- Dialysis is a process where a machine acts as the kidneys by cleaning the blood and returning it to the body.
- Dialysis is necessary for many people with chronic kidney disease, but the US has a high mortality rate despite spending the most on dialysis care.
- Richard Nixon signed a bill in 1972 that provided government-funded dialysis for those who needed it.
- Nearly half a million people in the US undergo dialysis, and it takes up almost 1% of the federal budget.
- DeVita is a for-profit kidney dialysis company, with significant issues, and its CEO Ken Theory has an eccentric management style.
- DeVita runs a lean operation with fewer nurses than non-profit competitors, leading to concerns about patient care.
- Dialysis workers in California are trying to unionize over staffing issues.
- Former DeVita nurses have reported feeling pressured to transition between patients quickly, compromising proper disinfection procedures.

- The video discusses concerns about the quality of care provided by DeVita, a healthcare company.
- The company's clinics have received high ratings from the government's rating system, but these ratings do not reflect government inspection reports.
- DeVita has been accused of finding ways to increase reimbursement from the government, including paying kickbacks to doctors for referrals.
- They have settled multiple lawsuits for large sums of money, denying wrongdoing in each case.
- DeVita has been accused of wasting drugs and overbilling the government for their use.
- The company also allegedly downplays the importance of kidney transplants in their education programs for dialysis patients.
- The video questions the quality of care provided by DeVita and raises concerns about their practices.

- The for-profit dialysis industry, including DeVita and Fresenius, has faced problems including lawsuits claiming their products caused heart problems and deaths
- Better oversight and incentives for transplants and early treatment of kidney disease are needed in dialysis clinics
- Individuals can combat the kidney shortage by becoming living kidney donors or organ donors when they die
- The care of America's kidneys should not be treated like a fast food experience
- Taco Bell is owed an apology for being dragged into the dialysis industry's problems
- Taco Bell responds with a commercial highlighting the differences between their business and dialysis clinics
- Taco Bell CEO is more professional and the company has not faced lawsuits like the dialysis industry
- Taco Bell acknowledges their food is medically inadvisable but encourages kidney transplants if possible

- Dialysis is a necessary process for people with chronic kidney disease.
- The US has a high mortality rate despite spending the most on dialysis care.
- DeVita, a for-profit kidney dialysis company, has significant issues and concerns about patient care.
- Former DeVita nurses have reported feeling pressured to compromise proper disinfection procedures.
- DeVita has been accused of finding ways to increase reimbursement from the government and has settled multiple lawsuits.
- The company allegedly downplays the importance of kidney transplants and has faced lawsuits claiming their products caused heart problems and deaths.
- Better oversight and incentives for transplants and early treatment of kidney disease are needed.
- Individuals can combat the kidney shortage by becoming living kidney donors or organ donors.
- Taco Bell responds to the dialysis industry's problems with a commercial highlighting their differences and acknowledging their food is medically inadvisable.

For-profit dialysis companies often maximize their profits at the expense of their patients. John Oliver explores why a medical clinic is nothing like a Taco Bell.

Connect with Last Week Tonight online...

Subscribe to the Last Week Tonight YouTube channel for more almost news as it almost happens: www.youtube.com/user/LastWeekTonight

Find Last Week Tonight on Facebook like your mom would: http://Facebook.com/LastWeekTonight

Follow us on Twitter for news about jokes and jokes about news: http://Twitter.com/LastWeekTonight

Visit our official site for all that other stuff at once: http://www.hbo.com/lastweektonight

-♪ ♪ -♪ ♪ We're going to talk about kidney dialysis.

And I know that right now you're probably getting ready to push the button on your TV remote marked, Dear God, Literally Anything Else.

But I promise you, this is worth listening to, because dialysis is not something that everybody understands.

Just listen to 1 patient describe a conversation that she had with a neighbor.

She said to me, where do you go 3 days a week?

I said, why, are you writing a book, a mystery?

I said, if you don't get out of my face, you will need a doctor.

