LOS ANGELES – Patients with kidney failure in California are coming under increasing pressure from operatives hired by a dialysis corporation to oppose a November ballot initiative designed to improve their patient care.

Fresenius, one of the two largest dialysis corporations in the United States, is aggressively moving to enlist patients to sign a petition to oppose the Fair Pricing in Dialysis Act, an initiative which qualified last month for the Nov. 6 California ballot.

“It’s so wrong how these companies are trying to scare us by claiming our clinics will close if we don’t sign the petition,” said Richard Adling, a dialysis patient from Jurupa Valley, Calif. “To me this just shows how manipulative the industry is and cares far more about itself than patients. What kind of people try to pressure and frighten patients who suffer from an often fatal disease?”

Industry representatives are circulating a petition in clinics, pushing patients to sign it after their treatment. Workers report some patients are being told by the operatives that their clinics will close as early as January 2019 and their Medicare benefits would be cut if they refuse to sign the petition.

A recent Facebook post by a representative of staffing agency Core Staffing Solutions says it is hiring workers for a five-day project “collecting signatures from patients at dialysis clinics” in three cities in Los Angeles County. A follow-up email from Core Staffing Solutions indicated the workers would be “…informing patients about a proposed measure that could lead to the closing of dialysis clinics and cutbacks in services.”

The temporary positions pay $18 an hour, which is up to $3 more per hour than the average wage for a patient care technician at Fresenius clinics in California, according to Glassdoor. Patient care technicians connect patients to dialysis machines and monitor patients throughout their three-hour treatment.

The ballot initiative would push dialysis corporations to invest more in the treatment of patients with kidney failure and improve conditions in the clinics, where patients have reported incidents of cockroaches, mice, blood stains and dirty bathrooms.

Two corporations dominate the dialysis industry in California: DaVita and Fresenius, which own and operate 72 percent of the clinics in the state. The profit margin of their dialysis clinics is nearly five times higher than the average hospital in California, and they reported a combined profit of $3.9 billion in 2016 from their U.S. dialysis operations.

According to the U.S. Renal Data System, 66,000 Californians have kidney failure, also known as End Stage Renal Disease, a life-threatening illness that typically requires being treated in a dialysis clinic. Patients often must undergo dialysis treatment three days a week at clinics to remove their blood, clean it, and put it back in their bodies. Each treatment lasts three to four hours.