In summary

Yes on Proposition 8: Kidney dialysis centers need more regulation for patient safety. No on Proposition 8: This initiative would harm patient care.

By Megallan Handford

Megallan Handford is a registered nurse who has worked for the past 17 years in dialysis clinics in Southern California owned by industry giants Fresenius Medical Care and DaVita Kidney Care, He wrote this commentary for CALmatters.

Every day, thousands of Californians with kidney failure receive dialysis treatment to keep them alive.

Dialysis is a process that removes a patient’s blood, cleans it, and puts it back into his or her body. It is a life-saving procedure that must be done three days a week for three or four hours at a time.

It also can leave patients feeling vulnerable and exposed. Dialysis patients place a huge amount of trust in their dialysis clinics to provide them with the safe care they need. Unfortunately, patients across California report alarming conditions of unsafe staffing levels and unsanitary conditions.

Testimonials from patients depict conditions that should concern us all. Dialysis patients have reported experiencing staffing levels so low that one technician was supposed to oversee treatment for 12 patients simultaneously, a situation that endangers patients.

Tangi Foster, a dialysis patient, has witnessed revolting conditions in her clinic. “I’ve seen bugs crawling in between the plastic that covers the light fixtures in the ceiling,” she said. “I’ve had to call the health department many times to report roaches, blood stains, and lack of adequate cleaning.”

These unsanitary conditions increase the risk of infections, hospitalizations, and death.

One source of the problem is that the industry is dominated by two big corporations—Fresenius and DaVita.

They operate more than 70 percent of the clinics in California and bring in $4 billion a year in profits. This industry dominance leaves patients with little choice but to suffer through these conditions in order to receive life-saving treatment.

To make matters worse, big dialysis corporations are charging some patients $150,000 a year for treatment, a 300 percent markup from the cost of actually providing the care.

The cost is not just a burden for these patients. Insurance companies must pass along the expense, driving up costs for all of us. One major California health insurance company reports that it takes 3,800 enrollees to offset the cost of just one dialysis patient.

Proposition 8, which will appear on the Nov. 6 ballot, will protect dialysis patients, reduce these corporations’ obscene profits, and push them to invest in improving care.

Under Proposition 8, profits will be limited to 15 percent above the amount spent on treating patients, leading to increased investment in care. By connecting the cost of patient care to profits, the proposition will push these big corporations to invest in hiring additional staff, improving overall clinic hygiene, reducing insect infestations, and buying new equipment.

All of these much-needed changes will improve the quality of care for patients. Dialysis is a multibillion-dollar industry that profits from the misfortune of patients with a life-threatening condition, and these corporations are reaping those massive profits at the expense of patient care.

Proposition 8 will ensure that the priority in California swings away from the current profit-driven system to one in which patients get the quality care they need.By Dr. Theodore M. Mazer

Dr. Theodore M. Mazer is president of the California Medical Association and a board-certified otolaryngologist who has been working in a solo practice in San Diego for more than 25 years, He wrote this commentary for CALmatters.

California physicians pay close attention to policies that negatively impact patients and decrease access to quality healthcare. Proposition 8 would be as bad for patients as anything we have seen in a long time.

Proposition 8 would put the lives of vulnerable dialysis patients at extreme risk by causing severe cutbacks in services and even outright closure of dialysis clinics statewide.

To stay alive, dialysis patients need treatment three times a week for three to four hours at a time. Dialysis is so critical that just one missed treatment increases the mortality risk by 30 percent.

If this initiative were to become law, they would have a harder time accessing a clinic for their life-saving treatment.

That’s why Proposition 8 has drawn the condemnation of my organization, the 43,000-physician Member California Medical Association, and numerous healthcare leaders including the American Nurses Association/California, California Hospital Association, emergency room physicians, renal physicians, dialysis caregivers, patient advocacy groups, community groups, veterans, and many others.

Proposition 8 would set severely low limits on what insurance companies are required to reimburse to dialysis clinics for dialysis treatments. These limits are arbitrary and would not cover the cost of providing high-quality care in a clinic.

Proposition 8 would specifically prohibit clinics from billing for necessary expenses such as physician medical directors, nurse managers, nurse clinical coordinators, and other staff positions and services critical to running a safe and efficient clinic.

A study by the former California Legislative Analyst estimated that 83 percent of clinics would be operating in the red if Proposition 8 passes. If clinics can’t cover their necessary operating costs, they would have to cut back services or shut down. Dialysis patients would lose access to life-saving care.

Living with kidney failure and being dependent on dialysis treatment is very serious.  The U.S. Centers for Medicare & Medicaid Services report that the average age of a dialysis patient in California is 62.

In addition to failed kidneys, many have other diseases such as hypertension, diabetes, heart disease or cancer.

Without outpatient clinics nearby to provide life-saving treatment, the only other option for patients to get dialysis three times a week would be in crowded hospital emergency rooms, where the same treatment costs significantly more and would unnecessarily burden the entire health care system.

In California, quality and patient satisfaction in dialysis clinics rank among the highest in the nation. California dialysis clinics are highly regulated at the federal and state levels to ensure quality. Facilities undergo rigorous reporting and review. California clinics outperform the national average in clinical quality and patient satisfaction, the Centers for Medicare & Medicaid Services reports.

Proposition 8’s supporters refuse to acknowledge that this irresponsible initiative would force dialysis clinics to operate in the red, which would trigger layoffs, clinic closures and a dangerous diminution in access to quality dialysis treatment.

You may be wondering why Californians are being asked to weigh in on such a personal and complicated health care issue that will harm dialysis patients.

There is no good reason this is on the ballot. To be clear, patient care is not the motive of supporters as they claim. The motive is political and a spokesman for the United Healthcare Workers West union, which is funding Yes on Proposition 8, admitted as much recently to the San Francisco Chronicle.

In our view, there is no acceptable scenario to put patients in harm’s way to achieve a political objective.

We must protect dialysis patients’ access to life-saving dialysis treatment. Please vote no on Proposition 8.

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