03/15/05

LC050315

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 County.

Val Zavala>> Tonight on Life and Times --

Think you're immune to the healthcare crisis because you have
insurance? Think again.

Carol Meyer>> I waited six hours for definitive care for her in
one of the major emergency rooms in this county.

Val>> And then --

Dr. America Bracho>> We have people amputated at forty, blind
at thirty-eight. This is a disease that is disabling our
community.

Val>> Reaching across cultural barriers to control chronic
disease.

It's all straight ahead on this special healthcare edition of
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>> Imagine you took a bad fall or are in a car accident.
You would be one of seven thousand people rushed to an emergency
room every day in Los Angeles County. And what if you needed a
specialist or a surgeon? Would they be there for you? Well,
more and more often, the answer to that question is no because
more and more doctors are refusing to treat patients in our
emergency rooms. Hospitals call it their dirty little secret.
This is the story of one woman who found that out for herself.

Carol Meyer>> "And I carried your arm into the ER. I'll never
forget it."

Val>> Paige Gunther is now twelve years old. Two years ago,
she was roller-skating in her Long Beach neighborhood when she
took a bad fall.

Carol Meyer>> I looked at her arm and immediately I saw the
deformity of her wrist and I knew that she had broken it.

Val>> Carol Meyer is Paige's mother. She's also a nurse and
knew it was a bad break. She rushed her daughter to the nearest
emergency room.

Carol Meyer>> And they put us in a chair and we sat and we sat
in a line of people that were also waiting.

Paige Gunther>> It was very crowded. It was very noisy. Lots
of kids. All I can remember was just me walking in there and
seeing just a bunch of doctors. That's all I can remember. I
remember sitting down and just kind of waiting there for about
probably an hour and then I got put on a bed and got my arm held
up. I probably waited there for about six hours until a doctor
finally came.

Val>> During the long wait for an orthopedist, ER doctors gave
Paige pain medication. At the end of those six hours and after
the specialist had set her arm, Paige had had so much pain
medication that she was admitted to the intensive care unit.
She wasn't released from the hospital until the next day.

Carol Meyer>> You know, we had a wonderful outcome. Paige's
arm is good and it's strong today. She had no complications.
But the fact that someone has to go to an intensive care unit
for a fractured arm is pretty unlikely in most situations.

Val>> Carol knows what she's talking about. She's not only a
nurse. At the time of Paige's accident and still today, she
heads up one of the largest emergency medical services agencies
in the country.

Carol Meyer>> I was the, you know, director of one of the
largest EMS systems in the United States. I had insurance, I
knew the ER doctor that walked in and I had a child who had an
injury that wasn't a matter of life and death, and I waited six
hours for definitive care for her in one of the major emergency
rooms in this county.

Dr. Mark Wellisch>> "Oh, it's not quite healed."

Val>> Dr. Mark Wellisch is an orthopedist. He's been in
practice for thirty years. He's also a spokesman for the
California Orthopedic Association. He admits getting
specialists to be on call for emergencies can be a problem. Are
you on call for the ER?

Dr. Mark Wellisch>> No.

Val>> Why aren't you?

Dr. Mark Wellisch>> Well, first of all, because I don't want to
be. Second of all because I'm a little old. And third because
our group as a group has a policy not to take calls.

Val>> The reason behind that policy is simple.

Dr. Mark Wellisch>> Because it hasn't been very remunerative
and it's been dangerous for us, liability-wise.

Val>> The problem of specialists refusing to show up in
emergency rooms is more complicated and it starts in crowded ER
waiting rooms like these.

[Film Clip]

Val>> Increasingly, the uninsured and under-insured are turning
to emergency rooms for all of their medical care. And even
though there are panels of specialists who are available for on-
call duty at emergency rooms around the county, the decision to
be on a panel is voluntary. Here at St. Francis Medical Center
where sixty thousand patients are treated in the ER every year,
there is only one orthopedist on staff willing to take ER calls.

