Legislation that would mandate staff to patient ratios in California dialysis clinics was approved by the State Senate on a 24-15 vote May 31 and received its first reading before the State Assembly on June 1.

The Assembly’s Health committee, the first to review the bill, must take action on the bill by July 14.

The latest version of the bill, called the Dialysis Patient Safety Act and introduced by Ricardo Lara, D-Desert Gardens, added a new 1 to 75 patient to staff ratio for dietitians. The bill already had ratios of 1 to 8 patients for nurses; 1 to 3 patients for patient care technicians, and 1 to 75 for dialysis social workers. Only one other state, Texas, mandates a staffing ratio for dietitians.

The newest ratio is supported by the California Academy of Nutrition and Dietetics (CAND), which said in a letter to Lara that the legislation “brings attention to the importance in dialysis centers of safety standards and minimum healthcare provider to patient ratios, including those of registered Dietitian Nutritionists (RDNs). Inclusion of RDNs in the requirement for minimum provider-to-patient ratios to facilitate necessary patient care in dialysis centers underscores the important role of dietitians in chronic disease treatment and management.” CAND is a nonprofit professional association representing more than 7,000 registered dietitian nutritionists (RDNs).

The bill had been amended five times since first introduced by Lara on Feb. 14. Aside from adding dietitians to the ratio formula, legislators also made significant changes to the penalties written into the bill’s original language. The revisions give the Department of Health (DOH) much wider discretion on specific penalties for clinics who do not meet the ratios.

Legislators removed the entire Article 5, “Suspension, Revocation, and Penalties,” language from the bill that would create a schedule of penalties for dialysis companies and clinic managers who didn’t comply with the regulations.

That section was replaced by language that would “authorize the department to assess an administrative penalty for a violation of these provisions and would require the department to promulgate regulations to establish criteria for assessing these penalties.”

Sean Wherley, head of media relations for SEIU-United Healthcare Workers West, which supports the bill and has been trying to unionize dialysis workers, said the changes to the penalties “mean the regulation of dialysis clinics in California will be brought in line with how hospitals and other health facilities are regulated.”