Founding the California Dialysis Council

California Establishes Statewidedialysis Facilities Membership Organization

On May 21, 1982, the California Dialysis Council was established. For the first time in the State of California, and perhaps any State, dialysis facilities, represented by their Medical Director and Administrator, met together to adopt an organizational structure which will serve as a vehicle for coordination and communication to meet needs and interest of its members statewide.

California Dialysis Council has filed for incorporation as a Nonprofit, Mutual Benefit Corporation. Its formation was a straightforward approach to bring dialysis facilities together; hospital-based, freestanding, nonprofit, for profit. Northern California, Southern California, physicians, and administrators. The organization was not designed or intended to duplicate other professional organizations and it supersedes purposely individual interests and individual personalities. California Dialysis Council was not the product of one or two individuals, but the result of many physicians and administrators working together to meet a common needs.

Background

During the month of November 1981, a group of concerned administrators and medical directors from dialysis facilities throughout the State of California met for the purpose of discussing alternative courses of action necessary to deal with continuing and escalating legislation affecting the health field, and in particular, dialysis. This initial meeting was organized by a small handful of dialysis facilities who, having financially supported legislative advocacy on proposed legislation, foresaw the need to broaden the base of financial support and active involvement. The legislation, Assembly Bill 931 (Reuse) and Assembly Bill 932 (Licensing of Hemodialysis Technicians) was of interest to a larger percentage of dialysis facilities than just a small handful. It followed that a larger percentage of facilities, if given the opportunity in an organized and structured way, would participate in a statewide effort to collectively communicate with the legislature and support the cost in doing so.

Out of the discussions of this meeting emerged a consensus that the dialysis community in California must be better organized to deal effectively with the legislative process and State bureaucracy which is being created in this field. Therefore, a Steering Committee was formed for the purpose of structuring a statewide organization. Steering Committee members represented a broad cross section of the dialysis provider community. Represented on the committee were Northern and Southern California, hospital-based and freestanding, for profit and not-for-profit, and physicians and administrators.

Need For Statewide Organization

The Steering Committee, at its first meeting in early December 1981, reexamined why there was an interest, and more importantly, a need to bring dialysis facilities together through a statewide voluntary membership organization.

Organizational and Administrative Crack

In the State of California, renal failure and our dialysis facility community falls between the cracks organizationally and administratively. There is no central organization to act as spokesman, coordinate unified action, respond to needs and interest, and to act as watchdog over the administrative interest of the dialysis community. Facilities, collectively as a group, are not directly represented through the membership structure of Hospital Councils, California Hospital Association, County Medical Associations, and California Medical Association.

There is no central organization in the State of California even though there has been a proliferation of dialysis related organizations in our field across the country: NCC, NKF, AANA, CNNT, RPA, AWD, ASN, NAPHT, NRAA, ASAIO. Each of these organizations has its own specific purpose, however, the combined purpose of all of these organizations does not meet the purpose of the California Dialysis Council.

The Network Coordinating Council organizational structure (now ESRD Neworks) did not provide the structure to obtain the purposes of CDC for the following reasons:

1.) Two (2) networks cover California. Network Coordinating Council #3 covers Northern California and Nevada (excluding dark county). Network Coordinating Council #4 covers Southern California and Southern Nevada (Cark County). Network Coordinating Councils would, therefore, not provide a centralized statewide organization.

2.) Network Coordinating Councils were created by federal legislation and are federally funded. Network Coordinating Councils are, therefore, not voluntary organizations.

3.) By definition, Network Coordinating Councils serve as a resource to community health planners and as a liaison to the federal government ( Title 20, Chapter III. Part 405.2102 (0) ).

Reason Why to Organize

The Steering Committee discussed the following five reasons why dialysis facilities should become organized:

  1. United effort - (Single voice) - A way of creating a spokesman for our dialysis community.
  2. Man Power Resource - A way to bring all of us together to lend our individual talent and interest in an organized way.
  3. Tap existing resources - A way to take advantage of the resources of our own people and other health organizations.
  4. Provide necessary money as a vital resource - A way to provide the means to purchase services to meet our objective and to support our activities.
  5. Centralized Coordination - A way to effectively coordinate throughout the State of California to meet and respond to our needs and interests.

Interests

Whereas the following areas of interest of dialysis facilities were identified, the primary motivation and interest to form the California Dialysis Council at this time was to deal with the continuing and escalating legislation affecting the dialysis field:

  • Legislation
  • Reimbursement
  • Quality of care
  • Administrative Practices
  • Legal Practices
  • Public Opinion

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Purpose Of The California Dialysis Council

The primary purpose of the California Dialysis Council is to create within the State of California, a central organization to coordinate unified action, respond to our needs and interest, act as a watchdog over the dialysis facility community interests.

