State Senate Takes Key Step to Save Lives of California Dialysis Patients

May 2017

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May 31, 2017

Contact: Jeff Rogers, Communications Specialist
Jeff.Rogers@unacuhcp.org | 909-263-7230

State Senate Takes Key Step to Save Lives of California Dialysis Patients

SACRAMENTO—By passing the Dialysis Patient Safety Act (SB 349) today, the California State Senate took a key step in protecting the lives of 66,000 Californians who rely on thrice-weekly dialysis treatments in 560 clinics around the state to stay alive.

Dialysis patient mortality rates are significantly worse in the United States than in Europe and Japan. Worse staffing and infection control have been cited as the most likely causes. SB 349 seeks to address both problems for California’s chronic dialysis clinics in three ways. First, it would set safer per-patient staffing ratios of registered nurses (RNs), patient care technicians (PCTs) and social workers (SWs). Second, it would mandate a 45-minute minimum transition time between patients, to allow technicians to properly clean and disinfect treatment stations of the blood and fluids which carry infection risks and are a common byproduct of the dialysis procedure. Finally, the bill increases accountability in the industry by mandating annual inspections of dialysis clinics—as currently required for nursing homes and restaurants—which are now inspected only every five to six years.

“A safe transition time is crucial to prevent the spread of infection,” said Enrico Maniago, PCT. “Cleaning up a treatment station between patients can be a lengthy process. We have to wipe blood off the floor and chair and apply bleach to prevent infection. We’re often pressured to rush new patients in before the bleach is even dry, making them vulnerable to infectious diseases like hepatitis.”

In leading the effort to win SB 349 to protect their patients, dialysis RNs and PCTs are going up against two huge for-profit corporations, Fresenius Kidney Care and DaVita, which have alarming safety records but a virtual stranglehold over dialysis care in California and the United States. Fresenius and DaVita dominate the U.S. dialysis market, serving almost 85% of patients, even though one 2010 study found a 19% higher risk of death at Fresenius facilities and a 24% higher death risk at DaVita than for patients receiving care at the biggest nonprofit chain. Lower staffing levels along with questionable infection control and patient care practices have been suggested causes. DaVita has paid out close to $1 billion in Medicare and Medicaid fraud settlements in recent years. Fresenius recently settled a $250 million lawsuit for knowingly selling products that were linked to sudden cardiac arrest in patients.

Dialysis is a multi-billion-dollar industry, yet despite the alarm bells on patient safety it has operated largely in the dark and unregulated for decades. During that time, its dominant companies have amassed massive profits, operating with profit margins significantly higher than most hospital chains. Their net incomes have grown significantly over just the past five years as they continue to open new clinics, while acquiring or forming joint ventures with physician groups, laboratories, urgent care centers and more. Fresenius’s 2016 operating margin was almost 15% ($2.6 billion) and DaVita’s almost 13% ($1.9 billion). By contrast, the 2016 operating margins of major California hospital chains included Sharp Healthcare with 6.2%, Scripps Healthcare with 4.9% and Kaiser Permanente with 3.0%.

With such huge profit margins Fresenius and DaVita can well afford to invest more in patient care and safety. Still, they’ve mounted a full-scale opposition campaign against the Dialysis Patient Safety Act (SB 349), authored by State Senator Ricardo Lara and co-sponsored by the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP). The companies have predicted doomsday scenarios involving clinics closing, nurses and technicians being laid off, and treatment hours cut, even though all health and economic indicators show the numbers of patients needing dialysis only increasing in coming years.

If the past is any indicator, the companies’ predictions of disaster are merely defensive tactics and will not be borne out. In 2007-2008, the Centers for Medicare and Medicaid Services (CMS) instituted a requirement for at least one RN to be on-site during dialysis treatments. Both companies predicted clinic shutdowns, caregiver layoffs and reductions in services to patients. None of these consequences occurred, and in fact the companies have seen dramatic growth in the number of clinics they operate. Several states already have minimum staffing ratios for chronic dialysis clinics. New Jersey’s ratios are most like those proposed for California and resulted in no reported reductions in employment, shifts or treatment hours.

Dialysis PCT Enrico Maniago first approached UNAC/UHCP last year, seeking help in winning safer caregiver-to-patient ratios from the union that was instrumental in winning the 1999 passage of California’s trailblazing nurse staffing law, which made it the first state in the nation to establish minimum RN-to-patient ratios in hospitals.

“Studies consistently show that improved staffing in dialysis settings improves patient outcomes, decreases hospitalizations and reduces exposure to infectious disease,” said Denise Duncan, a 35-year RN and President of UNAC/UHCP. “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 the companies who profit from the care.”

Having passed in the Senate, the bill must be taken up next by the California State Assembly.


United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP) represents over 28,000 registered nurses and other health care professionals, including RNs who specialize in dialysis; optometrists; pharmacists; physical, occupational and speech therapists; case managers; nurse midwives; social workers; clinical lab scientists; physician assistants and nurse practitioners. UNAC/UHCP is affiliated with the National Union of Hospital and Health Care Employees and the American Federation of State, County and Municipal Employees, AFL-CIO.


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