If I was her neighbor, I would not fuck with that lady.

What I would do is get out of her face, go home, Google what dialysis is, just to cool down the temperature in that relationship.

Dialysis is basically where a machine acts as your kidneys, by taking blood out of your body, cleaning it, and then returning it to you.

Think of it as a Brita picture for your blood, which, yes, is more disgusting than I needed to make it sound.

--AUDIENCE LAUGHS- --Dialysis can be a truly exhausting process.

You're typically sitting in a chair, physically attached to a machine, for 3, four-hour sessions a week.

And Americans have been at increasing risk of needing it, because chronic kidney disease is the ninth leading cause of death in the United States.

And while a lucky few manage to get transplants, for many, dialysis is their only option to stay alive.

But, interestingly here, while America spends more, by some accounts, than any other nation on dialysis care, we have 1 of the industrialized world's highest mortality rates.

So we're spending the most to essentially get the least.

We're basically paying for a fully loaded Lamborghini and receiving a drunk donkey on roller skates.

This story, the story of dialysis, is an amazing case study of good intentions being thwarted by bad incentives, poor oversight, and profiteering.

And 1 of the key characters in this story is incredibly this guy.

Just take those old records off the shelf

I sit and listen to them by myself ♪ ♪ Today's the music game You got the same song ♪ ♪ I like that old time Rock and roll...

♪ Now, if you are understandably thinking, who is that man doing barefoot gymnastics to Bob Seger while dressed like the third saddest waiter at a medieval times?

Well, that is the CEO of DeVita Incorporated, a for-profit kidney dialysis company, and I promise we will get to that man in a moment.

But first, let me give you a sense of the history of dialysis in this country.

Because in the early years of the machines, access to them was so limited, 1 hospital had an actual death panel to decide who would get to use them.

Somebody has got to decide who shall live and who shall die.

I don't know why, either for medical reasons or psychological reasons, or just didn't have the $30,000.

Duff, what happened to those who were turned down?

Also, your pet only loves you because you feed it.

The tooth fairy is your father, and 30% of babies grow up to be assholes.

Now, in 1972, though, something amazing happened.

Richard Nixon, yes, Richard Nixon, signed a bill into law which said that the government would pay for dialysis for anyone who needed it, which is really incredible.

Essentially, we have universal healthcare in this country for 1 organ in the body.

It's like your kidneys and only your kidneys are Canadian.

Oh, sorry, there's 2 of us, Don't mean to take too much space up down here, That's a good accent and I do not apologize for it.

Now, at the time that bill was passed, it only covered around 10,000 patients, but 4 decades later, thanks in part to the rise of diabetes and high blood pressure, nearly half a million people are undergoing dialysis.

Technically speaking, that is a pug's face worth of folds.

-...and as a result, And this is true, treating end-stage kidney disease takes up nearly 1 percent of the entire federal budget.

We devote 2 percent of the federal budget to the Department of Education, and that's the thing that helps you know what a percent is.

And a vast industry has emerged to accommodate all these patients.

There are around 7,000 outpatient dialysis clinics in the country today, and around 70% are owned by just 2 big for-profit companies, Fresenius and Davita.

And let me be clear, there are significant issues with both of them, but to understand this system, tonight, we're going to focus on DeVita.

Their CEO, Ken Theory, is the showboating musketeer that you saw earlier, and he loves to inspire his employees at meetings.

He's also made grand entrances on a bicycle.

And spare a thought for that horse there.

That is by far the most humiliating credits on its resume, and it did used to do porn, so you have to bear that in mind.

-♪ ♪ -♪ ♪ Theory is a former Bain & Company consultant who managed to take DeVita from near bankruptcy to being valued today at $13 billion.

He's even been the subject of an admiring case study taught at Harvard Business School, which called his management style, arguably eccentric.

He calls his company a village, his employees teammates or citizens, and as for himself, well, he's got his own special title.

This is KT here, your mayor from the Casa Nueva in Colorado.

