The Importance of Supporting SB 349: the Dialysis Patient Safety Act


By Sonia Perez

Two years ago, a man in his early 40s started receiving treatment at my dialysis clinic in Riverside County, California. He seemed like a happy person and he always told me everything was fine. But a couple of months after starting, his girlfriend came in one day crying and asking if he had shown up for his appointment. I said he hadn’t. Only later when I called his mother, his emergency contact, did I learn that he shot himself.

It was horrible news. I never got enough time to talk with him and understand what was bothering him. I had a caseload of 136 patients between two clinics at the time, and it rarely allowed sufficient time other than to ask patients in passing: “How are you doing?” If I had fewer patients, I would have been able to spend more time getting to know him and building trust so that he might confide in me.

It still bothers me to this day what happened to him, and it’s part of the reason I’m working to reform the dialysis industry and create safer staffing levels for social workers.

Dialysis is a life-saving treatment for people with kidney failure who must have their blood removed, cleaned, and put back into their bodies. A treatment session lasts three to four hours, and must be conducted three days a week.

The process leaves them susceptible to nausea, diarrhea, and alarmingly low blood pressure. For those with depression, it can be difficult to adhere to a strict diet and attend all their dialysis appointments.

While I became a social worker to provide comfort to patients and their families, I feel like my employer is so greedy and doesn’t care if lives end. Rather than invest in safer staffing levels, the company expects me to push through it.

Sadly, my situation is not unusual. Social workers in California consistently have higher patient loads than other states, according to Joseph Merighi, an associate professor of Social Work at the University of Minnesota, who has studied dialysis social worker caseloads for more than a decade. He testified at a California Senate Health Committee hearing in March 2017 and detailed the problems facing the industry.

His research found that of all the states, California dialysis social workers had the highest patient caseload in 2007; the second highest rate in 2010; and the second highest rate in 2014.

This comes despite a recommendation from the National Kidney Foundation’s Council of Nephrology Social Workers that full-time dialysis social workers be assigned no more than 75 patients. With the increasing number of dialysis patients, due to rising cases of diabetes and hypertension and an aging population, the ratio is likely to jump in the coming years.

It’s not right what’s happening in my clinic and those across California. The two largest dialysis corporations – DaVita and Fresenius – made a net profit of $2.9 billion from their dialysis operations in the United States in 2015. Rather than invest in their workers and patients, it seems the companies care more about their shareholders.

Rather than leave the dialysis industry or profession altogether out of frustration, nephrology social workers in California are uniting to improve job conditions and patient care:

  • We’re organizing to join a union, SEIU-United Healthcare Workers West, to speak with a unified voice to elevate our profession and improve patient care in clinics without fear of retaliation from management; and
  • We’re supporting California state legislation, SB 349 – the Dialysis Patient Safety Act, that requires a minimum staffing ratio of one dialysis social worker for every 75 patients. This ratio will allow us to provide proper care to our patients. The National Association of Social Workers’ California Chapter supports the legislation.

The staffing requirements in SB 349 would allow social workers to better assist our patients with depression screenings and treatment, motivate them to take their medication, and develop ways to reduce missed or abbreviated dialysis sessions.

Eight other states already have minimum staffing levels for dialysis clinics, but only one of those includes social workers. With passage of SB 349, California has the opportunity to inspire other states to stand up for dialysis social workers and their patients. To sign the petition in support of the legislation or to learn more, visit

Sonia Perez is an MSW and lives in Perris, Calif.