Fellowships retrospective: on emergency rooms, poverty stats and running amok

This weekend was the second session of the California Endowment Health Journalism Fellowship conferences in Los Angeles, and the event provided some fascinating and newsy morsels. Here's a round-up of what some of the speakers had to say (Check out more detailed blog items here as well.).

Waits in emergency rooms could get longer, if what's happening at the Los Angeles County/University of Southern California Medical Center is any indication. Dr. Edward Newton, chairman of that hospital's emergency department, told fellows that about 40 of the ER's 200 nurses would be getting pink slips as a result of budget pressures.

That's bad for a hospital in any state, but it has unique ramifications in California, where state law mandates nurse-to-patient ratios in emergency departments. The rub, Newton said, is that the hospital is likely to see more patients waiting in emergency rooms – some for 16 hours or more – to get care.

The nurses on the other side of the waiting room door can only attend to four patients at a time, no matter how many people are waiting or how long they must wait.

Newton led the group on a tour through the hospital's new emergency department, which was quiet on Friday evening.

Steven P. Wallace, a professor at the UCLA School of Public Health, spoke about the popular conception of baby boomers as wealthy consumers, referencing a recent Tom Brokaw report on "Baby Boomer$ (emphasi$ on the bling.).

He presented charts, though, that turn that notion on its ear. More than 40 percent of Hispanic elders struggle to make ends meet with incomes at no more than double the federal poverty level. And the chasm between the amount of wealth held by white Americans and African Americans during retirement is ever widening, he explained.

The reason for the trends, he said, is that some minorities are more likely to work in agriculture or service professions that do not come with pensions or 401k plans. Nor do ethnic elders enjoy the benefits of long-term home ownership at the same rates as Caucasians.

A complicating factor underlying the trends, Wallace pointed out, is how abysmally low the federal poverty line is. The result is a massive under estimation of the true frequency of poverty, since only the most desperate are assumed to live beneath the poverty line, which is used to determine eligibility for public aid programs.

Wallace explained that the poverty measure was devised based on 1950s data on the cost of food one would need to survive (we're talking rice and beans) during an emergency.

The poverty line has inched up with the consumer price index, but does not take into account the surge in housing and health care costs in the intervening decades. The poverty level is about $14,000 for a couple regardless of whether they live in San Francisco or Boonesville, Ind. While that amount may cover a year's rent in rural Indiana, it only leaves $2,000 for any need aside from rent in a place like Los Angeles.

Wallace said efforts to align the poverty measure with reality during the mid-90s was thwarted. Even a proposal in the California Legislature to base some Department of Aging measures on the Elder Economic Security Standard – a more reality-based measure of living costs – was vetoed by Gov. Arnold Schwarzenegger.

The veto message, Wallace recounted, was on the basis that the standard could create "cost pressure," apparently meaning that it might force the agency to spend more to meet seniors' needs.

Wallace also referenced his and colleagues' recent report on how proposed state budget cuts will further shred seniors' safety net, which is descriptively titled "Budget Proposals Turn Back Clock 30 Years in Long?Term Care Services for California Seniors."

The first speaker of the conference, Ethan Watters, described his new book, "The Globalization of the American Psyhce: Crazy Like Us." He also described his recent his experience as a guest on the Daily Show with Jon Stewart.

Watters' book explores how Americans have exported our unique notions on mental disorders, much like we've exported rap music, McDonald's food and Nike shoes to the rest of the world. He described how anorexia in Hong Kong was a very rare and isolated condition until one case hit the headlines. Afterward, journalists turned West for questions and answers about the disorder, within months importing a set of ideas about body image and self-esteem.

Watters also explained how some mental disorders manifest themselves in unique ways in different times and places. For instance, Indonesian men are known to experience "amok," (as in the term "run amok") in which they react to a social insult with brooding and rage. In the Middle East, Watters wrote, men suffer fom a disorder called "zar," believed to be linked to spirit possession and characterized by crying, laughing and shouting.

Americans' notion of post-traumatic stress disorder was not even on the radar screen in many cultures, until well-meaning Americans put it there, Watters said.

It was a set of ideas I had never thought through, and I can't wait to read his book.

And of the Daily Show? Watters advises would-be guests: Don't even try to be funny.

NOTE: This blog item was cross-posted from California Watch, where Christina Jewett is a staff writer. For more information, see www.californiawatch.org.