los anjalis to anjuquerque

I penned a piece for LAist.com on last week’s White House Regional Health Forum – held at the California Endowment in downtown Los Angeles, and the well-populated single-payer rally outside the event. Thanks to Dr Susan Partovi for the photos.

Check it out! If you’re a registered user at LAist, you can comment or recommend the post.

Last week I was a resident. This week, a fellow.

Ack! Suddently, I’m supposed to be smarter, more beautiful, more intense, and lots more fun. All that in wonderwoman style, with such a quick transition from Family Medicine resident to Family Medicine Fellow? Bollocks!

What in the world is a “fellow”? As always I first consult the handy dandy Wikipedia:

A fellow in the broadest sense is someone who is an equal or a comrade. Historically, the term fellow was also used to describe a man, particularly by those in the upper social classes. Nowadays, it is most often used in an academic context: a fellow is often part of an elite group of learned people who work together as peers in the pursuit of knowledge or practice.

Ah yes, elite. One would think that’s a bad thing after all the “elitism” thrown around about the Obama campaign. Anyway, I just completed an intense 3 year long residency training in Family Medicine (in early August i’ll take my Family Medicine boards exam, which means that after passing, I’ll be properly boarded in this field and if I want, I’ll be able to set up my own little humane, innovative clinic for low-income folks).

I made the decision to pursue a 1-year Fellowship in Faculty Development at my program in Los Angeles, with a focus on Homeless Health Care (and Resident Education). It’s a win-win situation for me. It’s not that I don’t know what i’m going to do and thus am stalling with a fellowship. No-ho-HO. I gave up a wonderful move to Albuquerque to do totally rad work there, I passed on a better salary and possibly more flexibility in my work in Los Angeles, to do this fellowship. It’s all part of a larger strategy for the 10 year clinic/neighborhoodchange/community-building/healing plan :>

I’ll post some of my goals for the year in another post (after I’m done narrowing them down — you have NO idea how long that list is right now!). But for now, this fellowship will afford me opportunities to continue to develop as a competent (and hopefully excellent – in the future) physician, opportunities to teach residents (and therefore really solidify my knowledge as well as develop my teaching skills), and opportunities to also work with homeless populations in Los Angeles and pursue some really rad projects with amazing folks in LA.

So it’s off I go, first thing tomorrow, to serve as a “preceptor” in the clinic in the AM (which means family medicine residents will present a story, if you will, of the patient that they’re seeing in clinic, and i’ll give feedback and suggestions and ask questions about what they plan to do for management of that patients’ conditions, before they go back in to finish seeing the patient and explain their thought processes to the patient to come up with a solution that both of them find acceptable). I’m excited and nervous, and stoked to develop skills to nurture, teach, and challenge doctors in training!

(I’ve also made the decision to try to blog more spontaneously here at Los Anjalis and on the community health justice blog Cure This, which turned one years old this past week!) Hope to share more of what inspires me, more on music, and more on strategy for community change, on a more regular basis.

Woohoo! Doctors for John Edwards!

A physician posted a diary over at Daily Kos entitled “A Physician’s View of John Edwards” and has received quite a warm crowd of positive responses from other physicians who feel as passionately about Edwards. A few months ago, two friends and I thought it would be super rad to create an informal Docs for Edwards group, to put some weight of support behind Edwards from what others might initially think was an unlikely group of supporters given his work in medical malpractice. Physicians too often have a knee-jerk negative reaction to Edwards, because of his previous work. But that work was directly supporting patients who had been wrongly treated, and for those who like to think more broadly about presidential candidates, Edwards really has something to deliver on universal health care, labor/trade issues, medical review boards, economic justice, and other truly important issues. Plus, check out who taketh the money:

Do you know which two United States senators took in the most money from HMOs this current cycle?