The Steering Committee, having discussed the needs to organize, reasons why to organize, and the interest to organize, developed and documented the following Seven Statements of Purpose:

1. "To establish a statewide organization for dialysis providers."

This Statement of Purpose was listed first in that it speaks directly to the primary reason to form the California Dialysis Council, - to create a central statewide membership organization for all licensed dialysis facilities in California. The need had been identified, - to fill the crack which currently exists organizationally and administratively. The whys had been identified, - united effort, manpower resource, tap existing resources, provide monetary support and centralized coordination.

2. "To provide for centralized coordination - to meet the needs and interests of its members."

This Statement of Purpose was listed second in that it decribes the basic function of a mutual benefit organization:

  • To bring people together for common purposes.
  • To have dialog - to talk to each other.
  • To get to know each other - not just locally, but statewide.
  • To share ideas and concerns.
  • To leverage individual effort.
  • To plan together, and work together.
  • All of which leads to a coordinated effort for common needs and interests.

    3. "To propose, influence, and/or participate in the implementation of legislation of interest to members."

    This Statement of Purpose was listed third in that, as stated previously, the primary motivation and interest to form the California Dialysis Council at this time was to effectively deal with the continuing and escalating state legislation affecting the dialysis field. Dialysis health care providers today, perhaps more than ever before, have a monumental challenge and obligation to communicate with the legislature on legislative issues. AB 931 and 932 spotlighted the need for good communication during 1981. Now in 1982, additional legislation has been proposed and will be proposed that may have a profound impact on the ability to safely and economically provide quality of care. During this time of uncertainty, heightened by proposed major changes in reimbursement, dialysis facilities can ill afford to sit idly by and let uninformed, or misinformed legislators, legislate away their ability to fulfill their purpose.

    The remaining Statements of Purpose, 4. through 7, round out the organization and establishes a base for growth as the California Dialysis Council moves forward and builds momentum. California is doing something that's never been done before, in the dialysis field. No other State has attempted to form this type of organization, its structure has just been developed and members just starting to work together, plan together and, will set priorities together as priorities change.

    4. “To provide a central source for interaction with State and Federal Regulatory Agencies on issues of interest to its members.”

    5. “To provide an organizational structure for interaction and interrelationship with other health related organizations and associations.”

    6. “To support educational seminars/workshops for its members.”

    7. “To support shared service programs which would facilitate cost containment/reduction for its members.”

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    Goals

    Specific short and long-range goals of the California Dialysis Council will be developed by the membership.

    The Steering Committee, however, as part of its discussions, reviewed the following legislative objectives:

    • Monitor proposed legislation of interest.
    • Formulate a position on proposed legislation.
    • Coordinate membership response to proposed legislation.
    • Identify areas of need for new legislation.
    • Coordinate response and involvement in the implementation of new legislation.
    • Implement an ongoing program for cultivating, educating and influencing elected officials and their staff on issues and/ or legislation of interest.
    • Develop a program for ongoing relationship with California Medical Association, California Medical Association Political Action Committee, California Hospital Association, California Hospital Association Political Action Committee, United Hospital Association, Catholic Hospital Association and other health related organizations.
    • Organize, amongst its membership, a network of contacts, memberships, and lines of communication with the Legislative Affairs Committee of the County Medical Associations/Societies, California Medical Association, Hospital Councils, California Hospitals Association and other health related organizations and associations.

    Back in December, at an early Steering Committee meeting, a Sacramento lobby firm was retained to represent the Steering Committee, to follow the implementation of AB 931 and AB 932 and the introduction of other legislation. This firm is continuing to work on behalf of the California Dialysis Council.

    Articles Of Incorporation And Bylaws

    The Steering Committee, dedicated to the formation of the organization, drafted Articles of incorporation to establish a nonprofit, mutual benefit corporation, under the California Corporation's Code. This corporate structure was adopted over a profit or political action committee structure to fill the organizational and administrative crack for dialysis facilities.

    Having determined the legal structure, the Steering Committee drafted Bylaw for the organization. The most time-consuming and debated item was arriving at a definition of the membership. The committee struggled with two points of view. First, to be as broad-based as possible to achieve maximum support and involvement, and secondly, to not establish another professional organization. To provide individual voting memberships, (i.e., nephrologist, administrative, nursing, dietitian, social worker, etc.) the organization would potentially duplicate existing professional organizations. Therefore, the Steering Committee recommended two (2) classes of membership: Facility Members and Supporting Members. Facility Members, voting members, was defined as any licensed dialysis facility in the State of California each member facility to be represented by its Medical Director and Chief Executive Officer or their designee. The definition of Supporting Members, non-voting, is currently being developed.

