01/04/05

LC050104

This Life and Times healthcare special is made possible by a
grant from QueensCare, a public charity providing healthcare to
the low-income and uninsured residents of Los Angeles.

Val Zavala>> Tonight on Life and Times --

Community clinics are about to lose a financial lifeline and the
uninsured are being hit the hardest, but why should you care?

Kazue Shibata>> We're all one. I mean, you can't just let
certain segments of the community suffer and act like nothing is
happening.

Val>> And then, a program that's helping healthy families stay
that way. Plus, a new tool to catch heart problems in
youngsters.

It's all straight ahead on tonight's Life and Times.

Life and Times is made possible through the generous support of
the L.K. Whittier Foundation dedicated to improving the quality
of life by supporting innovative endeavors in the fields of
medicine, health, science and education.

And by a generous grant from Jim and Anne Rothenberg.

Val>> Welcome to this Life and Times healthcare special. For
thousands of low-income families, it's often the free
neighborhood clinics that can be such a lifesaver. These
community clinics also help take the pressure off of our
emergency rooms and hospitals, but soon about sixty of them will
be facing a financial crisis. In June, millions of dollars in
federal money will disappear. Toni Guinyard takes a look at
what it means to one clinic and the people who go there.

Toni Guinyard>> It's a scene repeated day after day, hour after
hour, in clinics throughout Los Angeles County. Waiting rooms
fill up with patients sitting shoulder to shoulder waiting to
see a doctor.

>> "Eduardo Flores?"

Toni Guinyard>> Few have money to pay for their medical care.
This is Clinica Monsenor Oscar A. Romero. It's one in a network
of fifty-four private healthcare facilities in Los Angeles
County that receives federal funds earmarked to provide care to
the county's poor.

Dr. Eduardo Gonzalez>> The majority of our patients are adults
who are uninsured, working people. Many of our patients have
two and up to three jobs without health insurance.

Toni Guinyard>> Barbara Perez has been a patient at Clinica
Romero for about one year. She's out of work and she's
pregnant.

Barbara Perez>> I'm not paying a single dime in here, nothing.
It's free. They help you. I think the community needs a place
like this.

Toni Guinyard>> It's important then?

Barbara Perez>> Yeah. Oh, yeah, because a lot of people can't
afford to go and get checkups and things like that.

Toni Guinyard>> No health insurance, no ability to pay, yet
many here receive medical care because of a program dating back
to 1995. At the time, the Los Angeles County Department of
Health Services was facing a $655 million dollar budget deficit.
The county turned to the federal government for funding to cover
the cost of caring for the uninsured.

Dr. Thomas Garthwaite>> It's a massive problem. There are more
uninsured in California and Los Angeles than almost anywhere
else in the country.

Toni Guinyard>> A short-term solution came in the form of
what's called an 1115 Medicaid waiver. It infused millions in
federal funds into the county's critically ill public healthcare
system. In turn, the county had to shift its focus to
preventive care and drastic cost-cutting.

Dr. Eduardo Gonzalez>> A lot of the clinics that the county
used to run were being closed. The 1115 waiver allowed the
county to continue providing services.

Toni Guinyard>> The result? A unique partnership forged
between private healthcare facilities and the County Department
of Public Health. This public-private partnership is what's
allowing the county to continue providing care to low-income and
uninsured patients.

Dr. Thomas Garthwaite>> So the cost of all of our healthcare
goes up because of the burden on our higher healthcare system of
the uninsured, so it affects us all. It's all inter-related.

[Film Clip]

Dr. Eduardo Gonzalez>> Clinica Romero, before the 1115 waiver,
was a very small clinic run primarily by volunteer physicians.

[Film Clip]

Dr. Eduardo Gonzalez>> We could not afford physicians as part
of our staff. The 1115 waiver granted us the first monies so we
could hire the first providers on staff. That made an enormous
difference in how we delivered service.