#1. Hillary Clinton
#2. Barack Obama

First and second place– out of all 100 senators, Republican and Democrat. (from Open Secrets)

Health Services/HMOs: Money to Congress, Election cycle: 2008

1) Clinton, Hillary (D) — $246,480

2) Obama, Barack (D) — $175,093

John Edwards was completely right– the Clintons had all three branches of government, and they didn’t get anything passed that remotely resembled Universal Health Care. Regardless of their true intentions, that’s what “sitting at the table” gets you.

John has a history of taking on big HMOs for the little guy and winning. He and Elizabeth are now fighting to bring good health care coverage inexpensively to everyone.

Just like they’re fighting to end global warming and our dependence on non-renewable energy.

Just like they’re fighting to redeploy the combat troops from Iraq, and bring most of them home to their families.

I can’t speak for all physicians, but this physician trusts John Edwards to do the right thing.

Corporate control of congress must come to an end– now.

We deserve a President who is bought and paid for by the American people.

Oooh I like that — we deserve a president who is bought and paid for by the American people! Edwards repeatedly talks about the corporate interests in medicine, something that Hillary Clinton and Barack Obama omit from their discussions (for reasons stated above, perhaps?) And I recall Edwards saying, “when i’m president, dissent will once again be patriotic”.

(yes, it’s true, Kucinich has the MOST progressive platform of ANY democratic candidate, by a landslide. But it’s a discussion for another time — why I’d vote for Edwards over Kucinich right now, when it’s SO imperative that we have a dem win in 2008. though i did hear on KPFK FM this morning that Kucinich is risin’ up in the polls for the Iowa primaries, and that’s SUPER rad).

You’re going to be moved by this one.

At the AFL-CIO democratic presidential candidate debate this past week, retired union member Steve Skvara asked a simple health care question of the candidates.  In response, he received a STANDING OVATION from thousands of audience members in the stadium.  This is phenomenal, it is amazing how front-and-center health care is in the peoples’ minds, during this election.  Check out the video:

And Mitt Romney was challeneged on health care while giving a stump speech in a restaurant, where he mentioned his desire to export “healthcare diplomacy” to other nations, and a waitress really prodded him on the american health care system.  Video below:

Exciting.  Also related, not to health care but to the use of these technologies — the CNN/YouTube republican presidential candidate debate is coming up (september 17th).  Thanks to Pop and Politics for sharing sharing two YouTube videos that americans have submittedthese two videos submitted by viewers — good, solid, hard-hitting questions:

I’m so absolutely fascinated by videoblogging, YouTube, and other video/audio technologies, and especially with their use in politics and health.

In the meantime, I’ll be participating in tomorrow’s Great LA Health Care Rally sponsored by OneCareNow and other organizations, in support of universal health care in California, and hope to post some video footage from that event!

[cross-posted at Cure This]

Don’t front. It *is* the GREAT LA health care rally. This coming Saturday. A few doctor folks will be participating, showing our solidarity as providers uniting for universal health insurance, by wearing our very sexy white coats. YOU should come participate in this historic event. But if you laugh at us in our sexy white coats, or hide your children from us, I’ll come after you :>

More info at the One Care Now website. Yes, it’s being hailed as the LARGEST rally for single payer universal health care in U.S. history. Given it’s Los Angeles and there are SO many interesting things to do on a saturday afternoon, I really hope it can stay true to that claim.

A few of us are going to try to interview some folks there, participants and passersby, to document their stories. Perhaps we’ll share some of these videos on Cure This! (email me or write a comment to this post if you’d like to join in on this piece of the participation).  So, see you there, maybe? You wouldn’t want to miss the largest health care rally in the U.S., now would you? :>

…or “the tale of an unlucky appendix at the hands of the daughters of charity, in the city of angels.”

