THIS HEARING OF THE SENATE
ASSEMBLY COMMITTEES ON HEALTH
WILL COME TO ORDER GOOD MORNING
AS WE CONTINUE TO TAKE SOME
PRECAUTIONS TO MANAGE THE
ONGOING COVID 19 RISKS, THE
SENATE CONTINUES TO WELCOME THE
PUBLIC HAS PROVIDED ACCESS TO
BOTH IN PERSON AND
TELECONFERENCE PARTICIPATION FOR
PUBLIC COMMENT. FOR INDIVIDUALS
WISHING TO PROVIDE PUBLIC
COMMENT VIA THE TELECONFERENCE
SERVICE THAT PARTICIPANTS TOLL
FREE NUMBER AND ACCESS CODE IS
POSTED ON OUR COMMITTEE WEBSITE.
AND IT WILL BE DISPLAYED ON THE
SCREEN AND I WILL ANNOUNCE IT
NOW. TODAY'S PARTICIPANT NUMBER
IS 844. 2914185 AND THE ACCESS
CODE IS 984 113 AGAIN. THIS
HEARING IS ON AND OVERVIEW ON
PROPOSITION 29 TESTIMONY NEEDS
TO BE PERTINENT TO THE SUBJECT
OF THE HEARING. I WILL MAINTAIN
DECORUM DURING THE HEARING. IS
THIS CUSTOMARY IN ANY INDIVIDUAL
WHO IS DISRUPTIVE MAY BE REMOVED
FROM THE REMOTE MEETING SERVICE
OR HAVE THE CONNECTIONS MUTED?
WE ALSO HAVE REPRESENTATIVES WHO
ARE PARTICIPANTS WHO ARE
PARTICIPATING REMOTELY VIA ZOOM
FOR OUR REMOTE PARTICIPANTS.
PLEASE MUTE. YOUR PHONES ARE
COMPUTERS. THIS WILL GREATLY AID
IN ELIMINATING ANY ACOUSTIC
FEEDBACK. I ASKED THAT EVERY
TIME YOU WISH TO BE RECOGNIZED
THAT YOU USE YOUR RAZOR HAND
FEATURE OF THE PROGRAM. EACH
TIME YOU'RE RECOGNIZED TO SPEAK
A POP UP WINDOW WILL APPEAR
ASKING IF YOU'D LIKE TO MUTE.
PLEASE SELECT MUTE BEFORE HE
BEGINS SPEAKING. ALRIGHTY
PERSONNEL WILL PUT YOU BACK ON
MUTE. WHEN YOU ARE DONE ONCE
RECOGNIZED TO SPEAK. PLEASE MAKE
SURE YOU CAN BE SEEN ON THE
SCREEN THAT YOUR NAME AND THEN
AND THAT YOU'RE READY TO ADDRESS
THE COMMITTEE. FOR DEAD AIDS
HEARING WILL BE HEARING ALL OF
THE PANELS OF WITNESSES ON THE
AGENDA PRIOR TO TAKING ANY
PUBLIC COMMENT. ONCE WE HAVE
HEARD FROM ALL OF THE WITNESSES,
WE WILL HAVE A PUBLIC COMMENT
PERIOD FOR THOSE WISHING TO
COMMENT ON THE TOPICS IN TODAY'S
AGENDA, WE WILL PERMIT EACH
PERSON TESTIFYING FOR PUBLIC
COMMENT ONE MINUTE. IN ADDITION
FOR THIS PARTICULAR HEARING FOR
THE WITNESSES WHO ARE INVITED TO
TESTIFY, WE ASK THAT YOU CAN
KEEP YOUR REMARKS TO FIVE
MINUTES. MAXIMUM WITH THAT
AGAIN. THIS HEARING IS ON AN
OVERVIEW OF PROPOSITION 29. THIS
IS A PROPOSITION THAT WILL BE ON
THE BALLOT IN NOVEMBER TWO
ADDRESSES, DIALYSIS CLINICS AND
ISSUES RELATED THEREOF. I WANT
TO THANK ALL OF OUR WITNESSES
FOR THEIR FLEXIBILITY. WE TRIED
TO FIND A DAY AND TIME TO HOLD
THIS REQUIRED SUBJECT MATTER
HEARING ON PROPOSITION 29. AND I
WOULD LIKE TO ALSO THE
OPPORTUNITY FOR MY CO CHAIR DR
WOOD CHAIR OF THE ASSEMBLY
COMMITTEE ON HEALTH TO MAKE ANY
OPENING REMARKS AS WELL. BEFORE
WE BEGIN OUR FIRST WITNESS
DOCTOR WOULD WELCOME THANK YOU,
DOCTOR PAN. I JUST LIKE TO NOTE
THAT THE GOAL OF THIS HEARING IS
TO HAVE A FAIR AND IMPARTIAL
PRESENTATION OF THE RELEVANT
FACTS ABOUT THE INITIATIVE. AND
TO AID THE ELECTORATE IN
REACHING AN INFORMED JUDGMENT
REGARDING THIS MEASURE. LOOKING
FORWARD TO HEARING FROM
EVERYONE. THANK YOU, MR CHAIR.
THANK YOU SO MUCH TO ASSEMBLE A
MEMBER AND CHAIR DOCTOR WOULD SO
WITH THAT WE'RE GOING TO GO
AHEAD AND BEGIN FROM OUR
PRESENTERS WILL BEGIN WITH AN
INITIATIVE OVERVIEW FROM THE
LEGISLATIVE ANALYST'S OFFICE AND
SO WE'LL START WITH SONJA PEDIC
PRINCIPAL FISCAL POLICY AND US
ANALYSTS WITH THE L A. OH,
WELCOME. PLEASE BEGIN YOUR
TESTIMONY. THANK YOU. GOOD
MORNING, DOCTOR. PAN DOCTOR
WOULD AND MEMBERS AND SONIA
PADDOCK FROM THE LEGISLATIVE
ANALYST'S OFFICE AND WILL
PROVIDE SOME BACKGROUND AND AN
OVERVIEW OF PROPOSITION 29. IT'S
ESTIMATED FISCAL EFFECTS ON
STATE AND LOCAL GOVERNMENT. YOU
SHOULD HAVE A HANDOUT PREPARED
BY OUR OFFICE, AND I'M ALSO
GOING TO SHARE MY SCREEN. UH
HUH. OKAY I'M NOT GONNA I'M NOT
GOING TO SHARE MY SCREEN. I'M I
DON'T HAVE THE CAPABILITY TO DO.
LET ME SEE IS ARE WE ABLE TO
MAKE MISS PETRICKA HOST SO SHE
CAN SEE HER SCREEN? I DON'T KNOW
WHO'S MANAGING THE ZOOM. SORRY,
MISS PADDOCK WILL HOLD ON DOWN
HERE. CREDIT, RIGHT? OKAY. DON'T
YOU TRY AGAIN? OKAY OH, GREAT.
YEAH. THANK YOU. OKAY? OKAY?
THANK YOU VERY MUCH, UM OKAY, SO
I'M MR MING, YOU CAN SEE THAT,
OKAY? UM IF YOU DO THIS, BY THE
WAY, THIS HANDOUT IS ALSO
AVAILABLE ON OUR WEBSITE AT LAO
DOT CA.GOV, AS WELL AS THE
WEBSITES FOR THE SENATE HEALTH
AND ASSEMBLY HEALTH COMMITTEES.
UM, IF YOU COULD TURN PAST THE
COVER PAGE, I'M GOING TO BRIEFLY
MENTION OUR OFFICES ROLE IN THE
INITIATIVE PROCESS. SO PRIOR TO,
UM AN INITIATIVE OR A MEASURE
BEING CIRCULATED FOR SIGNATURES
. STATE LAW REQUIRES OUR OFFICE
TO WORK WITH THE DEPARTMENT OF
FINANCE TO PREPARE A JOINT
FISCAL ANALYSIS OF EACH MEASURE
BEFORE IT CAN BE CIRCULATED. IF
A MEASURE THEN QUALIFIES. STATE
LAW REQUIRES OUR OFFICE TO
PROVIDE AN IMPARTIAL ANALYSIS OF
THE MEASURE. THIS ANALYSIS
APPEARS IN THE VOTER INFORMATION
GUIDE AND DESCRIBES THE
PROPOSITION AND IT'S ESTIMATED
FISCAL IMPACTS. I WOULD ALSO
NOTE THAT OUR ROLE IN THIS
PROCESS IS A LITTLE DIFFERENT
FROM THE TYPICAL ELO RULE. SO,
FOR EXAMPLE, WE CANNOT DISCUSS
THE PROS AND CONS OF THE MEASURE
OR OFFER ALTERNATIVES OR
RECOMMENDATIONS. INSTEAD OUR
DUTY IS TO DESCRIBE FOR VOTERS
WHAT THE MEASURE WOULD DO AN
ESTIMATE ITS FISCAL IMPACT YOU
TURN TO THE NEXT PAGE. I'LL JUST
BRIEFLY PROVIDE SOME BACKGROUND
INFORMATION ABOUT DIALYSIS
TREATMENT. UM KIDNEY DIALYSIS
PATIENTS TYPICALLY NEED
TREATMENT ABOUT THREE TIMES A
WEEK, AND EACH SESSION TYPICALLY
LASTS ABOUT FOUR HOURS. THESE
TREATMENTS ARE MOST OFTEN
RECEIVED AT DIALYSIS CLINICS IN
CALIFORNIA. THERE ARE ABOUT 650
LICENSED DIALYSIS CLINICS, AND
TOGETHER THEY SERVE ROUGHLY
80,000 PATIENTS PER MONTH.
