SAN FRANCISCO (AP) — California voters have rejected a ballot measure to require a doctor or highly trained nurse at each of California’s 600 dialysis clinics.

With more than 9 million votes tallied Tuesday, Proposition 23 had just 37% of votes. It is the second measure seeking to regulate dialysis clinics placed on the ballot in recent years by unions that represent health care workers and drew more than $110 million in spending.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.

Proposition 23 was the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market.

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