Senate bill will harm dialysis patients August 6, 2017 Dr. Amy Gen I have been a nephrologist, or kidney doctor, in Fresno for 13 years. I chose this specialty to help patients who are suffering from end stage renal disease, or kidney failure, because they are among the most vulnerable in our community. I take my oath to protect patients very seriously. That is why I am so strongly opposed to Senate Bill 349 – the dialysis clinic staff ratio bill currently making its way through the state legislature. SB 349 would greatly reduce access to life-saving dialysis care by reducing available appointment slots and threatening the viability of many dialysis clinics, especially in rural and poorer communities. It also adds a 45-minute chair “time out” between patients. Taken together, these two provisions limit dialysis caregivers’ ability to customize dialysis treatment based on their unique patient population. Patients with kidney failure must receive dialysis treatment three days a week for three to four hours at a time. During dialysis treatment, a machine cleans the toxins from kidneys and removes fluid from the body. Dialysis treatment is a requirement to stay alive.That is why it is disappointing that special interests are trying to play politics with the lives of my patients. SB 349 is sponsored by a labor union, United Healthcare Workers West (UHW), which is seeking to unionize dialysis clinic workers. SB 349 establishes rigid mandatory staffing ratios for technicians, nurses, social workers and dieticians in dialysis clinics. Under SB 349, clinics have two choices. To treat their current patient load, clinics must hire additional staff to meet the ratio requirements. But if hiring more people is not financially feasible – which will be the case for many clinics in low-income and rural areas in Fresno – dialysis clinics will have to cut the number of patients they treat. This is bad policy, especially since there is no evidence that staffing ratios lead to better quality patient care. The bill also inexplicably includes a provision that would require a 45-minute “time out” between patient treatments, even if the dialysis station is ready. Imagine having to wait 45 minutes while a chair sits empty, ready to go. According to the California Dialysis Council, under SB 349 more than 15,000 patients (out of 60,000-plus statewide) could have their access to dialysis appointments disrupted. This bill is particularly troublesome for our region. Demand for dialysis is skyrocketing and we need to be adding more dialysis capacity, not less. I remember not long ago, in the mid-2000s, when we did not have enough dialysis clinics to serve the growing demand in our region. As a result, patients would be dialyzed in the hospital, where they would stay weeks at a time waiting for an available dialysis slot to open at a clinic. Not only was that extremely costly, but it was highly disruptive for patients. Fortunately, we’ve built new dialysis clinics since that time, but we are still struggling to keep pace with growing demand. SB 349 would take us backward. With reduced access to clinics, more and more patients will be forced to dialyze in the hospital. Or worse, patients could miss treatments altogether – which can be fatal. Missing even one dialysis treatment increases patient mortality by 30 percent. As a doctor, if I thought staffing ratios would improve care, I would support them. But according to independent data from federal regulators, California already outperforms other states in clinical quality, lower infection rates, and better patient satisfaction – including states with mandatory ratios. SB 349 is opposed by the Renal Physicians Association, National Medical Association, National Hispanic Medical 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. This bill serves no purpose other than to further the political agenda of one group. SB 349 is dangerous for my patients. I urge our local Assembly members to oppose this legislation.