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Commentary: Prop. 23 abuses initiative system and uses vulnerable dialysis patients as political pawns

The San Diego Union-Tribune September 23, 2020 By Krystal Salcedo

As a dialysis nurse, I strongly oppose Proposition 23. My patients’ well-being is my primary concern. That’s why I’m outraged by this dangerous ballot initiative that would force dialysis clinics to cut services or shut down and that puts the lives of my patients in jeopardy.

I work in a hemodialysis clinic in Carmel Mountain. Our clinic cares for 140 dialysis patients with failed kidneys who must get dialysis treatments to stay alive. Three times a week, for about four hours at a time, our patients are hooked to a machine that cleans toxins and fluids from their blood. Dialysis is so critical that missing just a single treatment increases a patient’s risk of death by 30 percent.

Statewide, approximately 80,000 Californians rely on dialysis for survival. Proposition 23 would irresponsibly jeopardize access to the care our patients need.

If passed, Proposition 23 would require dialysis clinics in California to have a physician administrator on site during all hours of operation. The physician would not be required to have any training in kidney disease or dialysis and would not have a role in caring for patients. This requirement will not improve patient care one bit. In fact, it would jeopardize patient care in a big way.

For starters, Proposition 23 will take thousands of doctors away from where they’re needed — hospitals, clinics and doctors’ offices treating patients — and put them in bureaucratic roles in dialysis clinics where they won’t even be caring for patients. Proposition 23 will make California’s physician shortage worse at the worst possible time during a pandemic.

Furthermore, an independent analysis by the Berkeley Research Group found Proposition 23 would increase dialysis treatment costs more than $320 million annually. The report also found that because of this increase in cost, about half of the dialysis clinics in the state would become financially unsustainable and be forced to cut back services or shut down completely — risking my patients’ lives and the lives of tens of thousands of others.

Without reliable access to care, dialysis patients will become very ill and wind up in the emergency room, leading to more overcrowding for all hospital patients.

At a time when internal data from dialysis providers shows demand we know the need for dialysis is increasing in California at about 5 percent a year, we should be doing everything we can to expand access to dialysis, not cut it off.

Proposition 23 is completely unnecessary. I know this because I’m part of the broad team of caregivers who work tirelessly to provide our patients with the best quality care. In fact, California quality care outperforms the national average.

Dialysis is strictly regulated by both the federal and state government. Each of the 600 dialysis clinics in California is already required to have a licensed physician medical director on site who oversees the entire clinic.

In addition, our patient care teams include specially trained dialysis nurses, patient care technicians, dieticians and social workers who administer dialysis treatments and oversee the patient’s care during the four-hour procedure. The patient’s own nephrologist (a medical doctor who is also a kidney specialist) prescribes the dialysis treatments and visits patients in the clinic while they are dialyzing.

The new physicians required by Proposition 23 would be in addition to all the doctors, nurses and medical professionals who oversee the patient care. And again, the new physician would not have any role in direct patient treatment. That makes no sense at all.

Despite being very sick, dialysis patients are some of the most resilient individuals I have ever met. It makes me happy to know the compassionate care we provide allows them to live as much a normal life as possible.

Proposition 23 is funded by the Service Employees International Union-United Healthcare Workers West (UHW) union. Two years ago it placed Proposition 8 on the ballot. It, too, targeted dialysis patients, but voters rejected it by nearly 20 percentage points. Now, UHW is it again, abusing the initiative system in an effort to advance its organizing efforts.

While unions have the right to try to unionize workers, it’s not right to abuse the initiative system and use vulnerable patients as political pawns.

That’s why Proposition 23 is opposed by more than 100 organizations, including the California Medical Association, American Nurses Association\California, California NAACP, Minority Health Institute, Renal Physicians Association as well as patient advocates, seniors, veterans’ groups, dialysis providers and many others.

Proposition 23 is a direct threat to my patients’ lives. In November, please vote no on Proposition 23, the costly and dangerous dialysis proposition.

Salcedo is a registered nurse and dialysis caregiver who lives in Carmel Mountain.