California patients fear consequences of third vote on dialysis

In fact, Toni Sherwin is looking forward to a procedure that will move her dialysis port from her chest to her arm, which will be easier to keep dry. Since starting dialysis in February — as part of her blood cancer treatment — she has been washing her hair in the sink and staying out of the pool to keep water from entering the harbor.

Sherwin, 71, goes three times a week to a dialysis clinic in Elk Grove, California, a suburb south of Sacramento where she lives, and lies strapped to a machine that filters her blood for about four hours. The treatment is exhausting, but she feels good that she is well taken care of and knows that the clinic staff will call the police if she doesn’t show up for her appointment and they can’t get in touch with her directly.

“They don’t play games,” Sherwin said.

Sherwin is concerned that her access to the clinic is in jeopardy. A sign in the clinic’s window tells patients and visitors to vote “no” on Proposition 29, the third statewide dialysis initiative in five years. It would impose new requirements on dialysis clinics, such as requiring a doctor to be on hand during treatment.

She and other California voters were also bombarded with television ads featuring patients in wheelchairs and doctors in scrubs warning that “29 would close dialysis clinics across California.”

“We’re scared,” Sherwin said. “If it stops, where do we go? We’ll just die.”

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Toni Sherwin has dialysis three times a week at a clinic near her home in Elk Grove, California. She believes what she saw on TV about Proposition 29 and is “terrified” that it would shut down the clinic she attends.

Sherwin is among roughly 80,000 Californians who rely on 650 dialysis clinics tucked away in shopping malls and medical centers across the state. Patients arrive in medical transport vans, minivans and the occasional mobile vehicle and are often too tired and hungry to drive home after treatment. They lug bags and pillows to clinics, prepared to sit for four or five hours at a time, usually three days a week, as their blood is cleaned and filtered through a machine because their kidneys can no longer perform these functions.

Proposition 29 would require clinics to report infections to the state and inform patients that doctors have a financial stake in the clinic, rules similar to existing federal regulations.

The biggest flashpoint is the requirement that a doctor, nurse or physician’s assistant be present at each clinic to treat patients.

Requiring an on-site physician would increase each facility’s costs by an average of “several hundred thousand dollars a year,” according to an analysis by the state’s nonpartisan Legislative Analyst’s Office. To deal with the additional costs, clinics have three options: negotiate higher rates with insurance companies, lose profits, or close the facility.

The Service Employees International Union-United Healthcare Workers West, which is sponsoring Proposition 29, said the reforms are necessary to keep patients safe during the physically demanding process of dialysis. The union, which tried unsuccessfully to organize dialysis workers, says the treatment is dangerous and that patients need access to highly trained medical professionals who can handle emergencies instead of relying on 911.

The union was also behind two previous dialysis ballot initiatives that failed by wide margins. Proposition 8 in 2018 would have limited industry profits, while Proposition 23 in 2020 was nearly identical to this year’s measure. Both broke campaign spending records.

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This clinic in Elk Grove, California displays a sign urging people to vote “no” on Proposition 29.

The Proposition 29 opposition campaign, funded largely by the dialysis industry, says keeping a doctor or nurse around all the time is expensive and unnecessary. Clinics employ registered nurses who check on patients and medical directors—doctors who oversee the facilities but are often on site only part-time. About three-quarters of California’s dialysis clinics are owned or operated by two companies: DaVita and Fresenius Medical Care.

So far, the two sides have raised at least $94 million, with roughly 85% coming from DaVita and Fresenius, according to the Los Angeles Times.

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Joe Damian takes his wife, Yolanda, to dialysis three times a week and would welcome a California requirement that clinics have doctors, nurse practitioners or physician assistants on staff. He thinks dialysis companies are creating fear when they say Proposition 29 would lead to clinic closings.

Joe Damian, 71, doesn’t buy the claim that clinics would close if Proposition 29 passes. Of course, he said, he would feel more comfortable having a doctor on site while his wife, Yolanda, is undergoing treatment. He also believes dialysis companies will continue to make money.

“How could it not be better?” he asked. “They just don’t want to give up any of their profits.

Damian drives his wife to Elk Grove for her treatment. He understands why other patients and their families are worried about the clinics closing, but he thinks the industry is creating fear.

“Closing the facility is a threat they will never make,” he said. “Why would they close shop with a profit?”

Proposition 29 includes provisions designed to protect against clinic closings, such as requiring facilities to get state approval before ending or limiting services, but opponents say those provisions won’t hold up in court.

Nearly all patients interviewed who went to or from dialysis appointments at five Sacramento-area clinics witnessed workers calling 911 for another patient. The majority said that the workers and rescue workers handled the crisis situation well. Overall, they said they felt that they were well taken care of by the dialysis clinic.

Most patients adopted the language of the opposition advertisements, which warned of clinic closures.

Norbie Kumagai, 65, spent last Thanksgiving at the University of California-Davis Medical Center, and his family was told it was time to say goodbye. But Kumagai, who has stage 4 kidney disease and high blood pressure, overcame that and had to wait months for a dialysis chair to open up at a clinic in West Sacramento, about 14 miles from his home in Davis.

Kumagai generally agrees that the dialysis industry needs reform. For example, he said he would like the technicians who help him every week to get a raise.

But he worries about what Proposition 29 could mean for the treatment that will keep him alive.

“I told my friends and neighbors that I’m scared to death if this goes through,” Kumagai said. “This facility will likely be closed.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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