California patients fear fallout from third dialysis ballot measure

ELK GROVE — Tony Sherwin is actually looking forward to the procedure that will move his dialysis port from his chest to his arm, which will be easier to keep dry. Since she began dialysis in February — as part of her blood cancer treatment — she washes her hair in the sink and stays out of her pool to avoid water entering the harbor.

Three times a week, Sherwin, 71, visits a dialysis clinic in Elk Grove, California, where he lives, a suburb south of Sacramento, and lies with a machine for about four hours while it filters his blood. Treatment exhausts her, but she feels well cared for and knows that clinic staff will call the police if she doesn’t show up for appointments and they can’t contact her directly.

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

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

He and other California voters have also been bombarded by TV ads, in which patients in wheelchairs and doctors in scrubs warn that “29 will close dialysis clinics across California.”

“We’re terrified,” Sherwin said. “If they stop it, where do we go? We just die.”

Sherwin is among roughly 80,000 Californians who rely on 650 dialysis clinics in strip malls and medical centers around the state. Patients arrive in medical transport vans, minivans, and occasionally ride-hailing vehicles, and often drive home very tired and hungry after treatment. They drag duffel bags and pillows into the clinic, prepared to sit for four or five hours at a time, usually three days a week, because their kidneys can no longer do those things as their blood is cleaned and filtered by a machine.

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

The biggest flashpoint is that every clinic must have a doctor, nurse practitioner, or physician assistant present when treating patients.

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

The Service Employees International Union-United Healthcare Workers West, which is sponsoring Proposition 29, said the reforms are needed to keep patients safe during the physically demanding dialysis process. The union — which has tried but failed to organize dialysis workers — argues that the treatment is dangerous and that patients need access to highly trained medical professionals to deal with emergencies without relying on 911.

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

The anti-Proposition 29 campaign, which is largely funded by the dialysis industry, says having a doctor or nurse practitioner around all the time is expensive and unnecessary. Clinics employ registered nurses who examine patients and medical directors — physicians who oversee the facility but are often only on site part-time. About three-quarters of dialysis clinics in California are owned or operated by two companies: DaVita and Fresenius Medical Care.

According to the Los Angeles Times, the two sides raised at least $94 million, with about 85% coming from DaVita and Fresenius.

Joe Damian, 71, doesn’t buy the claim that the clinic will close if Proposition 29 passes. Of course, he said, he would have felt more comfortable if a doctor had been on site during his wife Yolanda’s treatment. He also believes that dialysis companies will continue to make money hand over fist.

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

Damian takes his wife to Elk Grove for her treatment. He understands why other patients and their families are worried about the clinic closing but thinks the industry is scared.

“Closing the facilities is a threat they will never make,” he said. “Why would they stop a money making business?”

Proposition 29 included provisions intended to protect against clinic closings, such as requiring facilities to seek approval from the state before ending or reducing services, but opponents argue the provisions would not hold up in court.

Nearly all of the patients interviewed going to or from dialysis appointments at five Sacramento-area clinics saw workers call 911 for another patient. Most said the emergency was well handled by workers and emergency personnel. Overall, they said, they felt the dialysis clinics took good care of them.

Most patients internalized the anti-advertising language that warned of clinic closures.

Norby 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, had to wait months for a dialysis chair to open at a clinic in West Sacramento, about 13 miles from her home in Davis.

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

But he’s worried about what Proposition 29 might mean for the things that keep him alive.

“I’ve told my friends and neighbors I’m scared to death if this goes away,” Kumagai said. “This facility will probably close.”

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

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.

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