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Editorial: Reject union’s Prop. 23 attack on kidney dialysis firms

The Mercury News August 18, 2020 By MERCURY NEWS & EAST BAY TIMES EDITORIAL BOARDS

Just as they did two years ago, leaders of a large labor union are trying to use a statewide election to go after the kidney dialysis industry.

California voters saw through the political blackmail by the Service Employees International Union in 2018, when 60% of voters rejected Proposition 8, a misguided effort to regulate the industry. Now, they should turn down Proposition 23 on the Nov. 3 ballot, which would require each dialysis clinic to have a physician on site while patients are treated.

The dialysis industry has successfully rebuffed efforts to unionize dialysis workers and increase staffing ratios at clinics. Prop. 23 is the union’s latest harassment effort designed to force the industry into submission.

Requiring on-site physicians sounds good on the surface. But we already have a shortage of kidney doctors in California and throughout the United States. The vast majority of the dialysis clinics in the state would be forced to hire doctors with no expertise in the specialty field, adding hundreds of millions of dollars of cost for little or no medical gain.

Not even doctors who stand to financially benefit from the measure support it. The California Medical Association, Alameda-Contra Costa Medical Association, San Mateo Medical Association and more than 25 other medical groups throughout the state oppose Prop. 23.

About 80,000 Californians receive treatment three times a week at the state’s 600 licensed dialysis clinics.  It’s serious business. Doctors and dialysis patients agree that missing even one treatment can increase the chance of death by 30%.

Two for-profit companies — DaVita and Fresenius — treat about 70% of California’s dialysis patients and rake in profits approaching 20%. Those clinics can afford the extra cost of the on-site doctors, union leaders say. But the independent Legislative Analyst’s Office reports that Prop. 23 would increase the cost of each dialysis clinic by several hundred thousand dollars annually and prompt the closure of some.

Prop. 23 would create special challenges for non-profit clinics such as Satellite Dialysis, which has 48 facilities spread throughout the Bay Area. The legislative analyst warns that clinic closures could create overcrowding, forcing dialysis patients to seek treatment in more costly settings, like hospitals.

A provision of Prop. 23 would allow a dialysis clinic to seek a waiver if there is a valid shortage of doctors in the area, and allow a clinic to use a nurse practitioner or a physician’s assistant instead. But adding nurse practitioners and physician’s assistants with little or no training in dialysis also adds extra costs with minimal medical benefit.

Prop. 23 would also require clinics to report data on dialysis-related infections to the state health department and National Healthcare Safety Network. But dialysis clinics already report that information to the Centers for Disease Control and Prevention, which requires clinics to post a simplified version of the results in their waiting rooms. Another provision of the ballot measure requiring dialysis clinic operators to obtain consent from the state before closing a clinic would also be a meaningless formality.

Votes should send union leaders a strong signal that nuisance ballot measures have no business being on the California ballot. Vote no on Prop. 23.