Dr. Mark Wellisch>> "And good afternoon. How are you?"

>> "Okay."

Dr. Mark Wellisch>> "How's your ankle today?"

>> "The ankle still hurts."

Dr. Mark Wellisch>> In the past in years gone by, panels were a
wonderful thing to do as a new young doctor in a community. You
built your practice from the community of patients that came to
the emergency room and needed your care. They came to your
office subsequently and became your patients and became the
families to which you provided care for the rest of your
practice days.

Val>> But these days, many of those patients can't pay or can't
pay enough.

Carol Meyer>> The reimbursement rate for on-call physicians is
oftentimes so small because one out of every three patients in
Los Angeles County is either uninsured where is there is no form
of reimbursement or possibly the patient could apply for a
county program or be eligible for a county program or the
patient has Medi-cal or Medicare, which is truly an uninsured
program.

Dr. Mark Wellisch>> Our concern today is, in order to run an
office, you need to have enough money coming into the office to
pay the salaries for everybody that you're employing, their
healthcare, their 401k, make sure that you have splints and
plaster and x-rays and all the things that is necessary to
provide in a modern orthopedic practice. Most of those patients
from the emergency room can't help you do that.

Val>> Sometimes treating a patient in the ER doesn't end in the
ER. The patient may need follow-up care and that means going to
the specialist's office. That was a good thing thirty years ago
when Dr. Wellisch was building his practice. Not so today.

Carol Meyer>> There is no reimbursement for patients who are
uninsured for any type of aftercare through a physician's
office, for example.

Dr. Mark Wellisch>> For a variety of people that are called to
the emergency room, their patient contacts vary. If it's a
plastic surgeon, he sews up Mrs. Gladrocks' face and the sutures
come out in four or five days and their encounter is over. But
if Mrs. Gladrocks breaks her ankle at the same time, then I have
to put a cast on in the emergency room, x-ray her in my office,
change her cast, rehabilitate her, make sure she can get back to
dancing like she did when she broke her ankle. Or if Mrs.
Gladrocks is Mrs. Sadrocks, then I assume all the obligations
unless there's some way to make me whole for that.

Val>> And if she's uninsured?

Dr. Mark Wellisch>> Then I eat everything.

Val>> Although there's a measure of this shortage, one thing is
clear. It's especially impacting care in the inner city where
populations are sickest and least able to pay.

Carol Meyer>> There is no way to quantify what is happening,
but I can tell you that I believe people are dying and I believe
that people are having consequences of the delays that we have
in our emergency rooms today. But, no, I cannot quantify that.
And let's face it. What hospital is going to say this patient
died in my emergency room or my waiting room because they waited
too long? I think that it's going to get worse before it gets
better and I think that part of the problem is I really don't
believe the public understands this.

Val>> Some say the answer is for hospitals to make up the
reimbursement shortfall. Others say we need some form of
universal coverage. But one ER doctor put it this way. We are
one celebrity death away from a solution. Whatever the answer,
it's clear that the shortage of specialists is systemic and
there are no easy fixes.

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Val>> It is one of the most common diseases in our society.
Six percent of Americans are diabetic and the percentage is even
higher among Latinos. The disease can't be cured, but it can be
managed if patients get on board. As Saul Gonzalez tells us,
one woman in Santa Ana has found the key for getting the word
out, diabetic by diabetic.

Saul Gonzalez>> Santa Ana, a heavily populated Latino city, is
home to Latino Health Access. In this neighborhood of converted
bungalows, Dr. America Bracho is trying to save lives.

Dr. America Bracho>> Diabetes is the most serious disease that
we see. We have people amputated at forty, blind at thirty-
eight. This is a disease that is disabling our community.

Saul Gonzalez>> She founded the organization twelve years ago.
Its primary mission? Helping people cope with chronic disease.

Dr. America Bracho>> Chronic diseases are a challenge because
they are chronic. They will not go away. It's like a marriage
in which you have a commitment for life and you cannot get away
from it. The disease is not going to forget that it is in your
body and the sugar in your body is going to be damaging to your
system regardless of the fact that you remember or not. So
chronic diseases are difficult to manage. They are a challenge.

