San Francisco General Hospital's Renal Center is the only location where the City's vulnerable poor, homeless, or mentally-ill population with End-Stage Renal Disease can get life-saving kidney dialysis.

This fact sheet on kidney dialysis was prepared by the workers the the SF General Renal Center, and their union AFSCME 3299. DPH is planning to close the Renal Center, which will do irreparable harm to poor and largely minority end-stage-renal-disease patients in San Francisco.

There are over 380,000 patients suffering from end-stage kidney disease in the United States. This number has doubled over the last ten years and is expected to double again to an estimated 661,330 by 2010. In 1995 there were 843 patients suffering from end-stage renal disease in San Francisco and this number has increased to 1175 as of 2002. Patients with end-stage renal disease (ESRD) require three times a week hemodialysis or daily peritoneal dialysis to sustain life.

San Francisco General Hospital Renal Center, one of the first dialysis units in California, currently treats 83 hemodialysis and 30 peritoneal dialysis patients. Due to space shortages at the SFGH Renal Center, the physicians at SFGH follow an additional 60 SFGH patients at other San Francisco dialysis units. Most of these patients use SFGH as their primary hospital and none have private insurance. The racial mix of our dialysis unit is 50% African American, 30% Asian/Pacific Islander, and 25% Latino. In addition, over the last 10 years we have treated over 100 patients with ESRD and HIV.

San Francisco Dialysis Facilities

The dialysis units in San Francisco are Gambro (Chinatown and Geary Street locations/for profit), DaVita (Ocean, Haight, and Potrero Hill locations/for profit), UCSF-Mt. Zion (independent), California Pacific Medical Center (Davies and Pacific campuses/independent), and San Francisco General Hospital Renal Center (independent). All the San Francisco dialysis facilities are near full capacity due either to space constraints or nursing and technician shortages.

What will happen if the San Francisco General Hospital Renal Center closes?

The current plan assumes the patients currently treated at the San Francisco General Hospital Renal Center could be referred to the other dialysis units in San Francisco. However this plan will not work due to the severe dialysis nurse and technician shortage in the Bay Area. In reality, some patients would be referred but many others would require hospitalization at SFGH to receive three times a week dialysis. When UCSF threatened to close the dialysis unit in 2002, no new admissions were made to the SFGH dialysis unit, and due to the inability to refer new patients to other dialysis unit, dialysis patients were hospitalized for their treatments. This corresponds to the year when SFGH hospital dialysis treatments increased from 1424 in 2001 to 1910 per year in 2002. A conservative estimate would be that the number of patients dialyzed in the acute hospital setting would double if the dialysis unit actually closed. Medi-Cal or Medicare does not reimburse dialysis treatment costs for providing acute dialysis to outpatients. Closing the SFGH dialysis unit will thus result in a tremendous financial loss to the hospital (estimate: $90,000 year/patient).

Dialysis care of some of the most vulnerable patients in San Francisco will be fragmented and patients will suffer. Missing one or two dialysis treatments can result in death, and not being able to provide chronic dialysis becomes a liability concern for the City.

If the City were successful in referring 82 SFGH hemodialysis patients to other dialysis units, an outpatient dialysis availability crisis would develop. All available dialysis chairs in San Francisco would be occupied. No dialysis slots would be available for patients with new onset renal failure. This, at a time when the incidence of kidney disease is rising and more services are needed.

²Undesirable² patients (those with mental health or substance abuse problems) would not be accepted at outside private dialysis units and would require long-term hospital dialysis care at SFGH. Private dialysis units have the legal right to ³discharge² or to deny treatment to patients who are non-compliant with treatments.

Dialysis patients are all insured by Medicare and/or Medi-Cal and thus, in the long term, our inability to care for dialysis patients will ultimately result in a loss of hospital income. Currently, dialysis-associated procedures such as surgical and radiological procedures, and paid hospital days generate revenue for SFGH. The potential loss in revenue totals more than 3 million dollars.

You are being told that all dialysis patients have Medicaid and that they will be taken care of in the community. Due to documentation status, 15-20% of our patients only have emergency Medi-Cal. The majority of dialysis units and hospitals in SF do not accept patients on emergency Medi-Cal.

It sometimes takes 3 months before Medi-Cal or Medicare coverage takes effect after an uninsured patient starts dialysis. The majority of dialysis units in SF do not accept patients with pending insurance.

Patients from Hunters Point and the Mission District, areas where the incidence of kidney failure is the highest in SF, currently serviced by the SFGH Renal Center would be forced to receive their dialysis treatments three times a week at dialysis units far from their homes.

THE ISSUE

The San Francisco Department of Public Health (DPH) decided to assume the responsibility of running the SFGH dialysis unit in 2003 after UCSF threatened to close the unit. In January of this year, the dialysis unit passed State inspections and was licensed under SFGH. Billing started shortly after the license was issued, and it is not yet known whether the financial benefits of being a hospital-based dialysis unit will lead to financial benefits for SFGH.

So why has the leadership of the DPH reversed its position and its commitment to the staff and patients of the dialysis unit?

One reason given is the savings of $339,000 to the City's general fund. However, the finances presented to the Health Commission provided no analysis of the hospital revenues potentially lost when the patients are referred to other hospitals. In addition, the analysis presented is based on projected revenues based on money collected over a four-month period. The dialysis unit has an operating budget of over 3 million dollars. However, the DPH decided to close the dialysis unit instead of asking the dialysis unit to cut the $339,000 in costs.

The second reason given is the prospect of building a replacement dialysis unit and replacing equipment prior to the next JCAHO inspection. The S.F. DPH states that the dialysis unit would not pass a JCAHO inspection. However, the SFGH dialysis unit passed State of California inspections this year. There is no reason to believe that the dialysis unit would fail a JCAHO inspection. Despite available options to partner with the non-profit sector or with industry, DPH has not considered aggressively pursued these options.

But the apparent rush to close a respected, award winning and historic institution will hopefully make the public ask some very important questions, especially since the public record provides an inadequate discussion of the impact of the closure of the dialysis unit.