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05/03/06
This Life and Times health care special is made possible by a grant from QueensCare, a public charity providing health care to the low income and uninsured residents of Los Angeles County.
Val Zavala>> Tonight on Life and Times --
These doctors wanted to help their low income patients, but was their dedication enough to save a failing hospital?
Dr. George Ma>> Our patients have no insurance or lack of adequate insurance. We want to prescribe a drug. They can't afford it. We want to do a blood test. They can't afford it because someone denied it or somewhere along the way, there are roadblocks.
Val Zavala>> And then, the only Native American health care clinic in Los Angeles County could shut down. Should Indian casinos pitch in to help?
It's all coming up next on tonight's Life and Times.
Announcer>> 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 Zavala>> Welcome to this Life and Times health care special. Hospitals are big business and that often pits the needs of patients against profits. But what if doctors were to buy, own and run their own hospitals? Would patients be better off? Especially the poor and uninsured? Well, we found one doctor who's giving it a try. Toni Guinyard went to Chinatown to meet Dr. Ma.
Toni Guinyard>> In the Chinatown office of Dr. George Ma, the patients keep coming one after another day after day.
[Film Clip]
Dr. George Ma>> According to the federal government, we serve the most low income probably in the nation in this area because they're all immigrants.
Toni Guinyard>> Is that a distinction that the hospital is proud of?
Dr. George Ma>> No. It's a fact of life.
Toni Guinyard>> Dr. Ma is an internist, Chinese-born, California educated and, at times, frustrated with the very health care system he cares so much about. High health insurance rates and low Medicare reimbursements are taking a toll.
Dr. George Ma>> I have patients with no insurance or lack of adequate insurance. We want to prescribe a drug. They can't afford it. We want to do a blood test. They can't afford it because someone denied it or somewhere along the way, there are roadblocks.
Toni Guinyard>> His practice gives us a glimpse inside the world of health care for the uninsured and under-insured. It's a world forcing physicians to become creative to make sure patients get the care they need.
Dr. George Ma>> I do my own billing. My wife chases the bills because most insurance just doesn't pay.
Rebecca Ma>> There's so much obstacle in getting paid, not to mention that reimbursement is very low to begin with. But getting paid is like we have to jump over so many obstacles.
Dr. George Ma>> I talk to large drug companies. They sometimes send me free drugs for these patients with no insurance. I have done that, probably sustaining around maybe a hundred and some patients on samples.
Toni Guinyard>> But it's his relationship with the nearby Pacific Alliance Medical Center that marks the opening chapter in a lesson that could be called "how to save a community by saving a hospital". It's a story of determination and business savvy that begins in Los Angeles's Chinatown at the site of what once was the French Hospital.
Dr. Shi Yin Wong>> They opened the hospital to serve the French people and, later on, the Asians.
Toni Guinyard>> Dr. Shi Yin Wong has a private practice in Chinatown.
Dr. Shi Yin Wong>> Because of the health care changes, they have to declare bankruptcy because they feel they don't have the funds or the resources to continue the hospital.
Toni Guinyard>> The hospital was a medical lifeline for the community. It was built in 1860 by the nonprofit French Society to serve French immigrants. But over the years, the French moved out of the neighborhood, Chinese immigrants moved in, and doctors followed. In the 1960s, Dr. Wong was a successful scientist, but he returned to school to study medicine at a time when there were few Asian doctors to serve the growing Chinatown community.
Dr. Shi Yin Wong>> After I finished my study at UCLA and also at that time because of the "Marcus Welby" program, I went to Santa Monica Hospital and really wanted to be Marcus Welby.
Toni Guinyard>> You wanted to be Marcus Welby, but for the Chinese community?
Dr. Shi Yin Wong>> For the Chinese community, yeah.
Dr. George Ma>> I came to this country with a hundred dollars and a one-way ticket.
Dr. Shi Yin Wong>> We had to work for our way, so we know how hard it is as an Asian in America. So that's why, you know, after we are able to succeed to become doctors, here are the Asians to comfort and help.
Dr. George Ma>> And you want to repay some of the nice things that people have done for you and what the community has done for you.
Toni Guinyard>> By 1989, after one hundred twenty-nine years of serving the community, French Hospital was bleeding money and threatening to close. Then, as it is now, the majority of the patients were low income or uninsured. Timing is everything. Dr. Ma had just opened his private practice here in Chinatown hoping to give something back to the community. Well, that's when he got the call from Dr. Wong saying let's save the hospital.
