At 87, Joanne Frost is one of the estimated 80,000 Californians who get dialysis because of damaged kidneys. That means that three times a week, she goes to a clinic and gets hooked up to a machine that cleans waste material from her blood, the machine doing the work of what healthy kidneys would do.

Each dialysis session, which lasts between three and four hours, leaves Frost feeling exhausted.

"It really tires you," she says. "I just sleep all the rest of the day. I just ... I'm really tired. I’ve been drained."

But for people like Frost, with serious kidney problems, not getting dialysis isn’t an option.

"If I can't be attached to that machine every three days, I'll die. That's it," she said.

An elderly Latina woman sits in a wheelchair on the street outside her home, looking at the camera. — Joanne Frost, 87, outside her retirement home in Glendale. She is one of tens of thousands of patients who rely on kidney dialysis treatment to stay alive. (Saul Gonzalez/KQED)

Into this life-and-death treatment comes Proposition 29 on the state’s November ballot, a measure that’s about health care profits, union and corporate clout — and kidneys. If passed, the measure would require the state’s more than 600 licensed dialysis clinics to have physicians or nurse practitioners on staff, along with dialysis technicians.

"The heart and soul of this is we're going to add a clinician to the dialysis," said David Miller, research director of SEIU-United Healthcare Workers, the labor union that put Proposition 29 on the ballot. "We think it's incredibly important. We think there's millions of bad incidents of quality of care in dialysis clinics, and we think adding a clinician or an MD to the clinic would help resolve some of the poor care. So we think it's very important in terms of improving patient quality, and to help the clinics adhere to their own clinical policies that they are currently violating millions of times over the last several years."

But California’s powerful dialysis industry has a very different take. It argues that the state’s dialysis clinics are already safe and well-staffed, and that the cost of adding more personnel would force the industry to make cuts and close clinics.

Proposition 29, the dialysis industry contends, is really about hardball union tactics to intimidate the industry, not about protecting dialysis patients’ lives.[pullquote size="medium" align="right" citation="Joanne Frost, kidney dialysis patient"]'I didn't know much about dialysis until they told me my kidneys were going bad. I just want my procedure done. I just want to make sure that they stay open so that my kidneys can keep functioning.'[/pullquote]"The motives of the groups behind Proposition 29 are ballot box extortion," said Kathy Fairbanks, a spokesperson for the No on Proposition 29 campaign, which is bankrolled by the dialysis industry. She argues that Proposition 29 is part of a long-term pressure campaign by SEIU-UHW to organize dialysis workers.

"It's not about improving patient care," said Fairbanks. "It's about trying to unionize dialysis workers when they have so far said to the union, 'We're not interested.' This is the union's way of putting pressure on the dialysis providers."

And this is hardly the first showdown between the two major players in this debate. Two past attempts to pass dialysis-industry reform propositions in California in 2018 and 2020 — both backed by SEIU-UHW — failed at the ballot box, with dialysis companies spending big to defeat them. And the industry is once again opening its wallet to oppose Proposition 29, raising more than $86 million so far, much of which has been spent on a multimedia advertising blitz — including some ads that feature dialysis patients claiming that the proposition, if passed, would put their lives at risk.

No on 29’s Kathy Fairbanks says the dialysis industry has no choice but to spend big to defeat the measure.

"If I'm a voter and I don't know about dialysis and how it works, adding additional medical personnel doesn't sound like a bad thing," Fairbanks said. "So we have to educate them: 'Well, actually, it's not necessary. It'll cost a lot of money. It'll put clinics in the red and they'll be forced to cut back or close.'"

But Proposition 29 supporters say the vast sums of cash that are being spent to defeat the measure expose the industry's deep pockets and its clear capacity — despite claims to the contrary — to add more staffing without disrupting services. Dialysis is a $3.5 billion business in California dominated by two out-of-state companies — DaVita Incorporated and Fresenius Medical Care — which own or operate 75% of the clinics in the state.

David Miller, of SEIU-UHW, contends that the industry is blatantly prioritizing profit over the well-being of its patients and staff.

"I mean, 80% or 90% of this industry is for profit, and (Proposition 29) would restrict the amount of money that they could return to their shareholders," Miller said. "So I think we're having a big fight over where the dollar goes. We're trying to wrestle it back into patient care. We think there's billions and billions of dollars across these systems that can be put into patient care. And they're trying to wrestle these dollars free to return them to shareholders."

An elderly Latina woman stands outside her home leaning on her walking aid, looking pensively at the ground. — Joanne Frost stands outside her home in Glendale. Three times a week, Frost goes to a clinic and gets hooked up to a machine that cleans waste material from her blood, the machine doing the work of what healthy kidneys would do. Without the treatment, she would die. (Saul Gonzalez/KQED)

Patient Joanne Frost, though, says she has little understanding of the measure, let alone the ins and outs of the industry. She’s just focused on staying alive, and she knows she can’t do it without dialysis.

"I didn’t know much about dialysis until they told me my kidneys were going bad," she said. "I just want my procedure done. I just want to make sure that (the clinics) stay open so that my kidneys can keep functioning."

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Prop. 29 Pits Dialysis Companies Against Labor Union for Third Time, Leaving Patients Stuck in Limbo Again