I don't know how you can make money in this environment. And only going to get worse. I do the ordering for our clinic and the vendors are saying we need to pay up or we're not releasing product.

Well I am sure like anyone else the economy is affecting your vendors the same as it is affecting you. Your vendors have suppliers that are probably squeezing them to pay their bills on time. Dialysis clinics have always been slow payers, some worse than others. Your vendors have been getting squeezed for years, both margins and profitability thanks to the likes of Fresenius, Henry Schein, etc. The snowballs roll downhill, it just took this long to get to you.