Some people would say that DCI began when the doors to the first clinic were opened. Some would also say that’s starting in the middle. The true beginning lies in the heartbreaks and successes of early dialysis. In 1943, during the time of World War II, Willem Kolff invented the first practical dialysis machine, the rotating drum. Kolff’s invention was revised and redeveloped and even inspired others to create new dialysis machines and tools. By 1948 the Kolff-Brigham Dialysis Machine and the Skeggs Leonards Plate Dialyzer were created. In 1952 the Guarino and Guarino Artificial Kidney was developed. While the artificial kidney was a monumental development, at the time it had limited use because it had a very low blood volume and there was concern regarding the possibility of the dialyzing fluid leaking into the blood. At this same time in 1952 the Pressure Cooker Artificial Kidney by Inouye and Engleberg was being used. This was one of the first devices that allowed doctors to determine how much excess fluid was being drawn out of a patient’s blood. In 1960 the Kiil Dialyzer was created in Norway by Dr. Fred Kiil. This type of device was used for overnight, unattended hemodialysis that was pioneered by Dr. Belding Scribner and his group in Seattle, Washington. Dr. Scribner and his team took matters one step further when they converted an old hotel into the first outpatient dialysis center, the Northwest Kidney Center, in Seattle, Washington.
This is where heartbreak and success meet. Pioneers like Scribner were making dialysis a reality. Unfortunately, the need greatly outweighed the availability. At the Northwest Kidney Center there were six stations available for treatment and a waiting list for patients who needed to use them. During this era, if a patient had diabetes or lupus, he or she wouldn’t be referred for dialysis. If there was any other complicating medical issue, a patient would not be referred. If a patient was over 45 years old, he or she was not eligible for chronic renal treatment. Then, if by chance, a patient was referred for dialysis, the patient had to be placed on a list with other potential patients to be reviewed by an anonymous panel who decided who should receive treatment because there simply weren’t enough resoures to treat everyone. Finally, if a patient was given the chance to live by receiving dialysis, he or she had to deal with the overwhelming cost of treatment.
During this time of tough choices, things were beginning to change in Nashville, Tennessee. It was the late 1960’s and Dr. H. Keith Johnson was out of the army and completing his nephrology training at the VA Medical Center. At Vanderbilt there was a three-station unit that was responsible for dialyzing acute patients, backing up the kidney transplant program, delivering home training, and in addition, trying to care for a few chronic patients. To put it mildly, there were too few resources to meet so many needs. Faced with this dilemma, Dr. Johnson and Dr. Ron Watham in the midst of their nephrology training would dialyze chronic patients until midnight or 2 a.m. in order to keep these patients alive because they had no where else to go. It was after many grueling months of 16-hour days taking care of patients that Dr. Johnson and Dr. Watham began to toss around ideas in the wee hours of the morning. They were considering a freestanding dialysis unit modelled after the success of the Northwest Kidney Center in Seattle. They figured if it worked in Seattle, they could give it a try in Nashville.
Armed with the idea of starting a clinic in Nashville, Dr. Johnson began to seek advice. It was during a winter walk on a beach in 1970 that Dr. Johnson explained his idea to his father, Dr. Harry Johnson, a practicing physician in New York. Dr. Harry Johnson had a foundation set up to focus on preventative medicine providing annual check ups in order to keep patients healthy. Dr. Harry Johnson considered his son’s idea and offered to provide the seed money assistance from his foundation because he knew that this idea was a worthwhile option for patients with kidney disease. With that offer, the idea became a reality.
In December of 1970, things were beginning to take shape. Upon incorporation, the decision had to be made whether DCI would be for-profit or nonprofit. Dr. Johnson and his team understood that 80% of patients referred for dialysis had no funding. They knew that many had to choose between mortgaging their homes, spending their children’s inheritance money, or simply returning home to die because they couldn’t afford treatment. Dr. Johnson and his team refused to benefit from this situation. Therefore, the team unanimously decided on the non-profit status and also determined that any excess revenues generated would be used for research and education in the field of kidney disease or in other ways that would benefit people with kidney disease. Just five months later, in April of 1971, Dialysis Clinic, Incorporated, was established, a location was secured for the first clinic, negotiations were held with Vanderbilt to move the patients over to the new facility, and patients began dialyzing.
While it was wonderful and exciting, this was also the first big step into a scary, new frontier. The first DCI clinic was housed in a 1,000 square foot, refurbished home on 21st Avenue in Nashville, Tennessee. This new ‘unit’ had a sign on the bathroom door that read, “Don’t flush while patients are dialyzing.” If someone didn’t read the sign and flushed anyway, the water pressure would drop, alarms would sound, and nurses and physicians would hustle to ensure that adequate water pressure was quickly restored. It was no wonder that the nurses were nervous being away from the hospital and their familiar environment and support system. Soon, however, the staff adapted. The clinic became a family of staff that did everything they could to take care of the patients. The mission, “The service of the patient is our reason for existence,” was not only adopted, it was lived. Doctors, nurses, and the administrator all helped unload the drums of dialysate. Everyone worried about where the money would come from to provide the next set of treatments for those patients who couldn’t afford it.
Funding dialysis treatments was not easy. In 1971, with DCI’s first clinic already operating, there was no Medicare funding and most patients still did not have insurance to cover the cost of treatment. That didn’t stop the DCI staff from providing treatment to patients. No, it simply motivated them to find a solution. To the surprise of citizens all over Nashville, Tennessee, road blocks were established. These weren’t typical police road blocks; but were a different kind of road block set up to shamelessly ask the community for help. Dr. Johnson and his staff asked Kentucky Fried Chicken for KFC buckets to collect donations. Then the staff placed pictures of patients on their red and white buckets. On Saturday and Sunday afternoons, the staff made their way to the busiest intersections in Nashville. They stood on the sizzling, hot pavement directly in the middle of traffic begging for whatever generosity people could afford. After hours on the street collecting loose change and the occasional dollar bill, the staff would call it a day, secure in the knowledge that they had done all they could do to provide for their patients. On a good weekend, they could raise $10,000 to help pay for treatments, but it would only last for so long and then they would be out conducting road blocks again. To everyone’s relief, in 1973, the Medicare ESRD Program began, and thousands of dialysis patients across the U.S. were able to receive treatment that was and still is paid for by that program.
Over the years, the cost of care keeps rising and yet the Medicare payout remains about the same. Somehow DCI manages to find ways to provide more than expected. For instance, DCI Donor Services was created to provide for organ and tissue recovery and transplantation. Camp Okawehna was established for the pediatric renal patient. DCI has given over $188,000,000 to research initiatives. DCI operates over 230 dialysis clinics, not including the acute facilities within hospitals. DCI employs over 5,000 people and serves over 15,000 patients within 28 states. DCI is the only leading dialysis provider to have remained under its own control since its founding. It has successfully remained non-profit and the staff is providing care that the U.S. Government says is better than the larger for-profits.