Dr. George Ma>> Dr. Wong came to my office and I don't know him that well. He said, "I need fifty thousand dollars from you." I tell Dr. Wong, "You know, I just opened my office. I'm seeing two patients a day. You want fifty thousand dollars for what?" (laughter).
Dr. Shi Yin Wong>> We feel that this is the only hospital that can really serve the community and then we think that we are with the Asian root and we should be the ones to save the hospital, to care for the poor in Chinatown.
Toni Guinyard>> Dr. Wong convinced about forty people, mostly doctors and a few businessmen, to each pitch in fifty thousand dollars to raise the two million dollars needed to help save the hospital. It took millions more to dig the hospital out of debt.
Dr. George Ma>> We were right in the hole right away. Nine million bucks.
Toni Guinyard>> But they succeeded in transforming French Hospital into the Pacific Alliance Medical Center, a for-profit hospital devoted to filling the needs of Chinese immigrants, many of whom speak little or no English.
Dr. George Ma>> And we had patients coming not just from this community, but coming from Long Beach and everywhere because they needed our help because they don't speak English.
Dr. Shi Yin Wong>> So you've got to understand the culture. You've got to understand the language.
Dr. George Ma>> We have in this hospital -- we calculated it once -- twenty-six languages. I'm serious. I have a couple of Bulgarian patients. I have a Russian patient. I don't know what they're talking about (laughter). It's hard to take care of them when you don't know what they're talking about.
Dr. Shi Yin Wong>> Through our marketing and everything because we feel that not only a hospital now serves the Asian community, we should extend it to other communities. So now the patient population ratio changes.
[Film Clip]
Dr. Shi Yin Wong>> So we have patients of all races, Koreans, Chinese, Black, Hispanic, and so on and so forth.
Toni Guinyard>> And you want it that way?
Dr. Shi Yin Wong>> I want it that way because this is America.
Toni Guinyard>> There are still needs to be filled. Since buying the hospital, the group of doctors has started an HMO.
Dr. George Ma>> The hospital loses money, so we were able to acquire and start an HMO which is CareFirst. That was in 1995. That is very profitable.
Toni Guinyard>> And they haven't stopped there. With the population and their patients aging, the next step is building a skilled nursing facility in Chinatown.
Dr. George Ma>> This time, we did it right. A nonprofit organization called Union Pacific Foundation and we're trying to get a nursing home in this area.
Toni Guinyard>> Encouraged by a community they love, the doctors have achieved more than they ever expected, succeeding in providing health care to people who can afford it least. Looking back on it all, they say it's a business model that works for one reason.
Dr. George Ma>> The people want it. They want to see us succeed and they support the things that we do.
Rebecca Ma>> We thought the chances of succeeding are not very good, but we thought, well, at least we have to try. It turned out that, through all the community, the doctors, the hard work and devotion, we are doing okay and I think we should be very proud because it's not easy.
Toni Guinyard>> So they'll keep doing what they've been doing, taking risks to provide the under-served access to health care. I'm Toni Guinyard for Life and Times.
Announcer>> Kcet.org is the place to look for the very latest on Life and Times. You'll find previews of upcoming stories, plus transcripts and audio of past episodes and links to some of our most interesting features. Just go to kcet.org, scroll down the page and click on "Life and Times".
Val Zavala>> Latinos traditionally have lower rates of skin cancer than other groups, so when health researchers started noticing more and more Hispanics with a lethal form of skin tumor, they got very worried. What's causing it and how do they prevent it? Hena Cuevas takes a look at a disturbing rise in melanoma.
Hena Cuevas>> It's a lesson twenty-six year old Bernadette Flores never thought she needed, making sure she's protected every time she goes outdoors.
Bernadette Flores>> I use scalp sunscreen, which I didn't know existed before. Who knew?
Hena Cuevas>> Because of her dark skin, Flores didn't give much thought to skin cancer. Then four years ago, her hair dresser found this on the back of her head.
Bernadette Flores>> It started bleeding and I went to the emergency room a couple of days later and they said, you know, you should go to a dermatologist. I went to a dermatologist and he removed it. It came back. He called me like on New Year's Eve and I thought, "Who calls on New Year's Eve?", you know, so I knew it was bad.
