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7/20/07
Announcer>> 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 --
Millions of dollars are flowing to help the mentally ill, but is it making a difference?
Ida Pascual>> My culture thought that, you know, mental health services are only for people who are mentally ill, retarded, you know, with really big problems, so I said that I'm not going to go see a psychiatrist or a psychologist. They're only for crazy people and I'm not crazy.
Val Zavala>> And then, health care costs are already sky-high. Would you pay more for really good health care?
It's all straight ahead 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. Remember the millionaire's tax? That one percent tax on the wealthy to fund services for the mentally ill? Well, now three years later, the money is starting to flow, three hundred million dollars to Los Angeles County alone. But is it making a difference in the lives of the mentally ill? Sam Louie went to find out.
Sam Louie>> Ida Pascual is spending a typical Tuesday cooking at home in South Central Los Angeles, but life has been anything but typical for this twenty-four year old single mother of two.
Ida Pascual>> I struggled a lot. You know, I was afraid for my children because we've never been in that kind of environment before.
Sam Louie>> Ida is referring to the squalor of Skid Row. She and her kids spent more than a year jumping from shelter to shelter.
Ida Pascual>> They were confused. They didn't know what was going on. They didn't know where we were at and they were afraid.
Sam Louie>> It began when Ida started drinking heavily, lost her job and was eventually kicked out of her grandmother's house. She almost lost her children to the state as well. Ida was suffering from a deep depression.
Ida Pascual>> I didn't know what was going on. I thought it was just a normal phase where people go through. I was drinking, smoking, you know, doing partying and clubbing and all this stuff.
Sam Louie>> Health experts say a large portion of the homeless are like Ida, their troubles stemming from an emotional or mental problem. Lisa Wong is with the Los Angeles County Department of Mental Health.
Lisa Wong>> I think generally in the United States, it's estimated that about twenty-five percent of the homeless population has a serious mental illness. Here in Skid Row, they've done studies and we've found that it's closer to about forty percent of the population.
Sam Louie>> The good news is that mental health services and outreach have changed dramatically over the years.
Lisa Wong>> Traditionally, you know, we would have somebody who stays homeless and mentally ill and we would get them to come into our clinic by doing outreach. We'd give them medication to help them stabilize.
Sam Louie>> And in 2004, services started getting better. That's when voters approved Proposition 63, the Mental Health Services Act, or MHSA. It imposed a one percent tax on millionaires and now it generates close to seven hundred million dollars annually for mental health agencies in California.
Lisa Wong>> With the advent of the Mental Health Services Act and sort of an increase in the array of services we offer, now we can see that person on to wellness, you know, being reintegrated into the community.
Sam Louie>> What has it meant for Ida? Well, she's able to get many of her needs met in one place, at the downtown mental health center.
Ida Pascual>> My gain for welfare to work is there. DPSS is there. My benefit, my cash aid and food stamps is there. Medi-Cal is there.
Lisa Wong>> Previous to this, Ida would have had to seek out mental health services here, seek out financial help here, seek out housing help over here. "So, Ida, how is it going in the new place?"
Ida Pascual>> "Everything's fine."
Sam Louie>> It was here that Ida realized the benefits of regular weekly counseling from professional therapists.
Ida Pascual>> To me, I feel like counseling really helps. It helps a lot.
Sam Louie>> Ida began to see how her heavy drinking was a response to her own grief at the loss of her grandfather. She also realizes how her own Filipino culture made her resistant to counseling early on.
Ida Pascual>> From where I came from, my culture thought that, you know, mental health services are only for people who are mentally ill, retarded, you know, with really big problems.
Sam Louie>> Lisa Wong with the county's Mental Health Department says this is a common myth that's hard to dispel.
Lisa Wong>> I think that the biggest misconception out there is that the people who are receiving mental health services are just sort of beyond hope, you know, that if they're getting county mental health services, these are the sickest of the sick and there's nothing much they can do.
>> "Yes, I have a client, a fifty year old Latin male, speaks Spanish only, so I got all this information."
Sam Louie>> Proposition 83 monies are also going towards entirely new programs. Example? The Augustus Hawkins Mental Health building in Lynwood, a unique mental health clinic opened in late 2004 and offers 24/7 around the clock crisis care. Carol Vernon is the district chief at Augustus Hawkins.