Saul Gonzalez>> Yet trying to get people to understand the
problems of chronic disease is a big challenge. People like
Alvaro Ramirez. When he found his way here two years ago, he
was nearly blind in one eye.

Alvaro Ramirez>> My sight started to deteriorate about two and
a half years ago, especially in my left eye. So now it's made
it difficult to work and to do simple things.

Saul Gonzalez>> Alvaro is one of seventy thousand Latinos with
diabetes in Orange County. Many of them are under or uninsured.
However, all the services here are free.

Frank Torres>> Most studies show that the more aggressive we
get, at the earlier time that we get aggressive, there's less
negative outcomes in the end.

Saul Gonzalez>> Frank Torres is a physician's assistant who
takes care of Alvaro and others at Latino Health Access.
Another obstacle for people in this community? Language.
Alvaro speaks little English, so everyone here speaks Spanish.

[Film Clip]

Saul Gonzalez>> Then there are the cultural barriers. Placing
Latinos on a healthy track also means trying to get them to
change their diet, so traditions must bend for entire families.

Dr. America Bracho>> We had a case of this woman with diabetes
in which she said, well, I use a lot of fat because of the way I
prepare the food. So she changed the way she made the
enchilada, but what defines the role in the family is that she
cooks pretty good. So when she changed the way she made the
enchilada, the family complained. When instead of saying, well,
tough, you can do it, we just said, well, then let's cook
something they have never tried and let's go with those,
introducing new ingredients and new way of preparation and she
did. She did broccoli burrito and it was a success.

Saul Gonzalez>> Key to Dr. Bracho's success is a tradition from
her native Venezuela. In Venezuela and many third world
countries, healthcare professionals have discovered that the
best way to deliver healthcare is to use community volunteers.
In Spanish, they're called promontores, or promoters.

Dr. America Bracho>> They are the ones that run the program
because they have the experience of the issue and how it
affected their lives and how they overcame the issue. These are
the community experts. These are people with a great sense of
social justice. They speak the language of the community. In
the case of our diabetes program, all of our promontores have
diabetes which makes an incredible difference. The promontores
talk at a level in which people connect. They are advocates.
They are bridges between clients and the system. They inform
us. They tell that it's not working.

[Film Clip]

Saul Gonzalez>> It turns out that Alvaro Ramirez was lucky in a
couple of ways. First, he was diagnosed. Over five million
people in the United States with diabetes aren't and, second, he
was assigned a promontore to help him deal with his diabetes.

[Film Clip]

Saul Gonzalez>> Antonio Flores himself has diabetes. He was
diagnosed three years ago. When he met Alvaro, he knew all
about the lifestyle changes that Alvaro would have to make.

Antonio Flores>> When you take that information for your
control, it's very important to take that step. Doctor,
medication, diet and exercise. That's a big change.

Saul Gonzalez>> Once Antonio got his diabetes under control, he
wanted to help others do the same.

Antonio Flores>> When I'm working with different people, my
mission is a personal mission and I like helping my community
all the time because when I come to this agency, this agency
helped me. You know how much that cost to help me? Nothing.
Completely free.

Saul Gonzalez>> Alvaro, who used to be a cook, has now found a
community. When he meets with Frank Torres and a resident twice
a week, Antonio is always at his side.

[Film Clip]

Saul Gonzalez>> And while doctors have long stopped making
house calls, Antonio makes regular visits to Alvaro's home to
make sure he's eating right and exercising. This afternoon,
Alvaro learned that, although his blood sugar level is more or
less in range, his blood pressure is slightly elevated.

[Film Clip]

Saul Gonzalez>> For Alvaro, controlling his diabetes is a
delicate balancing act.

Alvaro Ramirez>> Yeah, I feel very happy when he's with me and
it kind of eases my tension a little bit.