Hena Cuevas>> And it was. The doctor told her it was a tumor, the worst kind of skin cancer, melanoma.
Bernadette Flores>> I decided I was dying because when you see the pictures online and you read the stories, it's like mine looked worse than all of those. So I thought this is it. I'm dead.
Hena Cuevas>> Because the tumor was so large and so deep, it had already spread to her lymph nodes. These pictures show her growing out her hair after two surgeries and chemotherapy.
Bernadette Flores>> It felt like it grew from zero to huge in like a day, but the doctors say that, by the time it popped out of your scalp, it's already been there for years and years and years.
Hena Cuevas>> Did they tell you what caused it?
Bernadette Flores>> No. Everyone says it's like a medical mystery. I'm Hispanic, I was young, I never went to tanning salons, I never lived by some sort of, you know, crazy chemical field. I mean, all the things that you think about, everyone's like, "I have no idea." It's the same question wherever I go. When I meet a doctor, they can't believe it.
Hena Cuevas>> It's thought that having darker skin provides an added level of protection from skin cancer. After all, the highest rates are among those with fair skin. But that may be changing. According to Myles Cockburn, Professor of Preventive Medicine at USC, melanoma is on the rise among the Hispanic population.
Myles Cockburn>> The thickest melanomas, those with the poorest survival, the ones you are most likely to die from, were increasing not only the most rapidly, but far more rapidly than they were in other populations, other non-Latino populations.
Hena Cuevas>> His team analyzed data from the California Cancer Registry which lists statewide cancer information. The incidents of skin cancer in Hispanics is still low compared to the white population, but what's most alarming is the speed at which melanoma is increasing among Latinos.
Myles Cockburn>> We also had a look at some other biological properties of the tumors and noticed that the Latino population tends to get a particularly lethal type of melanoma as well.
Hena Cuevas>> USC dermatologist, David Sawcer, has treated advanced melanomas in patients with darker skin tones. Part of the problem, he says, is the delay in identifying and treating the disease. Usually when Hispanics go see a doctor, they're rarely if ever screened for skin cancer.
David Sawcer>> It's erroneous to guarantee in almost everyone that comes in that because they have darker skin that they're exempt. The "get out of jail free" card doesn't work like that, I'm afraid.
Myles Cockburn>> Screening is not conducted as widely as we would like it to be for skin cancer prevention and particularly in the Latino population. It's just something we don't necessarily think of doing and I'm not sure the Latino population thinks of being screened for it either.
Hena Cuevas>> Another problem is that melanoma, unlike other skin cancers, is closely tied to genetics. If someone in your family had it, there's a chance you'll develop it as well. Melanoma is the most serious form of skin cancer and it can be deadly if it's not detected early.
But doctors say its incidence isn't necessarily related to sun exposure, but the other two forms of skin cancer are and that's why they recommend people limit the amount of time they spend outside and, if they have to, to make sure they protect themselves. This is especially critical for anyone who works outside. For example, gardeners and construction workers, jobs with high concentrations of Latinos, are particularly susceptible.
Myles Cockburn>> Even although we're not entirely sure that sun exposure is the only thing that causes melanoma, we get kind of a double bang for our buck because we prevent many of the skin cancers, the non-melanoma skin cancers.
Hena Cuevas>> To help his patients identify changes in their moles, Dr. Sawcer uses this A-B-C-D card.
David Sawcer>> And the more strikes that you have on this list, the worse off that mole is.
Hena Cuevas>> A is for Asymmetry where both sides are uneven. B is for Border, how defined the edges are. C stands for Color, any changes in pigmentation. And D is for Diameter.
David Sawcer>> And anything that's bigger than the head of a pencil, if you think of the eraser on the tip of a pencil. If you can cover your mole in it, then that mole is probably okay.
Myles Cockburn>> We're hoping to educate doctors and physicians that are being trained in dermatology and general physicians as well to take note of everybody that's in front of them if they have a mole which looks bad or if a spot on their skin looks bad.
Hena Cuevas>> He's also hoping to train more than just doctors. USC premed student, Christina To, read Cockburn's study and is now looking into the impact of teaching children about skin cancer.