Robert Issai

President and CEO
Daughters of Charity Health System
26000 Altamont Rd.
Los Altos Hills, CA 94022-4317

Dear Mr. Issai:

I recently suffered from appendicitis, and was admitted to the emergency room at Saint Vincent Medical Center in Los Angeles on November 10 of last year. I underwent an appendectomy and was released from the hospital on the morning of November 12. I have no complaints about the quality of my care. My surgeon, Dr. Charles Hunter, was excellent, and with very few exceptions all of my encounters with hospital staff were as pleasant as they could be under the circumstances. But I received a profound and unpleasant shock shortly after returning home. The bill arrive, account number XXXX, if you’re curious.

I was charged — am being charged, I should say, as I have not yet paid — $15,833 for the care I received during the 40-odd hours I spent at Saint Vincent. I then received additional bills from the surgeon, the anesthesiologist, and the emergency room physician for their respective services. (The latter is asking for more than $800 for the approximately three minutes he spent at my side.) I am a freelance journalist, and I am fortunate enough to have health insurance at the moment. Blue Cross covered $12463 of your bill. But $3370 is still a considerable sum of money, so I telephoned the billing office and asked for an itemized account of the charges.

I hardly know where to begin. Perhaps with the $21 I was charged for each of ten 10 ml saline IV flushes. I do not know the going rate for a 500 ml bottle of saline solution at CVS, but considerably less than $105, I am sure. I was charged $80 for each of three 50 cc doses of .9% sodium chloride, a few spoonfuls of table salt, and $154 for each of twelve one-liter bags of sugar water. For my pajama pants — of such flimsiness that I would be hard-pressed to find their equivalent at a 99-cent store — I was charged $35. Given such absurdities, it seems hardly worth mentioning that I was charged $982 for an hour and three quarters spent unconscious on a gurney in the Recovery Room and $1768 for each night of room and board. Rents are high in Los Angeles I know, but that is nothing less than an outrage.

A few weeks later, I was doing a little research to find out where to send a friend who had broken her ankle in New Mexico and needed surgery in Los Angeles. One of your own orthopedic surgeons advised me to use another hospital. “Saint Vincent is notorious for overcharging its patients,” he said. This was not news to me. Another example: my friend was charged $1.05 for a 2 ml dosage of fentanyl at the ER in Albuquerque. At Saint Vincent I was charged $71 for a 250 mcg injection of the same. Assuming a standard 50 mcg/ml concentration, you overcharged me by a factor of approximately 28. I can only congratulate you for your chutzpah.

Mr. Issei, if you were in any other line of work, no one would hesitate to call you a thief. I understand the complexities of our healthcare system better than most do, but this is inexcusable, and all the more so in an institution that masks itself with the gospel of charity. Medicine is a noble profession. You render it shameful. I am sure you have better insurance than I do. I wish you good health, and poor sleep.

Yours sincerely,

Ben Ehrenreich

Source: “Medical Larceny” by Barbara Ehrenreich, in the Huffington Post.
Mr. Ehrenreich is author Barbara Ehrenreich’s son. She says this about the issue:

The odd thing is that many politicians and pundits believe that the only way to control health costs is to get consumers to limit their consumption of health care – as if an appendectomy, for example, was a kind of self-indulgence. In my son’s case, we have someone who is vividly aware of his health care costs, if only because he bears so much of them. His letter is not only an individual complaint but an act of good citizenship. We all need to be prepared to blow the whistle on medical larceny.

There are some interesting comments and perspectives written by readers of the post, at the link above. Imagine what kind of discourse and building and action could grow from folks around the country sharing these stories? What’s your story?

