The Judiciary Committee for the California State Senate is holding a hearing April 25 on a bill that would set patient to staff ratios for the estimated 560 freestanding dialysis clinics and 63,000 dialysis patients in the state.

Senate bill 349, called the Dialysis Patient Safety Act and introduced by state senator Ricardo Lara, D-Bell Gardens, advanced out of the state Senate’s Health Committee on March 29 by a 6-2 vote; a positive vote today would send the bill to the Senate Appropriations Committee for a hearing in May.

The hearing today is slated for 1:30 pm PST, but the committee will be looking at close to 30 other bills as well. You can listen to it live.

SB 349 would set a 1:8 nurse-to-patient ratio, a 1:3 patient care technician-to-patient ratio, and a 1:75 social worker-to-patient ratio. The bill also proposes to establish a 45-minute transition period between treatments, and require state surveyors to inspect clinics at least once a year.

Dialysis providers are opposed to the legislation, saying the ratios would be tough to meet because of an ongoing nursing shortage, and increasing staffing would not have a significant impact on the quality of care in the state.

According to, a coalition of dialysis providers and professional associations opposed to the bill, California has the highest percentage of dialysis clinics with a four- or five-star ratings in the Center for Medicare & Medicaid Services’ Star Rating Program compared to other states.

Among the seven states in the country that already have staff-to-patient ratios, none have that high of a percentage of clinics with 4-5 star ratings, according to the group (see infographic provided by

No on SB 349 Quality Infographic 4.18.17

“Mandated staffing ratios would lead to a reduction in available appointments, reduce operational flexibility and threaten the existence of dialysis facilities that are providing high-quality care to patients in underserved areas but underperforming financially,” dialysis provider DaVita Inc. said in a statement.

“Reduced access to dialysis could disproportionately affect socioeconomically vulnerable patients, augment the need for emergent dialysis treatments and hospitalizations, and increase total costs to state and federal payers. Likewise, the longer transition time of 45 minutes between treatments might push third or fourth shifts to much later in the day, or force clinics to shut those shifts down altogether.”

The Renal Physicians Association has come out against the bill, saying there is little evidence that ratios improve the quality of care. “Having adequate numbers of staff is important, but there is no evidence that regulations with specific nurse to patient staffing ratios, or technician staffing ratios, have led to greater safety or improved outcomes in states where those regulations exist.” said Michael D. Shapiro, MD, MBA, FACP, CPE and president of the Renal Physicians Association.

The National Kidney Foundation said in an April 18 letter to Senator Hannah-Beth Jackson, Chair of the Senate Judiciary Committee, and Committee members, that it was “unable to take a position on SB-349,” but agreed with the RPA that “the evidence that mandating specific ratios will lead to improvements in patient care is limited.” They also said, “We are unaware of evidenced-based guidelines requiring that the dialysis chairs remain empty for 45 minutes.”

While supportive of the intent of the bill, members of NKF’s Executive Council of Nephrology Nurses and Technicians have commented that the proposed ratios “would be difficult to meet. The legislation may require facilities to hire more staff, which can be difficult in certain regions of the state,” the NKF said in the letter.