Carol Vernon>> Crises don't necessarily end at five o'clock, so individuals who may have a crisis can still get in our urgent care center by making a call and making contact and that evaluation can be done to, again, assess their needs.
Sam Louie>> The goal is to keep the mentally ill from ending up jailed, homeless or hospitalized just because the help wasn't there when they needed it.
Carol Vernon>> Sometimes they just need someone to just listen to them. They may have walked in with a crisis, but sometimes just listening to them for the forty-five minutes or an hour, whatever it takes, sometimes will help to stabilize and calm them down.
Sam Louie>> And those who need to spend the night do so in a recliner style bed with more help available for them.
Carol Vernon>> If it is medication, then they can be evaluated for medication by a psychiatrist. If they need housing or if they need food, whatever they may need, whatever it takes for us to assist that client and stabilize them so that they can be reintegrated back into the community, that's what we do.
Sam Louie>> Another service funded from the millionaire tax is finding a more permanent home for the mentally ill who end up on the streets. Ida lives in a two-bedroom duplex. A housing specialist found it for her.
Specialist>> Having a community where they can return is a challenge. A lot of communities are not open to taking people who were formerly homeless and mentally ill.
Sam Louie>> With seven hundred million to spend statewide and improve services coming on line, you'd think the mentally ill would be lining up for treatment. Not always. County mental health workers say their biggest frustration is the reluctance among the mentally ill themselves to get treatment.
Lisa Wong>> Even if you gave us all the money in the world, there's still going to be the challenge of reaching people and convincing them that mental health treatment works and that there's no shame in getting the treatment and that they can have a life again.
Sam Louie>> Maybe the best people to persuade them are people like Ida who have survived the streets and have emerged from the hell of mental illness.
Ida Pascual>> Oh, I'm very thankful. I am very thankful for the whole crew that helped me, DPSS, you know, DMH, you know, Los Angeles city, all of that. I'm very thankful because, if it wasn't for them, I don't think I would be in this place right now.
Sam Louie>> Ida has her children, she has a home and, most importantly, she also knows where to go for help when she needs it.
Ida Pascual>> When I wake up every day, first I thank God every day that, you know, gives us another day.
Sam Louie>> I'm Sam Louie 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>> How much would you be willing to spend for really great medical care, including seeing a doctor whenever you want? Well, more and more people are willing to pay extra for that attention and convenience and more doctors are willing to oblige. It's called "concierge medicine", but is it for everyone? Toni Guinyard has our story.
Toni Guinyard>> In a high-end hotel, the concierge is the person who can get you tickets to the hottest show or reservations at the trendiest restaurant. Now you can get that same kind of luxury service at your doctor's office.
>> "Would you like something to eat or some juice? You've been fasting all day."
Dr. Tom Lagrelius>> The patient is treated like a family member, like a physician would treat his own family.
Toni Guinyard>> It's called concierge medicine, also known as retainer, membership or boutique medicine. Here, your doctor treats you like a VIP, but for a price. Each patient pays an annual retainer fee and, in return, the doctor agrees to limit the number of patients he sees.
Dr. Tom Lagrelius>> This is a practice for people who don't want to waste their time and want personalized, excellent, immediate access care.
[Film Clip]
Toni Guinyard>> Dr. Tom Lagrelius is one of about three hundred doctors across the country who have adopted this model. He converted his Torrance office to concierge medicine in late 2005 after nearly twenty-five years in private practice.
Dr. Tom Lagrelius>> "I want you to tilt to the left."
Toni Guinyard>> Each concierge doctor works differently with varying fees, caseloads and services. Lagrelius charges eighteen hundred dollars a year and limits his practice to six hundred patients. That fee is on top of insurance premiums, co-payments and deductibles. It includes a comprehensive annual physical, a complete medical history on a wallet-sized disc, same day or next day appointments, plenty of time with the doctor and 24/7 access.
Bill Oberhaulzer>> I had an ear problem just a few weeks ago and I came in to see him. He said, "How long has this been bothering you?" and I said, "Several days" and he said, "Why didn't you call me at home?"
