Leadership Tomorrow Workshop # 4

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HEALTH AND HUMAN SERVICES DAY

Thursday, December 10, 1998

Workshop Coordinators: Steven Moreau & Celeste Jarlin-Haug, Board Members

"The only gift is a portion of thyself" -Ralph Waldo Emerson

"We all have to be part of the solution to the community's needs" - Nancy Beverage, Class of '94

Mr. Stephens began by giving a brief history of the hospital as it has developed in this country. He pointed out early hospitals were nothing more than places for people to go and die and that it was the growth of the health insurance industry that caused them to evolve into what hospitals are today. Mr. Stephens also pointed out the basic differences between healthcare in Europe and and the United States. In a word, healthcare in Europe is an entitlement, but the U.S. has never really embraced that model. He made what I thought was a very astute observation when he said that in Europe health services are subject to many criteria such as age and health status. In the U.S. regardless of your age or whether you have an acute illness, you will be provided with aggressive treatment.

Blue Cross Health Insurance began being offered through employers in the early 1930s. WW II helped fuel research in medicine that increased hospital demand and Kaiser advanced the first Health Maintenance Program shortly after the war ended. Up until 1966, hospitals remained primarily volunteer organizations. Then the Congress adopted Medicare and Medicaid for the elderly. Today, 55 percent of the payments to hospitals come from one of these two programs. With the money now available, the private sector became interested in opening hospitals and the growth of physician-owned hospitals and other for-profit hospitals continues today. Nationally 85 per cent of hospitals are not-for-profit, and in Orange County, 60 percent are not-for-profit.

Mr. Stephens addressed one question many of us were concerned about and that is a hospital refusing treatment to a patient that does not have health insurance. He explained that Hoag, as well as all other hospitals with emergency care units, have what is referred to as the Hospital safety Net. Essentially what that mandates is that a hospital must provide emergency care to anyone in need of it regardless of their ability to pay. Mr. Stephens pointed out that there is no other industry with a similar mandate. In Orange County it is estimated that two-thirds of those who do not have health insurance are, in fact, employed. There are many reasons why someone who is gainfully employed may remain without health insurance. One the growth of contract work in the high-tech industries. Two, many young entrepreneurs, again in the hi-tech industries that opt not to carry heath insurance because they feel that they are young and do not require it at this time in their lives.

The California Legislature requires that hospitals develop a Community Benefit Program every three years. It is essentially a needs assessment. The data from this study showed that for Orange County citizens the priorities were 1) affordable costs, 2) transportation for senior care, 3) preventive services such as immunizations and education. For the medical community; 1) hearth, 2) cancer research, and 3) senior health. Mr. Stephens was careful to point that although Hoag recognizes the cause of many of the healthcare dilemmas facing Orange County. It does not attempt to address those, but rather it treats the symptoms. The reason is simple according to Mr. Stephens, the hospital must remain within its area of expertise which is providing treatment.

Cost of healthcare premiums have dropped dramatically in recent years primarily because of the growth of Health Maintenance Organizations such as Pacific Care. Mr. Stephen attributes the substantial economic growth in recent years to this phenomenon. However, he warned that Medicare is in trouble, possibly presenting a greater risk to the "babyboomers" than the collapse of the Social Security System. The Medicare system will be threatened as early as 2010 which is twenty years earlier than the projected demise of Social Security. Mr. Stephens pointed out that there are really only three solutions to the financial crisis facing the Medicare program. Those would be raise the FICA deduction, raise the retirement age, or a "means test" which essentially means that the higher your income, the more you must contribute to off set the costs. The nature of our political system seems to be that nothing will be done about the crisis looming for Medicare until its collapse is upon us. Instead growing into one of these solutions, our society will have to undergo a very abrupt change.

The next presentation was made by Dr. Chris Duma. It was about the Gamma Knife procedure in treating Cancer. The Gamma Knife procedure is a form of surgery but without cutting. It uses beams of radiation to shrink and destroy the cancerous tumor. Dr. Duma began the procedure at Hoag in 1997 and has had 141 patients undergo the procedure so far. He estimates that approximately 50% of the patients he sees are are candidates for the procedure.