(cross-posted at To the Teeth)

I’m finally a second year resident in family medicine (yikes!). 2nd year started off with a bang — I’m on week two of working at a hospital in downtown Los Angeles, doing obstetrics/gynecology. That means I’m triaging women who are possibly in labor early or in labor on time, admitting women to the Labor & Delivery section of the hospital, delivering babies (YAY!), assisting in cesarean-sections, and caring for women for the 1-3 days they’re in the hospital after deliveiring their babies. I’m working with both physicians and midwives, which is a great experience. I’ve got lots of stories from my past week, but yesterday I worked overnight, and my last patient in the early AM hours was a 17 year old girl who came into the hospital to be evaluated because she was having contractions regularly. She was 39 weeks pregnant, so contractions would make sense, she was in active labor and ready to deliver her baby. The only issue? Well, she hadn’t told her parents until that morning that she was even pregnant. They were livid, but calmed down appropriately in time. But what? She lives with them, and they didn’t notice that she had gained weight or looked different. And in the process of not telling anybody, she never got any prenatal care. A social work consult was in the works, and I hope everything ended up going well in her delivery, which happened after my 28 hour shift.

During this month, i’m improving my baby delivering skills but also observing how the senior residents and attending physicians and midwives “coach” laboring women and gain great rapport with them as they’re going through some of the most intense pains any of us may ever feel. Humor during this process really helps, and as we’re crouched in front of a woman’s vagina, coaching her to push as if she’s having a bowel movement (to push the baby out of the vagina), the first bit of the baby we obviously see is his/her hair. So some of the more recent hair comments by the physicians:

“Oh my goodness, your baby has hair! We’re off to a good start”
“Hmm…mommy your baby has black hair, no highlights”
“No way, your baby has a mohawk!”
or “No way, your baby has dreds!”

Day Labor

So moving on from the hospital to the folks who make it run — nurses. Right now a battle is being waged against them by Bush’s National Labor Relations Board:

In a series of pending cases known as Kentucky River, the Bush board could strip what remains of federal labor law protections from hundreds of thousands-perhaps millions-of workers whose jobs include even minor, incidental or occasional supervisory duties. The pending cases involve charge nurses in a hospital and a nursing home and lead workers in a manufacturing plant, but these workers could be just the tip of the iceberg.

The Bush National Labor Relations Board is easily the most anti-worker labor board in history, but even against this sorry backdrop, the scope of what they now are contemplating is breathtaking….

The stakes are high for the public, too. In health care, for example, scholarly research has documented that heart attack survival rates are higher for patients in hospitals where nurses have a union than in hospitals where nurses do not.

Already in 2000, months before George W. Bush was declared president, Human Rights Watch issued a powerful report that found U.S. labor laws were grossly out of compliance with international human rights norms. That organization’s bill of particulars was lengthy, but the first item on their list was the failure of U.S. labor law to cover millions of workers, including among others, managers and supervisors in the private sector…

It is therefore imperative to push back against the Bush board’s assault on workers’ rights. We must, moreover, go beyond good defense; we must win serious protections for workers’ rights. The Employee Free Choice Act (EFCA) is the most significant federal legislative proposal in nearly 30 years to protect the freedom of America’s workers to form unions and bargain collectively. Since its introduction in the 109th Congress by Ted Kennedy, D-Mass., and Arlen Specter, R-Pa., in the Senate (S. 842), and by George Miller, D-Calif., and Peter King, R- N.Y., in the House (H.R. 1696), EFCA has garnered 215 House cosponsors, just three shy of a majority, and 43 in the Senate…

(from Lawless Workplaces by Stewart Acuff and Sheldon Friedman of AFL-CIO

And more from AFL-CIO:

Have you ever shown a co-worker how to perform a task, or been asked to look over someone else’s work? If so, your freedom to form a union and bargain collectively is in danger. The Bush-packed National Labor Relations Board (NLRB) is considering three cases that could alter the definition of supervisor—and that could mean hundreds of thousands of nurses, building trades workers, newspaper and television employees and others could be prohibited from forming unions…

During the week of July 10, hundreds of thousands of union members will take to the streets in a week of action to fight for their right to union membership. Already, some 7,000 nurses and other health care workers at eight New Jersey hospitals threatened to strike to protect nurses’ right to speak out for their patients through their union.

You can send a quick letter to your congresspeople here.