Saul Gonzalez>> In addition to promontores' home visits and
one-on-one attention, Latino Health Access offers classes for
diabetics and their families. Many of the people in this class
are here because promontores like Antonio Flores encourage them
to come.

[Film Clip]

Saul Gonzalez>> Some of the patients in this class will become
promontores themselves, diabetics working with other diabetics.
America Bracho has a theory about how it came to be.

Dr. America Bracho>> My theory is that the first promontore was
a cavewoman and, in that case, they discovered fire. The first
thing this woman did was to share the fire with a neighbor and,
since then, that's what promontores do. They share the fire.

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Val>> Doctors have recently detected a new and more aggressive
strain of HIV. This adds yet another challenge to the fight
against AIDS. There are about fifty thousand people in Los
Angeles County who are HIV-positive and one in five don't even
realize they're infected. That's not the case for basketball
great, Magic Johnson. As Hena Cuevas tells us, this AIDS
warrior and others like him are not giving up.

Magic Johnson>> "This November, it will be fourteen years for
me, so people are living with this disease."

Hena Cuevas>> This is the most public face of HIV AIDS in Los
Angeles and it delivers a powerful message.

Magic Johnson>> "It's hitting us in a big way. When you look
at the numbers, over sixty percent of all the new cases, I don't
care if it's children, adults, men or women, they're running
through the minority and African-American communities in a big,
big way. We must change that."

Hena Cuevas>> Today Magic Johnson is dedicating an AIDS clinic
on West Adams near downtown Los Angeles. It will be named after
him.

Magic Johnson>> You know that it's there. You know you have to
do the right thing, taking your medicine, keeping a positive
attitude, keeping stress out of your life and, for me, working
out five times a week.

Hena Cuevas>> But there is another side to the epidemic that
many of us never see.

Robert Johnson>> "It's a miracle that I'm able to stand here
before you speaking."

Hena Cuevas>> Robert Johnson has more in common with Magic than
just a last name. Robert is also HIV-positive.

Robert Johnson>> As a result of HIV, I'm no longer able to
dance and that was my life. My whole body gaining control of
each step I take was what I did for a living and for my passion,
so getting over that has been the hardest battle.

Hena Cuevas>> Robert has AIDS, although only a few symptoms
have shown up so far. Like Magic, he has benefited from
powerful anti-retroviral drugs introduced in 1996. Now both
men's life expectancies are normal. This clinic used to be
where AIDS patients went to die. Now they come here to live.

Magic Johnson>> This is where the magic happens.

Hena Cuevas>> Some patients like Robert are outpatients, but
others who need more intensive care are inpatients, people like
Mitchell Diaz.

[Film Clip]

Hena Cuevas>> Here patients can learn to take the drugs that
are keeping them alive, but the regimen is complicated and
difficult.

Robert Johnson>> Truth be told, they make you sick. They're
toxic, you know. Some people have an easier transition when
they take them. I did not. The constant diarrhea, the constant
nausea, the constant being aware of my stomach.

Hena Cuevas>> Mitchell had problems taking his AIDS drugs
because he was also a drug addict.

Mitchell Diaz>> "A meth problem off and on since high school."

Michael Weinstein>> We know that we need about a ninety percent
or ninety-five percent rate of people taking their drug on time
to have effective treatment.

Hena Cuevas>> Michael Weinstein is president of the AIDS
Healthcare Foundation, the largest AIDS agency in the country.

Michael Weinstein>> Without it, [inaudible] drugs which impairs
peoples' ability to have successful treatment and it's a problem
across the board. But we have a more severe problem with the
people of color communities and in poor communities. I just
came back from Africa where we treat thousands of patients and,
across all of our sites in Africa, we have ninety-five percent
or more in treatment and here we're lucky if we can get fifty
percent.

Hena Cuevas>> Why is that?

Michael Weinstein>> Because people take it for granted.
They're complacent about it.

