Bill aimed at dialysis centers advances
Legislation to increase staffing, inspections clears committee
SACRAMENTO — California could become one of almost a dozen states in the country to require higher staffing levels at dialysis clinics if a bill by a Southern California legislator becomes law.
The proposal, which would also mandate annual inspections of each facility, cleared its first legislative hurdle on Wednesday when the Senate Health Committee voted 7-2 in favor of the measure.
But Senate Bill 349, carried by Sen. Ricardo Lara, D-Bell Gardens, is being fiercely opposed by a coalition of doctors, patients, rural clinics and dialysis centers.
Opponents of the measure argue that federal data shows that California’s dialysis clinics are currently ranked among the highest in the nation for quality of care and clinical outcomes.
“The dialysis business is heavily regulated by the Centers for Medicare & Medicaid because it is a lifesaving procedure for which most patients are covered through government-sponsored insurance,” said Dr. Bryan Wong, a Berkeley-based physician who specializes in treating diseases of the kidneys. “I take exception with the way the bill is written now because it has several provisions that are very harmful to patients.”
Lara disputed the notion that the federal standards are enough. He noted that dialysis clinics in the Golden State are inspected on average every six years, while nursing homes in California must be inspected every year. And he pointed out that federal guidelines specify that worker-to-patient ratios at these clinics should be “adequate,” but don’t specify what that means.
“I introduced the Dialysis Patient Safety Act because we need to go beyond the bare minimum regulations for dialysis clinics where thousands of patients receive critical, life-saving treatments each day,” Lara said in a statement. “Long-term patient outcomes can be improved by reducing infections, preventing unnecessary hospitalizations, and by more closely monitoring patients’ overall health.”
SB 349, which is backed by the Service Employees International UnionUnited Healthcare Workers West, would require a minimum of 45 minutes for dialysis technicians to clean the equipment after each dialysis treatment. And it would mandate a ratio of one nurse to eight dialysis patients; one technician for every three patients; and one social worker for every 75 patients.
Lara counts labor unions among his biggest political supporters, and dialysis workers in California have been organizing to join that union.
Union spokesman Sean Wherley cited federal data showing that in California an average of 13 patients assigned to each dialysis clinic died every year from 2011 to 2014.
And one out of every 8 of those deaths was caused by infections, according to the data.
Dialysis is a lifesaving treatment administered at 562 clinics to more than 63,000 Californians with kidney failure, but their patient care is suffering, Lara said.
He said the nation’s two largest dialysis corporations — DaVita and Fresenius — make $2.9 billion a year in profits from their dialysis operations in the U.S. But, Lara said, workers say the companies are not spending enough money to improve patient care or provide adequate staffing in their clinics.
Wong, who in addition to his private practice also is a medical director at a DaVita dialysis clinic in Napa and a Fresenius clinic in Oakland, said it takes only about 20 to 30 minutes to prepare a dialysis machine for each new patient, so requiring 45 minutes between each patient would back up appointments until the late night hours.
Moreover, he said, California can be compared with all other states and specifically to states with minimum staffing levels in dialysis clinics, including Georgia, Maryland, Massachusetts, Oregon, South Carolina, Texas and Utah. U.S. government data shows that California has 47 percent 4- or 5-star clinics, while all other states have on average only 40 percent.