Toni Guinyard>> Bill Oberhaulzer has seen Dr. Lagrelius for over twenty years, so he was surprised when he learned about the new system.
Bill Oberhaulzer>> I was a little skeptical at first. It seemed like an extreme measure to take.
Toni Guinyard>> But now he's glad he signed on.
Bill Oberhaulzer>> You walk right in and you have your appointment and there's no waiting. It used to be that I got pretty frustrated.
Toni Guinyard>> Another long-time patient, Don Tuffli, feels the same way.
Don Tuffli>> I've walked out of here before. You know, I don't like to sit in a doctor's office. My time is worth something too. Ever since he went to this system, there is no waiting.
Toni Guinyard>> But what about everyone else still waiting in their doctor's offices? Critics of concierge medicine call it "wealth care" and question why doctors are charging additional fees just for their time.
Dr. Neil Wenger>> Every physician should be providing those services. Why is that one would need to pay an extra amount to have your doctor be accessible to you or to provide continuity of care?
Toni Guinyard>> Dr. Neil Wenger is director of the UCLA Health Care Ethics Center.
Dr. Neil Wenger>> One could look down the road and see a two-tiered health care system where the best doctors are available to those with means and those that aren't quite as accomplished are available to the masses.
Dr. Tom Lagrelius>> Some people do drive Cadillacs and some drive old Chevys. I think a basic level of medical care for everyone needs to be available, but I also think that we need to recognize that medical care is a service and a product that costs money.
Toni Guinyard>> Is concierge medicine a cure for America's sick health care system or just a band-aid?
Dr. Neil Wenger>> The people who make the decisions about how the health care system works are the ones who'll have the resources to be able to buy concierge care, so are they going to worry about making the system work for everyone else, all the rest of us who can't afford a concierge doctor?
Toni Guinyard>> Lagrelius thinks that concierge medicine is affordable for most people and can be a real solution to the health care crisis.
Dr. Tom Lagrelius>> This is not for just the elite. You know, I have teachers and plumbers and union members in this practice. I would like to think that, down the line in ten or fifteen years, it would be the primary mode for maybe seventy percent of Americans. "These are all the lab tubes we're going to use for your annual exam, Bill."
Toni Guinyard>> As the debate continues on those larger issues, the American Medical Association has issued ethical guidelines for doctors switching to concierge practices that include helping patients who don't want to pay find new doctors.
Dr. Tom Lagrelius>> That's very important when you're setting up a concierge practice to make sure that anyone who doesn't want to join has smooth, seamless care.
Toni Guinyard>> But that's often easier said than done, as Vanessa Wiegandt found out.
Vanessa Wiegandt>> I tried looking around for doctors. I've had to go to a couple and, each time you go, you have to have like another checkup so they learn about you and it's kind of annoying because I haven't really found a doctor that I really kind of click with.
Dr. Neil Wenger>> How does one guarantee continuity? In fact, is there any oversight going on to ensure that these patients who lose their ability to continue in a practice do have continuity to other specialists and other primary care doctors? There's also a professional responsibility to pay back to society.
Dr. Tom Lagrelius>> It is the obligation of concierge physicians in my opinion to do charity care.
Toni Guinyard>> Despite all the criticisms, concierge medicine continues to grow.
Don Tuffli>> It's just very positive. I think it's good for him, it's good for the patients and I think it's the way to go for a lot of doctors myself.
Toni Guinyard>> I'm Toni Guinyard for Life and Times.
Val Zavala>> It sounds like a cliché, what every woman should know about ovarian cancer, but this time you should pay attention because researchers have pinpointed the four symptoms that every woman can spot herself. I talked with Dr. Beth Karlan, a gynecologist oncologist at Cedars-Sinai. She's also director of the Women's Cancer Research Institute.
So, Dr. Karlan, recently there have been some recommendations or guidelines for women who can watch their own bodies that might be sending signals about ovarian cancer, a really important thing. What should women be looking for?
Dr. Beth Karlan>> That's exactly right, Val. I think for a long time there's been a myth that ovarian cancer is a silent killer. I think we've finally come to debunk that myth. Ovarian cancer does have symptoms.
