Guest view: State senate bill endangers dialysis patients July 30, 2017 Jagjit Singh, MD
I have been a nephrologist (kidney doctor) for more than 25 years. I’m responsible for the care of 125 patients in San Joaquin County who have End-Stage Renal Disease (ESRD), or kidney failure. Patients with kidney failure need dialysis, which means they need to be hooked up to a machine three days a week, for three or four hours at a time so the machine can clean toxins from their blood and fluid from their bodies. Without dialysis, they have no chance for survival.
Senate Bill 349, a bill moving through the California Legislature, will endanger my patients’ access to dialysis. The bill mandates one-size-fits-all staffing ratios, meaning that dialysis centers will be forced by this bill to hire more staff to treat the same number of patients. Centers that can’t afford to hire more staff will be forced to cut back on the number of patients they can treat. It could put some centers out of business altogether. This bill is unnecessary, costly and will be dangerous for patients because it will reduce access to life-saving dialysis.
There’s no factual data to demonstrate that mandated ratios are needed in California or that more staff equates to better care. The factual data we do have, data from the federal Centers for Medicare & Medicaid Services, which regulates dialysis centers nationwide, shows that California outperforms the rest of the nation and ratio states in both quality of patient care and in patient satisfaction.
The same data from CMS 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.
The fallout for patients will be severe if SB 349 becomes law. Patients in underserved communities, where dialysis centers already struggle to keep their doors open, would be hit hardest because they’d be the first to cut back or close. That includes centers in San Joaquin County. Centers in underserved communities 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 centers would end up dialyzing in hospital Emergency Departments at significant cost to the state. Or, they might have to travel farther to be seen at a different dialysis center. 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. For not-for-profit dialysis centers like Satellite Healthcare where many of my patients receive their dialysis, any additional revenue left over after paying out expenses is used to benefit patients. Revenue is used to improve access to dialysis by building new centers or enhancing existing centers.
SB 349 is opposed by many health care providers, including 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.
These groups all strongly support efforts to improve patient care. But SB349 is dangerous and will hurt patients by cutting their access to dialysis, which they need to stay alive. I can’t support anything that puts my patients’ lives in jeopardy.
Dr. Jagjit Singh is a board certified nephrologist in Stockton.