A title so ridiculous, you may not have noticed, he's standing next to a fucking falcon.

-♪ ♪ -♪ That is the most humiliating thing on that bird's resume, and it used to do porn.

At this point, we should probably address the whole weird musketeer thing.

It's an obsession that apparently stems from the Leonardo DiCaprio movie, The Man in the Iron Mask.

Which, yeah, which theory says inspired him to make a transformative life decision to take the DeVita job, which is already insane, because this is a ridiculous movie to choose as the basis for anything.

That remains 1 of the weirdest decisions in movie-making history.

Hey, the world's biggest heartthrob at the peak of his popularity agreed to be in our movie.

Oh, I know, let's put him in a weird mask that covers his whole face and just have him stand there.

I guarantee that teenage girls all across America are going to have that image on their bedroom walls.

Theory even closes company meetings quoting that movie.

For shareholders, theories, techniques have worked.

DeVita posted nearly $800 million in profit last year.

But the experience for patients can be different.

DeVita runs a pretty lean operation, which the government allows.

The federal guidelines don't require clinics to have a doctor on site At any given time, which seems a little odd, they also require that only 1 nurse be present in the facility.

And a study has found that for-profit clinics have about a third fewer nurses than their non-profit competitors.

And that might explain why some DeVita patients say they can feel like they're a product on a factory line.

I getting my full treatment that I'm supposed to be getting?

Yeah, you can't just speed up dialysis because you're behind schedule.

It is a critical medical procedure, not a shower.

Oh, I've only got 3 minutes, So I'm just washing the important parts, hair, armpits, and penis, because it's my little buddy.

Dialysis workers in California are currently trying to unionize over issues including staffing levels, and 1 former DeVita nurse of more than a decade, who DeVita told us was fired for violating company policy by asking employees to join a union at a clinic where he no longer worked, says workers felt constantly pressured to transition between patients as fast as possible.

Well, when I was working at DeVita, the priorities for, transitioning patients was to get them on dialysis and get the next patient on as soon as possible.

You want to get them in, get their dialysis done, and get the next patient on.

And you would have sometimes 15, maybe 25 minutes to get that next patient on, on the machine.

So you were not properly disinfecting or doing the things that you needed to do properly.

I don't even want to go into a movie theater that hasn't had enough time to be cleaned.

And the worst thing that can happen to you there is shuffling through a waist-deep layer of popcorn and dried, sticky cherry Coke.

And look, Davida will tell you, its clinics operate to a high standard of care, its patients aren't rushed, they have many happy staff and customers, and they've shown steady improvement over the years.

And they'll even point to the high number of clinics that have received 4 and 5 stars from the government's rating system.

But that actually points to another oversight issue here, because weirdly, those ratings don't reflect things like government inspection reports for the clinics.

Because remember that patient from before?

We actually pulled her clinic's most recent report, which cited, among other things, multiple problems with infection control practices, and a failure to demonstrate overall responsibility for the governance and operation of the facility, which placed all patients, staff, and visitors at risk of harm and possible death.

So that four-star rating should really come with a big asterisk, which, to be fair, does technically constitute a fifth star.

And if it's beginning to feel like DeVita is run like a volume business, Well, when you listen to Kent Theory, that can seem like it's by design.

Just listen to him addressing business students at UCLA about what he sees as his company's role in society.

I almost never refer to patients in the entire thing, Because for me, it's not about the patients, it's about the teammates.

When you're in healthcare, it is nicer, easier, whatever, in the sense that you're actually very directly helping human beings.

If I had 1,400 Taco Bells and 32,000 people who worked in them.

He just said he manages DeVita, a healthcare company, like he would a Taco Bell, the exact opposite of a healthcare company.

Look, Taco Bell has made a shell entirely out of fried chicken.

So when you see the naked chicken chalupa with the first shell made entirely out of fried chicken, you might think it's crazy.

-♪♪ You know, it's a pretty safe sign that your product is awful when your commercial has to assure people on 2 separate occasions, look, we know we sound mentally ill, but trust us, it is food.