The most common symptoms that have been shown with studies have been abdominal bloating, low back pain, changes in your urinary habits that you feel like you have to go more often and feeling like you're full very early, what we call early satiety. Those four were the most common symptoms seen in women with ovarian cancer.
These symptoms are very common and I don't want everyone out there thinking, "Oh, my goodness, I have ovarian cancer." What we saw with the studies was that women where these symptoms were a sudden change for them. You said already, know your body. This is something that'd different for you. It happens every day. It's getting worse.
Val Zavala>> And it persists.
Dr. Beth Karlan>> Persistent and progressive. It persists each day and continues to progress and get slightly worse over a couple of weeks even. Don't delay. See your physician. Tell them about the symptoms and ask, "Could it be ovarian cancer?"
Val Zavala>> Ovarian cancer compared to, say, breast cancer, much more likely to be fatal? Is that correct? I should say, a larger percentage of women die? Is that correct?
Dr. Beth Karlan>> Exactly right. Overall, the five-year survival from ovarian cancer is only about forty-five percent, so less than half of those diagnosed with the disease live five years. For instance, breast cancer where almost ninety percent of those diagnosed with breast cancer will live five years.
But the key is early detection. The key is our goal to find a screening test. With ovarian cancer, less than a quarter of the women are found at stage one when the disease is confined to the ovaries.
Val Zavala>> Less than a quarter are found early?
Dr. Beth Karlan>> Less than twenty percent even are found early. When it's found early, if you're lucky enough to have ovarian cancer stage one, your cure rate is better than ninety percent. Ninety-three percent of women with stage one ovarian cancer will live five years. The problem is, so many patients are diagnosed when the horse is long gone from the barn. It's already spread throughout the abdomen. While we have effective treatments and we can get women into remission, cure is really very, very difficult.
If you have two or more of those symptoms and they're a change for you, they're different from what your body usually experiences, they happen daily and they seem to be getting worse, call your health care provider, discuss with him whether or not this could be ovarian cancer. If they think it might be, then ask him if you could see a specialist, a gynecologist oncologist, because clearly having the surgery the first time by the right doctor will also be an important ingredient to your cure.
Val Zavala>> Dr. Karlan, thank you so much. That's great advice.
Dr. Beth Karlan>> Thank you so much.
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Val Zavala>> It's not surprising that poorer neighborhoods have fewer doctors and it's not surprising that people who live there must rely on free clinics for much of their health care. But you may be surprised to learn who runs one of the few free clinics in South Los Angeles. Hena Cuevas has our story.
Hena Cuevas>> In a post-9/11 world, Americans tend to be wary of Muslims and the nature of the Islamic faith, but none of those fears are in evidence here.
Yasser Aman>> In an environment where, unfortunately, you always hear that Muslim Americans or Islam preaches a lack of any value of human life, you are finding a project in South Los Angeles that's preserving human life.
Hena Cuevas>> UMMA Community Clinic was founded in 1996 by a group of UCLA medical students, all of them Muslims. It offers free and low-cost health care to area residents. Yasser Aman is President of UMMA Clinic, which stands for University Muslim Medical Association, and he says the name UMMA is more than an acronym.
Yasser Aman>> The root word of UMMA is UM which means mother. That's exactly the relationship that we would like to have with our patients. But the whole word means actually community.
[Film Clip]
Hena Cuevas>> UMMA provides its patients with primary health care, including medications and screenings. It's one of only seven clinics to serve nearly one million people in South Los Angeles. Steven Murphy is UMMA's medical director.
Steven Murphy>> If they weren't coming here, they would be in the public ER. When we count up providers per patients in this part of the city, it's one doctor for every twenty-nine thousand people.
Hena Cuevas>> It was the riots of 1992 that led to the creation of UMMA. The clinic founders were all members of the Muslim Student's Association at UCLA. The students were already involved in volunteer work and they decided that South Los Angeles was the area that most needed their help.
Raziya Shaikh>> There was this spirit of idealism that I think only comes with youth.
Hena Cuevas>> Raziya Shaikh was one of the founding students.
Raziya Shaikh>> We actually collected a hundred fifty thousand dollars in donations without having a site, without having anything concrete. People were willing to give us exam tables, computers, things that we would need based just upon the enthusiasm and an idea.
