PD Endorsement: No to Proposition 29 - no to attack on dialysis care

For the third time in four years, California voters are getting dragged into a fight between a national labor union and kidney dialysis clinics.

Proposition 29, an initiative on the Nov. 8 ballot, would impose medically unnecessary staffing requirements on California dialysis clinics.

The initiative is bankrolled by Service Employees International Union-United Health Care West, which has tried to organize workers in the clinics. Having failed at its primary objective, the union is waging a costly ballot-box war against clinic owners. This is, as we said in 2018 and again in 2020, an abuse of the initiative process.

Voters soundly rejected the first two initiatives, and they would be wise to say no once again.

We do not have a position on whether clinic employees should form a union. That’s up to them. However, we believe an initiative is the wrong way to regulate a specialized medical procedure that literally is a matter of life and death for people suffering from serious kidney disease. Without advanced medical knowledge, even the most diligent voter would be hard-pressed to determine the best approach to delivering kidney dialysis.

If new rules are needed, the job should be handled by the Legislature and the state Department of Public Health Services in consultation with medical experts.

About 80,000 California residents require dialysis, a procedure that uses machines to remove a patient’s blood and filter waste and excess fluids before returning the blood to their bodies. The lifesaving treatment takes about four hours, and patients must undergo dialysis three times a week. Dialysis is big business, with about 600 licensed clinics employing thousands of people in California.

The first union-backed initiative, which targeted clinics’ profits, got barely 40% of the vote. The second, which aimed to drive up operating costs by requiring an on-site physician whenever a clinic was open, got 36%. Proposition 29 takes a similar tack, requiring a physician, a nurse practitioner or a physician assistant.

Having a doctor present may sound sensible, but patients’ treatment is overseen by their personal physician. A physician or other health care professional at the clinic wouldn’t be involved in their care but would add to the cost of their care.

Moreover, federal regulations already require clinics to have a medical director who is a board-certified physician, though the director isn’t required to spend a set amount of time at the clinic.

Imposing that requirement would add several hundred thousand dollars a year in new costs, which could result in higher rates for patients and insurers or clinic closures, according to California’s nonpartisan legislative analyst.

Proposition 29 is opposed by advocacy groups for dialysis patients and health care professionals, including the California Medical Association, the state chapter of the American Nurses Association, the American Academy of Nephrology and many other organizations.

Union leaders say their organizing efforts are unrelated to the trio of initiatives targeting dialysis clinics. If so, and if they can identify real threats to patients’ health, they should go to the Legislature for relief. Three years ago, Assemblyman Jim Wood of Santa Rosa passed a law to outlaw some anti-consumer billing practices employed by dialysis clinics.

In baseball, it’s three strikes and you’re out. Those rules don’t apply to ballot measures, but California voters can send a clear message about exploiting the initiative process by saying no to Proposition 29.

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