And from the California Nurses Association:

The National Labor Relations Board will soon issue a major ruling that could jeopardize the ability of RNs to receive the protections afforded by CNA/NNOC representation. At the request of healthcare employers and anti-union consultants, the Board is expected to make the absurd ruling that many thousands of RNs are “supervisors” under the law because they make clinical patient care assignments to other staff. Under federal labor law, supervisors have no protection. THEY HAVE NO RIGHT TO UNION REPRESENTATION.

This coming Tuesday, CNA is organizing rallies in Los Angeles and Oakland. More info here.

Art and Labor

On a very related note, I’m hoping to check out the “At Work: the Art of California Labor” exhibit at Pico Gallery, Downtown Los Angeles, sometime in the coming month. Details below and more information here, comment below or email me if you’re interested in joining me or if you’ve already checked it out! Looks good…

The story of labor – which comprises passionate struggles and triumphs as well as dehumanizing forces – has figured largely in the art of our time. At Work: The Art of California Labor exhibition opened at the Pico House Gallery at El Pueblo de Los Angeles Historical Monument on June 13, 2006. It is the first exhibition to explore this important topic through the eyes of artists who witnessed or were inspired by some of the most significant trends and events in the history of the 20th Century…

Many Californians are aware of San Francisco’s 1934 General Strike, but probably few realize to what degree labor movements shaped the state’s political and social climate. Even fewer know of the copious art which both inspired and reflected California’s labor struggles throughout the 20th century. “At one time, the strongest and most important artists in California made art about labor,” explains Mark D. Johnson, Professor of Art at San Francisco State University. A mid-century backlash, however, including the persecution of labor sympathizers in the McCarthy era, has all but erased from public memory the very “vast and compelling” art surrounding the labor movements, he says.

And lastly — Manual Labor

Ending on an upbeat note (pun intended), join me for some manual labor, aka dancing, each of the next 3 thursdays, at the Root Down party at the Little Temple in the silverlake area of Los Angeles. I’ve got each of the next 3 fridays off and I’m working each of the next weekends, so it’s party time each thursday night, and this party/movement is where it’s at.

(cross-posted at To the Teeth)

Last week I was blown away by med students. I spoke at a conference on universal health care, organized by some great medical students at UCLA, and attended by over 100 medical and premedical students from ALL the southern california medical schools. The topic I was asked to speak about was how to be a Universal Health Care activist. Yikes! Umm…i dunno… do you? So I shared some thoughts on where I thought medical students and physicians fit in with the movement, and some ways that medical students are thinking outside the box with creative education and action pieces. And then I turned the 2nd half of the session into a discussion, as there wasn’t another place in the conference for discussion and i’m big on reflection. We had a fascinating discussion on taking this information and translating it into further education and meaningful action. What was fascinating was that the conversation turned QUICKLY from that into the specifics of “framing” messages on the topic and it seems the med students in the session really felt that framing was the biggest issue that needed work. These folks were definitely ahead of the game, and that was fun. Inspiring med students rock :>

And these cats aren’t stopping there. Way back in September, when I visited a friend of mine in San Francisco, I bumped into a med student at UCSF, Renuka Tipurneni, who shared with me that the California med schools’ AMSA chapters were teaming up to pull off a coordinated lobby day event later in the year. And they did it — at the UCLA conference, Duncan Parker, a med student at UC Irvine, riled everyone up about SB 840, the single-payer healthcare bill sponsored by Cali senator Sheila Kuehl. And from these and other medical students’ coordinated efforts (thanks to Vanessa Calderon for putting on the UCLA conference, a number of other med students in Cali organizing these events, and Kao and Chris from the national AMSA office for putting efforts into it too and creating wonderful talking points on the bill), along with endless energy from Don Bechler and others at Health Care for All Cali and folks at California Physicians Alliance, more than 150 medical students are going to Sacramento to lobby on this bill tomorrow! I’m bummed I can’t go, I’ll be in the medical ICU at the hospital, but I do wish them all luck, and those of us who can’t go are awaiting fun photos and stories from the event.