    Informational Meetings

    The Steering Committee, having developed California Dialysis Council's Statement of Purpose, Articles of Corporation and Bylaw, conducted two Informational Meetings in the State to present the material and respond to questions on the purpose and structure of the statewide organization. The first Informational Meeting was held in Northern California on April 21, 1982, and the second meeting was held in Southern California on May 7, 1982. Those attending the informational Meeting expressed strong support for the organization.

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    First Organizational Meeting Of Members

    On May 21, 1982, the initial members of the California Dialysis Council met and adopted Articles of incorporation. Bylaw, and elected its fifteen (15) member Board of Directors. Elected to the Board of Directors were:

    • Mark Crone ~ Dialysis Network International-Northridge
    • John De Palma, M.D. ~ Glendale Renal Center
    • Robert Fortner, M.D. ~ El Camino Hospital
    • Allen B. Fulmer ~ Doctors Artificial Kidney Center
    • Robert Gipstein, M.D. ~ Santa Monica Hospital Medical Center
    • Benjamin A. Halpren, M.D. ~ East Bay Dialysis Medical Clinics
    • Beverlee Human ~ North County Dialysis Center
    • Frank M. Kieran ~ Satellite Dialysis Centers
    • Louis G. Livoti, M.D. ~ Sutter Memorial Hospital and Dialysis
    • Melinda Martin, R.N. ~ Community Dialysis Services of Daly City
    • Stephen H. Mayhew, M.D. ~ Burtec
    • Arnold S. Roland, M.D. ~ Bio-Medical Dialysis of San Diego
    • James M. Spiegel ~ Fresno Dialysis Clinic
    • Robert S. Swenson, M.D. ~ Stanford Hemodialysis Center
    • Wesley D. Young ~ Artificial Kidney Foundation of California

    First Organizational Board Of Directors Meeting

    Also on May 21, 1982, the newly elected Board of Directors met and determined the term of Board memberships, elected officers of the organization, and designated standing committees and their membership. Officers of the California Dialysis Council were elected as follows:

    • President Wes Young ~ Artificial Kidney Foundation
    • Vice President Robert Fortner, M.D. ~ El Camino Hospital
    • Treasurer Jim Spiegel ~ Fresno Dialysis Clinic
    • Secretary Arnold Roland, M.D. ~ Bio-Medical Dialysis of San Diego
    • Legislative Committee
    • Allen Fulmer, Chairperson -Doctor's Artificial Kidney Centers
    • Robert Fortner, M.D. -El Camino Hospital
    • Arnold Roland, M.D. -Bio-Medical Dialysis of San Diego
    • Louis Livoti, M.D. -Sutter Memorial Hospital and Dialysis
    • Don Simmons -El Camino Hospital
    • Frank Lacey -Santa Cruz Community Dialysis Center
    • John De Palma, M.D. -Glendale Renal Center
    • Membership Committee
    • Mark Crone, Chairperson -Dialysis Network International-Northridge
    • Robert Swenson, M.D. -Stanford Hemodialysis Center
    • Stephen Mayhew, M.D. -Burtec
    • Robert Gipstein, M.D. -Santa Monica Hospital Medical Center
    • Melinda Martin, R.N. -Community Dialysis Services of Daly City
    • Beverlee Human -North County Dialysis Center
    • Jim Spiegel -Fresno Dialysis Clinic

    Liaison Committee

    • John De Palma, M.D., Chairperson -Glendale Renal Center
    • Benjamin Halpren, M.D. -East Bay Dialysis Medical Clinics
    • Frank Kieran -Satellite Dialysis Centers
    • Melinda Martin -Community Dialysis Services of Daly City
    • Elaine Crowner -East Bay Dialysis Medical Clinics
    • Norman Coplon, M.D. -Satellite Dialysis Centers

    Summary

    The formation and establishment of the California Dialysis Council as a nonprofit, voluntary, statewide dialysis facility membership organization is the only such organization at the time in the country. It was formed to meet an unmet need, to provide an organizational structure which heretofore did not exist. It provides an organizational structure to interface with other existing health organizations and associations. It provides a way to collectively communicate with the legislature and governmental agencies. It provides a vehicle to develop programs to meet organizational and administrative needs and interest.

    California Dialysis Council was established because its formation was a straight-forward cooperative effort of physicians and administrators working together to bring all dialysis facilities together on a statewide basis. The uncertainty of change, legislation and reimbursement, provided the catalyst, inquiries to the California Dialysis Council are welcomed and can be addressed to 1904 Naomi Place Prescott, AZ 86303.