UC Renal Center Up for Sale

By John Graham
From UCSF Weekly

The UC Renal Center at SF General Hospital, and its 130 patient files, are up for sale to a private firm and the sale could be finalized within the month. Sources say that the price of the Center is to be 4.5 million dollars. The company buying the center is a joint venture between Total Renal Care (TRC) and Satellite, going by the name of Golden Gate Renal Partners. TRC, controlling partner of the venture with a 51 percent share, is the second largest dialysis chain in the country. The sale, negotiated by Dr. Talmadge King (UC Department of Medicine), has been protested by the staff and physicians at the Center. Claiming that "other options have not been seriously researched," the staff and physicians have twice gone to the Regents to protest the sale of the Center. Dr. King, in response, has told the group that "this is a business deal." In reponse, the Center’s physicians and staff have issued a statement and petition, "Why The UC Renal Center Should Not Be Sold," which states that the Center’s profitability should not be the central reason for excising its service status from UCSF as the operation of the Center fulfills the University’s "public mission to provide indigent care." A similar argument was used by those opposing the closure of Mt. Zion’s emergency room.

A San Francisco Tradition
The UC Renal Center at SF General Hospital is one of the oldest dialysis units in the City, providing care for both insured as well as indigent and "undocumented" patients. One concern of the staff and physicians is that those undocumented patients will be reported to the INS once paperwork changes hands. There are also uninsured patients in need of dialysis who may be shed once the Center is sold to a for-profit organization. The staff also worries about its future–there is no word on what their employment status would be if the center’s operations were sold. Therefore, concerned about patients as well as themselves, medical and technical staff have distributed a signed petition, dated November 19 of last year, summarizing their doubts about the impending sale. Of the twenty-some signatures on the petition, half of them end with the initials MD, RN, and CMT.

The Trend
The selling of the UC Renal Center at SFGH is part of the UC trend to subcontract facility operations. Both UCLA and UCSF are familiar with the outsourcing of laundry operations. Critics have pointed to the spotty track record of operations based on a business philosophy that disengages the moral dynamic of a health sciences philosophy. Where philosophies fail to persuade, there is always the science of statistics. Citing the New England Journal of Medicine, the staff and physicians at the Center report: "The quality of care at profit-making facilities is worse that at non-profit facilities . . . People with kidney failure who had dialysis at for-profit treatment centers were 20 percent more likely to die and 26 percent less likely to be referred for a transplant than patients at non-profit center."

TRC Is Troubled
The staff and physicians at the UC Renal Center are also troubled by TRC’s continuing legal and financial problems. Last year, a class action suit against TRC purported that the company "fraudulently recognized revenue by billing Medicare for dialysis treatments in amounts well above what (Total Renal) knew Medicare would pay." Its own shareholders sued the company. As well, both the CEO and CFO of the TRC resigned in July of last year when the second-quarter results of the company fell far below previous estimates. This lead to a decline in TRC’s stock value.
The Center’s profitability should not be the central reason for excising its service status from UCSF as the operation of the Center fulfills the University’s "public mission to provide indigent care." A similar argument was used for Mt. Zion.
Clearly, TRC is in financial trouble, and its lack of proper fund handling and profit-making in a profit-motivated business move have staff and physicians at the Center wondering what is going on. Since uninsured and indigent patients make no money for the center, the worry is that the first people to be let go when the TRC money belt is tightened will be the vulnerable, "unprofitable" patients.

Other Concerns
Issues outside the realm of TRC’s financial and management problems have also been raised by the staff and physicians at the UC Renal Center. Golden Gate Renal Partners has a staff to patient ratio of 1 to 10 versus an industry average of 1 to 8. While these numbers essentially are about profit and finances–fewer workers administering more tasks–the health sciences’ philosophy of the primacy of the doctor-patient relationship is undermined. To make matters more suspect, the UC Renal Center’s statement claims that Golden Gate Renal Partners’ head nurse has no dialysis experience. And, if and when the sale is finalized, the fear is that a burden would fall on the Center’s indigent patients, since the Golden Gate Renal facility will be located one mile from SFGH and is not served by a bus line.

The Future?
Ironically, the UC Renal Center and the University have separate agendas. While the University is not releasing any information to the physicians and staff regarding the future ownership of the renal center–supposedly the University is carrying on with the sale of the Center–the staff and physicians there are doing their best to stop the sale. Last Wednesday, they met with Steve Kawa of Mayor Willie Brown’s office in an attempt to get mayoral support for stopping the sale. Without the institutional power to write a check to manage its fate, the UC Renal Center at SFGH will await the next announcement from the University–while continuing to serve their patients. It is, after all, a "business deal." Or is it?