ELK GROVE – Toni Sherwin is really looking forward to the procedure that will shift the position of her dialysis port from her chest to her arm, which will make it easier to stay dry. Since starting dialysis in February – part of her blood cancer treatment – she has washed her hair in the sink and stayed out of the pool to prevent water from entering the port.
Three times a week, Sherwin, 71, drives to a dialysis clinic in Elk Grove, California, a suburb south of Sacramento where she lives, and lies clamped to a machine for about four hours while it filters the blood. The treatment left her exhausted, but she felt well cared for and knew that the clinic staff would call the police if she didn’t show up for her appointment and they couldn’t contact her directly.
“They don’t play games,” Sherwin said.
Sherwin feared her access to the clinic would be in jeopardy. A sign on clinic windows tells patients and visitors to vote “no” on Proposition 29, the third statewide dialysis initiative in five years. It will place new requirements on dialysis clinics, such as requiring a doctor to be present during treatment.
She and other California voters were also hit by TV ads in which patients in wheelchairs and doctors in fetal clothes warned that “29 will close dialysis clinics across California.” “.
“We were terrified,” Sherwin said. “If they stop us, where are we going? We just die.”
Sherwin is among about 80,000 Californians who rely on 650 dialysis clinics located in malls and medical centers around the state. Patients arrive in medical transport vans, minivans, and sometimes vans and are often too tired and hungry after treatment to drive themselves home. They drag duffel bags and pillows into clinics, ready to sit for four or five hours at a time, usually three days a week, as their blood is cleaned and filtered through a machine because their kidneys can’t do the work. that function again.
Prop 29 would require clinics to report infections to the state and let patients know when doctors have a financial stake in the clinic, rules similar to current federal regulations .
The biggest takeaway is the requirement that a doctor, nurse, or physician assistant be present at every clinic while the patient is being treated.
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Requiring an on-site clinician would increase the cost of each facility by “an average of several hundred thousand dollars annually,” according to an analysis by the nonpartisan state’s Office of Legislative Analysis. To deal with the added costs, the analysis concluded, clinics had three options: negotiate higher rates with insurance companies, lose profits, or close facilities.
Service Workers International Union-United Healthcare worker West, which sponsors Proposition 29, says reforms are needed to keep patients safe during the physically arduous process of dialysis. The union – which tried to organize but failed to organize dialysis staff – argued that the treatment was dangerous and that patients needed access to highly trained medical professionals to deal with emergencies instead of relying on 911.
The union is also behind two previous dialysis voting initiatives, which failed due to too wide profit margins. Proposition 8 in 2018 would cap industry profits, while Proposition 23 in 2020 closely resembles this year’s measure. Both broke records for campaign spend.
The campaign against Proposition 29, which is largely funded by the dialysis industry, says keeping a doctor or nurse around is both costly and unnecessary. Clinics employ registered nurses to examine patients and medical directors, doctors who oversee the facilities but often work part-time on site. About three-quarters of the dialysis clinics in California are owned or operated by two companies: DaVita and Fresenius Medical Care.
To date, both parties have raised at least $94 million, according to the Los Angeles Times, with about 85% coming from DaVita and Fresenius.
Joe Damian, 71, does not support the claim that clinics will close if Proposition 29 is passed. Of course, he said, he would feel more comfortable if a doctor was on site while his wife, Yolanda, treated her. He also believes that dialysis companies will continue to make money by fist.
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“How could it not be better?” he asks. “They just don’t want to give up any of their profits.”
Damian drove his wife to her treatment facility in Elk Grove. He understands why other patients and their families are worried about clinics closing but thinks the industry is scared.
“Closing facilities is a threat they would never do,” he said. “Why would they close a business that makes money?”
Prop 29 includes provisions intended to protect against clinic closures, such as requiring facilities to obtain state approval before ending or cutting services, but opponents argue that these terms will not be admissible in court.
Nearly all of the patients interviewed to or from dialysis appointments at five clinics in the Sacramento area saw staff call 911 for another patient. Most said emergencies were handled well by workers and emergency personnel. Overall, they said, they feel the dialysis clinics take good care of them.
The majority of patients used the language of anti-clinic advertisements warning of clinic closures.
Norbie Kumagai, 65, spent her last Thanksgiving at the University of California-Davis Medical Center, and his family was told it was time to say goodbye. But Kumagai, who has stage 4 kidney disease and high blood pressure, made it through and had to wait months to open a dialysis chair at a clinic in West Sacramento, about 13 kilometers from his home in Davis.
Kumagai generally agrees that the dialysis industry needs reform. For example, he says, he wants technicians to help him every week for a raise.
But he’s worried about what Proposition 29 might mean for the treatments that keep him alive.
“I told friends and neighbors that I was scared to death if it passed,” Kumagai said. “This facility is likely to close.”
This story is produced by KHN, the publishing company of California Healthline, an editorially independent service of the California Health Care Foundation.
Kaiser Health News is a national health policy news service. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