PATIENTS DO HAVE THEIR OWN
PHYSICIANS WHO OVERSEE THEIR
PLAN OF CARE AND WHO REFER THEM
TO THE CLINICS FOR TREATMENT. IN
ADDITION, THIS PHYSICIAN THE
PATIENT'S OWN PHYSICIAN IS
REQUIRED TO VISIT THE PATIENT AT
THE CLINIC DURING TREATMENT AT
LEAST ONCE PER MONTH. CLINICS IN
CALIFORNIA ARE OWNED AND
OPERATED BY A VARIETY OF
ENTITIES. FOR EXAMPLE, NEARLY
75% ARE OWNED OR OPERATED BY TWO
PRIVATE FOR PROFIT COMPANIES,
AND THE REMAINING CLINICS ARE
OWNED BY A VARIETY OF NONPROFIT
ORGANIZATIONS AND FOR PROFIT
COMPANIES, SOME OWNERS AND
OPERATORS WITH MULTIPLE CLINICS
MAY USE THEIR HIGHER EARNING
CLINICS TO HELP SUPPORT CLINICS
OPERATING AT A LOSS. HOWEVER
THIS MIGHT NOT BE SUSTAINABLE.
OVER THE LONGER TERM. YOU TURN
TO THE NEXT PAGE. I'LL GO OVER
WHO PAYS FOR DIALYSIS TREATMENT
? THERE'S REALLY THREE MAIN
SOURCES. MEDICARE MEDIC, AL AND
GROUP OR INDIVIDUAL INSURANCE.
MOST PATIENTS WITH KIDNEY
FAILURE END UP COVERED BY
MEDICARE AS KIDNEY FAILURE IS A
MEDICARE QUALIFYING CONDITION,
REGARDLESS OF AGE OR DISABILITY
STATUS. MEDICARE PAYS FOR THE
DIALYSIS TREATMENT FOR THE
MAJORITY OF PEOPLE ON DIALYSIS
IN CALIFORNIA. SOME PATIENTS
MIGHT BE ENROLLED IN MEDICAL,
WHICH IS THE STATE'S MEDICAID
PROGRAM WHEN THEY ARE ONLY
ENROLLED IN MEDICAL MEDICAL PAYS
FOR THE TREATMENT IF THEY ARE
ENROLLED IN BOTH MEDICARE AND
MEDICAL. MEDICARE IS THE PRIMARY
PAIR FOR DIALYSIS. SOME PATIENTS
HAVE GROUP INSURANCE, TYPICALLY
THROUGH AN EMPLOYER OR
INDIVIDUAL INSURANCE. AND THESE
PATIENTS CAN USUALLY
TRANSITIONED TO MEDICARE.
FEDERAL RULES REQUIRE A GROUP
INSURER TO BE THE MAIN PAIR FOR
A PERIOD OF 30 MONTHS, AFTER
WHICH MEDICARE BECOMES THE MAIN
PAIR. GROUP AND INDIVIDUAL
INSURERS TYPICALLY PAY MUCH
HIGHER RATES FOR DIALYSIS THAN
MEDICARE OR MEDICAL. I'D ALSO
NOTE THAT STATE AND LOCAL
GOVERNMENTS PROVIDE GROUP
INSURANCE FOR THEIR EMPLOYEES
FOR ELIGIBLE RETIREES AND THEIR
FAMILIES. NEXT NOTE. A FEW KEY
POINTS ABOUT HOW DIALYSIS
CLINICS ARE REGULATED. THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH LICENSES DIALYSIS CLINICS
TO OPERATE IN THE STATE. IT ALSO
CERTIFIES CLINICS ON BEHALF OF
THE FEDERAL GOVERNMENT
CERTIFICATION ALLOWS THE CLINICS
TO RECEIVE MEDICARE AND MEDICAL
PAYMENTS. EACH CLINIC MUST HAVE
A MEDICAL DIRECTOR WHO IS A
BOARD CERTIFIED PHYSICIAN AND
FEDERAL GUIDELINES INDICATE THAT
THIS POSITION TYPICALLY REFLECTS
ABOUT ONE QUARTER OF A FULL TIME
POSITION. FEDERAL RULES ALSO
REQUIRE CLINICS TO REPORT
INFECTION RELATED INFORMATION TO
A NATIONAL NETWORK. IF YOU TURN
TO PAGE FOR ALL NOW DISCUSS THE
MAIN PROVISIONS OF PROPOSITION
29. FIRST IT REQUIRES A CLINIC
TO HAVE A PHYSICIAN, NURSE
PRACTITIONER OR A PHYSICIAN
ASSISTANT ON SITE DURING ALL
PATIENT TREATMENT HOURS. THIS
PERSON MUST HAVE AT LEAST SIX
MONTHS EXPERIENCE PROVIDING CARE
TO KIDNEY PATIENTS IN THE EVENT
THAT A CLINIC IS IN AN AREA WITH
A VALID SHORTAGE OF THESE TYPES
OF PROFESSIONALS. IT CAN REQUEST
AN EXEMPTION FROM THE DEPARTMENT
OF PUBLIC HEALTH. AND IF THAT
REQUEST IS APPROVED, IT CAN
FULFILL THE REQUIREMENT VIA
TELEHEALTH. THE EXEMPTION LASTS
FOR ONE YEAR. PROPOSITION 29
INCLUDES A VARIETY OF REPORTING
REQUIREMENTS. EVERY THREE MONTHS
, CLINICS ARE REPORTED OR PARDON
ME. CLINICS ARE REQUIRED TO
REPORT INFECTION RELATED
INFORMATION TO THE DEPARTMENT OF
PUBLIC HEALTH. IT ALSO REQUIRES
CLINICS TO PROVIDE PATIENTS WITH
A LIST OF PHYSICIANS WHO OWN AT
LEAST 5% OF THE CLINIC. UM AND
THIS MUST OCCUR AT THE START OF
TREATMENT ANNUALLY THEREAFTER OR
UPON REQUEST. THE MEASURE ALSO
REQUIRES EACH CLINIC TO PROVIDE
THE DEPARTMENT OF PUBLIC HEALTH
WITH A LIST OF PERSONS WHO OWN
AT LEAST 5% OF THE CLINIC. THIS
MUST OCCUR EVERY THREE MONTHS,
AND THIS INFORMATION MUST BE
POSTED ONLINE BY THE DEPARTMENT
AS WELL AS BY THE CLINIC.
PROPOSITION 29 REQUIRES CLINICS
TO NOTIFY AND OBTAIN CONSENT
FROM THE DEPARTMENT OF PUBIC
HEALTH BEFORE CLOSING A CLINIC
OR SUBSTANTIALLY REDUCING
SERVICES. AND FINALLY, I'D NOTE
THAT PROPOSITION. 29 PROHIBITS
CLINICS FROM DENYING CARE TO A
PATIENT BASED ON WHO THE PAIR IT
IS. IF YOU TURN TO THE NEXT PAGE
, I'LL GO OVER OUR ESTIMATE OF
FISCAL EFFECTS ON STATE AND
LOCAL GOVERNMENTS. THE BOTTOM
LINE IS THAT WE ESTIMATE
PROPOSITION 29 WOULD RESULT IN
INCREASED STATE AND LOCAL
GOVERNMENT COSTS LIKELY IN THE
TENS OF MILLIONS OF DOLLARS
ANNUALLY. WE ASSUME THAT THE
MEASURE WOULD INCREASE COSTS FOR
CLINICS AND SPECIFICALLY THE
REQUIREMENT TO HAVE A PHYSICIAN
, A NURSE PRACTITIONER OR A
PHYSICIAN ASSISTANT ON SITE
DURING ALL TREATMENT HOURS.
