Capitol Alert

Dialysis Patient Safety Act still moving despite concerns from health care professionals

Senator Ricardo Lara, D-Bell Gardens, poses for a portrait at the State Capitol on Wednesday, Aug. 4, 2016, in Sacramento, Calif.
Senator Ricardo Lara, D-Bell Gardens, poses for a portrait at the State Capitol on Wednesday, Aug. 4, 2016, in Sacramento, Calif.

Arguing that for-profit dialysis clinics put profits over patients, Service Employees International United Healthcare Workers West, some patients and nurses helped pass legislation through the Senate on Wednesday that would set a fixed ratio for the number of nurses per patient.

The bill authored by Sen. Ricardo Lara, D-Bell Gardens, passed with a vote of 25-14 despite criticism from many doctors, nurses, dialysis corporations and patients themselves. All Republicans voted no, as did two Democrats, Sen. Steve Glazer, D-Orinda, and Bill Dodd, D-Napa.

Supporters say it will give patients more one-on-one, specialized care.

The measure would also mandate that clinics have no more than eight patients per nurse and that the transition time between patients be 45 minutes. It would require that inspections occur every year and that social workers in the clinics have no more than 75 patients.

Currently, dialysis clinics are only inspected every five to six years, said Sean Wherley, spokesperson for SEIU-UHW. Wherley argued large dialysis corporations make enough money and it won’t be a burden for them to hire more nurses. In the first quarter of 2017 Davita reported their net income was $448 million.

“They have the means and now they need the will to enact these reforms and put their patients before profits,” Wherley said.

According to Wherley, dialysis clinic workers came to SEIU-UHW with concerns on patient treatment and wanted to unionize.

Megallan Handford used to work at a DaVita clinic. He appeared on a recent segment on HBO’s “Last Week Tonight” that scrutinized the dialysis industry. Handford said that employees have been targeted by DaVita regional managers and “union busters” for speaking up against company policies.

“The public doesn’t understand what’s going on, and I need to take time to take care of my patients,” Hanford said.

The company said in a written statement that it opposes the bill.

“We are part of a broad coalition of physicians, nurses, patient advocates, CA Dialysis Council and others who believe SB 349 will be dangerous for patients,” it said.

Lara said it’s important to hold dialysis clinics to the same inspection standards as nursing homes.

“Dialysis is a growing business in California, and particularly for low-income communities and people of color,” he said in a statement. “Without better oversight California is on a collision course for a patient safety crisis. Safer staffing levels and inspections will keep patients safe.”

Opponents of the measure say it would be difficult to implement given California’s nursing shortage and could lead clinics to drop patients to maintain that eight to one ratio. If patients are dropped, they will need to get dialysis at a hospital, which is more expensive.

Emma Gonzales works at a DaVita clinic in West Sacramento. She said that this bill would limit her flexibility to take care of her patients.

“Things come up that you don’t prepare for, and having a ratio would put a rigid structure on our workflow,” Gonzales said. She said if a patient needed to come in earlier, they might not be able to. Too many patients at once, she said, could put nurses in the uncomfortable situation of either seeing a patient or breaking the law.

According to data collected by the Centers for Medicare and Medicaid Services, 69 percent of dialysis patients in California give their clinic a ranking of nine or 10 out of 10, and only 10 percent of patients rated their clinic at a six or below.

Opponents argue, then, that clinics are already operating better than other states with similar ratio structures. A Californian Health Care Foundation study in 2009 found that “ratios have had no clear impact on the quality measures that are associated with nursing care,” though it gave no specific data on dialysis nurses.

Dr. Bryan Wong, who has worked in dialysis for about 30 years, says the bill will create unintended consequences for his patients.

“The bill as it exists does not have enough safeguards that will allow treatment of patients being paramount,” Wong said. He said that because the new law requires that chairs be vacant for 45 minutes, all shifts would be pushed up, and patients who usually come in at night could no longer be treated.

As far as increased inspections, Wong said the inspecting entity, the California Department of Public Health, is already understaffed.

Most of all, he is worried that some clinics will need to close, leaving many people with nowhere to go. “It boggles my mind why things like that are not being discussed to begin with,” he said.

Hawken Miller: 916-321-11046, @HawkenMiller