Wednesday, August 12, 2009

GOOD NEWS IN BAD TIMES - RAM: Forum Super Clinic finds super need in L.A. region + Steve Lopez

LATimes/LA NOW | 6:47 AM | August 12, 2009

More photos

Hundreds of people spent the night outside the Forum in Inglewood in hopes of getting free medical and dental care.

More than 2,000 sought services on the first day of the medical clinic -- and hundreds were turned away. People were lined up Tuesday night, hoping to get in. The MTA announced it was extending service of Line 115 because of "overwhelming demand" for service to the clinic, which runs for eight days.

The Remote Area Medical Foundation is a trailer-equipped service that has staged health clinics in rural parts of the United States, Mexico and South America. It brought its health camp to urban Los Angeles County on Tuesday to begin a stint that the group's officials described as its first foray into a major urban setting.

Organizers expected big crowds in a county with high unemployment and an estimated 22% of working-age adults lacking health insurance.

On Tuesday, the turnout was so large that hundreds had to be turned away.

"We're shorthanded," said the mobile clinic's founder, Stan Brock. About 100 dentists were needed, but only about 30 showed up Tuesday. Twenty eye doctors were required, but only about five were on hand, Brock said.

The mobile clinic, based in Knoxville, Tenn., has staged 576 medical clinics over the last 25 years. They have treated nearly 380,000 patients and provided care valued at $36.9 million, said Executive Director Karen Wilson. The group raises money through contributions.

Doctors, nurses and other medical workers who donated their time said most visitors' ailments were basic. But "many have chronic diseases -- high blood pressure, diabetes, asthma -- conditions we can't deal with in just one day," said Dr. Nancy Greep of Santa Monica. Some had problems, such as a recurring cancer, that demand long-term treatment.

-- Bob Pool and Kimi Yoshino

Photo: Dozens of patients receive dental care Tuesday at The Forum in Inglewood. More photos

Credit: Genaro Molina / Los Angeles Times.

Steve Lopez: Doctor has common-sense fixes to healthcare crisis. Glendale surgeon Paul Toffel would dump '50-state patchwork' of coverage and switch to competing national plans, cap malpractice suits and reinstate limits on insurance company fees.


Steve Lopez | LA Times Columnist

August 11, 2009 - They came with toothaches, limps, blurred vision and sniffling children.

Inglewood's Fabulous Forum, where Magic and Kareem once operated, became a MASH unit Tuesday for 1,500 uninsured people who began queuing up at 2 a.m., desperate for medical attention.

What an inspiration it was to see teams of volunteer doctors and nurses helping patients as part of a charity called Remote Area Medical. And what an indictment, as well, that a group known for its work in Appalachia was needed in the land of palm-shaded mansions.

"I got here at 4:10 and this is my number," said Rita Dirden, who at 11 a.m. was still waiting in the parking lot for 998 to be called. Her friends had numbers 1,131 and 1,193, and all three were desperate for eyeglasses and dental work.

Inside the arena, Andrea Scott had gone from eye doctor to dentist to gynecologist before lining up for a mammogram. She said she'd been uninsured since losing a job in real estate finance in 2003, and had avoided medical visits because of the cost.

"You just deal with it, honey," she told me. "What can you do?"

Actually, I know a doctor who has an answer that he calls simple, tax-free and apolitical.

Could there be such a thing?

"It's not a Democratic plan," Glendale surgeon Paul Toffel told me recently. "It's not a Republican plan. It's a common sense plan."

One that doesn't include President Obama's call for a public option, because Toffel thinks that if the government were involved, too many patients would be denied costly specialized care when they need it. But the doctor's pitch won't make any health insurance executives happy either.

"Somebody has to have the courage to go against that industry," Toffel said.

His plan might never get farther than this page. But it's not as if they're approaching a consensus on any aspect of healthcare reform in Washington, where it's looking more like a mud-wrestling exhibition than a high summit. So why not at least hear from a doctor with 40 years in practice and a desire to make medicine affordable to every American?

Toffel, a clinical professor at USC's Keck School of Medicine, is a head and neck surgeon whose patients have included truck driver Reginald Denny (a beating victim in the 1992 riots), basketball player Rudy Tomjanovich (hit with a nearly fatal punch from Laker Kermit Washington in 1977), and me (for mere sinus surgery). Toffel dedicated his career to his father, a Watts shoe store owner who was shot and killed during a hold-up in the aftermath of the 1965 Watts riots.

Toffel was vacationing recently with Bill Habermehl, Orange County education department superintendent, who liked what his friend said about a healthcare fix and encouraged him to get it down on paper. The result is a document that Democrats will love and hate, and the same is true for Republicans.

"Thank you," Toffel said, taking that as a compliment.

As Toffel sees it, the corporatization of healthcare in the 1970s and 1980s was a debacle we're still paying for. So the insurance companies get hammered in the first three points of his five-point plan.

If Toffel were the healthcare czar, he would dump the "50-state patchwork" of private insurance programs that can't cross state borders and switch to competing national plans that would be required to take all comers, with no exemptions for preexisting conditions.

Then he would reinstate federal regulations abandoned in the 1980s that limited insurance companies' fees. Freedom from those limitations, Toffel believes, was part of what caused healthcare to shift from its mission of treating the sick to the business of printing money.

Toffel would also move away from employment-based healthcare, with companies paying higher salaries, instead, so employees can shop for a suitable plan and carry it with them from one job to the next.

On point four, Toffel would cap frivolous malpractice suits across the nation, as California did many years ago.

So what about the 1,500 people expected to show up today and each of the next six days at the Forum, as well as the rest of the nation's millions of uninsured and under-insured?

"This is where your son comes in," Toffel told me.

My son, who earned a graduate degree a year ago, has not found steady work with benefits, so he was uninsured earlier this year when he was mugged and needed reconstructive face surgery.

He went to his alma mater in Philadelphia, Temple University, but was turned away for lack of insurance.

If Toffel were king, every teaching hospital in the nation would have but one mission -- treating the uninsured residents of its own community, as County-USC has done.

If there's a publicly funded component to Toffel's plan, it's that such schools would be subsidized as necessary with grants and a variety of federal, state and local funding.

That could be expensive, too, if those schools provide preventive care and health maintenance as opposed to just crisis care.

But that money, Toffel argued, should go "directly to the delivery of medical care rather than the expansion of bricks and mortar.

"Great USA-style medical care can be provided cost-effectively in simple perk-free settings, as in the U.S. military hospitals, without requiring private rooms and flat-screen TVs for every patient."

Experts will quibble, no doubt, with virtually every aspect of Toffel's plan. I've advocated a single-payer universal plan, myself, but that's not going to happen, and no system would be without flaws. In Canada's nationalized program, there are complaints of long waits to see a doctor and roadblocks to specialized care.

Lord knows we can do better than having people wait all day in a parking lot hoping their numbers will be called.

At the Forum on Tuesday, Dr. Arthur Collins, who practices in Crenshaw, did 50 mammograms and said many of the patients had been putting them off for years.

"I've even had breast cancer survivors in here today," Collins said, telling me that despite the risk of recurrence, the women hadn't been able to manage regular checkups.

In his regular practice, Collins said, "I see people who've lost their jobs, lost their coverage, or do two and three jobs and can't afford healthcare in America.

"It's a damnable shame."

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