Healio Special Report: Health Care and Politics
Healio Special Report: Health Care and Politics
June 22, 2020
3 min read

California ballot initiative would mandate physicians to monitor all dialysis treatments

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

California voters will likely decide on Nov. 3 whether a physician needs to be present during all dialysis treatments in an outpatient clinic operating in the state.

Provisions of the Protect the Lives of Dialysis Patient Act also require state department of health approval before a dialysis provider can close a clinic, mandate that dialysis providers report infection rates among patients to the state and state that all patients should receive the same treatment regardless of the payer.

dialysis machine
Source: Adobe Stock

Health care workers union Service Employees International Union-United Healthcare Workers West organized the effort to get the issue on the ballot. The union has been involved in both legislative and ballot-directed initiatives in the past that dealt with the dialysis industry.

The ballot initiative is opposed by dialysis providers and a coalition of state health care organizations.

“The main provision of the ballot measure requires that each of the roughly 600 dialysis clinics in California have a physician on the premises during all operating hours, a provision currently not mandated by the extensive state and federal regulations that already govern the dialysis community,” Stop the Dangerous & Costly Dialysis Proposition, a group funded by dialysis providers DaVita Inc. and Fresenius Medical Care, said in a press release. “A study by the Berkeley Research Group, an independent economic research firm, found this provision would increase dialysis treatment costs by $320 million every year and that nearly half of the clinics in the state would become financially unsustainable.

“This ballot measure would unnecessarily increase health care costs and make the doctor shortage worse for all Californians by moving thousands of practicing doctors into non-caregiving roles in dialysis clinics,” Peter N. Bretan, MD, president of the California Medical Association, said in the release. “This proposition jeopardizes access to care for tens of thousands of patients who depend on dialysis to stay alive.”

The act would require “at least one licensed physician present on site during all times that in-center dialysis patients are being treated. This physician shall have authority and responsibility over patient safety and to direct the provision and quality of medical care.”

The ballot language does allow for an exception to the rule if the clinic can prove that a shortage of qualified physicians prevents it from satisfying the requirement. As noted in the language, “Upon such a showing, the department may grant an exception that permits the clinic to satisfy the requirement in subdivision (a) by having at minimum one of the following on site during all times that in-center dialysis patients are being treated: a licensed physician, a nurse practitioner or a physician assistant.”

The exception would last for up to 1 year.

“By moving nephrologists and experienced physician assistants (PAs) out of the hospital and offices, where a significant amount of our most vital work is done, this ballot measure will put all nephrology patients at risk,” countered Kim Zuber, PA-C, executive director of the American Academy of Nephrology Physician Assistants. “This measure would increase the already high cost of kidney failure for absolutely no additional benefit for the safety and care of dialysis patients.”

The ballot initiative also calls for a review by the state department of health if a provider plans to close a dialysis clinic. “The department shall have discretion to consent to, give conditional consent to, or not consent to, any proposed closure or substantial reduction or elimination of services,” according to the act.

The state can look at the impact of the facility’s closing on availability and accessibility of health care services to the affected community, “including but not limited to the clinic's detailed plan for ensuring patients will have uninterrupted access to care.”

The act would also require dialysis clinics in the state to provide quarterly reports to the department of health on health care-associated infection (HAI) data, including the incidence and type of dialysis clinic HAIs at each chronic dialysis clinic.

The department of health would then post the HAI data from each clinic on its website, and dialysis clinics would be required to report the data to the National Healthcare Safety Network.


  • www.oag.ca.gov > files > pdfs > 19-0025A1 ((Dialysis))