Prop. 23 could hurt dialysis patients. Here’s why California voters should reject it

The Sacramento Bee October 14, 2020 By The Sacramento Bee Editorial Board

Danny Iniguez of Fresno was 12 when he had a crash on his bike. Unlike most boyhood scraps, this one unfortunately led to kidney failure. His mother donated a kidney to her son, and it worked well for seven years. But then his body rejected the transplant.

So Iniguez had to resort to kidney dialysis, getting three treatments a week at an outpatient clinic. That continues today as he awaits another transplant.

The system works well, with 600 dialysis clinics across California serving 80,000 people each week who must have regular dialysis in order to survive. Dialysis is the blood-filtering process done by machine when kidney failure occurs.

Dialysis is one area of health care that is working well. But now a state proposition threatens to upset that network. Proposition 23 would require clinics to have at least one licensed doctor on site during treatment.

While that seems reasonable, the requirement would increase health care costs by $320 million, according to an estimate by the Berkeley Research Group. That, in turn, could pressure the private companies that operate the clinics to cut back on facilities to save money, thus limiting where dialysis patients can go.

Most importantly, the physician requirement mandated by Proposition 23 would not improve medical oversight of dialysis patients in any meaningful way.


It is important to note that the proposition is being pushed by a union for health-care workers, SEIU-UHW West.

That is the same union that in 2018 supported Prop. 8, which would have capped profits at the clinics and required refunds. The CEO of one of the two main clinic operators in California said then that Prop. 8 put “patients at risk to force unionization of employees.”

An SEIU spokesman denied that, but it is hard to understand why the union would return with a different measure two years after voters turned down Prop. 8 except to grow its ranks.


While Prop. 23 mandates an on-site licensed physician whenever treatments are being given, those doctors would not actually be in charge of individual treatment plans. That would remain the domain of specially trained nurses and technicians, as is done now. Additionally, each dialysis patient already has a personal kidney doctor, a specialist known as a nephrologist.

If the measure was a real benefit to health care, and to doctors in particular, the California Medical Association would support it. But that group is opposing it.

“This ballot measure would unnecessarily increase health care costs and make the doctor shortage even worse for all Californians by moving thousands of practicing doctors into non-care roles in dialysis clinics,” association president Peter N. Bretan said in a statement. “The proposition jeopardizes access to care for tens of thousands of patients who depend on dialysis to stay alive.”

The specter of dialysis patients flooding into hospital emergency rooms for treatments is overblown, say Prop. 23 proponents. The measure also demands that the companies operating clinics have to justify to state regulators why they might need to close down treatment centers.

However, it is difficult to see how the state could force the owners to keep clinics open if that means operating at a loss.


If a dialysis patient misses just one treatment, the odds of dying go up by 30 percent. Dialysis patients already face the threat of the COVID-19 pandemic the nation is suffering through. As Iniguez put it in an op-ed in The Bee, “This ballot measure is a terrible idea at the worse possible time.”

Dialysis centers operate well and provide life-sustaining treatments for their patients. Prop. 23 would put that in jeopardy. The Sacramento Bee Editorial Board recommends a no vote.