More than 50 workers and union representatives from Europe, North and South America and Asia have launched an international union network to negotiate a global framework agreement with massive healthcare company Fresenius Medical Care to protect the fundamental rights of all employees in its operations worldwide.

The workers met in Frankfurt at the same time Fresenius was holding its annual general meeting of shareholders.

The 21 participating unions in the coalition are, in part, reacting to anti-trade union practices by Fresenius, especially in the United States, Peru and South Korea. Growing concern about the direction of Fresenius was not limited to workers. A key shareholder advisory group, ISS, recommended that investors vote against management, and only 56.81 percent of shareholders voted to support the Fresenius executive board’s business conduct during 2018. Approval rates are typically above 95 percent and are seen as a key gauge of investor sentiment, according to Reuters.

The worker action is part of an  effort by workers in the U.S. to expose corporate practices in the dialysis industry that inflate prices and drive massive profits at the expense of patients and workers. The California Assembly is expected to vote before May 31 on a bill, AB 290, that would contain costs in the dialysis industry that otherwise result in higher insurance costs for all consumers.

“It’s an important step that we will have the power and support of our worldwide partners in our efforts to hold Fresenius accountable to patients and workers,” said Nadine Richardson, Registered Nurse and Vice President at 1199SEIU, United Healthcare Workers East. “Our worldwide partners were shocked to learn what happens here in the United States.”

“We have exposed the massive profits this industry makes off people who literally can’t live without this treatment,” said Asra Abbasi, a patient care technician at the Fresenius clinic in Colton, Calif. “We are proud that we exposed the conditions in our clinics and how inflated prices drive up healthcare costs for everyone.”

Dialysis is a life-saving treatment for patients with end-stage renal failure in which their blood is removed, cleaned, and then put back into their bodies. The treatment takes hours and typically must be done three times a week.

The alliance is coordinated by Public Services International (PSI) and UNI Global Union, two global union federations representing workers in public and private services.