COULD INCREASE COSTS FOR EACH
CLINIC BY SEVERAL HUNDREDS OF
THOUSANDS OF DOLLARS ANNUALLY.
IN RESPONSE, WE ASSUME THAT
CLINICS WOULD DO ONE OF A FEW
THINGS ONE OR MORE OF A FEW
THINGS. FIRST WE ASSUME THAT
CLINICS WOULD TRY TO NEGOTIATE
HIGHER PAYMENT RATES WITH
PRIVATE COMMERCIAL INSURERS AND
TO A LESSER EXTENT WITH MEDICAL
MANAGED CARE PLANS. WE ASSUME
SOME CLINICS WOULD CONTINUE
THEIR CURRENT OPERATIONS BUT
WITH LOWER PROFITS. AND WE
ASSUME THAT SOME CLINICS OR SOME
OWNERS AND OPERATORS WOULD CLOSE
CLINICS AFTER SEEKING CONSENT
FROM THE DEPARTMENT OF PUBLIC
HEALTH, SPECIFICALLY THE CLINICS
THAT ARE OPERATING AT A LOSS. UM
IF YOU TURN TO THE NEXT PAGE
THESE RESPONSES COULD INCREASE
STATE MEDICAL COSTS AND STATE
AND LOCAL EMPLOYEE AND RETIREE
HEALTH INSURANCE COSTS. DUE TO
HAVING TO PAY HIGHER RATES AND
IN THE CASES WHERE SOME PATIENTS
COULD REQUIRE TREATMENT AND
COSTLIER SETTINGS LIKE HOSPITALS
, IF A CLINIC WERE TOO CLOSE. WE
ESTIMATE THAT PROPOSITION. 29
THEREFORE WOULD LEAD TO
INCREASED COSTS FOR STATE AND
LOCAL GOVERNMENTS LIKELY IN THE
TENS OF MILLIONS OF DOLLARS
ANNUALLY. THERE MAY ALSO BE SOME
INCREASED COST TO THE DEPARTMENT
OF PUBLIC HEALTH FOR THEIR
REQUIRED REGULATORY ACTIVITIES.
BUT THE MEASURES TO BE AWAITS
THAT THOSE WOULD BE COVERED BY,
UM, FEARS THAT THE CLINICS PAY.
SO WITH THAT, I'M GOING TO
FINISH MY PREPARED REMARKS. AND
IF YOU HAVE ANY QUESTIONS, I
WOULD BE HAPPY TO TAKE THOSE.
THANK YOU VERY MUCH PANIC FROM
ELIO. ARE THERE ANY QUESTIONS OR
COMMENTS FROM COMMITTEE MEMBERS?
SAYING NONE WILL MOVE ON. THANKS
VERY MUCH FOR THE PRESENTATION
WILL MOVE ON TO TESTIMONY FROM
THE SUPPORTERS OF PROPOSITION
29. WE HAVE. TWO PEOPLE
SCHEDULED TO TESTIFY AND I
BELIEVE ONE FOR TECHNICAL
QUESTIONS. UH SO WE HAVE.
CECILIA GOMEZ GONZALEZ, DIALYSIS
PATIENT ADVOCATE, AND EMMANUEL
GONZALES DIALYSIS PATIENT CARE
TECHNICIAN. AND THEN JOAN ALLEN
FROM C L U H W AND I BELIEVE
EMANUEL GONZALEZ WILL BE THE
FIRST ONE TO TESTIFY. SO AGAIN,
IF YOU CAN TRY TO KEEP YOUR
REMARKS TO FIVE MINUTES OR LESS,
AND THEN THERE MAY BE QUESTIONS
FROM COMMITTEE MEMBERS. SO BEGIN
WITH EMANUEL GONZALEZ, DIALYSIS
PATIENT CARE TECHNICIAN WELCOME.
THANK YOU. GOOD MORNING AND
THANK YOU FOR HOLDING A HEARING
ON THIS IMPORTANT ISSUE THAT
WILL BE ON THE NOVEMBER BALLOT.
MY NAME IS AMANDA GONZALES,
PATIENT CARE TECHNICIAN AND
BALANCES CLINIC AND I LIVE IN
BALDWIN PARK, CALIFORNIA. TODAY
I'M HERE IN SUPPORT OF
PROPOSITION 29 PROTECT THE LIVES
OF DIAL SIX PATIENTS ACT.
ALONGSIDE PATIENTS AND
CAREGIVERS. MY FELLOW DIALYSIS
WORKERS AND I HAVE BROUGHT OUR
CONCERNS ABOUT THE DIALYSIS
INDUSTRY TO THE LEGISLATURE
SEVERAL TIMES IN RECENT YEARS,
AND WE APPRECIATE THE ATTENTION
THAT YOU AND YOUR COLLEAGUES
HAVE GIVEN TO THEIR THESE ISSUES
. HOWEVER THERE IS STILL MORE
WORK TO BE DONE IN ORDER TO
REFORM AND IMPROVE CALIFORNIA'S
DIALYSIS INDUSTRY. IN CRAFTING
PROPOSITION, 29. WE WORKED WITH
THE COALITION OF DIALYSIS
PATIENTS AND WORKERS TO IDENTIFY
CRITICAL RISKS TO PATIENT CARE
AND TO CREATE POLICY SOLUTIONS
THAT WILL MAKE DIALYSIS
TREATMENT SAFER AND MORE
EQUITABLE FOR CALIFORNIANS WHO
RELY ON THIS LIFE SAVING
PROCEDURE. THE VAST MAJORITY OF
DIALYSIS CLINICS IN CALIFORNIA
ARE RUN BY LARGE MULTINATIONAL
CORPORATIONS THAT ARE MORE
FOCUSED ON PLEASING THEIR SHIRT
, THEIR SHAREHOLDERS THAN
IMPROVING THE QUALITY OF CARE
FOR PATIENTS HERE IN CALIFORNIA.
WE NEED TO IMPROVE OVERSIGHT OF
THE INDUSTRY TO ENSURE THAT
PATIENTS AND CONSUMERS ARE
PROTECTED. THAT IS WHY I'M
SUPPORTING PROPOSITION 29, WHICH
IS A SET OF COMMON SENSE REFORMS
THAT WILL IMPROVE DIALYSIS CARE
HERE IN CALIFORNIA. HAVING A
DOCTOR, NURSE PRACTITIONER OR
POSITION ASSISTANT ON SITE
DURING TREATMENT IS AN IMPORTANT
STEP TOWARDS MAKING DIALYSIS
SAFER. WELL EVERY CLINIC HAS A
MEDICAL DIRECTOR. MANY SPEND
LITTLE TIME AT THEIR CLINICS
THAT ARE OFTEN ACTING AS THE
MEDICAL DIRECTOR FOR MULTIPLE
DIALYSIS CLINICS. AT THE SAME
TIME, TECHNICIANS AND NURSES ARE
LIMITED BY THEIR LICENSE WITH
REGARD TO WHAT TYPE OF TREATMENT
WE CAN OFFER AN EMERGENCY
WITHOUT A PHYSICIAN ON SITE. THE
NURSES AND TECHNICIANS OFTEN
HAVE TO CALL AN AMBULANCE AND
HAVE PATIENTS TRANSPORTED TO THE
HOSPITAL WHEN SOMETHING GOES
WRONG DURING THEIR TREATMENT. IN
ADDITION TO HELPING TO STABILIZE
PATIENTS WHO ARE EXPERIENCING A
PROBLEM DURING DIALYSIS, HAVING
A DOCTOR ON SITE WILL GIVE THESE
VULNERABLE PATIENTS MORE
OPPORTUNITY TO ADVOCATE FOR
THEIR OWN HEALTH AND CARE.
INCREASED REPORTING OF
INFECTIONS WILL ALSO MAKE
DIALYSIS CLINICS ACCOUNTABLE TO
IMPROVING CARE AND SAFETY. 2017
STUDY BY U. C DAVIS FOUND THE
DIALYSIS FACILITIES ARE OFTEN
DEFICIENT AND MEETING EXISTING
INFECTION CONTROL STANDARDS.
REQUIRING DIALYSIS CLINICS TO
QUICKLY REPORTING INFECTIONS.
