Opinion: Bill in Legislature is dangerous for dialysis patients July 28, 2017 Dr. Bryan Wong I’m a nephrologist (kidney doctor) practicing in the East Bay. I am also the past president of the California Dialysis Council. We treat more than 1,100 patients throughout the Bay Area with End Stage Renal Disease or kidney failure. To live our patients must get dialysis three times a week for three to four hours at a time. That’s why I and every nephrologist I’ve spoken to is opposed to legislation moving through the State Capitol that will be dangerous for dialysis patients. Sponsored by the United Healthcare Workers union, SB 349 (Lara) will institute mandatory staffing ratios for nurses, technicians, social workers and dieticians in dialysis clinics. The bill also includes a 45-minute empty chair time in between patients. While this may sound good, there is no evidence that staffing ratios lead to better quality care or that leaving the chair open while patients sit in the waiting room will benefit them. Instead, SB 349 will result in dialysis shift cuts or clinic closures — making it harder for dialysis patients to get access to treatments. I have a lot of experience in dialysis clinics. Several times a month we visit our patients while they are getting treatments. Nothing described in the op-ed from Banbury Holmes “Patients deserve better dialysis care in California,” resembles the care I’ve seen in the dialysis clinics where I visit my patients. Dialysis caregivers are detail-oriented and treat patients with compassion, respect, like family, and with high-quality care. Under SB 349, clinics will be forced by the state to hire more staff to continue treating the same number of patients they treat today. Clinics that can’t afford to hire more staff will be forced to cut back on the number of patients they can treat to meet the ratio mandates. If that happens, shifts will be cut. Clinics in underserved areas where there are high numbers of Medi-Cal patients, where the state doesn’t cover the cost to provide the care, will be the first to cut shifts and possibly close their doors. Patients unable to get appointments at their regular clinic due to cutbacks will have to change clinics and drive further distances to get their treatment. Or, patients could end up in hospital ER rooms at significant cost to the state Medi-Cal program which covers tens of thousands of low-income California patients. At a time when federal health care reform could wipe tens of billions away from Medi-Cal in California, the last thing we should do is unnecessarily add additional cost pressures. If I thought staffing ratios would lead to better care, I’d be in favor of this bill. But there is no clinical evidence that staffing ratios lead to better care. In fact, evidence from the federal Centers for Medicare and Medicaid Services (CMS), which regulates dialysis clinics shows that California outperforms the rest of the nation in both quality of patient care and in patient satisfaction, including when compared to the handful of states that have mandatory ratios. The same CMS 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. SB 349 is opposed by many health care providers, including the Renal Physicians Association, California Dialysis Council, National Medical Association, National Hispanic Medical Association, American Nurses Association of California, California Association of Rural Health Clinics, and many others. SB 349 is dangerous and will hurt patients by cutting their access to dialysis which they need to stay alive. The bill will be heard in the Assembly Appropriations committee in August when the Legislature reconvenes. I urge legislators in the Bay Area to oppose SB 349. Dr. Bryan Wong practices with the East Bay Nephrology Group in Berkeley.