Blood Money

How dialysis clinics are making a killing off deathly ill patients.

- By Carrie Arnold. Ilustrations by Anson Chan

Tommy Alba could be a pain in the ass.

It's how he ran two bustling cafes in coastal Virginia. His linebacker physique and booming baritone, with more than a hint of a childhood New Jersey accent, could make him intimidating. Even Lorene Alba, who adored her baby brother, said he wouldn't take no for an answer. This obstinance served him well, not just in business, but also for the dialysis treatment he received after his kidneys failed in 2011. He lacked health insurance, and his diabetes and high blood pressure had gone undiagnosed for years, working quietly in concert to destroy his kidneys.

For at least four hours, three times a week, in a dilapidated strip mall on busy Jefferson Avenue in Newport News, staffers at a dialysis clinic attached Tommy to machines that removed toxins from his blood, a process that often left him weak and exhausted. While his life had once revolved around his cafes, the machines that mimicked the work of his kidneys were now at the center of everything. Without dialysis, his doctor told him, he would die within days. Tommy's clinic was one of nearly 3,000 US dialysis centers run by a company called DaVita. Together with rival Fresenius, the two corporations control more than three-quarters of dialysis centers in the United States.

Hemodialysis requires intense poking and prodding: Large-bore needles connect the veins in a patient's neck, arm, or wrist to a device that draws their blood, detoxifies it, and then returns it to their body.