THE DEPARTMENT OF PUBLIC HEALTH
WILL ENSURE THAT PROBLEMS ARE
CAUGHT MORE QUICKLY AND THAT
SYSTEMIC ISSUES CAN BE FIXED
RATHER THAN IGNORED. PROPOSITION
29 WILL ALSO PROTECT PATIENTS
AGAINST BUSINESS PRACTICES THAT
MAY NOT BE IN THEIR BEST
INTERESTS. AND THEY'LL DO THIS
BY ENSURING TRANSPARENCY AROUND
CLINIC OWNERSHIP. THE INITIATIVE
WILL GIVE PATIENTS THE ABILITY
TO DECIDE FOR THEMSELVES WHETHER
OR NOT TO CHOOSE A DIALYSIS
CLINIC THAT IS FINANCIALLY
BENEFITING THEIR NEPHROLOGIST.
IT ALSO REQUIRES. THE ANALYSIS
CONNECTS TO GET APPROVAL FROM
THE STATE BEFORE CLOSING CLINICS
OR REDUCING SERVICES. THE
INITIATIVE WILL PROTECT ACCESS
TO DIALYSIS TREATMENT, ENSURE
THAT DOUBTS SOMEBODY'S CANNOT
MAKE CHANGES TO SERVICES BASED
SOLELY ON PROFIT. AND BY
PREVENTING CLINICS FROM
DISCRIMINATING AND PATIENTS
BECAUSE OF THEIR TYPE OF
INSURANCE IN 29 WILL PROTECT
PATIENTS, REGARDLESS OF WHETHER
THEY ARE MEDICARE THAT ACCOUNT
OR PRIVATE INSURANCE. MY CO
WORKERS ARE VERY PROUD TO CARE
FOR DOWELS CALIFORNIA'S DIALYSIS
PATIENTS AND WE WANT TO IMPROVE
OUR INDUSTRY SO THAT DIALYSIS
CARRIES A SAFE, ACCESSIBLE AND
EQUITABLE AS POSSIBLE HERE IN
CALIFORNIA. THANK YOU FOR TAKING
THE TIME FOR THIS HEARING ABOUT
HOW PROBLEMS IN 29 WILL PROTECT
VULNERABLE DIALYSIS PATIENTS AND
HOLD DIALYSIS CORPORATIONS
ACCOUNTABLE. I WANT TO HAND OFF
MY HANDED OFF TO THE ANALYSIS,
PATIENT ADVOCATE CECILIA GOMEZ
GONZALEZ. THANK YOU. THANK YOU
VERY MUCH, UH, MANUAL GONZALEZ
WILL NOW BEGIN. HAVE CECILIA
GOMEZ GONZALEZ. DIALYSIS PATIENT
ADVOCATE TESTIFY WELCOME. THANK
YOU. GOOD MORNING. MY NAME IS
CECILIA GOMEZ GONZALEZ AND I AM
THE DAUGHTER AND CAREGIVER OF A
MOTHER AND A FATHER, WHO BOTH
WENT THROUGH DIALYSIS FOR YEARS
. I WAS WITH MY PARENTS FOR
THEIR TREATMENTS, AND I'VE SEEN
A WIDE RANGE OF PROBLEMS THAT
PATIENTS DEAL WITH THAT DAY. I
WAS CLINICS I HAVE. I HAVE ALSO
BECOME AN ADVOCATE FOR IMPROVING
THE ANALYSIS CARE AND CALIFORNIA
AND I HAVE TALKED WITH MANY
PATIENTS, CAREGIVERS AND FAMINE
IN NUMBERS OF DIALYSIS PATIENTS
ACROSS THE STATE. I AM HERE
TODAY IN SUPPORT OF PROPOSITION
29 BECAUSE IT WILL IMPROVE CARE
FOR DIALYSIS PATIENTS. MY MOTHER
ONLY LIVED LESS THAN FIVE YEARS
AFTER HER COULD EAT, THEIR
KIDNEYS FAILED AND SHE BEGAN
DIALYSIS. BUT MY FATHER SPENT 17
YEARS ON DIALYSIS BEFORE HE
PASSED AWAY. HE WENT THROUGH
SOME DIFFICULT EXPERIENCES
DURING HIS TIME ON DIALYSIS.
MANY PEOPLE DON'T REALIZE WHAT
DIALYSIS CAN DO TO PATIENTS. IT
MAKES SOME OF THEM WEAK OR
NAUSEOUS. IT CAN MAKE THEIR
BLOOD PRESSURE AND HEART RATE
UNSTABLE AND SOME PATIENTS ARE
VERY HEAVY LEADERS JUST LIKE MY
DADDY WAS. IN THE 12 YEARS. I
CARE FOR MY MOTHER AND FATHER
DURING THE DIALYSIS TREATMENT. I
SAW PATIENTS BLEED OUT IN THEIR
CHAIRS, FAITH AND THROW UP
REGULARLY. I SAW CHAIRS STAINED
WITH BLOOD AND A STEADY STREAM
OF AMBULANCES CARRYING AWAY L
PATIENTS. THOSE AMBULANCES WERE
TAKING PATIENTS TO HOSPITALS
WHERE THEY COULD BE TREATED BY
DOCTORS. INSTEAD, IT WOULD BE
BETTER TO HAVE A DOCTOR AT THE
DIALYSIS CLINIC THAT WAY
PATIENTS WHO ARE EXPERIENCING
DIFFICULTY DURING THE TREATMENT
COULD HAVE HAD HAVE BEEN HELPED
FASTER, AND SOME MAY HAVE
AVOIDED THE STRESS OF AN EXPENSE
AND HAVING TO GO TO THE
EMERGENCY ROOM. THIS IS WHY I
SUPPORT THE REQUIREMENT AND
PROPOSITION 29 TO HAVE A DOCTOR
OR OTHER MEDICAL PROVIDER AT
EACH FAILS THIS CLINIC FROM MY
EXPERIENCE, I ALSO KNOW THAT
THEY ALWAYS PATIENTS ARE VERY
WORRIED ABOUT THE RISK OF
INFECTION. THESE ARE VULNERABLE
PATIENTS AND AN INFECTION CAN
LEAD TO HOSPITALIZATION OR EVEN
DEATH. REQUIRING PATIENTS
CLINICS TO I'M SORRY, REQUIRING
DIALYSIS CLINICS TO REGULARLY
REPORT AND ANY INFECTIONS THAT
HAPPENED AT THE CLINIC WILL MAKE
CLINICS MORE AWARE OF THE NEED
TO BE BENEFIT FACTIONS, AND
WE'LL GIVE PATIENTS A BETTER WAY
TO EVALUATE WHETHER THEY'RE
DIALYSIS TREATMENT IS SAFE. THE
OWNERSHIP OF THE VEILS.
COMPANIES ALSO MATTER TO
PATIENTS AND THEIR FAMILIES.
AFTER YEARS OF GETTING TREATMENT
AT AN INDEPENDENT DIAL'S CONNECT
. BOTH MY PARENTS HAD TO MOVE TO
A NEW CLINIC THAT WAS OWNED BY A
LARGE DIALYSIS CHANGE. THAT'S
WHEN THINGS GOT WORSE. THEY WENT
FROM A CLINIC OR THE STAFF AND
PATIENTS FELT LIKE A FAMILY TO A
CLINIC WHERE IT FELT LIKE THEY
WERE JUST ANOTHER BODY. IT IS
IMPORTANT FOR PATIENTS TO KNOW
WHO IS PROFITING FROM THEIR
TREATMENT, AND THAT IS WHY I
SUPPORT THE REQUIREMENT OF
PROPERTY IN PROPOSITION 29 FOR
THE L S P CLINICS TO PROVIDE
MORE TRANSPARENCY ABOUT THE
CLINIC OWNERSHIP. IN CLOSING. I
ALSO I OFTEN THINK ABOUT ALL OF
THE PATIENTS I MET WHILE CARING
FOR MY PARENTS AS THEY RECEIVE
VEILS, SIS AND THE PATIENTS I
HAVE MET DURING MY ADVOCACY. I
REMEMBER THE STORIES THEY SHARED
WITH EACH OTHER WHILE THEY WERE
WAITING TO START THEIR TREATMENT
, JUST DEALING WITH DIALYSIS AND
YOUR LIFE IS DIFFICULT. IT
CHANGES EVERYTHING FROM YOUR
PHYSICAL STAMINA TO YOUR ABILITY
TO WORK. IT'S NOT RIGHT THAT ON
TOP OF ALL THAT PATIENTS HAVE TO
DEAL WITH AN UNNECESSARY STRESS
BECAUSE OF HOW DANGEROUS THEIR
CLINICS CAN BE. IT MAKES ME SAD
THAT THIS MOVEMENT TO IMPROVE
DIALYSIS CARE DIDN'T EXIST. WHAT
MY PARENTS WERE STILL ALIVE, BUT
THAT'S WHY I'M HERE. TO FIGHT IN
THE IN THEIR PLACE AND FOR
PATIENTS WHO ARE TOO WEAK AND
TOO INTIMIDATED O FIGHT BECAUSE
I AM NOT THANK YOU FOR HOLDING
THIS HEARING PROPOSITION 29 WILL
HELP VULNERABLE PATIENTS
DIALYSIS SUSPICIONS, AND I
APPRECIATE YOU ALLOWING US TO
SHARE OUR STORIES AND OUR
CONCERNS ABOUT THE SALES
INDUSTRY. THANK YOU VERY MUCH.