Toni Guinyard>> Clinica Romero now has ten doctors on staff.

[Film Clip]

Toni Guinyard>> The demand for medical care in this community
is so great that patients must make an appointment four to six
weeks in advance to see a doctor. If a patient is too sick to
wait, they can arrive for a walk-in appointment as long as they
get here by seven o'clock in the morning.

Shirley Moss>> And I was standing outside at 6:30, but they
also told me I'd be here from seven to twelve or even longer, so
I came prepared to stay all day.

Toni Guinyard>> Patients are willing to wait. Clinica Romero
does not advertise. People learn about the services provided
here by word of mouth. That's how Shirley Moss found out about
the clinic. She arrived hoping to get her prescriptions filled.

Shirley Moss>> I don't know what the price will be here or if I
have to pay anything, but I have an emergency. I have a heart
problem, high blood pressure.

Toni Guinyard>> Each patient visit costs the clinic an average
of $113, about ten dollars less than the patient visits were
costing the county. The clinic is reimbursed $83.82 for each
visit. This clinic makes up the difference with private
donations.

Dr. Eduardo Gonzalez>> For every dollar the federal government
gives us through the 1115 waiver, we match one-third of it so we
can cover the entire healthcare needed by a patient visit.

Dr. Paul Giboney>> There's less of bureaucracy, less of
administrative structure. So much more of every dollar of
funding that we get goes straight into the community that people
often overlook that. We're able to do more for less than an
organization that has a lot more overhead or a lot more
bureaucracy to pay for.

Toni Guinyard>> The federal funding which has decreased over
the life of the waiver and the $900 million dollar waiver
extension will end in June 2005 when the waiver expires. There
was initial fear that, once the funding dried up, the low-income
patient would be turned away with private clinics unable to
absorb the cost of treating them.

Dr. Eduardo Gonzalez>> If PPP were to disappear, we'll have
this patient with diabetic coma, for instance, ending up in the
emergency room costing the system thousands and thousands of
dollars. I believe that our elected officials are committed to
making the 1115 waiver continue in some shape or form.

Toni Guinyard>> County elected officials have indicated that,
just because the waiver will expire, the program will not end.

Dr. Thomas Garthwaite>> Our budget projections have included
continuation of the public-private partnership, the funding at
the same levels into the future. We did not assume -- I did not
assume -- that when the funding ran out federally that was
supporting that, that we would just walk away from that.

Toni Guinyard>> But the unpredictability of the county budget
remains a cause of concern. Kazue Shibata is Chief Executive
Officer of the Asian Pacific Health Care Venture. It is also a
participant in the public-private partnership program.

Kazue Shibata>> We can't always feel that the programs that we
have today are going to exist a year from now, so we're really
walking a fine line between what is available and what may not
be available next year.

Toni Guinyard>> Four thousand to five thousand Asian Pacific
Health Care Venture patients are enrolled in the program.

Kazue Shibata>> We have multiple budgets, counting this year.
You know, one budget scenario is a hundred percent elimination
of PPP. What are we going to do, you know, with the patients
that we have? That's the number one scenario. Number two
scenario, if it's fifty percent budget cut, what are we going to
do with the patients?

Toni Guinyard>> Los Angeles County residents are eligible for
the program if they do not qualify for Medi-Cal and have an
income at or below 133-1/3 percent of the federal poverty level,
about $25,000 for a family of four. U.S. citizenship is not
required.

Dr. Thomas Garthwaite>> Those individuals who are here
illegally, eighty percent of them have jobs. They're working
for your friends, neighbors and maybe for you. They are out
amongst us and, if they have a disease or a condition that is
infectious, you certainly want it diagnosed and treated.

Kazue Shibata>> You know, we're all one. You know, you can't
just let some segment of the community suffer and act like
nothing is happening.