There are several advantages to the procedure over conventional surgery to extract tumors. One is that the typical neural surgery will require a minimum of 17 days in the hospital. The Gamma Knife patient has the procedure in the morning and can literally play golf that afternoon.

In addition to tumors, the procedure can also be used to "rewire" the brain in the case of those suffering from Parkinson's Disease. The procedure is also useful for navigational purposes. It can be used to pinpoint tumors in the brain even if the the Gamma Knife procedure is not the appropriate method to deal with the tumor. In addition it can be used to eliminate nerves in the brain that are responsible for certain kinds of pain.

Dr. Duma also informed the group about an option for cancer patients called Immunotherapy. The treatment produces a similar effect to vaccines. It activates the immune cells or "supercharges them to destroy the tumor.

Following Dr. Duma was Dr. Robert Dillman, Director of the Hoag Cancer Institute. He began is talk with a statistic regarding the number of people who die from cancer in a year. The number is 555,000. His analogy, to impress upon us how vital the Cancer Institute is at Hoag, was that there are more deaths in a year to to cancer than the deaths to American soldiers in all the wars this century which was estimated to be at 445,000.

Dr. Dillman was quick to point out that there is no cancer epidemic. But, because of the decrease in incidents of cardiovascular disease. people are living longer and are more likely to develop cancer. He pointed out that while many cancers are on the decline, some are on the rise and there are different explanations for this. For example, lung cancer particularly in women is on the rise. Dr. Dillman attributed this to the add campaigns utilized by the tobacco industry glamorizing smoking. Stomach cancer on the other hand is on the decline primarily because improvements in sanitation over the years. Prostate cancer is on the rise because again, men are living well beyond the age of 65 now. However, in the case of prostate cancer, the mortality rate is low. The incidence of breast cancer has remained relative constant this century and mortality rates are highly influenced by early detection. Uterine cancer for women is on the decline mainly do to the PAP Smears now available to women for early detection as well as public education.

Prostate and breast cancer make up approximately 1/3 of all new cancer cases in men and women. Lung, colon or prostrate make up 50-60 percent of all cancer afflictions. Of these three, lung cancer is the number one in mortality rates, with prostrate and breast cancer number two, third is colon cancer. He emphasized that with medical advances today in the treatment of cancer, "the issue is how to live with cancer rather than dying from it."

Prevention continues to be order of the day. Diet, particularly in the case of colon cancer is very important. A low fat, high carbohydrate diet increases the amount of fiber. Dr. Dillman carefully pointed out that once can look at their own bowel movement and estimate the amount of fiber intake. The larger it is, the more fiber was ingested, the smaller, more carcinogens were  absorbed. I am not sure that I really want to look that closely!

The elimination of all tobacco products is important. Dr. Dillman estimated that 70-90 percent of all cancers of the head, neck and chest would be eliminated if tobacco were not a factor. Dr. Dillman made an interesting observation about all of the litigation going on between the federal government and the tobacco industry over compensation to Medicare for the treatment of tobacco related illnesses. He said the government finally realized that what they were gaining in taxes from tobacco sales they were losing in Medicaid expenses for treatment of people suffering from tobacco related illness and conditions.

Sun exposure is another big problem. Dr. Dillman pointed out that Australia leads the world in the incidence of melanoma. In short you can help to prevent cancer by not smoking, adhere to a low fat, high carbohydrate diet, limit your exposure to the sun, limit the number of sex partners you have, follow medical advice on all pre-cancer lesions and avoid radiation exposure.