Hena Cuevas>> The group found an abandoned site for their clinic just blocks from Florence and Normandy, the infamous flash point of the riots.
Raziya Shaikh>> When we found it, it was a completely dilapidated property.
Hena Cuevas>> The building was a former auto shop that had been used as a child care center.
Raziya Shaikh>> And there was actually toxic waste underneath.
Hena Cuevas>> The group transformed this eyesore into the first Muslim clinic in the country.
Raziya Shaikh>> One of the foundations of our faith is philanthropic work. Islam is based on five basic pillars. One of the basic pillars is you have to give in charity and you have to help those who are in need, and not only that. You have to want for them and try to get to them what you have yourself.
Hena Cuevas>> Only two percent of UMMA's patients are Muslim. Most are from the South Los Angeles neighborhood and about seventy-three percent are Latino and seventeen percent are African American. The clinic employees also come from diverse ethnic and religious backgrounds. Murphy, who is not Muslim, says he enjoys working in a faith-based clinic.
Steven Murphy>> A clinic that's founded on, you know, these faith principles has a leg to stand on. It's not going to go anywhere. It can get through hard times because it's guided by something more than just a business model. It's also guided by faith and the virtues that inspired the founders.
Hena Cuevas>> But does that faith ever restrict how the clinic's doctors practice medicine?
Yasser Aman>> As Muslims, we are very specific on peoples' individual right to make their choices. We don't have any specific limitations nor do we put it on any of our providers. In fact, I mean, Islam actually promotes helping people for the sake of the public health and public benefit. We provide family planning because we understand that that's a need, you know, to help curb the spreading of sexually transmitted diseases. It's a community interest and a community benefit.
Hena Cuevas>> If anything, they see the clinic as a way to expose people in the community to Islam.
Norma Arambula>> I knew a few Muslims, but I didn't know much about their religion and their background. Now I know a lot more and I'm less judgmental.
Hena Cuevas>> Norma Arambula is a devout Christian who first came to UMMA when she lost her job and health insurance.
Norma Arambula>> I prayed that God will take me somewhere where I was going to be taken care of and where I was going to be treated like a person, not just like a number. Since the beginning, everybody treated me very nicely. I knew about different clinics in the neighborhood, but I was surprised to find such a clean and nicely staffed clinic.
Hena Cuevas>> The clinic handled eight hundred visits in its first year and, in just one decade, that number has grown to seven thousand a year. UMMA board member, Munaf Khadri, was there from the very beginning.
Munaf Khadri>> Of course, I wanted to do this when I was asked, you know, would you be interested in helping us. It was not even a question. It was like when and not if.
Hena Cuevas>> It's the volunteer doctors that have helped keep the clinic going, along with medical students from the local universities.
Munaf Khadri>> "Then I got three calls from students who are like, 'We want to work at UMMA'."
Steven Murphy>> "Are they medical students?"
Munaf Khadri>> "Medical students. One is an undergraduate."
Steven Murphy>> UMMA has always put a high focus on education and training the next generation of doctors.
Raziya Shaikh>> The idea is that not only do they serve the under-served population right now, but we want them to be inspired to go on in the future to serve the greater society.
Hena Cuevas>> But UMMA's top priority is providing quality health care to anyone who needs it regardless of ability to pay.
[Film Clip]
Yasser Aman>> We strive to become an organization that becomes a medical home for our patients as opposed to the "diagnose-adios" scenario that you see in many areas.
Raziya Shaikh>> It doesn't matter if you're a drug addict. You still deserve respect. It doesn't matter if you're homeless. You still deserve respect. We've had a lot of homeless patients come through who've really appreciated the care that they've gotten.
Norma Arambula>> From what I feel from this clinic is that it's a little heaven, a little piece of heaven in -- I don't want to say hell -- but in a very bad area, where I feel safe.
Hena Cuevas>> I'm Hena Cuevas for Life and Times.
Val Zavala>> For more information on these and past health care stories, you can go to our website. Just go to kcet.org, click on Life and Times and then the Health tab. And that's our program. I'm Val Zavala. Thanks for watching. We'll see you next time.
Announcer>> 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.
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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