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Founding the California Kidney Care Alliance

A look back at the impetus of our 42-year journey shaping and innovating comprehensive kidney health today.

California Establishes Statewide Dialysis Facilities Membership Organization.

On May 21, 1982, the California Kidney Care Alliance (formerly 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 that served as a vehicle for coordination and communication to meet the needs and interests of its members statewide


California Kidney Care Alliance (CKCA) filed for incorporation as a Nonprofit, Mutual Benefit Corporation. Its formation was a straightforward approach to bringing dialysis facilities together, whether hospital-based, freestanding, nonprofit, or for-profit across Northern and Southern California.


The organization was not designed or intended to duplicate other professional organizations, and it purposely superseded individual interests and individual personalities. CKCA was not the product of one or two individuals, but the result of many physicians and administrators working together to meet a common need.


In November 1981, a group of concerned administrators and medical directors from dialysis facilities throughout the state met for the purpose of discussing alternative courses of action necessary to deal with continuing and escalating legislation affecting the healthcare 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. 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 help finance this movement.


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 impacting kidney care. 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 entities, as well as physicians and administrators.


Need for Statewide Organization

Los Angeles

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.

In the State of California, renal failure and our dialysis provider community fell between the organizational and administrative cracks. There was no central organization to act as a spokesperson, coordinate unified action, respond to needs and interests, or act as a watchdog over the administrative interest of the dialysis community. Facilities, collectively as a group, were not directly represented through the membership structure of Hospital Councils, California Hospital Association, County Medical Associations, or the California Medical Association.

There was no central organization in the State of California, even though there had 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 these organizations does not meet the purpose of the California Kidney Care Alliance.

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


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

  2. Network Coordinating Councils were created by federal legislation and were federally funded. Network Coordinating Councils were, 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) ).​


Reasons to Organize

Image by Robina Weermeijer

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


  1. United effort (single voice): Creating a spokesperson for our dialysis community.

  2. Human capital: Bringing all of us together to lend our individual talent and interest in an organized way.

  3. Existing resources: Leveraging and growing our individual and collective networks.

  4. Provide necessary money as a vital resource: Providing the means to purchase services to meet our objective and to support our activities.

  5. Centralized Coordination: Coordinating throughout the State of California to meet and respond to our needs and interests.


Whereas the following areas of interest of dialysis facilities were identified, the primary motivation and interest to form the CKCA 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​


Purpose of the California Kidney Care Alliance


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

The Steering Committee, having discussed the need 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 CKCA — to create a central statewide membership organization for all licensed dialysis facilities in California. The need had been identified to fill the gaps that currently exist organizationally and administratively. The whys had been identified: united effort, human capital,  existing resources, financial 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 describes the basic function of a mutual benefit organization:

  • To bring people together for common purposes,

  • To maintain an open dialog with one another,

  • To get to know each other, not just locally, but statewide,

  • To share ideas and concerns,

  • To leverage individual effort, and

  • To plan and work together,


All of which led 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 Kidney Care Alliance at this time were to effectively deal with the continuing and escalating state legislation affecting the dialysis field. Dialysis healthcare 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. In 1982, additional legislation was proposed that had a profound impact on the ability to provide quality of care safely and economically.

The remaining Statements of Purpose, 4 through 7, round out the organization and establish a base for growth as the California Dialysis Council moves forward and builds momentum. California embarked on something that had never been done before in the dialysis field. No other State had attempted to form this type of organization with members working, planning, and setting priorities together as agents of 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.”




Specific short- and long-range goals of the California Kidney Care Alliance 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 relationships 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.


In December 1981, 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 CKCA.


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 gaps for dialysis facilities.

Having determined the legal structure, the Steering Committee drafted a Bylaw for the organization. The most time-consuming and debated item was arriving at a definition for 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 second, 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, or voting members, were defined as any licensed dialysis facility in the State of California with each member facility represented by its Medical Director and Chief Executive Officer or their designee.


Informational Meetings

In a Meeting

The Steering Committee, having developed CKCA’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 Meetings expressed strong support for the organization.


First Organizational Meeting of Members

Staff Meeting

On May 21, 1982, the initial members of the CKCA met and adopted the Articles of Incorporation, Bylaw, and elected its 15-member Board of Directors. Elected to the Board of Directors were:

  1. Mark Crone | Dialysis Network International-Northridge

  2. John De Palma, M.D. | Glendale Renal Center

  3. Robert Fortner, M.D. | El Camino Hospital

  4. Allen B. Fulmer | Doctors Artificial Kidney Center

  5. Robert Gipstein, M.D. | Santa Monica Hospital Medical Center

  6. Benjamin A. Halpren, M.D. | East Bay Dialysis Medical Clinics

  7. Beverlee Human | North County Dialysis Center

  8. Frank M. Kieran | Satellite Dialysis Centers

  9. Louis G. Livoti, M.D. | Sutter Memorial Hospital and Dialysis

  10. Melinda Martin, R.N. | Community Dialysis Services of Daly City

  11. Stephen H. Mayhew, M.D. | Burtec

  12. Arnold S. Roland, M.D. | Bio-Medical Dialysis of San Diego

  13. James M. Spiegel | Fresno Dialysis Clinic

  14. Robert S. Swenson, M.D. | Stanford Hemodialysis Center

  15. Wesley D. Young | Artificial Kidney Foundation of California


First Organizational Board of Directors Meeting

Colleagues in 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 CKCA 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



In a Meeting

The formation and establishment of the California Kidney Care Alliance 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 that 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 interests.

CKCA was established because its formation was a straightforward 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.

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