Following a very interesting morning, were boarded the bus and headed for an organization called Share Our Selves (S.O.S.). This organization is located just up Superior from Hoag Hospital. The address is 1550 Superior Ave. Costa Mesa, CA. The phone number is (714) 650-0640. Essentially S.O.S. is a Medical and Dental Clinic which provides medical and dental care for the low-income population of Orange County. This group does not have access to Medi-Cal, MSI, or Medicare. You will not see a website link for S.O.S. because .96 out of every dollar donated goes to the people relying on its services. The services provided at the clinic are:

• out patient examination and treatment/primary ambulatory care,
• laboratory, X-ray and diagnostic procedures
• referral to specialist physicians
• full dental care for adults

In addition to the clinic, the volunteers at S.O.S. provide food, monetary assistance and resources for jobs and other essentials. Karen McGlinn, the Executive Director explained the food distribution this way. If someone were facing having the electricity turned off in their home and they had to choose between paying the bill or buying food for their family, S.O.S. could either provide the food or financial assistance to pay the bill. This way, the person would never be forced to make such a difficult choice. She emphasized that all one has to do is just ask, and they will be provided with assistance and be treated with dignity and compassion.

One of the major supporters of S.O.S. has been Taco Bell whose corporate offices are located here in Orange County. Ms. McGlinn was quick to tell us before we walked into the kitchen that it would look just like the ones found in all of the Taco Bells...and in fact it does. After the kitchen we were taken back to where the food is packed in grocery sacks for distribution. We were all impressed by two things. One the variety of food that was available and two, the balance of nutrition that was maintained as the sacks were filled. S.O.S. does not refuse any food. Ms. McGlinn explained that recently a shipping company had called and said that they had some ice cream from Europe that was not claimed. Immediately S.O.S. dispatched someone to pick  it up. To their surprise, there were several cases of it. That day all sacks included some very exclusive European Ice Cream.

Following our tour of S.O.S. we were bused to the Oasis Senior Center located in Corona Del Mar and treated to a typical "Senior" lunch and a very special treat from an Organization named Stop-Gap. For the past 20 years Stop-Gap has designed and delivered educational and therapeutic programs to schools, social service agencies, corporations, hospitals and other community agencies throughout Southern California. I teach critical thinking in reading to college freshmen and sophomores and on more than one occasion discussed with my classes bibliotherapy. Bibliotherapy is essentially a fictional story that deals emotional trauma brought on by a variety human events. Some of these are divorce, the death of a pet and many others. This is what Stop-Gap does only in a theatrical mode of delivery.

The group performed a drama of three women facing breast cancer. In a word, it was powerful. The acting was superb. At the end of the drama an interactive session takes place between the audience and one or more of the characters. Our group selected one character that they would like to explore further. A member of our group volunteered to explore further this character's struggle with breast cancer.It was all impromptu, and gave our group a sense of how individual and group therapy can take place following one of these vignettes Other vignettes that the company has developed include; teen pregnancy, drug abuse and divorce. I had no idea that groups such as Stop-Gap existed and exposure to groups like Stop-Gap is one of the real pluses of participating in Leadership Tomorrow.

Following the Stop-Gap presentation, Celeste Huag, the Director of the Oasis Senior Center talked to us about the role of Senior Centers in Orange County and took us on a tour of the Oasis facility. Ms. Haug was quick to recognize that all of us may be holding misconceptions about what a "senior center" is like. She was certainly right about me. In my mind, a senior center was closely associated with a retirement home or a nursing home. What I saw at Oasis was a center for activities that appealed to a wide variety of interests rather than age. Those activities ranged from computer technology to ceramics, from playing pool to herb gardening. I didn't see one knitting class!

The Oasis Senior Center provides classes and activities as well as a comprehensive human services program for the senior population in and around Corona Del Mar. The activities include a wide range of topics from exercise, to investment counseling to ceramics. On human services side are transportation services, Meals on Wheels. The center simply provides these opportunities, the seniors themselves take the responsibility to get involved, make choices and decide what it is that they want to do. Ms. Haug stressed the importance of not fostering dependence in the senior, but rather independence for the purpose of maintaining a sense control over their own lives.

The next panelist was Dr. Cordulla Dick-Muelke the Executive Director of Adult Day Services of Orange County. Adult Day Services plays somewhat of a different role than the senior centers like Oasis. The adult day service is for seniors, who for a variety of reasons can not be left alone during the day, thus preventing what would otherwise be premature institutionalization. Dr. Dick-Muelke explained that there are three levels of care provided for seniors. Those are 1) adult activities, 2) social day care, and 3) adult day healthcare.