Toni Guinyard>> So they continue to see patients, many of whom
have never received comprehensive medical care, never had a
doctor to call their own until now, medical care funded by a
program most have never heard of, put in place to help the
neediest of Los Angeles County residents. I'm Toni Guinyard for
Life and Times.

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and Times".


Val>> For years, we've watched as the ranks of the uninsured
continue to swell. Well, now someone is finally doing something
about it. A coalition of major foundations and organizations
have launched a massive effort to get tens of thousands of
children insured. It's a multi-million dollar effort that picks
up where government programs leave off. I went to the northeast
San Fernando Valley to see how one community is getting
healthier one child at a time.

Elsa Cruz is a mother of two. Juan Pablo is seven, Paula is
three. Their life in this low-income neighborhood of Pacoima
looks the same, but recently there was a major change: her
children now have health insurance. The Cruz family lives here
in a one-room house behind another house. Elsa came to the
United States from Mexico to join her husband. That was four
years ago. Elsa's husband is a construction worker. His
employer doesn't offer insurance and, because they don't have
legal residency, they don't qualify for Medi-Cal. But even if
they were documented, they would not be eligible.

Elsa Cruz>> We didn't qualify for any insurance program because
we either made too little or too much and Medi-Cal is for low-
income families and we're a little above that. We never had
health insurance. If we got sick, my husband would pay for
medicine or visits to the clinic with what little he had.

Val>> Paula, a bright and active little girl, was born here.
Her older brother was born in Mexico. Shortly after Paula was
born, doctors detected a heart problem.

Elsa Cruz>> They sent us to UCLA and, since we only had
prenatal insurance, they told us they couldn't cover everything.
So they did what was necessary and said we would figure out the
bill later. We received a bill. Thank God we didn't have to
pay for it.

Val>> Paula is now doing fine, but it was a close call. Still,
the family continued for another four years with no insurance.
Then a few months ago, Elsa heard about a new program for
working families called Healthy Kids.

Elsa Cruz>> I asked my friend, how do you get insurance for
your kids? She told me to go to the clinic and ask for a person
named Chiquita and ask her how she can help us because my kids
didn't have insurance.

Val>> So she came here and, instead of being overwhelmed by
complicated paperwork and documentation, clients meet people
like Vilma Champion. Vilma is a Certified Application Assistant
and she helps families fill out the forms line by line.

Vilma Champion>> A lot of our families unfortunately still are
barriers to enrollment because they still feel that stigma with
public charts, so therefore --

Val>> -- you mean, taking some help from the government or from
nonprofit charitable help?

Vilma Champion>> Yeah, because they fear that they're going to
have to pay back the system for accessing healthcare services.

Val>> And unlike government-sponsored programs, Healthy Kids
covers families of four who earn up to $54,000 a year. That
would include the Cruz's. Howard Kahn is head of L.A. Care, the
nonprofit agency that administers the Healthy Kids insurance
program.

Howard Kahn>> It's tough to make it for a family of four on
$55,000 a year and paying healthcare premiums is just something
that most couldn't do, so that started with the up to five year
old group. What we did at that point was L.A. Care, the
California Endowment and the County Department of Health
Services came together and said let's figure out how to solve
this problem for all kids in Los Angeles County. It was
wonderful because, as soon as we started this, we had all sorts
of other organizations say that we want to be a part of that and
now we're a coalition of over fifty organizations.

Val>> And unlike government programs, Healthy Kids doesn't
require that the children be citizens. That's something Elsa
was concerned about.

Elsa Cruz>> I have one child who was not born here. He was
born in Mexico and he did not qualify for a different insurance
program. Through this insurance program, both of them
qualified. They didn't ask for any documents which I wouldn't
be able to provide and that's why they both qualified.

Val>> And the cost? Incredibly low.

Elsa Cruz>> We are paying six dollars per child per month.

Val>> So for twelve dollars a month, both children are covered
and that includes not just medical care, but vision and dental
services as well. How can the premiums be so low? Because the
Children's Health Initiative, a joint effort among more than
fifty nonprofit groups and foundations, has raised $82 million
dollars so far.