More info on SB 840, the bill they’re lobbying on here and here, and a link to California Senator Sheila Kuehl’s website.

The press release for the event tomorrow is below. Good luck to the med students tomorrow! Whether single payer or other related health care reform, it’s great that there’s positive movement and by future physicians too. Some say — as California does, the US follows… let’s see :>

FOR IMMEDIATE RELEASE

Contact:
David A. Brown
Phone: 949-241-1935
Email: dabrown@uci.edu

MEDICAL STUDENTS TO CONVERGE IN SACRAMENTO, DEMAND HEALTHCARE REFORM

IRVINE, Calif., Jan. 17th, 2006 – The next generation of doctors has a different prescription for the health of California. Alarmed by the growing disparity in healthcare statewide, medical students from all 10 California medical schools will converge on the state capitol from 12-1 PM on Jan. 17th, 2006 to demand an expansion of healthcare access to all Californians.

This gathering will mark the largest ever coordinated effort by California medical students to promote universal healthcare. More than 150 students are expected to demonstrate on the capitol steps, followed by meetings with State Senators and Assembly Members. The event is being organized by local chapters of the American Medical Student Association (AMSA), which is the oldest and largest independent association of physicians-in-training in the United States.

The rally and legislative visits will support a 2005 California State Senate bill introduced by Senator Sheila Kuehl (D-Santa Monica) that proposes to establish the California Health Insurance Agency, which would provide single-payer healthcare coverage to all residents of California. The bill, designated SB 840, passed the State Senate and Assembly Health Committee last year, and will be reintroduced to the State Assembly this year. Senator Kuehl is the keynote speaker at the rally and will address the students at 12 PM.

“That our newest generation of doctors is exhibiting such a strong commitment to universal health care means it is only a matter of time until it becomes a reality,” said Kuehl. “In a system faced with growing numbers of uninsured and medical bankruptcies, as well as rapidly deteriorating quality of care, these future doctors are acting to protect not only their future patients, but also their own ability to practice good medicine. We must listen.”

Now topping over 6.5 million, the burgeoning number of medically-uninsured state residents has sparked widespread activism and legislative action…

(cross-posted at To the teeth)

California based Consejo de Latinos Unidos brought the issue of ‘price-gouging of uninsured patients by hospitals who receive millions in tax breaks’ to national attention first. Now they’re holdin’ the catholic hospitals to their religion and mission. What happened to “thou shalt not price-gouge your neighbor?” It’s simple — nonprofit hospitals (under which Catholic hospitals fall) receive tons of tax breaks (on property, on income, etc) as compensation for providing low-cost and charity care to folks. Then they don’t provide this service, and charge uninsured patients up to 7 times what they would charge Medicare or private insurance companies, and pocket millions to billions in tax-free profits.

Something wrong with this picture?

From today’s Kaiser Daily Health Policy Report:

Catholic not-for-profit hospitals are reaping high profits while charging uninsured patients up to seven times as much as those covered by Medicare, according to a report by Consejo de Latinos Unidos, the Denver Post reports. The report, which is based on annual tax returns filed by seven large Catholic health systems, found that net income at the hospitals doubled between 2003 and 2004. The hospital systems also have amassed $20 billion in cash and investments. For example, Denver-based Catholic Health Initiatives reported revenues of $5.9 billion during the first nine months of fiscal year 2005, an increase of 5.6% from the same period last year. In addition, CHI’s investment income increased to $203.4 million, compared with an $80 million loss in 2003. Revenues increased 10.5% to $7.4 billion in FY 2004. Catholic Healthcare West, which has $3 billion in nontaxable assets, made $249 million in tax-free profits in 2004, according to the report. Sister Carol Keehan, a spokesperson for the Catholic Health Association, said the nation’s “turbulent health care system” requires Catholic hospitals to “maintain large financial reserves” to ensure continuous operation.