UM THERE ARE QUESTIONS OR
COMMENTS FROM COMMITTEE MEMBERS.
SAYING THAT I JUST HAVE A BRIEF
QUESTION, PERHAPS FOR MR FOR
JOAN ALLEN. UM SO ONE OF THE
REQUIREMENTS OF THE PROPOSITION
IS THAT IF A PHYSICIAN RESPECT
ISHAN ER OR NEEDS TO BE ON SITE
, WHAT IS THE DEFINITION OF ON
SITE? SO FOR EXAMPLE, COULD THE
PHYSICIAN BE SEEING PATIENTS IN
THE SAME BUILDING? IS THAT ON
SITE OR DID THEY HAVE TO BE, UH,
ONLY IN THE DIALYSIS CENTER
WITHOUT ANY OTHER DUTIES,
CLINICAL DUTIES AT ALL. MISS
ALLEN? YES THANK YOU. JOAN ALLEN
S C. I U UNITED HEALTHCARE
WORKERS, UM THE REQUIREMENT
WOULD BE THAT THEY BE WITH THAT
THEY BE ON SITE OF THE CLINIC.
AND SO, HOWEVER, THE CLINIC IS
LICENSED BY DPH. THAT WOULD BE
THE REQUIREMENT. THERE ALSO, IS
THERE THE ABILITY FOR CLINIC
THAT IS IN A PROVIDER SHORTAGE
AREA TO APPLY FOR A WAIVER TO
ALLOW THAT PHYSICIAN NPR P A TO
BE AVAILABLE VIA TELEHEALTH. UM
TO MAKE IT SO THAT WE CAN WE CAN
RESPECT THOSE POSITIONS SHORTAGE
AREAS. THANK YOU. THANKS VERY
MUCH FOR THAT ANSWER. HEY IS
THERE ANY OTHER QUESTIONS OR
COMMENTS? SAYING THAT WILL NOW
MOVE ON TO THE OPPONENTS OF
PROPOSITION 29 AGAIN WILL BEGIN
WITH DWAYNE COX DIALYSIS
PATIENT, UM WELCOME AND YOU HAVE
AGAIN. I ASK EACH OF THE
WITNESSES TO PLEASE TRY TO KEEP
YOUR REMARKS TO FIVE MINUTES OR
LESS. GOOD MORNING. MY NAME IS
DWAYNE COX NUMBER DOLLARS JUST
PATIENT IN LOS ANGELES AREA. I
WOULD PREFER TO HAVE DR WONG
BEGAN IF POSSIBLE. OKAY WELL, WE
CAN HAVE DR WANG BEGAN THEN SO
WILL THEN BEGIN WITH DR BRIAN
WONG WILL COME BACK TO YOU, UH,
MR COX, SO DR BRYAN WANG WELCOME
AND AGAIN. TRY TO KEEP YOUR
REMARKS TO FIVE MINUTES. GOOD
MORNING. I'D LIKE TO THANK THE
SENATE AND ASSEMBLY HEALTH
COMMITTEE FOR HAVING ME TODAY.
MY NAME IS BRIAN WONG. I'M AN
APOLOGIST, WHICH IS A KIDNEY
SPECIALIST. I TREAT A VARIETY OF
KIDNEY PATIENTS IN OAKLAND AREA
AND SPECIFICALLY MY DIALYSIS
PATIENTS OR ETHNICALLY DIVERSE,
ECONOMICALLY DISADVANTAGED AND
MAINLY A LOW INCOME PATIENT
POPULATION IN AUCKLAND. UM I
WANT TO SPEAK SPECIFICALLY HOW
THE ENTIRE POSITION COMMUNITY
BELIEVE THAT PROP 29 WAS
DIRECTLY HARMED. BIOLOGIST
PATIENT AND INDIRECTLY, ALL
PATIENTS IN CALIFORNIA. FIRST I
WANT TO PROVIDE AN OVERALL VIEW
OF DIALYSIS IN CALIFORNIA AND
THEN GO TO THE SPECIFICS OF PROP
29. DALLAS IS PROVIDERS ARE
ALREADY REGULATED BY CENTER FOR
MEDICARE AND MEDICAID SERVICES,
OR CMS, CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH, AS, UH, TESTIFIED
EARLIER THAT ALSO PROVIDERS
ADHERE TO MORE THAN 300
REGULATIONS AND REGULARLY REPORT
UH, DATA TO CMS, INCLUDING IN,
UH, DATA ON INFECTION THROUGH
THE NATIONAL HEALTHCARE SAFETY
NETWORK, HOSPITALIZATION AND
MORE. SHE MUST ALSO TRACKS
PATIENT SATISFACTION THROUGH
SURVEYS GIVEN SEVERAL TIMES
DURING THE YEAR. YOU THINK THIS
PUBLICLY REPORTED AND AVAILABLE
DATA WE CAN COMPARE QUALITY AND
PATIENT SATISFACTION CALIFORNIA
TO OTHER STATES, AND WE FIND
THAT CALIFORNIA CONSISTENTLY
RANKED ABOVE THE NATIONAL
AVERAGE, BOTH IN PATIENT QUALITY
BENCHMARKS AND IN PATIENT
SATISFACTION. SO IT IS VERY
FRUSTRATING THAT WE'RE HERE
AGAINST THE THIRD TIME IN THREE
ELECTION CYCLES TO OPPOSE YET
ANOTHER DANGEROUS ANALYSIS.
BALLOT MEASURE IS NORTH. WORDING
THAT PROP 29 IS A CARBON COPY OF
PROP 23, WHICH THE VOTER
REJECTED TWO YEARS AGO BY A 63%
MARGIN. PROP 29 HAS FIVE
PROVISIONS. PROVISIONS OF
CONCERN IS THE PROVISION THAT
REQUIRES A PHYSICIAN, A NURSE
PRACTITIONER OR A PHYSICIAN
ASSISTANT TO BE IN THE CLINIC AT
ALL TIMES. THIS PROVISION
UNNECESSARY AND SUPERFLUOUS. FOR
MANY REASONS. FIRST, THE CLINIC
ALREADY HAS A MEDICAL DIRECTOR.