Howard Kahn>> Every needy child in Los Angeles County under
three hundred percent of the poverty level can get coverage
either through Medi-Cal, through Healthy Families or through the
Healthy Kids program.

Val>> That's an amazing statement to be able to make for Los
Angeles County.

Howard Kahn>> Yeah, we're pretty excited about it. The good
news is, we started out with ninety percent of the kids in
California already having healthcare coverage, so we're dealing
with the last ten percent.

Val>> But that last ten percent is often undocumented. Kahn
realizes that medical care to undocumented immigrants is a
controversial proposition, but he says this initiative is
focused on a larger issue.

Howard Kahn>> The kids, because the payoff is the biggest,
because you've got a child who's in school who you want to be
able to learn, to be able to see the blackboard, not be out of
school because of dental care problems, etc. and this gives them
an opportunity to get the care when they need it. And the
future investment for us, for Californians, is tremendous
because the more successful they are in school, the more likely
they'll be able to get jobs and be productive residents of
California in the future.

[Film Clip]

Val>> At the Northeast Valley Health Corporation in San
Fernando, Dr. Richard Seidman examines a four month old. The
problems he sees here day after day are typical.

Dr. Richard Seidman>> Common vision problems, hearing problems,
developmental delays. Get kids in the early intervention
programs, controlling their asthma, treating their ear
infections early so they don't wind up missing more school. One
of our most common diagnoses is allergies. You know, just hay
fever.

Val>> But what's not typical is the ease with which these
clients are served. The nurses and doctors here speak Spanish.

Dr. Richard Seidman>> Roughly two-thirds of our patients are
Spanish-speaking, but we're always dealing with immigrants from
many countries, from Pakistan and Southeast Asia, Egypt.

Val>> And the paperwork is kept to a minimum. The Healthy Kids
application is only four pages long, a vast improvement over the
twenty-eight page application for a somewhat similar government
program. The original application was so intimidating that
California lost millions of dollars in matching federal funds
because so few families had signed up. Administrators for the
Healthy Kids program had other obstacles to overcome like the
reluctance to pay premiums for services you may not need.

Dr. Richard Seidman>> There was a lot of discussion about how
to handle the monthly premium, whether or not there should be a
monthly premium, and how to handle families if they should
default on the monthly premium. The policies have been written
in a way to be quite forgiving if need be for families in need
that truly are making those choices between a meal or insurance
for their children.

Val>> At the Northeast Valley Clinic in Pacoima, mothers and
children, all clients of the clinic, line up. But today they're
not here to see a doctor. They're here to see this familiar
figure.

[Film Clip]

Val>> It's a few weeks before Christmas and the clinic has had
a very successful toy drive. The $82 million dollars raised so
far by the Children's Health Initiative has brought thousands of
children into community clinics, but the coalition's goal is
even more ambitious. They want to raise another $30 million
dollars to insure virtually every needy child in Los Angeles
County.

Howard Kahn>> And that was part of the vision in creating the
Children's Health Initiative, that we would first lead by
example. Do it, start enrolling the kids, demonstrate how much
need there was and, as well, how much impact there could be.
Then, in a sense, push ourselves as Californians to make a long-
term commitment.

Val>> Still, there are limits. Much of the foundation funding
for Health Kids is committed for three years. What happens
after that?

Howard Kahn>> We think that the state will be able to do it and
for a relatively modest amount of money.

Val>> For the next few years at least, Juan Pablo and Paula
will have easy access to medical care, but the family is still
vulnerable. Elsa and her husband remain uninsured.

Elsa Cruz>> We just pray to God that nothing happens because my
husband is the only breadwinner and it would be hard to pay our
bills. I hope one day we do have coverage, at least for
emergencies.

