Supporters of a state bill requiring staffing improvements at dialysis clinics say that poor working conditions create a safety risk for the thousands of Californians being treated for end-stage kidney failure.
SB 349, the Dialysis Patient Safety Act, would mandate annual inspections of dialysis clinics. Current law requires inspections every six years; by comparison, nursing homes in California must be inspected every year, and hospitals every two years.
If enacted, owners of dialysis clinics would also be required to adhere to new staff-to-patient ratios designed to ensure that workers have at least 45 minutes to prepare stations between patients.
Dialysis treatment involves the draining and filtering of blood to remove toxins. The blood is then returned to the patient. Blood infections from contaminated equipment are among the dangers if clinic workers do not have time to adequately clean their stations.
The bill’s advocates say dialysis clinic staffing is an important issue in communities of color, citing statistics that kidney failure and dialysis-related infections are higher among African Americans and Latinos.
“Patients are being rushed through the treatment process,” says Joan Allen, a government relations advocate for Service Employees International Union-United Healthcare Workers West (SEIU-UHW). “Some patients leave the clinic still bleeding, making them vulnerable to infection. Caregivers need enough time to clean and sanitize the chair … The bill is needed because without enough transition time and enough staff, you can’t treat patients safely.”
Allen spoke at a media forum about the bill on May 4. Dialysis clinic workers are currently trying to organize to join SEIU-UHW because the two companies that dominate the state’s treatment industry – DaVita and Fresenius Medical Care – have been unresponsive to staff concerns, says Megallan Handford, a dialysis nurse from Riverside County.
Handford says he has been required to work with as many as 24 patients at one time.
“It’s all about profits,” he says. “Company policies and procedures set us up to fail … When you bring up issues, you will be targeted and you will be fired. The industry does not want us to have a voice.”
A dialysis patient at the forum – Vince Gonzales of Pomona – says he saw a fellow patient die at a clinic while he was being treated.
“I wondered, ‘Can I be next?’” he says. “The other day, I walked into a dialysis center that had 16 patients and one nurse. To me, this is a wake-up call.”
Gonzales’ son, Emanuel, told reporters he decided to become a dialysis nurse after seeing the dedication some dialysis nurses showed to his father, and wanting to “give back” to other patients.
Diverse patients at the forum also called for staff increases. Brenda Grant of Oakland recounted one experience.
“After the treatment, the nurse told me, ‘Brenda, we need this chair,’” she says. “I felt a little weak but I had to get up and go.”
Cristina Castro, a patient from Sacramento, says her treatment has also been compromised because staff have been overstretched and have had to rush her in and out.
“I support the bill because clinics don’t have enough staff,” she said.
A coalition of dialysis treatment companies oppose the bill, which has passed through two of the committees required to qualify for a full state senate vote. The companies contend that increased costs associated with the measure could force clinic closures throughout the state and reductions in appointment slots.
Some clinics located in communities of color might have to close if the bill is passed, unless the federal government provides more funding for dialysis treatment, according to Dr. Randall Maxey, a provider of kidney treatment in Los Angeles and an owner of clinics in Puerto Rico. Currently, 562 clinics provide dialysis for California’s 63,000 patients.
“This legislation appears to be good, but as practitioner, I know we are heavily regulated,” he says. “We need a better system.”
Cass Gualvez, the organizing director for SEIU-UHW, says evidence doesn’t support the concern that the legislation would trigger reductions in clinic operations. She says eight other states with minimum clinic staffing standards have not had declines in treatment centers.
“[California] dialysis treatment companies made $3 billion in profit in 2015,” Gualvez says. “So there is enough money for more staff.”