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ER doc talks sense on health care

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ER doc talks sense on health care

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Mike Tharp is the executive editor of the Merced Sun-Star. He attended the Mar. 2010 seminar for the California Health Journalism Fellows as the editor of Fellow Danielle Gaines, where he met the subject of this column, Dr. Edward Newton, chair of Emergency Medicine at the Los Angeles County USC Hospital.

<a href="">Merced Sun-Star</a>
Saturday, March 20, 2010

As the up/down, "deem" or damned health care bill lurches to some sort of ending, meet a man who talks a lot of sense about our health care crisis.

He's a Canadian cardiologist who works in America's busiest ER ...

LA County USC.

It's where the Navy sends its officers and corpsmen to train before they go to Iraq or Afghanistan. Sixty-eight emergency residents treat 450 patients a day. They give free care in return for, say, training as a brain surgeon. It's a one-word badge of honor, like the Marines, to say you trained at "County."

The sense-talker is Ed Newton, professor and chairman of the Department of Emergency Medicine at the sprawling complex east of downtown L.A. The 60-ish gray-goateed doctor grew up in Montreal and came to L.A. for training. In a sense, he's never left.

His ideas about problems and solutions to health care in this country come from his experiences living in two drastically distinct societies separated by a 3,145-mile border. He witnessed Canada moving from a minimalist health care system to one where half its people have their own family doctor.

A system where health care is a birthright, and prescriptions are free or cheap.

And he's watched for years as Angelenos -- 77 percent of them nowadays uninsured -- have staggered from 70 ambulances a day to his ER with gunshot wounds, heart attacks, freeway injuries and hypertension.

All that gives him a unique platform from which to diagnose, prescribe and treat.

Let's start with his solutions:

  • any U.S. national health plan should not be linked to insurance companies and employers;
  • funding should be provided for EMTLA, the 1986 federal law that prohibits any emergency department from turning away anybody based on insurance status;
  • increase in-patient psychiatric and convalescent hospital bed capacity;
  • every hospital should have a "surge capacity" plan that involves the whole institution (in case of a huge natural or man-made disaster);
  • primary care capability should be built up;
  • entice more nurses by increasing wages, benefits and training;
  • mandate participation in emergency department on-call service as a condition for medical staff privileges;
  • legislate gun control, violence intervention and rehab programs.

By now those of you who believe in "death squads" will be calling for Dr. Newton's scalp -- or his stethoscope.

More reasonable folks might pay attention because this man, this physician, has seen it all, from both sides of the border. He's been bloodied by sucking chest wounds from tattooed gangbangers.

His ideas are based on experience ranging from when he broke his hand as a boy and went without a cast for two weeks because his poor father couldn't afford it (in the days before Canada's present health care system); to dealing with 16 gunshot wounds a day on average at County in 1988 at the depth of the gang/crack epidemic; to this February when he flew to Haiti and had to decide which victims would die -- even with care and those he should try to save.

Life or death. The man knows what he's talking aboot.

Of our system today he says, "It's a weird way to deliver health care to a large population: The healthiest people have access to health insurance, and the sickest people don't have insurance."

At County, even if there were no federal law, "we can't turn 'em away -- we have no place to turn 'em away to."

And, contrary to what many of us might think, most of the increase in the number of patients to visit emergency rooms -- 114 million a year from 1993 to 2003 -- comes from insured patients.

"A lot of them work, and they don't have sick days like mainstream people," he explains.

Also, their insurance may not be generous -- MediCal or policies with high deductibles. (During that same '93-'03 decade, the U.S. lost 703 hospitals and 198,000 hospital beds.)

So why doesn't he move back to Canada (where he could make more money)?

"This is where the undiagnosed patients come, and you have to use your Sherlock Holmes talents on 'em -- it's more fun."

And after growing up with the Montreal Canadiens, he's now adopted the L.A. Kings hockey team.

A few more random Newtonian notes, told before and during a recent Friday night tour of his bailiwick with the USC Annenberg School's California Endowment Health Journalism Fellowships, including the Sun-Star's own Danielle Gaines:

  • some 60-79 percent of U.S. hospitals are operating at overcapacity;
  • more primary care physicians are referring people to ERs, especially sicker patients, because there are more invasive treatment options available (such as sonograms) that can't be provided in an office;
  • the rate of hospitalization hasn't changed, but the ratio of nurses has: by law it must be four patients to one nurse; if there aren't enough nurses, people have to stay in the waiting room, not an ER;
  • there's a two-year waiting list at County for hernias and gall bladders "because they're not life-threatening;"
  • 17 percent of people who come to County have MediCal; that figure rises to 45 percent of those leaving because many sign up while they're inside;
  • people wait up to 16 hours for treatment there -- "I guess that's why they call 'em patients;"
  • their average age is 40;

EMTLA costs every doctor in America an average of $12,300 a year in bad debts; for emergency physicians it's $138,000 a year. "It guarantees access for all patients, but it's an unfunded mandate."

"My personal physician in L.A. tells me, 'Yeah, we'll rush you right in -- see you in August.'"

Newton's medical education at McGill University in Canada ran about $700 a year in tuition (it's now around $1,500, he reckons). One reason U.S. health care costs so much is that the bills at med school are ionospheric -- "and moms want their kids to be specialists, not general practitioners."

Another reason U.S. health care costs so much is the high-end care at the end of life -- "$30,000 a day for 26 machines. This whole end-of-life issue is really dumb," he says. "People who plan on living forever are going to lose. In Canada, doctors say, 'Granny's dying.' In the U.S., they ask, 'Do you want us to do everything for Granny?' That's the wrong question."

So that's one man's Rx for what ails the U.S. health care system. Agree or disagree, you've got to admit, it's a diagnosis and a prescription based on facts.

Scariest of all is Doc Newton's only philosophical musing as he led a tour through the hallways and rooms where folks were getting treated one recent Friday night in L.A.:

"We may look back at now as the good old days."

Executive Editor Mike Tharp can be reached at (209) 385-2456 or