Proposition 29 marks the third time since 2018 that health care union leaders try to bring to fruition regulatory changes to dialysis centers in California. Prop 29 is heavily opposed by dialysis corporations that have spent tens of millions to combat it.
Dialysis is a treatment process for people suffering from renal failure. It does the job of a kidney by balancing chemicals in your body, controlling blood pressure and removing waste, salt and extra water. Without dialysis, people suffering from kidney failure would die. There are approximately 650 dialysis centers in California, with about 80,000 patients receiving treatment.
Proposition 29 would require all dialysis centers in California to have at least one physician, nurse practitioner or physician assistant available while patients receive treatment. It would also require these centers to report all dialysis-related infections to the state health department and the National Healthcare Safety Network. Prop 29 is very similar to 2020’s Proposition 23, which would have required at least one physician to be present at every dialysis center while patients are being treated — though it failed to pass. In response to Prop 23’s failure, its backers aimed lower, becoming more lenient in its proposed rules and allowing other types of medical professionals to be present at the centers while patients receive their treatment, such as nurse practitioners and physician assistants. The proposition also expands the possibility for physicians to be present virtually.
“Those that are in the rural area are probably … at most risk of getting harmed. Why? Because the density of dialysis clinics in rural areas is much, much less than in urban areas.”
— Bryan Wong, medical director at DaVita Oakland Dialysis
The health care workers union SEIU-UHW, the primary supporter of the proposition, argues that dialysis centers don’t invest enough in patient care. They say having a physician available at all times would improve safety conditions for dialysis patients and possibly reduce hospitalization. Physicians and nurses would also be able to immediately assist in case of emergency.
Opponents, like DaVita Inc. and Fresenius Medical Care, who own three-fourths of the dialysis centers in California, say Proposition 29 would add unnecessary costs, increasing spending by hundreds of thousands for each clinic annually. Numerous ads from the no on Prop 29 coalition claim these increased costs would put thousands of dialysis patients at risk.
“Nearly half of all of California’s 600 dialysis clinics could be forced to cut back services or close,” the No Prop 29 website reads. “Making it more difficult for dialysis patients to access their life-saving treatments and putting patients’ lives at risk.”
This claim may not ring so true. DaVita and Fresenius make billions of dollars each year and, according to the L.A. Times, spent a collective $79,000,000 opposing Prop 29. Both corporations also spent hundreds of millions opposing its predecessors — leading some to believe the corporations can afford the extra cost.
“I am often anxious when I’m sent home after treatment because I’m afraid that I’m going to bleed out more. A doctor on-site would be better able to evaluate my situation before I leave the clinic.”
— Carmen Cartagena, dialysis patient
The proposition also includes a measure that requires dialysis clinics to notify and obtain consent from the California Department of Public Health before closing or substantially reducing services.
The claim that some dialysis centers would close does breathe truth. According to Bryan Wong, a medical director for DaVita in Oakland, dialysis patients in rural areas are most at risk of losing their centers.
“Those that are in the rural area are probably even worse because those in a rural area probably have a huge amount of MediCal-only patients,” Wong said in an interview with KQED. “And those are the patients that are at most risk of getting harmed. Why? Because the density of dialysis clinics in rural areas is much, much less than in urban areas.”
Some dialysis patients have expressed support for the idea of having a physician present during their treatments. Carmen Cartegena, a dialysis patient, explained in an op-ed for the San Diego Tribune that patients will often bleed after their treatments and require assistance from staff to stop it.
“I am often anxious when I’m sent home after treatment because I’m afraid that I’m going to bleed out more,” Cartagena wrote. “A doctor on-site would be better able to evaluate my situation before I leave the clinic.”
However, this doesn’t mean dialysis patients aren’t agitated as organizations play politics with their life-saving treatment.
“When I see these propositions that are put before the voters, who have no idea what we go through and what’s necessary to keep us alive, it makes me angry because they’re playing politics for whatever their reasons are,” said DeWayne Cox, a dialysis patient, in an interview with KQED, “but they’re putting patients like me in the middle of it.”