Proposition 23 returns for 2022 California midterm election

photo of dialysis machine and chair
Monirb/Creative Commons
Despite dialysis-related propositions being rejected by voters in two consecutive state elections, an initiative to require physician, physician assistant or nurse practitioner to be on site at all times during treatment will appear on the ballot in the November midterm elections. (Photo by Monirb under CC BY-SA 3.0)

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The California Dialysis Clinic Requirements Initiative will be listed as a ballot item in California’s November midterm elections, supported by the workers’ union Service Employees International Union United Healthcare Workers, or SEIU UHW, West.

Dialysis, the process of using machines to clean toxins and fluids from the blood of patients with failed kidneys, supports about 80,000 patients in California, according to the initiative. The initiative would require a physician, physician assistant or nurse practitioner to be on site at all times during treatment in dialysis clinics.

Notably, the measure is making a reappearance: Similar ballot items were proposed in 2018 and 2020 as Propositions 8 and 23, both of which were ultimately rejected by voters.

“The purpose of the initiative is to improve dialysis patient safety and outcomes,” said SEIU UHW West spokesperson Renée Saldaña in an email. “The current model of the dialysis industry is predatory and hurts patients, taxpayers, and consumers.”

According to Saldaña, the current dialysis treatment industry is an outlier in healthcare due to both its lucrative nature and its harmful impact on patients and the public. She said the industry takes advantage of those in need of the treatment and the taxpayers who fund it.

Saldaña also commented on the repeated failures of similar ballot items in previous elections, attributing it to the large sums of money spent on campaigning by those against the initiative.

“Dialysis corporations have lobbied against efforts to enact protections for kidney dialysis patients in California, spending over $100 million in 2020 to scare and mislead California voters in order to protect their sky high profit margins,” Saldaña said in the email.

However, not all agree on the nature of the initiative. Stop the Dangerous and Costly Dialysis Proposition, a coalition of doctors, nurses, dialysis patients, caregivers and a number of other groups, opposes the proposition.

Kathy Fairbanks, spokesperson for the coalition, claimed that requiring a physician, physician’s assistant or nurse practitioner on site for dialysis is unnecessary. She added medical professionals currently overseeing dialysis patients, such as a personal nephrologist, were sufficient and noted the added personnel would only make treatment more expensive for both clinics and patients.

This mirrors the conclusion reached by the Berkeley Research Group, which found that costs would increase between $229 million and $445 million statewide. Fairbanks claimed such costs would drive many clinics to close, jeopardizing lives that depend on the treatment.

Fairbanks alleged the repeated ballot items are an attempt not to improve the quality of dialysis treatment but to unionize workers in the field. The initiative itself does not involve the unionization of dialysis workers, but Fairbanks claimed the union has made it “very obvious” that they will stop pursuing ballot measures if the workers do unionize.

Fairbanks also said fighting these measures is expensive for the care providers.

“It means putting pressure on the dialysis providers themselves, the companies and essentially trying to force unionization from the top down versus the bottom up,” Fairbanks said.

Fairbanks noted the reported quality of dialysis care in California is already above average, as reported by patients and as shown by patient data.

Contact Chanyoung Chung at [email protected], and follow him on Twitter at @chung_chanyoung.