Even with so much to consider under the planned PPACA reforms to healthcare, the design may overlook many peripheral issues contributing to the shortfalls of the current medical system. Illustrated here by three true examples from California’s central valley, it may be surprising to consider the direct impact that challenges such as poverty and intolerance can have on access to care.
Madera: Mile 0
The city of Madera was founded by the California Lumber Company in 1876. Dolores and her family made a pretty good life for themselves in Madera, Spanish for “wood.”
She cleaned houses for rich people. They paid her cash, and all the money was hers to keep, so she made good money. A few years ago, her daughter developed a growth on her wrist. She went to the clinic at the teaching hospital across the river in Fresno and they examined her girl. Then they scheduled her for surgery and removed the growth. Best of all, they charged her nothing. Free, gratis. When she told this story to one of the rich ladies she worked for, the lady scowled and said, “My husband pays a lot of money for us to have health insurance. Plus we still have to pay extra for every little thing we have done, and you got it for free…”
Dolores smiles when she thinks about her good fortune coming to this place. Her life isn’t perfect, though. When the girl’s high school offered an all-expenses-paid trip to Washington, D.C. for sophomores, the girl eagerly applied to go. When the daughter found out funding was only available to US citizens, she stumbled home in tears, crushed. Before that, she’d had no idea she wasn’t a US citizen. As well, her son is longing to reconnect with his dad back in Mexico. She doesn’t want to let him go, but when he turns 18, what can she do?
Delano: Mile 98
Also known as “Crow Town,” the moniker stuck because of the swarms of crows that roam there. This is a company town if there ever was one. Founded in 1869 as a rail depot by the Southern Pacific, Delano grew to become a major center for table grape production. In the 1950’s it also became a hub for the nascent farm workers movement. The majority of agricultural workers in the area were of Filipino descent, and under the auspices of the Agricultural Workers Organizing Committee they staged the, now infamous, Delano grape strike. The goal was to win better wages and working conditions from the table grape farms for the farm workers. In concert with Cesar Chavez’s National Farm Workers Association, they were ultimately successful, but it would appear that some people never learn…
Press release 8/19/2010: Delano Regional Medical Center (DRMC) Sued by the US Equal Employment Opportunity Commission for National Origin Discrimination. “According to the EEOC, the hospital prohibited Filipino staff from speaking Tagalog (or other Filipino languages) while allowing non-Filipino employees to speak other languages, such as Spanish. The EEOC contends that hospital management subjected the Filipino staff to a hostile working environment by singling them out for reprimands at company meetings, threatening them with audio surveillance, and encouraging other staff to report on them.”[i] The suit was joined several months later by the Asian Pacific American Legal Center, representing 52 nurses and medical staff members who allege they were targeted because they were Filipino. The lawsuit seeks an injunction to prevent future discrimination as well as financial compensation for the employees.
“‘I felt like people were always watching us,’ Elnora Cayme, 56, who worked for 20 years at DRMC, said. Even when we spoke English…people would come and approach us and tell us, ‘English only.’” [ii]
Uh, right. Time for DRMC to get out the checkbook? If these allegations are true, the lessons from history of the farm workers’ grape strike should have been a warning to DRMC.
Reedley: Mile 166
Wheat was king here in Reedley during the Gold Rush. Then the “Rush” turned “Bust,” and the Kings River was diverted for irrigation, transforming this area into the “Fruit Basket of the Valley.” Wave upon wave of industrious immigrants settled here: German Mennonites, Japanese, Armenian and Lebanese. Thus the stage was set for prosperity, based upon agricultural bounty.
Contrast that notion of growth with the declining status of small rural hospitals such as Sierra Kings District Hospital (SKDH), with only 44 beds. The residents of Reedley support SKDH with $1.5 million in property tax proceeds per year, but unfortunately that is not enough. Given the poor payer mix prevalent in agriculture-based economies in the Central Valley and the draw of larger, better funded medical centers for insured patients, SKDH seemed to be caught in an inevitable death spiral. Witness this sequence of events: From 2008 to 2009, the SKDH pension fund was raided to the tune of $1.4 million to cover the hospital’s payroll and operational expenses. In October 2009, SKDH filed for Chapter 9 bankruptcy protection. In 2010, SKDH continued to hemorrhage red ink. In June 2011, Reedley voters approve the sale of SKDH and its affiliated rural clinics to Adventist Health for $25 million over 15 years. Word on the street is that Adventist plans to shutter the facility or convert it to an extended care facility, and funnel the acute care patients to its new medical center in Hanford.
California’s central valley is rich in its ethnic, social and economic diversity. Stories like these are only a few examples of why solutions to poverty, intolerance and health care access are not easy to come by. It is not at all certain that health care reform under PPACA will provide reasonable solutions to the problems we see in these examples.
There are 53 towns and cities in the Central San Joaquin Valley. The land, sun, and irrigation gave some the opportunity to reach for wealth and freedom. Others were exploited under the sun’s harsh glare.
What’s your story?