And look, to be fair, DeVita might tell you that they have to run their business so lean because the reimbursement they get from the government doesn't really cover their costs.

But they have been repeatedly accused of finding innovative ways around that.

For instance, a few years ago, the company was sued over accusations it had paid kickbacks to doctors for business.

The scheme is kind of complicated, but it basically works like this.

DeVita would pick out doctors and physicians groups who cared for a large number of patients who had renal disease.

And then it would offer them lucrative deals to refer patients to their dialysis clinics.

You want to be sure that a doctor is referring you to a clinic because it's the best 1 for you, not because they have a financial relationship.

You should only advocate for a product that you really believe in, like DeWalt's ladders.

They don't pay me to say nice things about their products, people.

Now, now, DeVita denies wrongdoing, but they did settle that lawsuit for $389 million.

And remember that because it's about to become a theme.

Because in 2012, a former medical director at a DeVita facility went public with claims about how DeVita treated some of the medicine that it could charge Medicare for.

For instance, let's say a patient needed 100 milligrams of a drug called Venifer.

You could give them, say, 1 100 milligram vial, Or you could do this.

What Avita did, instead of this 1 vial, they gave 50 milligram out of this vial,

The more vials DeVita used, the more DeVita was able to bill the government.

That is the biggest waste of drugs since anyone who's done cocaine in a windstorm.

On the bright side, those pigeons look confident, and they have somehow written screenplays.

Now, now again, again, DeVita strongly denied wrongdoing, and they did so even as they agreed to pay up to $495 million to settle that case.

That's an almost half a billion dollar oops, or as Yankees fans call it, an A-rod.

And a separate case accused them not so much of throwing extra drugs into the trash as throwing them into patients.

And that involved something called epigen, a medication used to raise a patient's red blood cell count.

A whistleblower said that DeVita personnel referred to it as liquid gold.

At 1 point, it accounted for a quarter of the company's revenue, and up to 40% of its earnings.

Although, it was later discovered that at the higher dosage levels that DeVita was using, there was no solid evidence that Ipogen made people feel better, improved survival, or had any clinical benefits at all, which is incidentally also the new tagline for this television show.

DeVita denied any wrongdoing and settled that lawsuit for 55 million dollars.

And DeVita will say that they keep settling cases because they can't afford to get shut out from Medicare.

But the fact remains, Just the 3 cases I have mentioned in the last 5 years have resulted in them paying out nearly a billion dollars in settlements.

And that doesn't exactly give you confidence in their product.

If the Fleshlight Company paid a billion dollars in settlements, You would do what everyone else does, and you would fuck a microwaved cantaloupe.

The point is, here is where we get to the final and possibly the hardest part of this story.

Because the fact is, no matter what standard of care you get, the longer you are on dialysis, the worse things look for you.

People who are on dialysis, how long are they gonna last?

Right, so the statistics are that 1 year after being on dialysis, your death rate is 25%.

And numbers like that are why, If you are at all eligible to get a kidney transplant, you absolutely should get 1.

It can double or even triple your survival rate.

And yet, the government's main requirement for dialysis clinics in educating patients about transplants is that they simply check a box indicating that they've done so.

And multiple studies of the industry have questioned the quality of some clinics' education.

Thousands of kidney patients in the United States start dialysis without first being told about kidney transplants, or that the procedure would be cheaper and lead to longer lives.

The newspaper reviewed records from the United States renal data system, and they found that some patients spent 5 years on dialysis before being put on the kidney transplant list.

Some clinics are leaving out information that people really should know.

And information on transplants at a dialysis clinic is a bit like information about the number of ferrets you own while you're on a Tinder date.

You need to disclose that shit right up front so that people don't make a huge mistake.

-...-And look, DeVita disputes that those studies reflect their practices, saying that their most recent internal figures show them outperforming their competitors in percentage of patients receiving a transplant.

Although, for what it is worth, we wanted to get a glimpse of what their education might look like, and honestly, it wasn't great.

