California voters rejected increased regulations for dialysis clinics: What comes next?

Nearly 64% of Californians voted “No” on Proposition 23, a measure that would have expanded regulation for dialysis clinics in the state. Though official ballot results are not certified by the Secretary of State’s office until December 11, 2020, tallied ballots show over 10 million people voted to reject the measure.

Proposition 23 would have required chronic dialysis clinics to have an on-site physician, report data on dialysis-related infections to the state and get consent from the California Department of Public Health before closing a clinic. Additionally, the measure would have prohibited clinics from discriminating against patients based on their insurance or payment method.

In California, an estimated 80,000 people receive dialysis treatment to filter waste from their blood, a process that would normally be done by the kidneys. According to the National Kidney Foundation, during treatment, blood is removed from the patient and cleansed by machine—sometimes called an artificial kidney. Once the blood is filtered, it is then reintroduced into the patient’s body. This process can take up to three to four hours to complete, and patients must have treatment multiple times a week. Treatment can be critical and life-saving in the absence of a kidney transplant.

Representatives from Service Employees International Union-United Healthcare Workers West (SEIU-UHW), which sponsored the bill, say that dialysis treatment is big business, and the lack of regulation allows companies to turn profits at the expense of patients’ health care.

“The dialysis industry in California makes nearly $600 million in profits annually,” said Carmen Cartagena, a dialysis patient in the Bay Area who supports SEIU-UHW. “To protect their outrageous profits, the dialysis corporations have now spent nearly a quarter of a billion dollars to defeat ballot initiatives and to scare and mislead Californians. Had they used those millions instead to improve conditions in the clinics, there would have been no need for a Proposition 23.”

While dialysis patients’ treatment plans always include a physician specialist who can prescribe medication for kidney disease, it is less likely for clinics to have a full-time physician on-site at all times. One reason being there are more clinics than there are nephrologists, or kidney specialists, so some doctors provide care and rotate to different sites. In fact, most dialysis clinics are staffed with other medical personnel such as nurses, technical specialists, social workers, and nutritionists.

In California, there are 600 dialysis clinics in the state alone. However, some patients undergo treatment at home after receiving special training to do it themselves. Because some treatments can be self-administered by some patients at home, opponents to Proposition 23 say that overall, having a full-time physician on-site at clinics is unnecessary and would increase clinic operational costs.

Critics of the proposition say SEIU-UHW are trying to boost their union members under the guise of pushing for regulations.

But proponents like Cartagena believe the measure would have made a positive impact on patient care and standards. “It would have brought more equality to dialysis treatment,” she said. “Whether they are in a wealthy neighborhood or a poor, rural, Black or Brown community, all clinics would have been required to report. And every dialysis corporation would have been prohibited from discriminating against patients because of the type of insurance they have.”

However, Fresenius Medical Care North America, one of the two leading dialysis companies serving patients across the Bay Area, say they are pleased with the election results.

“It’s good news for patients that California voters have sided with a wide coalition of healthcare providers rejecting Proposition 23,” said Bill Valle, CEO of Fresenius Medical Care North America.

Valle believes voter rejection of the ballot measure is in the best interest of patients. “It safeguards access to dialysis in California by avoiding redundant and unnecessary requirements,” he said. “The overwhelming vote against Proposition 23 allows us to maintain our focus on providing the highest quality care possible for our patients needing life-sustaining treatment.”

Together with Fresenius Medical Care North America, DaVita Inc., another top dialysis treatment provider, spent over $100 million dollars to oppose Proposition 23. In Oakland, the two companies own ten of the twelve total clinics around the city. According to the Secretary of State, SEIU-UHW, who represents more than 97,000 healthcare workers and patients, spent $9 million to promote the measure.

For supporters of the measure like Cartagena, the fight is not over. “We are in this for the long haul,” she said. “Until the dialysis industry does the right thing, we intend to continue seeking to hold the dialysis industry accountable, through all means, including in the state legislature and through the ballot box. We won’t stop until it is truly reformed and puts patients before profits.”