A bill aimed at improving patient care and staffing at 560 California dialysis clinics that serve more than 63,000 patients is threading its way through the state Legislature despite sharp opposition from some in the industry.
Senate Bill 349, also known as The Dialysis Patient Safety Act, has cleared the Senate Health and Senate Judiciary committees and is headed next to the Senate Appropriations Committee before moving on to the Assembly.
Many local clinics affected
Authored by state Sen. Ricardo Lara, D-Bell Gardens, the legislation would affect 33 clinics in the San Gabriel Valley and 10 in Long Beach alone. The measure has been fueled by dialysis workers in California who have been attempting to unionize through SEIU-United Healthcare Workers West for safer working conditions and stronger worker and patient protections. It calls for annual inspections of dialysis clinics and safer staffing levels.
Dialysis is a life-saving treatment for people with kidney failure who must have their blood removed, cleaned and put back into their bodies. Treatments typically last three to four hours and must be done three days a week for the rest of the patient’s life.
More inspections, increased staffing
In California, dialysis clinics are typically inspected only once every five to six years. That’s far fewer inspections than most other health care facilities receive. California nursing homes, for example, must be inspected every year. SB 349 calls for a staffing ratio of one registered nurse for every eight dialysis patients, one technician for every three patients and one social worker for every 75 patients. It also mandates a 45-minute gap between the time one patient finishes treatment and the next one begins. That’s so staff would have time to properly clean the equipment, thereby reducing potential infections.
Megallan Handford, a registered nurse and dialysis worker from Corona, says patients’ lives are on the line.
“It’s nearly impossible to do what’s right for our patients when we’re responsible for too many vulnerable people at the same time,” Handford said. “We need more time to sanitize the dialysis equipment and monitor patients post-treatment, when their blood pressure is dropping and are at grave risk if we don’t respond fast enough.”
A patient’s perspective
Dialysis patient Amar Bajwa traveled to Sacramento on Tuesday to speak in support of SB 349.
“My treatments are from 1 to 5 o’clock and toward the end of that — around 4 o’clock — there is less staffing and patients are still sitting in their chairs,” the 62-year-old Fontana resident told lawmakers gathered there. “A few days ago I was supposed to start my treatment and I got there five minutes late. A chair wasn’t available and I had to wait while they cleaned everything up. They should have enough time to do that. And we’re talking blood here … there could be infection. That’s my concern.”
Pomona resident Vincent Gonzales, who began dialysis treatments 20 years ago, said caregivers at the clinics can’t keep up with the patient load. His story is inlcuded on the SEIU-United Healthcare Workers West website.
“I decided to take control of my health if I wanted to stay alive,” he said. “I watch my weight and pay close attention to the type of equipment they use because I know what filters and devices work best for me.”
SB 349 may be well intended, but a coalition of patient advocates, nurses, physicians and clinics specializing in dialysis care are firmly against it.
Data collected by the California Dialysis Council (CDC) show that increased costs associated with the measure — including longer transition times and mandated patient/staffing ratios — could force clinic closures throughout the state and reductions in appointment slots, particularly for dialysis patients who are treated in the evening.
All told, the coalition says up to 15,400 patients could lose their access to dialysis care if SB 349 is passed because of reductions in shifts and potential clinic closures. The group also noted that California performs better than the collective performance of states with and without staffing ratios.
Marketa Houskova, state director and senior policy analyst with the American Nurses Association/California, describes the bill as a “one-size-fits-all” approach to patient and staffing needs. In a letter to Hannah-Beth Jackson, who chairs the Senate Judiciary Committee, she noted that the legislation would subject nurses and other staff members at dialysis clinics to personal fines of up to $4,000 for violations of the mandated staffing ratio. That, she said, is “an administrative decision completely out of control for nurses!”
“How can we assure that our patients get high quality nursing care?” she asked. “Simple, by allowing those who spend the maximum time with patients and who provide the actual care day-in- and-day-out — registered nurses — the ability to make safe staffing decisions based not on a rigid mandate but on the actual health care needs of our patients.”
The coalition calls SB 349 “a thinly veiled attempt by the bill’s sponsors to push for unionization of workers.”