A bill creating new staff-to-patient ratios for California dialysis clinics advanced out of the state Senate’s Health Committee March 29 by a 6-2 vote despite a well-organized effort by dialysis providers to kill off the proposed legislation.

SB 349, the Dialysis Patient Safety Act, introduced by state senator Ricardo Lara, D-Bell Gardens, 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 ratios would be mandatory for the state’s estimated 560 freestanding dialysis clinics and 63,000 dialysis patients. The bill would also establish a 45-minute transition period between treatments, and require state surveyors to inspect clinics at least once a year.

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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.

Nephrologist Bryan Wong, who opposes the bill, told the health committee that 47% of California dialysis clinics have a four- or five-star ratings in the Center for Medicare & Medicaid Services’ Star Rating Program. Among the seven states in the country that have staff-to-patient ratios, none have that high of a percentage of clinics with 4-5 star ratings. The closest is Utah at 40%, said Wong.

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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, noted Al Hernandez-Santana, JD, the Associate Health Policy Analyst for the Indian Health Service. Those shifts tend to have fewer patients per station and clinics often have difficulty attracting nursing staff.

That would have an impact on patient Carl Riddle, who relies on his center’s late nocturnal hemodialysis shift to help keep his job. “[SB] 349 is trying to solve a problem that simply isn’t there,” said Riddle. “The quality of my care is great and this bill would have a negative impact on my lifestyle. I urge you to oppose this bill,” he said.

But Health Committee members and nurses in favor of the bill raised concern about reports of staff shortages at clinics; the ratios, they said, would force clinics to have ample staff on hand to cover the ratio.

“It bothers me a lot knowing I can’t give my patients the full attention and care they need and deserve because of short staffing,” said Emanuel Gonzales, a dialysis worker from Pomona, Calif., during his testimony before the committee. “I should be able to check in with them during their treatment to see how they’re doing, and have adequate time to make sure we thoroughly clean all the equipment before the next patient, but we just don’t have enough people.”

Wong told the committee that the state Department of Health reported 939 infections among 122 million dialysis treatment last year. Infection rates have been cited by supporters of the ratios, saying dialysis staff don’t have enough time to monitor the risk.

“We can do better, and we are doing better,” said Wong, but said he did not believe adding more nursing staff would reduce the infection rate.

Senator Lara said in the bill’s language that the ratios are needed because “current staffing levels in outpatient dialysis clinics in California are inadequate to protect patient health and worker safety, and therefore are presently causing harm to dialysis patients, including unnecessary and avoidable deaths, hospitalizations, infections, and medication errors.”

Seven states now have minimum staffing levels in dialysis clinics: Georgia, Maryland, Massachusetts, Oregon, South Carolina, Texas, and Utah.

Dialysis workers in California have been uniting under a union, SEIU-United Healthcare Workers West (SEIU-UHW), for safer working conditions and stronger worker and patient protections. SEIU-United Healthcare Workers West (SEIU-UHW) is one of the largest unions of hospital workers in the western United States with 90,000 members.

Opposition to SB 349

 California Dialysis Council

California Hospital Association

Renal Physicians Association

Association of California Healthcare Districts

National Renal Administration Association

California Medical Transportation Association

Providence Health & Services

Loma Linda University Medical Center – Kidney Center

Loma Linda University Children’s Hospital

Toiyabe Indian Health Project, Inc.

Valley Industry & Commerce Association

Orange County Business Council

DaVita Inc.

Fresenius Medical Care

U.S. Renal Care