Christina To>> They ask all sorts of questions like, "Oh, is it contagious? Am I going to catch it from someone?" I've been volunteering at this elementary school which has mostly Latino children for about two years and I've also been doing research in chemistry on the initial stages of skin cancer. So I thought it would be a great opportunity to tie them together and I really wanted to do what the article recommended which was to educate the population. I thought, well, the best way would be to have an education program for the children.
Hena Cuevas>> So she enlisted the help of other student volunteers. Today they're teaching these third graders at St. Vincent's Catholic School downtown the basics in sun protection.
>> "Slip on a shirt, wrap on a hat, slop on some sunscreen, and wrap on some sunglasses."
Christina To>> In general, they don't usually use sunscreen. Maybe they know about it, but they don't really think that it's important, so it's really for us to know that it is important and not to forget to put it on.
>> "I took my dog outside and then my mom said the sunscreen and I'm like okay, but then I forgot."
>> "So you didn't put any on? But the next time, you're going to remember to, right? Okay, good."
Hena Cuevas>> But when learning about the A, B, C and D of skin cancer, the kids had a little trouble with A for Asymmetry.
>> "If you have something like this, you can take it and fold it over and it's the same shape, then that means it's symmetrical. You know, if it had some kind of rip in it like this and you try to fold it over, that would be asymmetrical. It's not the same."
Christina To>> We're hoping that educating the kids about it will allow them to teach their kids when they grow up, as well as perhaps telling their own parents about it.
Hena Cuevas>> And that's also what Flores is hoping to do with her story.
Bernadette Flores>> I think there's a giant misconception because even when I told my friends or my coworkers, they're kind of like, "Huh? You had a mole or whatever." They don't think it's a big deal.
Hena Cuevas>> Flores is now working as a television reporter. She still has two more years of therapy to make sure the cancer doesn't come back.
Bernadette Flores>> I don't think it's one of those cancers that people know about and they don't take seriously, so I just want people to know that, even if you don't think sunscreen can help, why not wear it anyway because maybe it could help.
Hena Cuevas>> And perhaps, with this combination of prevention and early detection, the sunshine can continue to be the best part of living in southern California. I'm Hena Cuevas for Life and Times.
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Val Zavala>> You may think that all Native Americans live on reservations. Not so. There are seventy-seven thousand Native Americans in Los Angeles County and only one free clinic to meet their health care needs and now that clinic may have to close. Where can they go? Or should Indian casino money come to the rescue? Sam Louie has the story.
>> "Hi, Reuben. How are you today?"
Reuben Jenkins>> "Fine."
>> "Well, I'm glad you came in today so we can update your diabetes."
Sam Louie>> Seventy-six year old Reuben Jenkins has had diabetes for more than ten years. He's also Native American, so when he goes for his weekly checkups, he goes to the clinic of the United American Indian Involvement. He appreciates the staff, their sensitivity to his background and needs.
Reuben Jenkins>> They understand my culture, the people here, you know, and they're just easier and it makes you more at ease when you come here, you know, to take care of those things.
Sam Louie>> Indian casinos have made some Native American tribes very wealthy, but Native Americans who don't benefit from casino profits must depend on the federal government for their health care especially when they live in cities. He says seventy percent of Native Americans are urban Indians.
Now health care for urban Indians is in jeopardy. The funding, all thirty-three million dollars of it, could soon be gone. The Bush administration has proposed to eliminate the entire budget for urban Indian health clinics around the country starting in October of 2007.
Ron Andrade>> We have a lot of diseases that are, you know, really epidemic levels within the urban Indian communities, diabetes, alcohol and drug abuse. In this city of Los Angeles, we have a tremendous population of homeless. We have a six times higher rate in diabetes than the general population. We have something like a ten times higher rate than the general population in alcohol and drug abuse.
Sam Louie>> Ron Andrade is the Director of the Los Angeles City County Native American Commission. He says, if the federal dollars go away, 1.6 million urban Indians would be impacted. To make up for the loss, the White House recommends that Indians get their health care at local hospitals and clinics. But Andrade says that the public health system is already over-burdened and inadequate.
Ron Andrade>> The County of Los Angeles has already broken its health system. They've closed all the trauma centers. What are they going to do with a hundred to two hundred Indians that need dialysis? They're not going to be able to absorb them.
Sam Louie>> In addition to being overcrowded, opponents of the cuts argue that county-run facilities lack the cultural sensitivity to cater to the needs of Native Americans.
