I have been a nephrologist (kidney doctor), for nearly 20 years and am responsible for the care of 100 patients in Sonoma County with end-stage renal disease, or kidney failure. Patients on dialysis need to be hooked up to machines that replicate the function of the kidneys a minimum of three times a week for three or four hours at a time to filter toxins from their blood and fluid from their bodies. Without dialysis, they will die.
Senate Bill 349, a bill moving through the California Legislature, is a solution in search of a problem. Sponsored by the United Healthcare Workers union as part of a broader union organizing effort, the bill mandates one-size-fits-all staffing ratios for dialysis clinics. This bill is unnecessary, costly and would be dangerous for patients because it would reduce access to life-saving dialysis.
The bill will be up in the Assembly Health Committee, which is chaired by Assemblyman Jim Wood, D-Healdsburg, on Tuesday. I urge him and his Sacramento colleagues to reject this bill.
If I thought staffing ratios were the solution to better care, I would support them. But SB 349 is dangerous for my patients and the more than 60,000 patients on dialysis in California.
SB 349 would jeopardize access to dialysis treatment. The bill’s staffing mandates, combined with its mandatory 45-minute chair “time out” between treatments, would increase clinic costs, restrict available appointment times and saddle the state with higher health care system costs. Clinics unable to absorb the additional costs to hire more staff would have to respond by keeping the same staff but reducing the number of patients they see.
Patients in underserved communities, where dialysis clinics already struggle to keep their doors open, would be worst off because they’d be the first to close. Clinics there have high numbers of patients on Medi-Cal and Medicare, programs that don’t cover the cost of treatment.
Patients unable to get appointments in clinics would end up dialyzing in hospital emergency rooms at significant cost to the state. Or they might skip appointments. Just one missed dialysis appointment increases patient mortality by 30 percent.
Demand for dialysis is increasing in California. Anything that restricts access is movement in the wrong direction.
There is no evidence that staffing ratios lead to better care. In fact, objective data from the federal Centers for Medicare & Medicaid Services, which regulate dialysis clinics nationwide, shows that California’s clinics outperform clinics in other states, including states that already have mandated ratios. California is leading in both patient satisfaction and clinical quality scores.
The same data shows that California’s standardized infection rate is lower than that of all states with staffing mandates, except for Oregon’s with which it is tied.
So if California patients are highly satisfied with their caregivers and the clinics in which they receive their care, and if California’s dialysis clinics provide better quality of care compared to other states, then why does SB 349 exist?
From my perspective as a physician whose concern is for patients, this bill is not about quality patient care. That’s why SB 349 is opposed by many health care providers, including the Renal Physicians Association, American Nurses Association of California, California Association of Rural Health Clinics, California Hospital Association, Lupus Foundation of Southern California, California Dialysis Council and many others.