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California voters weigh in again on care at dialysis clinics

SAN FRANCISCO (AP) — California voters will again weigh in on the quality of care dialysis clinics provide to about 80,000 people in the state with kidney failure.

Proposition 23 would require a doctor or highly trained nurse at each of the state’s 600 dialysis clinics whenever patients are being treated to improve patient care. It was placed on the ballot by unions that represent health care workers.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.


“There are a tremendous number of complications that can occur during and around dialysis, and a doctor onsite will be able to respond not only to emergencies such as cardiac arrest, bleeding, dangerous fluctuations in blood pressure — all other common side effects of dialysis — but they also will be able to oversee the overall quality of care,” said Steve Trossman, a spokesman for the Oakland-based Service Employees International Union-United Healthcare Workers West, which spent more than $6 million in a signature drive to get it on the ballot.

Proposition 23 is the second attempt by the union to increase regulations of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market. Early voting begins Monday for the Nov. 3 contest.

In 2018, the union-backed Proposition 8, which sought to cap dialysis clinics’ profits and force them to invest more of their profits in patient care. Voters rejected the measure but not before it became the most expensive initiative on the 2018 ballot, generating more than $130 million in campaign spending — more than $111 million from dialysis companies to kill the initiative and about $19 million from unions that supported it.

Dialysis providers say most California clinics already offer high-quality care and are regulated by federal and state authorities. They also point out all patients already have a nephrologist — a kidney specialist — who oversees their care and that nephrologists also direct each clinic in California. They say the initiatives are part of a tactic to pressure the dialysis companies to let workers unionize.

“The motive is to force the dialysis community to spend a bunch of money to defeat it because ultimately this is more about a union organizing battle. I have no doubt that in 2022 there will be another initiative on the ballot targeting dialysis providers and dialysis patients,” said Kathy Fairbanks, a spokeswoman for No on Prop. 23, a coalition led by DaVita and Fresenius that also includes the California Medical Association and American Nurses Association-California.

The nonpartisan Legislative Analyst’s Office estimates dialysis companies currently make roughly $3 billion a year from their California operations.

So far this year, the union has raised nearly $6.2 million backing it and the coalition against Proposition