Opinion: Senate Bill 349 would harm dialysis patients August 22, 2017 Jay Agarwal, M.D. As a kidney doctor treating patients in Riverside County for more than 12 years, I’ve seen the large growth in demand for dialysis treatment in our community. The number of patients in Riverside County with end stage renal disease, or kidney failure, has increased by nearly 8 percent from 2009-2015 — far greater than the statewide average. Due to this growing demand, it has become much more difficult for patients in our community to find a dialysis clinic and appointment times to get these life-saving treatments. A bill in the Legislature, Senate Bill 349, would make matters worse by further restricting patient access to dialysis treatment — putting thousands of patients in Riverside County at risk. 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 does the job of the kidneys by cleaning toxins and removing fluid from the body. Dialysis treatment is not a choice, it is a requirement for patients with kidney failure to stay alive. Missing even one dialysis treatment increases the risk of patient mortality by 30 percent. Patients who miss dialysis end up very sick and in the hospital. That’s why Senate Bill 349 is so dangerous. The bill establishes rigid mandatory staffing ratios for technicians, nurses, social workers and dieticians in dialysis clinics. The bill also adds a 45-minute “time out” in between patients. Under SB349, many dialysis clinics will have to cut the number of patients they treat in a day to be in compliance with the ratios. SB 349 would greatly limit patient access to care by reducing available appointment slots and threatening the viability of many dialysis clinics. The bill will hit dialysis clinics in rural, urban and poorer communities in the Inland Empire especially hard. According to the California Dialysis Council, under SB349 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. As demand for dialysis is skyrocketing, we need to be adding more dialysis capacity, not less. In fact, throughout Riverside County there are several dialysis clinics ready to be open but waiting for the state inspection. If SB349 is passed, it’s likely that dialysis providers will stall any new expansion and they’ll actually reduce shifts at current clinics to meet the new law’s requirements. Fewer clinics and appointments jeopardizes patients’ ability to get treatment at a convenient time or close to home. Many patients unable to find appointment slots will end up in the hospital, very ill.