The Judiciary Committee for the California State Senate has approved Senate bill 349, called the Dialysis Patient Safety Act, which would set patient to staff ratios for the estimated 560 freestanding dialysis clinics and 63,000 dialysis patients in the state.
The bill, introduced by state senator Ricardo Lara, D-Bell Gardens, and backed by the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) will now advance to to the Senate Appropriations Committee for a hearing in May.
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.
In the bill, Lara and the union said, “There is broad consensus among medical professionals, academics, and other experts that higher ratios of direct caregiving staff to patients at outpatient dialysis clinics improve patient outcomes, including by reducing the rate at which patients suffer infections or must be hospitalized.”
The California Dialysis Council, an organization of dialysis providers in the state, said it opposes the bill because it would restrict facility flexibility, reduce available treatment shifts, lead to centers closing, and limit access to certain modalities like nocturnal dialysis.
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.
“It’s nearly impossible to do what’s right for our patients when we’re responsible for too many vulnerable people at the same time,” said Megallan Handford, a registered nurse and dialysis worker from Corona, Calif., who testified at the hearing. “We need more time to sanitize the dialysis equipment and monitor patients post-treatment, when their blood pressure is dropping and are at grave risk if we don’t respond fast enough. Patients’ lives are on the line.”
States that mandate staff ratios in dialysis clinics
There are only eight states in the U.S. that have staffing ratios for dialysis clinics. Texas was the first. Other states have followed, and include requirements for yearly licensure and/or estimating acuity levels of patients to help determine ratios (see below).
Jeff Rogers, a communications specialist for the United Nurses of California, says a group of dialysis caregivers from the Los Angeles area approached the union “because they felt that patient safety was at risk due to a lack of staffing ratios and high turnover in the industry.”