Hena Cuevas>> Treating AIDS patients may soon get even more
challenging. That's because the virus seems to have taken an
ominous twist. In February of this year, health department
officials in New York City announced the detection of a new
deadly strain of the HIV virus, one which turns into full-blown
AIDS in only a few months. Soon after, an eerily similar case
popped up in a patient in San Diego.

Michael Weinstein>> This is unique in two respects. First of
all, it's progressed into HIV AIDS in a very fast period of time
and they have a virus that was resistant to three of the four
classes of drugs that we have. That is very alarming because
it's going to make it very, very hard to treat those patients.
This is a symptom in this case of a bigger problem. I think it
is a very serious development and it has to be watched as
carefully.

Hena Cuevas>> But while researchers are contending with a new
strain of the virus, Weinstein is hoping to improve patients'
adherence to the current drug regimen.

[Film Clip]

Hena Cuevas>> Classes like these are one way to improve
compliance. Here, HIV-positive patients learn about the virus
and why it's important to take their meds on schedule.

>> "What we've found out does work is Norvir. All except you
are on Norvir, right, small amounts of Norvir."

Hena Cuevas>> Education can help a patient stay on his or her
medications, but there is a more elusive problem, one that stems
ironically from the effectiveness of AIDS medication. Dr.
Charles Farthing is Chief of Medicine at the AIDS Healthcare
Foundation.

Dr. Charles Farthing>> One of the concerning and worrying
things about our success with the HIV epidemic in that we have
good drugs and we're making people well and putting them back to
work is that susceptible populations are seeing that and saying,
well, this is not such a big deal, this disease. It doesn't
matter if I get it because I can get treatment. So unsafe
sexual practices are back with a vengeance.

Hena Cuevas>> He says that is a sure setup for disaster, one
that may already have arrived via the new AIDS cases in New York
and another in San Diego.

Dr. Charles Farthing>> We are seeing gonorrhea, we are seeing
syphilis, we are seeing another sexually-transmitted disease
called LGV that we very rarely ever saw in the past, and all
this indicates that people are having a lot of unprotected sex.
Now if we get a fast-moving HIV strain that's resistant to
therapy, then we'll have a huge epidemic that we won't be able
to treat.

[Film Clip]

Hena Cuevas>> So what does the future hold? Different things
for different people. For Michael Weinstein, the new strain of
HIV is a sobering reminder.

Michael Weinstein>> AIDS is smarter than we are and it's more
aggressive than we are. I mean, it takes a lot to control AIDS.
You can't conquer it and even to control it takes a lot, so I
think we should all be very humble about it.

Hena Cuevas>> For Dr. Charles Farthing who's been involved in
research and treatment since the AIDS epidemic began, it's a
challenge.

Dr. Charles Farthing>> Our public health system can only use
what's available. If it has drugs that work, it can use it. If
it doesn't have drugs that work, it can't. Just as the
beginning of the AIDS epidemic, we didn't, so thousands of
people died of AIDS. If we have a new epidemic of drug-
resistant HIV, it's moving so fast in making people ill so
quickly, that we haven't time to develop new drugs, then we're
going to see people dying, however clever our public health
service or however good it is.

[Film Clip]

Hena Cuevas>> For Mitchell Diaz, seven months sober and on his
meds, some good news.

Mitchell Diaz>> My T cells went from 123 to 201 in two weeks.
That's really good news.

Hena Cuevas>> And for Robert Johnson, now also able to stay on
his medication, more days ahead to write the poetry he loves.

[Film Clip]

Val>> Our segments were produced by Joe Dondan. I'm Val
Zavala. For everyone at Life and Times, thanks for joining us
for this Life and Times healthcare special.. Until next time,
stay well.

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 County.

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.

Val>> Next time on Life and Times --

He gave up a network television career to document the misery of
the poor and he's never been happier.

>> I think it's what motivated me to want to do films like
this, to tell the story of the poor, to bring the poor to you so
that you could see it and you could experience something you
wouldn't normally experience.

Val>> That's next time on Life and Times.