To send a comment or a question to our program, you can reach us
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Life and Times
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Val>> Convincing children to eat better and exercise more can
be a real challenge, but now one doctor is using a tool that
scans children's arteries and gives them a picture. And as Hena
Cuevas tells us, sometimes a picture can indeed be worth a
thousand words.

Dr. Jacques Barth>> "Hi, I'm Dr. Barth. What's your name?"

Daniel Lopez>> "Daniel Lopez."

Hena Cuevas>> Daniel Lopez has come to this doctor's office in
Beverly Hills for a special kind of physical.

Dr. Jacques Barth>> "What are you eating? Pizza?"

Julia Robles>> "Tacos (laughter)."

Dr. Jacques Barth>> "What are you eating?"

Daniel Lopez>> "Hot dogs."

Dr. Jacques Barth>> "Hot dogs."

Hena Cuevas>> At the tender age of twelve, Daniel already
suffers from high blood pressure. His mother, Julia Robles, is
worried he may develop diabetes or, worse yet, suffer a heart
attack.

Julia Robles>> I hope to God that everything turns out okay,
normal. I'm a little afraid because I know he's a little
overweight.

Hena Cuevas>> It's becoming more and more common to see
children as young as Daniel visiting cardiologists like Jacques
Barth.

Dr. Jacques Barth>> "Can you do me a favor and lay down with
your head over here and your feet over there?"

Hena Cuevas>> Barth is originally from the Netherlands. He
came to Los Angeles in 1986 to work at the Jet Propulsion
Laboratory, JPL. There he studied the effects of gravity on the
blood flow of astronauts. That's when he got the idea to
transfer that technology to everyday use.

Dr. Jacques Barth>> Ninety percent of all people are
asymptomatic though they have clogging of the arteries.

Hena Cuevas>> In other words, a person may not experience any
physical symptoms, but they can have blockages in their
arteries. It's this clogging that this new procedure, the
Cardio-Zone, can detect.

Dr. Jacques Barth>> You don't have to wait until you have a
heart attack to know that you are suffering from heart disease.

Hena Cuevas>> The Cardio-Zone is just like the ultrasound
machine used to see a picture of a fetus in pregnant women.
Only in this case, the picture is of the inside of an artery.

Dr. Jacques Barth>> We can reliably predict six years in
advance the likelihood of getting a stroke or a heart attack.

Hena Cuevas>> This predictability, he says, is key to being
able to stop the disease from advancing. It seems like we've
been hearing that there is an increase in heart disease. Is
this because our lifestyles are getting worse or is this because
the methods of identifying heart disease are getting better?

Dr. Jacques Barth>> No, we're getting unhealthier. The fact
that, for the first time, there are more people going to die
from obesity than from smoking-related diseases is an indicator
that, as New York called the United States, is fat land.

Hena Cuevas>> A fat land that is also creating fat children.
In recent years, the number of obese children in the United
States has increased significantly. In Los Angeles County
alone, one in five children are considered obese, most of them
Latino. One of the biggest problems facing kids today comes
from the constant advertising from fast food restaurants. The
high calorie content of the meals, as well as the larger portion
sizes, are part of the reason kids today are heavier than ever
and that's bringing diseases never before associated with kids.

Dr. Naomi Neufeld>> So now we are seeing in children problems
directly as a result of their obesity that we previously saw
only in adults.

Hena Cuevas>> Dr. Naomi Neufeld is a pediatric endocrinologist
specializing in hormonal disorders. She also heads up a program
to help obese children lose weight.

Dr. Naomi Neufeld>> Those problems include high blood pressure,
Type II diabetes, and now we're identifying early evidence of
heart disease.

Hena Cuevas>> Heart disease in children?

Dr. Naomi Neufeld>> Heart disease in children, the type of
disease that their parents might have had.

Hena Cuevas>> Two years ago, Dr. Neufeld joined forces with Dr.
Barth. With the Cardio-Zone as their newest tool, they are now
able to see the condition of their young patients' arteries.
The results surprised them both.

