Prop 23

I am voting No on California’s Ballot Initiative 23. 

I’ve been reading the positions on both sides and speaking with my colleagues at the National Kidney Foundation, and I have yet to find any indication that Prop 23 would ultimately benefit patients. 

Proposition 23 requires a physician be physically present at a dialysis center at all times.  There is currently a medical staff at every center that includes a medical director, registered nurses, dialysis technicians, social workers and other health care practitioners who are fully trained to address dialysis patient issues.  And while a physician isn’t mandated to be onsite at all times, nephrologists already see their patients every month, oftentimes at the dialysis center.  

As it is, there is a shortage of nephrologists in some communities, and requiring them to be onsite at the dialysis center would limit their time at hospitals and health clinics where they are needed to care for pre-dialysis kidney patients. 

Prop 23 also requires that dialysis clinics report infections to the state health department and National Healthcare Safety Network (NHSN).  I don’t necessarily disagree with this, but dialysis centers in California are already required to report infections to the Center of Medicare and Medicaid services (CMS) and the ESRD Networks.