide emergency services. Skeptics note that in-house emergency procedures might not get reported as they would when a patient is sent to a non-DaVita ER, thereby allowing DaVita to post favorable, but potentially misleading, clinical outcomes.) The Stark Law, passed in 1992 and revised in 1993, makes it illegal for doctors to refer patients to other health-care providers in which they have a financial stake. However, Congress has granted DaVita, its main competitor, Fresenius, and other dialysis providers key exemptions from Stark Law restrictions, on the grounds that, according to DaVita officials, “the provision of dialysis and related drugs present a low risk for potential abuse.” Such exemptions have enabled these business arrangements to continue almost unfettered.”

“Moreover, ESRD Networks, the dialysis industry’s primary nongovernmental quality-control organization, is comprised largely of dialysis company executives. At the federal level, Medicare’s governing body, the U.S. Centers for Medicare and Medicaid Services (CMS), has often employed senior-level officials with long-standing ties to the dialysis industry. For example, former CMS head Thomas Scully was on DaVita’s board when President George W. Bush appointed him to the post in 2001.”

"He’s (Thiry’s) got the momentum and the money, and he could hardly be more connected. President Obama’s health-care czar and deputy chief of staff, Nancy-Ann DeParle, made more than $2 million in compensation and stock sales as a DaVita board member from 2002 to 2008; and Thiry and Mitt Romney go back almost 30 years.

“Critics say this strategic placement of industry insiders has seemed to allow DaVita to elude law enforcement. Among the skeptics is the Justice Department itself. Since 2001, U.S. Attorney’s offices in Colorado, Missouri, and Texas have launched investigations into DaVita’s billing practices or its financial relationships with physicians. To date, none of the scrutiny has resulted in new lawsuits or prosecutions, and the investigations remain open and pending; DaVita officials won’t comment on any of them.”

“When it isn’t navigating its way through federal inquiries or whistleblower suits, DaVita encounters speed bumps at the clinical level, too. Dialysis patient advocates, many of them current or former nurses who have worked in the industry, cite dozens of examples in which for-profit dialysis companies routinely cut corners on treatment procedures, resulting in mistakes that have sickened—and sometimes killed—their patients. The more than half-dozen activists and patients I spoke with agreed that the most egregious violator, by far, is DaVita.”

“The same Kent Thiry who encourages his teammates to email him with concerns, critics say, isn’t so responsive to his patients. Some patients have accused techs of theft, sexual harassment, and, perhaps most often, of intimidating anyone who raises objections about quality of service. They say DaVita habitually ignores complaints, drags its feet, and twists the grievance process into a bureaucratic knot. The company is especially notorious among naysayers for refusing to treat patients who grouse too much, “dismissing” them to another clinic—usually not a DaVita center—regardless of the inconvenience it may cause. (This is especially harmful in rural areas, where the next clinic of any kind might be hours away.)”

“Some former patients have even accused DaVita of blackballing them to other non-DaVita dialysis clinics, which, if true, would be another federal privacy violation. “DaVita is number one in dumping patients,” says Arlene Mullin, an advocate in Battleground, Washington, who shared dozens of emails with me detailing alleged abuses of the patients she represents. She contends that DaVita clinics operate with virtually no accountability or oversight. “I’ve gotten notarized statements from patients so I can advocate for them, and neither ESRD Networks nor DaVita has recognized any of them. [ESRD Networks and the government] have no authority over these clinics. None.””

“In the meditative silence of the reflection room, Thiry tells me, with characteristic pride, that DaVita’s clinical quality is “way better” than the typical not-for-profit dialysis company. The clinical numbers bear this out, he says, as do the smiling faces on all of those Walls of Fame. (Although the for-profit/nonprofit argument is debatable, even the doctor-activist Peter Laird admits he’s received some excellent care in his limited personal experience with DaVita clinics.)”

“For some people it’s just unacceptable that this model is profit-based. They’ll always attack us. They’re not evil people. It’s just that their ideology doesn’t allow for a virtuous for-profit company.””