DeVita offers kidney-smart classes, basically orientation for pre-dialysis patients, And they're open to the public.

So, we sent 4 staffers to classes at 4 different clinics here in New York, and they were all struck by how little emphasis was placed on the benefits of transplants, and that they were often presented as an equivalent choice to dialysis.

In fact, here is what happened when 1 staffer asked specifically about whether people who came to that clinic sought transplants.

I've had patients that decided, no, I don't want that.

And even if you don't have a donor, you go on their transplant list, when they do call you, of course you have the right to say, no, I don't think so.

I know I say this and it sounds crazy, but I've had patients that said, no, I don't think I want to leave.

Suggesting that the cozy atmosphere of a DeVita dialysis center is a valid reason to turn down a kidney transplant is the moral equivalent of watching someone tread water in the middle of the ocean and not encouraging him to take a fucking rope.

Are you sure the ocean isn't your community?

Are you sure you want the people have turned this rope down before you know?

And look, we focused on DeVita because they have the most patience and Kent Theory dresses like an idiot all the time.

But a lot of the problems we've seen run throughout the for-profit dialysis industry, including their main competitor Fresenius, who just last year agreed to a $250 million settlement for thousands of lawsuits, claiming that the company's products had caused heart problems and deaths.

Claims that they deny, because you know, of course they do.

So, here's the thing, I know that all of this has been very complicated, but there are actually a few key lessons here.

First, We need to make sure that dialysis clinics have better oversight, and we need to create better incentives for transplants and for treating kidney disease earlier to keep patients out of dialysis in the first place.

And there are things that everyone can do to combat the kidney shortage.

Truly amazing people can donate 1 of their own kidneys while they're still alive.

And if you are someone considering doing that, holy shit, you're an amazing human being.

Feel free to go to giveandlive.us for more information on that.

And for the rest of us complete assholes, we should at least, at the very least, be organ donors when we die.

Because organs can go to waste as families hesitate to give approval when a loved 1 dies.

So please, please make sure that your family knows that you want to be a donor.

And once you've done that, maybe tweet out, hashtag, when I die, please take my kidneys.

Because if nothing else, it will really fuck with Twitter's trending topics tomorrow.

But here's the thing, this country did a truly amazing thing.

He said we should take care of people with kidney disease, and we did it.

And we should keep doing it, but we could do it a lot better.

The care of America's kidneys is way too important to be treated like a fast food experience, which actually reminds me, there is another victim of this story, and that is Taco Bell.

Taco Bell is owed an apology, and that sentence has never before made sense in the English language.

But Taco Bell, I am truly sorry that a middle-aged musketeer dragged you into this.

And I know that you're not gonna stand up for yourselves, Taco Bell.

You're too busy plotting your next Kristallnacht for the bowels.

We've prepared a commercial to return fire for you.

You may know us from Volcano Nachos, the Beefy Fritos Burrito, and that taco with fried chicken for a shell.

You don't want to run a health care business like a Taco Bell?

To be honest, you shouldn't really run a Taco Bell like a Taco Bell.

Because we're nothing like dialysis clinics.

For a start, you might actually be more likely to find a doctor in 1 of our restaurants than in a dialysis clinic.

And look, we've certainly made our fair share of dubious claims.

You know those breakfast burritos in our ads?

But we sure as shit haven't spent the last few years paying out nearly a billion dollars to settle lawsuits, because we run a tight ship at Taco Bell.

If I lick the dust off the Doritos taco shells, they become regular taco shells.

Okay, the important thing is, our food may be barely fit for human consumption, But at least our CEO dresses in a suit like a human person.

And he doesn't make us call him the mayor or do any

We're a company, not a child's birthday party.

And while our food may be medically inadvisable, Even we know that if you can, you should get a kidney transplant.

Oh, you know, yeah, yeah, you should absolutely get a kidney transplant.

See all LastWeekTonight transcripts on Youtube

Dialysis: Last Week Tonight with John Oliver (HBO)