Previous California Senator Ricardo Lara introduced a Senate Bill 2/14/2017 dubbed "The Dialysis Patient Safety Act" that would have greatly improved conditions for patients and Healthcare Workers in outpatient dialysis settings. Unfortunately, due to heavy lobbying by well funded groups, this Bill did not become law but is badly needed.

"(A) At least one nurse is providing direct care for every eight patients. A nurse shall only count toward this ratio during time periods the nurse has no responsibilities other than direct care. A nurse manager or charge nurse shall not count toward this ratio.
(B) At least one technician is providing direct care for every three patients. A technician shall only count toward this ratio during time periods the technician has no responsibilities other than direct care. Trainees shall not count toward this ratio. Nurses counted toward the nurse-to-patient ratio shall not count toward this ratio.
(2) Commencing July 1, 2018, a chronic dialysis clinic shall ensure that a social worker is not assigned more than 75 patients.
(3) The ratios described in paragraphs (1) and (2) shall constitute the minimum number of nurses, technicians, and social workers assigned to patients at all times. Additional nurses, technicians, and social workers shall be assigned to the extent necessary to ensure that an adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient-to-staff ratio is appropriate to the level of dialysis care given and meets the needs of patients.
(4) Commencing July 1, 2018, a chronic dialysis clinic shall ensure that the transition time is at least 45 minutes.
(c) The department shall not issue a license to any chronic dialysis clinic unless that chronic dialysis clinic demonstrates the ability and intention to comply with this section.
(d) (1) Every chronic dialysis clinic for which a license has been issued shall maintain, and provide to the department on a form prescribed by the department, at a minimum, the following information:
(A) Actual staffing ratio and transition time data for the period covered by the submission, which shall include, at a minimum, daily totals of the total number and actual hours worked by nurses, technicians, and social workers, the total number of patients and actual hours receiving direct care, and the daily average transition time for each treatment station.
(B) Every instance, no matter how brief, during the period covered by the submission when staffing ratios or transition times did not meet the requirements of subdivision (b) and the reasons and circumstances therefor.
(2) The medical director and the chief executive officer or administrator of the chronic dialysis clinic shall both personally certify under penalty of perjury that each of them is satisfied, after review, that all information submitted pursuant to paragraph (1) is accurate and complete.
(3) The chronic dialysis clinic shall periodically submit the information described in paragraph (1) to the department on a schedule and in a format prescribed by the department, provided that the clinic shall submit that information no less frequently than four times per year.
(e) The department shall inspect each chronic dialysis clinic for which a license has been issued at least once per year, and shall conduct such inspections as often as necessary to ensure compliance with the requirements of subdivision (b), the accuracy and completeness of information provided pursuant to subdivision (d), compliance with corrective action plans, if any, approved under subdivision (b) or (d) of Section 1240.1, and the adequacy of the quality of care being provided.
(f) Within 60 days of receiving a complaint from an employee, an association of employees, a vendor, a contractor, a patient, an association of patients, or a family member of a patient of a chronic dialysis clinic that the chronic dialysis clinic has engaged in a staffing-related violation or gross staffing-related violation, as those terms are defined in subdivision (a) of Section 1240.1, the department shall investigate the chronic dialysis clinic and, if the evidence shows a violation has occurred, the department shall impose discipline pursuant to Section 1240.1."

https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB349

"The Dialysis Patient Safety Act (SB 349), introduced by State Senator Ricardo Lara and sponsored by UNAC/UHCP, would establish caregiver-to-patient ratios and mandate safe transition times so equipment can be fully cleaned of blood and fluids between patients to prevent the spread of life-threatening infections."

“This bill forces the two largest dialysis companies, Fresenius and DaVita, to invest more in patient care. That means it will cut into their huge profit margins—which are now far higher than most health care providers,” said Denise Duncan, a 35-year RN and President of the United Nurses Associations of California/Union of Health Care Professionals (UNAC/UHCP). “That’s why the companies are fighting the bill so hard, making gloom-and-doom predictions about closing facilities and cutting treatment hours."

"“Studies consistently show that improved staffing in dialysis settings improves patient outcomes, decreases hospitalizations and reduces exposure to hepatitis C,” said Duncan. “Every objection the companies put up against the bill is simply a smoke screen to protect their huge profit margins. That’s why we believe that those who care for patients at the bedside every day should set the standards of care, not those who profit from the care.”

https://www.unacuhcp.org/dialysis-patient-safety-act-clears-next-hurdle-in-california-state-senate/

Please support ratios in outpatient dialysis for the welfare of patients and healthcare workers.