Tuesday, August 23, 2022







        California voters will be blinking and experiencing a sense of déjà vu when they see Proposition 29 on their fall ballots, a third attempt by a powerful labor union to meddle in the operation of dialysis clinics.


        This is actually the seventh time in the current young century that interest groups of various kinds have tried to create new laws state legislators previously refused to pass.


        Tobacco companies went first, trying twice to get local smoking restrictions removed. Anti-abortion activists made two attempts to pass an initiative requiring teenagers to get parental permission before having an abortion.


        Those attempts failed as badly on their second tries as on their first attempts. There’s no reason to believe fiddling around with dialysis clinics will fare better.


        One reason is the life-saving nature of dialysis, where clinics treat folks whose kidneys have failed. All their blood is removed, cleansed and reinjected three times weekly for more than two hours per session. Patients do this for their entire remaining lifespans, unless they obtain a transplant. Some of the 80,000-plus Californians who endure this have been on dialysis 25 years or longer.


        Most California dialysis is done at 550 centers, about three-fourths of them chain-owned by either the Fresenius or DaVita corporations, DaVita headquartered in Denver, Fresenius in Germany.


        All clinics operate under the supervision of doctors, who make rounds at varying intervals. At most times, a registered nurse is in charge; patients also can be visited regularly by their own kidney specialists, known as nephrologists.


        Into this picture steps the Service Employees International Union for another attempt at forcing each clinic to be supervised in person at all times by physicians or nurse practitioners. This could add exponentially to the cost of dialysis, most of which is covered by Medicare.


        One problem with this is that there is no demonstrated need to keep a doctor on site at every clinic all the time, especially with many clinics operating 16 hours per day.


        But Proposition 29’s effects could be directly harmful to California as a whole, a state with such a shortage of doctors and nurse practitioners that new medical schools have recently opened in several locations, two in the growing Inland Empire area around Riverside and San Bernardino.


        With some dialysis clinics running ‘round the clock every day of the year, this proposition would take upwards of 1,000 doctors and nurse practitioners away from patients who might urgently need them, placing them instead in clinic offices where they would treat patients only occasionally.


        Plus, reality at most dialysis clinics is that charge nurses – already present at all times – often become more expert at solving dialysis problems like clotting blood and sudden chills than the doctors who are nominally their supervisors.


        (Full disclosure: Columnist Elias has had a kidney transplant for more than 24 years. Prior to that, he underwent dialysis three times weekly for many months.)


        Nonpartisan analysis of the requirements of Proposition 29 and its failed predecessors has indicated the newly-required staffing would cost each clinic hundreds of thousands of dollars each year, to be paid by Medicare, Medi-Cal and private insurance companies. In short, taxpayers and insurance customers would foot the bills for this.


        Yet, there’s no evidence any of it would save or improve lives, as sponsors claim. For many dialysis clinics are located within hospital complexes; those that aren’t actually in medical buildings are usually very near them, especially in big cities. If there’s urgent need for a physician, most clinics can get one within minutes.


        As they have each time they’ve put their dialysis wish list before the voters, union leaders have added a few enticing improvements, this time seeking to require better reporting of clinic performance in preventing infections and more transparency in reporting infection rates.


        But rules like that can be set administratively or by the Legislature, no ballot measure needed. All of which makes the new measure as wasteful and destructive as its two predecessors.



    Email Thomas Elias at tdelias@aol.com. His book, "The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government’s Campaign to Squelch It," is now available in a soft cover fourth edition. For more Elias columns, visit www.californiafocus.net

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