The California Senate has introduced legislation that would impose staffing requirements and yearly inspections on the state's 562 dialysis facilities.
The bill, which passed the Senate Health Committee Wednesday, attempts to address concerns that nurses are overworked at dialysis centers, leading to subpar care for patients. But the proposal has received backlash from dialysis providers and others who say the legislation is too restrictive and won't improve care.
Currently, dialysis clinics in California are inspected every six years on average, according to Sen. Ricardo Lara, a Democrat and lead sponsor of the bill.
While most states—including California—allow dialysis centers to determine appropriate staff levels, the proposed law would require dialysis clinics employ one nurse for every eight patients. In addition, a social worker could not be assigned more than 75 patients per clinic.
Only seven states currently require minimum staffing requirements at dialysis centers.
The California bill also goes further, mandating a 45-minute transition time between patients at treatment stations. That transition period would allow staff to take breaks and clean up stations between treatments.
The SEIU-United Healthcare Workers West, which has 90,000 members, is one of the legislation's supporters. The union says its workers don't have the time to adequately care for patients because clinics are so short-staffed.
“It bothers me a lot knowing I can't give my patients the full attention and care they need and deserve because of short staffing,” said Emanuel Gonzales, a dialysis worker from Pomona, Calif., in an SEIU news release.
Dialysis providers DaVita, Fresenius Medical Care and U.S. Renal Care oppose the legislation, and so do the California Hospital Association, the Renal Physicians Association and the California Medical Transportation Association. The groups say that patients already receive appropriate care and the proposed staff-ratio mandates are unnecessary.
Rural dialysis centers have also expressed concern that the mandate would force them to treat fewer patients because they can't afford to hire more nurses to meet the requirements under the bill. Toiyabe Dialysis Center, a clinic in rural Inyo County, Calif., said in a letter opposing the bill that "it is already very difficult to recruit licensed personnel to live in this rural area."
About 40% of California's dialysis clinics in 2015 received three-star ratings from the CMS' Dialysis Facility Compare site. About 27% of centers received four stars and 20% received five stars.