Adult activities include both cognitive and participatory, for example, day trips to museums and volunteering at several not-for-profit organizations. The social day care program includes pet therapy, interaction with children, art and music. The adult day healthcare includes nutrition, occupation therapy, speech therapy, psychological counseling and case management. Many seniors requiring Adult Day Services suffer from Alzheimer's Disease . Dr. Dick-Muelke shared some interesting statistics with us about this debilitating disease. It is estimated that 4.1 million people suffer from Alzheimer's now and that figure is expected to rise to 14 million by the year 2050 because of the aging babyboomer generation. It is estimated that there will be 16 million people 85 years or older by 2050. In Orange county now, the average caregiver is a 46 year old woman caring for a 77 year old mother. The 65-85 year old population is growing and the 35-55 year o0ld population is shrinking.

The next panelist was Shelly Westmore of Girls Inc. GROWING UP IS SERIOUS BUSINESS! That is the motto of Girls Inc. You would not know this from the name, but according to Ms. Westmore, 40% of the participants are boys and that is ok with her because many of the serious problems faced by girls growing up have allot to do with boys. I didn't know this, and I am still a little dumbfounded by it, but California leads every industrialized country throughout the world in the incidence of teen pregnancy. AND...Costa Mesa, right here in Orange County is one of the cities in California with the highest rate of teenage pregnancy. There are approximately 400,000 people under the age of 18 in Orange County.

As big of a problem as teen pregnancy is, that is only one role that Girls Inc. serves. Ms. Westmore explained that for girls, junior high school is where the problem seems to arise. Their self-esteem/self- perception seems to take a slide during this period of their lives. Apparently, at this age many girls try very hard to "mask" how smart they are. Ms Westmore referred to a study that was conducted that had some interesting results. The question was posed to junior high age girls, "What if you were a boy?" Girls seem to come up with all sorts of advantages for being a boy. Less than 5% of the boys could think of one advantage to being a girl. In fact 16% of the boys responded that if they were a girl, they would commit suicide. That one got me!

According to Ms. Westmore, what seems to make a difference for girls, is working in small groups so that they can learn to value and respect each other. Also developing support groups seems to help along with encouraging abstinence, and sex education. They do not, however, provide any pregnancy counseling. That program is outsourced. Ms. Westmore pointed out that 65% of fathers of teenage births are 23 and the younger the girl, the older the boy. So the issue of power is very much a factor in this problem. That is why it is important to get more boys involved in the program.

Girls Inc. in Costa Mesa picks up the girls right after school, at 12 junior high schools in Orange County and do allot of work in math and science. There are 1800 kids in the program and they work at the high schools as well, giving presentations to faculty on how to encourage teenage girls. They also conduct workshops for parents on how to better talk and communicate with teenage daughters.

After our very informative afternoon at Oasis, we boarded the bus and headed for the Shalimar Learning Center. We were all sort of looking forward to this because it is run by one of our own, Kristina Wright. Again, the best seemed to be saved for last. The Shalimar Learning Center is an after school tutorial program. It occupies three of five apartments in an five apartment complex. There are three levels; elementary, junior high school and high school. Each level occupies its own apartment. There is one full-time executive director and a part-time staff of tutors and volunteers. There is a waiting list of kids to get in from this Costa Mesa neighborhood.

Last year they had their first 12 graduates from high school. Three of those were accepted to universities and are attending now. The students drop by after class and work on homework. They can get one-on-one tutoring and they have access to computers. Our group was free to walk around and the place was "jam packed" with students all busy doing homework. There is follow-up by the Center staff with teachers at the schools where these students. A common comment made by the teachers is that it is the Shalimar kids that can be relied on to turn in their homework assignments and sometimes they are the only students in class who do.

There are over 300 kids in the program now and that number is only limited by space. We were all wondering how long it might be before they take over the other two apartments in the complex. I personally hope it is soon.The program works and similar programs are being started up in other troubled neighborhoods  around Orange County. Research shows that many kids get in trouble between the hours of 3:00 p.m. and 7:00 p.m. If they have somewhere to go after school and get involved in activities that are productive rather than destructive, whole neighborhoods can be transformed as this one appears to have. Way to go Kristina!