California Proposition 23: Rules for kidney dialysis clinics

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The basics

What would Proposition 23 do?

Require kidney dialysis clinics to have at least one physician present during all operating hours, and to report infection data to the state. It also would require that operators get approval from the state’s health department before closing a clinic, and prohibit clinics from discriminating against patients based on insurance type.

Why am I voting on this?

The number of people with kidney failure who require dialysis treatment continues to grow; about 80,000 Californians depend on it. That also means a boom in the dialysis industry.

A powerful labor union, Service Employees International Union-United Healthcare Workers West, has targeted these companies.

Two years ago, the union introduced a ballot initiative that would have essentially limited clinics’ profits. After a very expensive battle, voters ultimately sided with the dialysis companies. The union said it would be back, so this is round two.

Supporters say

Kidney patients deserve better treatment than what they receive from many dialysis clinics, and these high profit companies haven’t invested enough in patient safety. The removal of people’s blood during dialysis treatment puts enormous strain on people’s bodies and leaves them vulnerable to medical crises. So having a licensed physician on site at all times —not just sometimes — means that during emergencies, a physician can respond immediately.

Opponents say

The proposition is unnecessary, as clinics already report infection data to the federal government. They also already have the necessary medical staff to keep patients safe, including a medical director. But adding physicians around the clock would only increase costs for clinics, pushing them to reduce hours or possibly close. What this is, at heart, is a union ploy to pressure clinics and organize dialysis workers.