Michael Reifel>> The majority of our employees are of Native American descent. The other employees who are not are people who were hired for the best qualities that they had to offer the population, for other people who are growing up with cultural or traditional values to seek health care, but not to be able to see a traditional healer, someone who understands about their language, their culture, their absolute values.
Sam Louie>> Reifel feels the cultural rift would cause some Indian patients to avoid treatment altogether.
Michael Reifel>> The most devastating is for the Indian person who does not wish to go to a county hospital or a private hospital, who is fearful of going to a professional that will not take the time to explain to them.
Sam Louie>> As for Reuben, he feels the loss of funding for urban Indian help would leave him lost in the shuffle at other clinics.
Reuben Jenkins>> There's big waiting lines there and sometimes you don't even get to see the doctor after you wait maybe two or three hours or five hours or something like that.
Sam Louie>> How scary is that for you?
Reuben Jenkins>> Well, it's very scary because, you know, in my condition, I want to keep check on my sugar count and my blood pressure and all that.
Sam Louie>> If the cuts go through, some Indians may turn to the American Indian Healing Center in Whittier.
>> "Hi, Ben. How are you?"
Ben>> "I'm fine."
>> "Good to see you again. You're here for a recheck on your ears?"
Ben>> "Yes."
Sam Louie>> This nonprofit clinic does not rely on federal funds, but it's small. It runs on a shoestring budget serving only about eight patients a day. John Andrews is the Executive Director.
John Andrews>> Right now, we could handle the extra two or three patients a day certainly. We've got providers, as I said, four days a week. We are able to provide for our patients right now a quality medical visit.
Sam Louie>> So if you had more patients, then how would this affect the quality of care?
John Andrews>> Well, for us, it would probably mean delays in scheduling appointments and, you know, further waiting times and so forth. It would also give us, you know, additional cause to seek new funding to try to expand our services and expand our hours and so forth.
Sam Louie>> The government counters that there's still three billion dollars for the Indian health service, but that money is only for Indians who live on the reservations. Critics claim that none of the three billion dollars could address the needs of urban Indians.
John Andrews>> When the American Indians migrate to urban areas, there's no portability of health insurance or anything like that. So whatever services they're able to obtain on the reservation, that doesn't carry with them, so when they come to an urban area, they're basically without insurance.
Ron Andrade>> These clinics aren't prepared for that. The community health clinics would go under. I don't care what clinic it is. You put in a thousand new clients into that, they will go under.
Sam Louie>> Andrade says the cuts were made with no apparent reason.
Ron Andrade>> It wasn't done from a review that they said, oh, every clinic is expensive or their cost per unit service is high, nothing. There was no evaluation mechanism utilized. It was just simply, "We think twenty-five years is long enough for you Indians."
Sam Louie>> But if the government won't fund the clinics, shouldn't the Native American casinos with their billions in revenue come to the rescue? Not according to Andrade. He says the public is misguided in their understanding of casino profits.
Ron Andrade>> Even those tribes that are giving out a lot of money, they're very small tribes. There's only like a hundred members of some of these tribes, these small ones. Yeah, a hundred people have gotten rich. My tribe, the La Jolla Indian Reservation, has still about a sixty percent unemployment ratio. They give me money. I get two thousand a year. That's it.
Sam Louie>> The cuts are not yet final. The House has approved them and it's now pending in the Senate, which is expected to vote on the budget by June 15. Meanwhile, Reuben and his friends will be watching Congress very closely.
Reuben Jenkins>> Well, it would be very devastating because I would have to go to the county hospital or something where they have long waiting lines and, you know, people that didn't understand you or your ways, your culture and all that.
Ron Andrade>> Our only hope is that the Congress can convince the White House that this is just a very foolish move, that budgetarily it will collapse the cities and the counties where they're closing the clinics.
Sam Louie>> I'm Sam Louie for Life and Times.
Val Zavala>> If you'd like to see other Life and Times health care stories, just go to our website at kcet.org. Click on "Life and Times" and open up the Health and Science page. And that's our program. I'm Val Zavala. Thanks for joining us for this Life and Times health care special.
Announcer>> This Life and Times health care special was made possible by a grant from QueensCare, a public charity providing health care 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.
Sponsored in part by:
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