THAT'S MANDATED BY CMS. THIS
PERSON IS A TRAINED NEPHROLOGIST
. SECONDLY EACH PATIENT HAS HIS
OWN, APOLOGIZED FOR THEIR OWN
KIDNEY DOCTOR WHO'S RESPONSIBLE
FOR THE PATIENTS, DIALYSIS
TREATMENT MEDICATIONS AND
PRESCRIPTIONS. THIRD EACH
PATIENT HAS A CARE TEAM OF
SPECIALLY TRAINED NURSES
CERTIFIED HEMODIALYSIS
TECHNICIANS, REGISTERED
DIETITIANS AND LICENSED SOCIAL
WORKERS WHO ON THE FLOOR WITH
THE PATIENT AT ALL TIMES THAT
THEY'RE RECEIVING CARE. EVEN IF
THIS NEW POSITION AS REQUIRED BY
PROP 29, IT'S STILL BY A DOCTOR
. THE DOCTOR WILL HAVE NO
AUTHORITY TO ALTER PATIENTS,
DIALYSIS TREATMENT OR MEDICATION
THAT CAN ONLY BE DONE BY THE
PATIENT'S OWN NEPHROLOGIST. IF
THERE WAS AN EMERGENCY THAT
OCCURS IN THE CLINIC, THE DOCTOR
HAS UH, NO ADDITIONAL, UH,
OBLIGATION OR DUTY TO CARE FOR
OTHER THAN TO CALL 911 WHICH, UH
, MOST OF THE TIME WE'RE ALREADY
DOING THAT'S THE PHYSICIAN, THE
NURSE PRACTITIONER OR THE
PHYSICIAN ASSISTANT, AS REQUIRED
BY PROPERTY ON UNITED WILL ONLY
BE ABLE TO DO AN ADMINISTRATIVE
ROLE AND MAY SAID EARLY BY EVERY
SINGLE DAY. GIVEN THE FACT THAT
THERE'S A SHORTAGE OF HEALTH
CARE PROVIDERS IN CALIFORNIA,
ESPECIALLY A SHORTAGE ON THE
PHILOLOGIST, THIS IS HARDLY THE
BEST USE OF THESE POSITIONS. AND
WE THINK THAT THE STOCK THE
PROVIDERS, AS REQUIRED BY 29
WOULD BE BEST SERVED BY TREATING
PATIENTS ELSEWHERE. THE
NONPARTISAN ELIO SAID THAT THIS
WILL COST ALISTAIR CLINICS IN
CALIFORNIA SEVERAL $100,000
ANNUALLY. OUR RESEARCH THROUGH
THE SAME CONCLUSIONS OF THE ELIO
THEY'RE MORE THAN 600,000
CLINICS IN CALIFORNIA, AND WHEN
YOU ADD THAT UP PROP 29 WILL
COST ANYWHERE BETWEEN TWO AND 29
TO $455 MILLION ANNUALLY AND
RISK CUTBACKS OR CLOSURES OF UP
TO HALF THE CLINICS IN
CALIFORNIA. CLINIC CLOSURE,
FORCED BY PROP 29 WOULD BE
DEVASTATING TO PATIENTS,
ESPECIALLY THOSE THAT LIVE IN
RURAL AREAS WHERE THERE ARE
FEWER DIALYSIS CLINICS AS
OPPOSED TO AN URBAN AREA CLINIC
CLOSES AND THE PATIENT NEEDS TO
GO FURTHER. THEY NEED TO THEY
CAN MISS UP MISTREATMENT, WHICH
WILL MAKE THEM SICKER AND COULD
LEND THEM IN THE HOSPITAL
EMERGENCY ROOM TO ACCORDING TO A
STUDY BY THE JOURNAL OF THE
INTERNATIONAL MISSING JUST ONE
DIALYSIS TREATMENT INCREASE THE
RISK OF DYING BY 30. DALLAS IS
PATIENTS GETTING TREATMENT IN
THE HOSPITAL WOULD INCREASE, UH
THE COST AND OFTEN CAN BE
AVOIDED IF CLINICS WERE NOT TOO
CLOSE. THAT'S WHY PROP 29 IS
OPPOSED BY THE CALIFORNIA
MEDICAL ASSOCIATION, THE
CALIFORNIA DIALYSIS COUNCIL, THE
RENAL PHYSICIAN ASSOCIATION AND
MANY PHYSICIAN GROUPS THROUGHOUT
THE STATE. THREE OTHER
PROVISIONS IN PROP 29 ALSO
CARBON COPIES OF 23, WHICH WAS
DEFEATED IN THE BALLOT. I'M
GONNA ASK YOU TO WRAP UP YOUR AT
FIVE MINUTES. OKAY? AS I SAID
EARLIER. IT'S TROUBLING THAT
WE'RE HERE AGAIN, AND IT'S
UNFAIR AND WRONG TO USE DIALYSIS
PATIENTS OF SPAWNS IN THIS
POLITICAL GAME, UH, ADVOCATED BY
S E I U AND U H W THANK YOU.
THANK YOU VERY MUCH. ALRIGHT.
WE'LL NOW MOVE ON TO THE WAYNE
COX. WELCOME AGAIN. THANK YOU
VERY MUCH. GOOD MORNING. AGAIN
MY NAME IS DWAYNE COX DIALYSIS
PATIENT IN THE LOS ANGELES AREA.
UM BUT I ORIGINALLY GREW UP IN
THE SOUTH SIDE OF CHICAGO, WHERE
MY PARENTS WERE. UNFORTUNATELY
BOTH HEROIN ADDICTS. THERE WAS A
LOT OF STRESS GROWING UP, AND WE
HAVE POOR DIET THAT LED TO A
DIAGNOSIS OF HIGH BLOOD PRESSURE
16 AND IN 2009, THE DOCTORS TOLD
ME THAT I HAD KIDNEY FAILURE. SO
YEARS, I GO TO DIALYSIS THREE
TIMES A WEEK, FOUR HOURS AT EACH
SESSION. DIALYSIS IS LITERALLY
LIFE SUSTAINING FOR ME. WITHOUT
DIALYSIS. I WOULD NOT BE HERE
WITH YOU TODAY HAVE ALSO BEEN AN
ADVOCATE DURING MY TIME AS A
TAOIST PATIENT. I CAMPAIGNED
AGAINST PROP. EIGHT IN 2018, AND
IT GETS PROPPED 23 2020. I'M
HERE TODAY BECAUSE I'M COMMITTED
TO MAKING SURE THAT PROP 29
SALES ALSO, JUST LIKE THE OTHER
TWO. BUT IT SHOULDN'T BE THAT
WAY. PROMPT 29 SHOULD NOT BE ON
THIS BALLOT. SPONSORS OF PROP 29
NO. WHAT THEY'RE DOING. THEY'RE
PUTTING $80,000 PATIENTS LIKE ME
IN HARM'S WAY TO ADVANCE THEIR
POLITICAL GENDERS. THEY DON'T
CARE ABOUT PATIENTS OR THEY
WOULDN'T THREATEN OUR LIVES
EVERY ELECTION CYCLE. 29 WOULD
RESULT IN PLAY CUTBACKS AND
CLOSURES. THIS IS VERY DIFFICULT
FOR DIALYSIS PATIENTS. WE
STRUCTURE OUR LIVES AROUND
DIALYSIS, AND OUR ROUTINE IS
VERY IMPORTANT FOR OUR WELL
BEING AND OUR QUALITY OF LIFE.
EVERY TWO YEARS WHEN THIS COMES
UP PATIENTS AND FAMILIES START
WORRYING ABOUT WHETHER OR NOT
THIS WILL PASS THAT STRESS IS
NOT HEALTHY FOR US. I'M LUCKY
BECAUSE I'M ABLE TO DRIVE. BUT
MOST PATIENTS DON'T THEY RELY ON
INCONSISTENT TRANSPORTATION
SERVICES PAID BY STATE FELLOW
PROGRAMS. THEY TAKE PUBLIC
TRANSPORTATION, OR THEY HAVEN'T
FROM MEMBER DRIVER. IF A
PATIENT'S CLINIC CLOSES. THERE
ARE RIPPLE EFFECTS. TO DRIVE
FURTHER FOR DALLAS, WHICH MEANS
TRANSPORTATION BECOMES MORE
UNRELIABLE. AND THAT LEADS TO
MISTREATMENT. FOR EXAMPLE, IF A
DIALYSIS CLINIC CLOSES AND THE
PATIENT DOES NOT MEET. AND THE
PATIENT NEEDS TO GO FURTHER TO
GET DIALYSIS OR GET DIALYSIS AT
A DIFFERENT TIME. IT'S VERY
POSSIBLE THAT FAMILY MEMBER WILL
NO LONGER BE ABLE TO HELP
BECAUSE THE NEW DIALYSIS
SCHEDULE WON'T FIT IN THEIR WORK
SCHEDULE. MANY PATIENTS ALSO
TAKE PUBLIC TRANSPORTATION, LIKE
THE CITY BUS. I KNOW ONE
PATIENT. INVEST CITY BUS. STOP
RIGHT OUTSIDE OF HIS APARTMENT
AND ALSO STOPS WITHIN WALKING
DISTANCE OF THIS CLINIC. IT
TAKES ABOUT AN HOUR AND A HALF
EACH WAY, BUT AT LEAST IT'S
DOABLE AND FOR HIS DIALYSIS
SCHEDULE. HE FEELS VERY LUCKY.
BUT WHEN IT'S CLEAR CLOSES, WILL
THE BUS TAKE HIM WITH HIM?
WALKING DISTANCE OF NEW CLINIC
AND THAT'S THE NEW TÌM. IT'S NOT
IS THERE A FAMILY MEMBER WHO CAN
TAKE HIM? CAN YOU GET SIGNED UP
FOR MEDICARE FUNDED
TRANSPORTATION SERVICES? CAN HE
AFFORD TO TAKE RIDE SHIFT? ALL
OF THESE SEEMINGLY MINOR THINGS
TO MOST PEOPLE ARE MAJOR ISSUES
FOR DIALYSIS PATIENTS WHO ARE
SICK AND DON'T DRIVE. STRESSFUL
AND STRESS LEADS TO MORE POOR
HEALTH OUTCOMES AND MISS
TREATMENTS WILL BECOME MORE
COMMON. PATIENTS GET SICKER.
