Opinion

August 24, 2022

No on California Proposition 29: This measure would put dialysis patients at risk

San Diego Union-TribuneBy Krystal Salcedo

Proposition 29 on the Nov. 8 ballot would make California dialysis clinics have certain reporting requirements, ownership disclosures and at least one physician, nurse practitioner or physician assistant on-site while patients are being treated. Here, two essays argue for and against the ballot measure, which is the third such try for dialysis regulation since 2018.

Salcedo is a registered nurse and dialysis caregiver who lives in North County.

As a dialysis nurse, I am furious that the same special interest is yet again sponsoring a dangerous dialysis proposition that puts my patients’ lives as risk.

Proposition 29 is a reckless and completely unnecessary attack that would jeopardize dialysis patients’ access to care, worsen our health care provider shortage and increase health care costs for all Californians. Proposition 29 imposes medically unnecessary requirements on dialysis clinics that would increase their costs and force them to cut back services or shut down. It must be defeated in November.

I’ve been a registered nurse for eight years. I work in a hemodialysis clinic in Escondido. Today, our clinic cares for 93 dialysis patients, all of whom have failed kidneys and must get regular dialysis treatments to stay alive. I love my job and the patients I care for. Their well-being is my No. 1 priority.

Three times a week, for about four hours at a time, the 80,000 dialysis patients in California are hooked to a machine that cleans toxins and fluids from their blood. Without dialysis, patients with failed kidneys will die. Dialysis is so critical that missing just a single treatment increases a patient’s risk of death by 30 percent.

Proposition 29 would require dialysis clinics in California to have a doctor, nurse practitioner or physician assistant on site during all hours of operation. This requirement is not medically necessary and instead will force dialysis clinics to cut back services or shut down.

There are myriad problems with Proposition 29. For starters, it would take thousands of health care providers away from where they’re needed — hospitals, clinics and doctors’ offices treating patients — and put them in administrative roles in dialysis clinics.

Dialysis nurses, technicians, social workers and dieticians make up the patient care team along with a medical director on staff at the clinic, a mandated position required by the Centers for Medicare & Medicaid Services.

We are all specially trained and skilled at providing dialysis. According to federal data, California dialysis clinics consistently rank above the national average on patient quality care and patient satisfaction due to the excellent care provided by dialysis caregivers like me.

Patients also have their own nephrologist, a kidney specialist, who prescribes that patient’s specific dialysis treatment and medications. The physician, nurse practitioner or physician assistant required by Proposition 29 would not be authorized to make any changes to a patient’s dialysis treatment or medications, yet this single requirement in the ballot measure would result in a massive cost increase for dialysis clinics.

According to the Berkeley Research Group, Proposition 29 would increase dialysis treatment costs by between $376,000 and $731,000 per clinic per year, or up to $445 million annually statewide. Half the dialysis clinics in the state could become financially unsustainable, particularly nonprofit dialysis clinics and those serving patients in rural areas.

If dialysis clinics are forced to cut back services or shut down completely, it risks my patients’ lives and the lives of tens of thousands of others.

Without reliable access to care, dialysis patients will become very ill and wind up in the emergency room, leading to more overcrowding for all hospital patients and an increase in health care costs for everyone in California.

Proposition 29 is funded by the SEIU-United Healthcare Workers West (UHW) union. In 2020, I campaigned against Proposition 23, a ballot measure also funded by UHW that was nearly identical to Proposition 29. Voters defeated Proposition 23, 63 percent to 37 percent. In 2018, UHW backed Proposition 8, a different dialysis ballot measure. That, too, was rejected by voters, 60 percent to 40 percent.

Now the same special interest is back again with Proposition 29 — the third dialysis ballot measure in three elections.

The attack on dialysis patients must stop. Dialysis patients have it hard enough without having to worry about whether they will be able to get dialysis or not.

While unions have the right to try to unionize workers, it’s not right to abuse the initiative system and use vulnerable patients as political pawns.

That’s why Proposition 29 is opposed by health care and patient advocacy organizations, including the California Medical Association representing California’s physician community, American Nurses Association-California, Minority Health Institute and Renal Physicians Association, as well as seniors, veterans’ groups and many others.

Proposition 29 is a direct threat to my patients’ lives. Please protect my patients’ lives and the lives of tens of thousands of other vulnerable dialysis patients by rejecting Proposition 29 in November.

Krystal Salcedo is a registered nurse and dialysis caregiver who lives in North County.