Dialysis Patient Safety Act Clears Next Hurdle in California State Senate

April 2017

A bill to improve safety for more than 63,000 Californians who undergo life-saving dialysis treatment several times weekly in more than 560 clinics throughout the state was approved today by the California State Senate Judiciary Committee.

The Dialysis Patient Safety Act (SB 349), introduced by State Senator Ricardo Lara and sponsored by UNAC/UHCP, would establish caregiver-to-patient ratios and mandate safe transition times so equipment can be fully cleaned of blood and fluids between patients to prevent the spread of life-threatening infections.

“This bill forces the two largest dialysis companies, Fresenius and DaVita, to invest more in patient care. That means it will cut into their huge profit margins—which are now far higher than most health care providers,” said Denise Duncan, a 35-year RN and President of the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP). “That’s why the companies are fighting the bill so hard, making gloom-and-doom predictions about closing facilities and cutting treatment hours.

“The truth is we’ve been down this road before,” Duncan continued. “When CMS decided to require just one RN on-site at all times to supervise dialysis treatments the companies made the same predictions of disaster—but nothing bad happened at all. In fact, the companies have seen dramatic growth, opening new clinics and adding more treatment hours all over the country. They’re tremendously profitable. Similarly, other states that have passed ratio bills have not seen clinic closures as a result.”

Senator Lara introduced the bill on February 15, 2017. On March 29, it passed the Senate Health Committee. With the Judiciary Committee’s favorable vote today, the bill goes next to the Appropriations Committee in a few weeks. The bill sets ratios for California’s chronic dialysis clinics of no more than 1 RN to 8 patients, 1 patient care technician to 3 patients and 1 social worker to 75 patients. Dialysis clinics have become a multi-billion-dollar industry. The two largest dialysis corporations in California and the nation, Fresnius and DaVita, brought in $17.9 billion and $14.7 billion in operating revenue respectively in 2016, with operating margins of 14.73% and 12.85%. By comparison, most major hospital chains have much smaller profit margins.

“Studies consistently show that improved staffing in dialysis settings improves patient outcomes, decreases hospitalizations and reduces exposure to hepatitis C,” said Duncan. “Every objection the companies put up against the bill is simply a smoke screen to protect their huge profit margins. That’s why we believe that those who care for patients at the bedside every day should set the standards of care, not those who profit from the care.”

Ciara Gatchalian, a chronic dialysis Patient Care Technician (PCT), testified to the committee on the need for ratios of technicians to patients and safe transition times between patients. “I come into the clinic at 3:30 AM in the morning to prep all of the treatment chairs by myself. Then the patients start coming, a new one every fifteen minutes. I hook one up to the dialysis machine and then the next one comes. The next technician doesn’t come in for two hours. Which means I’m alone with all those patients. I can’t watch two at once. One patient could be having a stroke while I’ve got my back turned, hooking up the next one. I need help. These patients deserve better. I see my patients two or three times a week, every week, month after month, year after year. They’re like family to me. They deserve to be safe.”