EPHRAIM MISSING TREATMENT. OUR
RISK OF HEART ATTACK GOES UP. WE
HAVE TROUBLE BREATHING AND WE
FEEL SICK AND DIZZY, DR WONG
SAID, MISSING JUST ONE TREATMENT
WITH EASILY LANDED IN THE
HOSPITAL. I'VE BEEN ONE OF THOSE
PATIENTS WHO LANDED IN THE E R N
AND NEW KILLED I FEEL MORE
COMFORTABLE GETTING DIALYSIS IN
MY CLINIC WHERE I GET EXCELLENT
CARE BY COMPASSION. WELL TRAINED
NURSES, TECHNICIANS, SOCIAL
WORKERS AND DIETITIANS. IN FACT,
MY OWN APOLOGISTS VISITS ME
EVERY WEEK. THERE IS THE
DIALYSIS. THEY KNOW ME. WELL, I
KNOW THEM WELL, AND IT GIVES ME
COMFORT AND LOWERS MY STRESS
LEVEL. I DON'T UNDERSTAND THE
COLD HEARTEDNESS OF PROP 29
SPONSORSHIP CLEARLY DON'T CARE
ABOUT THE IMPACTS ON DIALYSIS
SEECH. IT'S IMPOSSIBLE TO
BELIEVE THAT THEY CARE WHEN THEY
CONTINUALLY PUT OUR LIVES ON THE
LINE EVERY TWO YEARS. I FEEL
THAT THESE ACTIONS ARE VICIOUS
AND VINDICTIVE. I UNDERSTAND
THIS IS A UNION ISSUE, AND UHH W
HAS DISAGREEMENTS WITH DIALYSIS
PROVIDERS. I GREW UP IN A UNION
HOUSEHOLD. IN FACT, MY EX WIFE
AND MY DAUGHTER ARE BOTH UNION
MEMBERS. BUT I DO NOT SUPPORT
WHAT YOU H W IS DOING NOW.
PLEASE LEAVE THE HOUSE JUST
PATIENTS OUT OF YOUR ORGANIZING
CAMPAIGNS. WE'RE JUST TRYING TO
LIVE OUR LIVES. AS BEST WE CAN
WRAP UP TIME. WE'RE JUST TRYING
TO LIVE OUR LIVES AS BEST WE CAN
AND QUALIFYING BUDGET BALLOT
MEASURES THAT THREATEN OUR
ABILITY TO GET DIALYSIS IS THE
WRONG WAY TO GO ABOUT GETTING
SUPPORT AND OUR VOTER SUPPORT.
THANK YOU. THANK YOU VERY MUCH.
RIGHT NOW NOW. BRING IT BACK TO
COMMITTEE FOR ANY QUESTIONS OR
COMMENTS FOR THE OPPOSITION.
OKAY UM, JUST ONE BRIEF QUESTION
. DR WANG, UM, YOU HAD MADE IN
YOUR STATEMENT YOU HAD SAID THAT
THE PERSON ON SITE, THE
CLINICIAN ON SITE WOULD ONLY BE
ABLE TO ADMINISTRATIVE WORK ON
THIS POSITION MYSELF. THAT WAS A
LITTLE PUZZLING. THE SENSE THAT
WHILE I RECOGNIZE THE PATIENT
HAS THEIR OWN PHYSICIAN AND
FROLLO GIST, WHO'S MANAGING
THEIR CARE IN AN EMERGENCY
SITUATION, JUST LIKE IF SOMEONE
SHOWS UP AND SOMEONE'S ADMITTED
TO HOSPITAL, THEIR PRIMARY CARE
PHYSICIAN, OFTENTIMES IT'S NOT
THE PERSON CARING FROM THE
HOSPITAL AND HOSPITALIST OR
OTHER PHYSICIANS, AND THEY WOULD
BE FREE TO BE ABLE TO PROVIDE
CARE IS NEEDED WHILE THEY'RE IN
THE HOSPITAL WITHOUT NECESSARILY
ALWAYS CALLING AS A PRIMARY CARE
PHYSICIAN, SOMETIMES A LITTLE
ANNOYING, BUT ALWAYS HAVING TO
CALL THE PRIMARY CARE PHYSICIAN
. SO WHY? WHY WOULDN'T A
PHYSICIAN WHO'S ON STAFF AT THE
DIALYSIS CENTER? IF THERE'S AN
EMERGENCY IF THERE'S A PROBLEM,
BE ABLE TO ACTUALLY PROVIDE
CLINICAL CARE, THAT'S WHAT
THEY'RE LICENSED TO DO, AND IT'S
IN THE FACILITY IN WHICH THEY
ARE ASSIGNED. SO CAN YOU PLEASE
EXPLAIN THAT PART OF YOUR
TESTIMONY? YES, I'LL BE HAPPY TO
THE DIALYSIS PATIENTS HAVE. A
PRIMARY NEPHROLOGIST. ALREADY HE
OR SHE DIRECTS THE CARE AND
RIGHTS TO DIALYSIS PRESCRIPTIONS
THE MEDICATIONS AND KNOWS THE
PATIENT'S MEDICAL CONDITIONS
MORE THOROUGHLY. ANY STAFF
POSITION. NURSE PRACTITIONER OR
PHYSICIAN'S ASSISTANT THAT IS
ASSIGNED TO THE CLINIC IN PROP
29. WHEN AN EMERGENCY WERE TO
OCCUR WHEN HE CAN RENDER JUST
BASIC LIFE SUPPORT A WHILE THEY
CALL 911, FOR EXAMPLE, THEY
ALREADY PROTOCOLS IN PLACETO
DEAL WITH LOW BLOOD PRESSURE,
SYMPTOMS OF NAUSEA AND VOMITING
. AND THESE ARE POSITIONS AS UH
, REQUIRED BY PROP 29 DO NOT ADD
ANYTHING, ADDITIONALLY, TO THE
CARE OF THESE PATIENTS. OKAY SO
THE EMERGENCY WERE TO OCCUR. I'M
GOING TO END UP SORRY. AND BUT
JUST TO BE CLEAR, THOUGH. UM
CERTAINLY, IF IT'S A SITUATION
WHERE THEY NEED, UM, AMBULANCE
CARE. AH! THEY WOULD CALL 911,
HOWEVER. AND AGAIN AS I POINTED
OUT OTHER PHYSICIANS, OTHER
PATIENTS AND OTHER HEALTH
FACILITIES AND THEY HAVE A
PRIMARY PHYSICIAN WHO KNOWS THEM
BETTER. IT'S PROVIDED ORDERS,
ETCETERA WHO ISN'T IN THE
FACILITY, BUT THE CLINICIANS
WERE ACTUALLY AT THE FACILITY.
ARE ALSO ABLE TO PROVIDE CARE
BECAUSE THEY'RE AT THE FACILITY
. IF THEY'RE ADMITTED TO THAT
FACILITY, SO ONE CAN ARGUE THAT
IF YOU HAD A CLINICIAN ON SITE
AND THEY WERE AT ONE SOMEONE'S
AT AND THAT THEY WOULD ACTUALLY
BE ABLE TO RENDER CARE TO A
PATIENT. UM, WHILE THERE, UM,
CERTAINLY. WITHIN THE PROTOCOL,
BUT BECAUSE THEY ARE LICENSED,
AND IT WAS EITHER HIS POSITION
OR NURSE PRACTITIONER UPA THEY
WOULD ACTUALLY BE ABLE TO
PROVIDE ADDITIONAL CARE THAT MAY
PREVENT SOMEONE ACTUALLY HAVING
THE O TO THE EMERGENCY ROOM
OUTSIDE OF, WELL, P A. R NURSE
PRACTITIONERS HAVE TO FOLLOW
CERTAIN PROTOCOLS, BUT THEY
WOULD PHYSICIAN WOULD BE ABLE TO
PROVIDE INDEPENDENT CARE TO HELP
KEEP THE PATIENT STABLE AND
PREVENT THEM FROM GOING TO THE
HOSPITAL. WHY WOULD THAT THAT
NOT BE THE CASE? SO MY ANSWER IS
THAT THAT THAT KIND OF CARE HAS
TO BE DELEGATED FROM THE
PATIENT'S PRIMARY MYTHOLOGY.