Dr. Naomi Neufeld>> It blew his mind. He said these are like
fifteen year old adults. These are shocking. Up to two years
ago, we didn't know that children were having this degree of
abnormalities.

Hena Cuevas>> What Barth saw prompted him to conduct a study on
high school students.

Dr. Jacques Barth>> We provide them with a picture of their
arteries that they were happy to see and they dramatically
changed their lifestyle. Some lost twenty pounds. They started
not going anymore to fast food restaurants and I was impressed
and so was the school.

Hena Cuevas>> So this is a way for them to get a tangible
picture?

Dr. Jacques Barth>> Yeah, and to work with. Here is how I am
at age eighteen and, if I don't do anything right now, I will
hopefully reach age forty, so I need to do something now.

Hena Cuevas>> Using this handle covered in gel, Barth finds
Daniels carotid artery at neck level. This is the vessel that
carries blood away from the heart. The idea is that this
artery, although far away from the heart, is representative of
what the other ones look like.

Dr. Jacques Barth>> "This is the inter-medial thickness and
basically it looks fairly thin."

Hena Cuevas>> Dr. Barth is looking to see how thick the walls
are. The thinner the layers, the better. Any thickness shows
that fatty deposits are present and, if the clogging isn't
cleared, the patient is very likely to suffer from a heart
attack. Eighteen year old Samantha Castillion's problem is
weight-related. She suffers from a genetic condition that
affects her arteries.

Dr. Jacques Barth>> "How high is your cholesterol?"

Samantha Castillion>> "253."

Dr. Jacques Barth>> "And that's with medication?"

Samantha Castillion>> "No, without."

Dr. Jacques Barth>> "Okay. Kind of high for a person your
age."

Liz Castillion>> Basically, we have a family tendency towards
high cholesterol no matter what our diet or exercise or status
is. It's just something we're born with.

Hena Cuevas>> Her mother, Liz, brought her in to see Dr. Barth
so he could take a look at how Sam's arteries are doing.

Dr. Jacques Barth>> "We had the computer calculate how thick
you are, the vascular wall is, and what percentile you are as
compared to people your age."

Hena Cuevas>> He measures both sides of her neck.

Liz Castillion>> "Based on the numbers, you will be able to
know if she's at high risk or if she's currently at risk?"

Dr. Jacques Barth>> "I will tell you exactly what her risk is."

Hena Cuevas>> He'll have to wait two weeks for the computer
results, which will be in the form of a letter grade A to F just
like school. The grade will let them know where Samantha ranks
compared to others her age.

Dr. Jacques Barth>> "Basically we give you a comprehensive
report card and also advice on how to deal with the state that
you're in, how to reverse the disease."

Hena Cuevas>> The scan takes about fifteen minutes to perform
and costs between three hundred to five hundred dollars.
Neufeld says that young people are used to getting graded and
grades can be a motivator.

Dr. Naomi Neufeld>> They can put a figure to it, a number to
it. This is a real problem. This is my picture. This is my
heart and I have to work to make this better.

Hena Cuevas>> Barth hopes the Cardio-Zone becomes standard
procedure for overweight children. But until then, he has this
advice for kids. Stop eating all that junk food and exercise.
Your heart depends on it. I'm Hena Cuevas for Life and Times.

Val>> Cardio scores are now being used at forty different
locations across the country. As for Daniel, his score was a
"B" and Samantha's test was inconclusive, so they referred her
to a specialist. And that's our program. Thanks for joining us
for this Life and Times healthcare special. I'm Val Zavala.
We'll see you next time.

This Life and Times healthcare special was made possible by a
grant from QueensCare, a public charity providing healthcare to
the low-income and uninsured residents of Los Angeles.

By the L.K. Whittier Foundation dedicated to improving the
quality of life by supporting innovative endeavors in the fields
of medicine, health, science and education.

And by a generous grant from Jim and Anne Rothenberg.