California voters reject Proposition 29’s mandates for kidney dialysis clinics

A man using a laptop while receiving dialysis at a clinic
Adrian Perez receives dialysis at a clinic in Sacramento in 2018.
(Rich Pedroncelli / Associated Press)

For a third time, California voters rejected a statewide mandate to increase medical staffing at dialysis centers.

Proposition 29 would have required dialysis clinics to have a doctor, nurse practitioner or physician assistant present while patients are receiving care at any of the state’s 600 dialysis centers. Clinics also would have been required to disclose if a physician had ownership interest in a facility and to report patient infection data.

This marks the third time in four years that voters rejected a ballot initiative pushed by the Service Employees International Union-United Healthcare Workers that would change how dialysis providers care for the 80,000 people who rely on the life-saving treatment.

That includes the failed Proposition 8 in 2018, which would have capped revenues at dialysis centers, and Proposition 23 in 2020, which would have required dialysis clinics to have at least one doctor on site while patients are receiving treatment.


SEIU-UHW was accused during the 2018 and 2020 campaigns of using the ballot proposition system to target Fresenius Medical Care and DaVita, the state’s two largest dialysis providers, as well as to unionize dialysis workers. Union officials denied using the process for unionizing purposes and maintained their efforts were designed to hold dialysis companies accountable for better patient care. Patients who supported the proposition have said they wanted another health professional on site when getting dialysis.

Staffing requirements at dialysis clinics are not unheard of, as multiple states, including Georgia, Louisiana, Maryland, Massachusetts, New Jersey, Oregon, South Carolina, Texas and Utah, have staff-to-patient ratio requirements.

Fresenius Medical Care and DaVita spent tens of millions of dollars to defeat the three propositions over the last four years. Other opponents included major health players such as the California Medical Assn., the American Nurses Assn.’s California chapter and the American Academy of Nephrology Physician Assistants, which represents dialysis technicians.

For the third time, Californians will vote on whether to make sweeping changes at dialysis clinics that could affect the lives of 80,000 patients.

Oct. 28, 2022

Opponents of the proposition have said that, if the measure had been approved, dialysis clinics would have been potentially overwhelmed by the staffing costs and forced to close, leaving patients displaced. Patients who helped with the No on Prop. 29 campaign said they were scared of their clinics closing.