IT'S A DIFFERENT SITUATION WHEN
COMPARED TO AN EMERGENCY ROOM
WHEN A PATIENT ARRIVES IN THE
EMERGENCY ROOM OR HOSPITAL
DELEGATION OF CARE IN THE
HOSPITAL HOSPITAL THERE UNDER
ADMITTED UNDER THE CARE OF A
CLINICIAN WHO MAY NOT BE THE
PRIMARY CARE DOCTOR. IN FACT, WE
HAVE MANY PHYSICIANS WHO ARE
ACTUALLY HOSPITALISTS. THAT'S
THEIR JOB. THEY DON'T PROVIDE
CARE OUTSIDE THE HOSPITAL,
SOMEONE SOMEONE'S IN THE
HOSPITAL. THEY CAN PROVIDE THE
CARE WHILE THEY'RE IN THE
HOSPITAL. I THINK THAT IT'S
BECAUSE OF THE DELEGATION OF
AUTHORITY TO CARE FOR THE
PATIENTS. THAT HAS TO BE A HAS
TO BE EXTREMELY STREAMLINED AND
ALLOWS THE POSITION, UH,
APPOINTED BY PROP 29 TO RENDER
CARE OTHERWISE WITHOUT THE
DELEGATION WERE INTERFERING IN
THE PATIENT PHYSICIAN
RELATIONSHIP THAT IS ALREADY
ESTABLISHED. OKAY ALL RIGHT.
WELL, THANK YOU SO MUCH FOR YOUR
ANSWER. I JUST WANTED TO CLARIFY
THAT'S UH, THAT PART OF THE
TESTIMONY. ARE THERE ANY OTHER
QUESTIONS OR COMMENTS FROM
COMMITTEE MEMBERS? OKAY SEEING
NONE. UM, WELL NOW MOVE ON, THEN
TO PUBLIC COMMENT, AND I WANT TO
THANK ALL OF OUR WITNESSES, UM,
FOR THE TESTIMONY AND THANK YOU
VERY MUCH. AND AT THIS TIME, I'D
LIKE TO INVITE THE PUBLIC WANT
TO PARTICIPATE EITHER IN PERSON
OR BY TELECONFERENCE. SO IF
YOU'RE ON TELECONFERENCE, PLEASE
CALL IN NOW. PLEASE DIAL THE
TOLL FREE NUMBER 844291 OR 185.
WHEN PROMPTED. PLEASE USE THE
ACCESS CODE. 984113. WE'RE GOING
TO BEGIN THEIR PUBLIC COMMENT
HERE WITH PEOPLE. ANYONE IN THE
GALLERY WHO LIKES TO LIKE TO
ADDRESS THAT AGAIN, PROPOSITION
29 WALLAU, EACH PERSON UP TO ONE
MINUTE PIECE IN PERSON OR ON THE
ON THE LINE SO AGAIN WILL FIRST
BEGIN HERE IN THE PUBLIC
GALLERY. SEEING NO. ONE AT THE
MICROPHONE AND THE PUBLIC
GALLERY. THE MICROPHONE
MODERATOR. WE WILL NOW MOVE ON
TO WITNESSES PROVIDING PUBLIC
CONFIDENCE. TELECONFERENCE
SERVICE MODERATOR IF YOU PLEASE
PROP INDIVIDUALS WILLING TO
PROVIDE PUBLIC COMMENT. WE WILL
BEGIN AGAIN. EACH WITNESS HAS
MAXIMUM ONE MINUTE PERTINENT TO
THE TOPIC OF PROPOSITION 29 SO
MODERATE IF YOU PLEASE OPEN THE
LINES FOR WITNESSES WHO WISH TO
TESTIFY REGARDING PROPOSITION
29. TO TESTIFY. PLEASE PRESS
ONE, THEN ZERO ON YOUR TOUCH
TONE PHONE. YOU'RE HEARING
INDICATION YOU'VE BEEN PLACED
INTO Q AND AN 18 T SPECIALIST
WILL PROVIDE YOU WITH THE LINE
NUMBER. WILL OPEN UP YOUR LINE
WHEN WE ARE READY FOR YOU. ONCE
AGAIN. IF YOU HAVE YOU WOULD
LIKE TO TESTIFY. PRESIDENT ONE,
THEN ZERO AT THIS TIME. WE DO
HAVE ONE LINE QUEUING UP ONE
MOMENT WHILE WE PROVIDE THEIR
LINE NUMBER. THANK YOU.
WE WILL OPEN LINE. 11 GO AHEAD.
WELCOME. MORNING MR CHAIR AND
MEMBERS OF THE COMMITTEE BRANDON
MARCHI WITH THE CALIFORNIA
MEDICAL ASSOCIATION, AND WE'RE
OPPOSED TO PROPOSITION 29
BECAUSE IT WILL UNNECESSARILY
DRIVE UP HEALTH CARE COSTS. FOR
ITS LIFESAVING DIALYSIS CLINICS
TO CLOSE AND PUT PATIENTS BY
THIS PATIENT LIVES AT RISK.
PATIENTS RECEIVED TREATMENT FROM
THEIR DOCTOR AND TRAINED NURSES
AND TECHNICIANS REQUIRING
PHYSICIANS TO SERVE IN
BUREAUCRATIC NON PATIENT CARE
CAPACITY. THAT DIALYSIS CLINICS
. THERE'S NOTHING TO ADD VALUE
OR IMPROVED OUTCOMES FOR
PATIENTS AND INSTEAD EXACERBATES
THE CURRENT PHYSICIAN. WORKFORCE
SHORTAGE. THAT'S THOUSANDS
CLINICS ARE ALREADY REGULATED BY
FEDERAL AND STATE AGENCIES AND
HAVE HIGH RATINGS FOR QUALITY
CARE AND PATIENT SATISFACTION.
BY TAKING DOCTORS AWAY FROM
PROVIDING DIRECT PATIENT CARE
WHERE THEY ARE NEEDED
PROPOSITION 29 WOULD INCREASE
PATIENT WAIT TIMES INCREASED
COSTS TO PATIENTS AND REDUCED
CAPACITY TO RESPOND TO AND
ADDRESS MEDICAL EMERGENCIES AND
COMMUNITY HEALTH NEEDS. IT IS
FOR THESE REASONS, THE
CALIFORNIA MEDICAL ASSOCIATION
IS OPPOSED TO PROPOSITION 29.
THANK YOU. THANK YOU. THANK YOU.
NEXT WITNESS. WE HAVE NO FURTHER
LINES IN CURED THIS TIME. ALL
RIGHT. THANK YOU, MODERATOR.
BRING IT BACK TO THE COMMITTEE.
ARE THERE ANY FINAL QUESTIONS OR
COMMENTS FROM COMMITTEE MEMBERS?
SEEING NONE. I JUST CAN I WANT
TO HAVING HEARD ALL PUBLIC
TESTIMONY. UM AND, UH, I WANT
FIRST OF ALL. THANK EVERYONE, UH
, ALL THE WITNESSES FOR YOUR
TESTIMONY ON PROPOSITION 29.
THIS ABOUT THIS MEASURE WILL BE
GOING TO THE BALLOT IN NOVEMBER
AND AGAIN. WE ALWAYS APPRECIATE
HEARING FROM THE PROPONENTS AND
OPPONENTS OF PROPOSITIONS HERE
AND OUR COMMITTEE ON HEALTH FOR
THOSE PROPOSITIONS. UH, RELEVANT
TO OUR COMMITTEES, JURISDICTION
SO THAT WE CAN BETTER UNDERSTAND
THE ISSUES THAT WERE BROUGHT UP
. AND I KNOW THIS IS AN AREA IN
WHICH BOTH I AND THE DOCTOR
WOULD HAVE ENGAGED IN OVER OVER
THE YEARS AND EVEN THE AUTHORED
LEGISLATION AS WELL AS CERTAIN
LEGISLATION SO AGAIN APPRECIATE
EVERYONE'S TESTIMONY, AND
CERTAINLY THERE ARE SOME STILL
SOME ONGOING ISSUES WITH THAT.
SO WITH THAT, SAYING NO OTHER
QUESTIONS OR COMMENTS GIVING
THEM I THANK ALL THE
PARTICIPANTS WANT TO THANK THE
STAFF FOR PREPARING THE
MATERIALS, THE LÀ AS WELL FOR
YOUR REPORT, AND, OF COURSE, OUR
SERGEANTS AND OTHER STAFF WHO,
UH, AND MODERATORS ON THE PHONE
LINES TO HELP THAT THIS HEARING
GOES SMOOTHLY. WITH THAT THIS
JOINT HEARING OF THE SENATE AND
ASSEMBLY COMMITTEES ON HEALTH.
IS NOW ADJOURNED.