CVIndependent

Thu10292020

Last updateMon, 24 Aug 2020 12pm

Members of the Service Employees International Union-United Healthcare Workers West (SEIU-UHW) picketed at each of the three Tenet-operated hospitals in the area last week—claiming that employees at the hospitals need to take life-threatening risks every day to care for local patients battling COVID-19.

The members formed picket lines at the Hi-Desert Medical Center in Joshua Tree on Wednesday, Aug. 26, before moving to the Desert Regional Medical Center in Palm Springs on Thursday, followed by Indio’s JFK Memorial Hospital on Friday.

“The overlying reason is that we are in a contract negotiation right now, and at the same time, we are fighting to make sure that all of our workers are safe and have enough PPE, or personal protective equipment,” said union member Gisella Thomas via telephone before Friday’s picketing action in Indio. “Tenet is my employer. I’ve been a respiratory therapist for 48 years, and I’ve worked at Desert Regional for 10 years. I’m not a spring chicken anymore. I feel unsafe, not just for myself, but for my co-workers, too. If you have co-workers in other facilities who died because they didn’t have a face mask or other PPE, you want to make sure that doesn’t happen in our facilities here.

“We (at Desert Regional) have not had a death yet. We don’t want that to happen, and we want to make sure that we’re safe and protected.”

Tenet spokesman Todd Burke, in a statement issued on Thursday, Aug. 27, said: “While we value all of our employees who are represented by the SEIU-UHW, we are disappointed that the union is taking this approach. We have only been bargaining with the union on a successor contract since May and will continue to negotiate in good faith in hopes of reaching a successful resolution. We are proud of the professionalism and dedication demonstrated by our caregivers and staff during this unprecedented pandemic.”

Later in the statement, Burke noted: “Any employee, physician or vendor entering the hospital is required to wear a face mask. To prevent potential exposure, all physicians, nurses and staff who care for suspected or confirmed COVID-19 patients are required to wear the appropriate PPE, including N95 face masks and face shields or goggles. Employees are provided a new N95 or face mask with each shift.”

That policy, as described by Burke, is part of the problem, as far as Thomas and her picketing co-workers are concerned.

“We’re asking that there be a pandemic/epidemic clause added to our contract that assures every worker that there are provisions so that we are safe, and there’s enough PPE for us at all times,” Thomas said. “For 48 years, when I saw a patient where I needed protection—like gowns, gloves and a mask, a hat and shoe covers—I would put that stuff on before I went into the patient’s room. Then, when I finished doing what I had to with that patient, I’d come out of the room and take everything off. Then, for the next patient, I’d put on all fresh, clean, new PPE—gowns, gloves, the whole bit.

“Today, I’ll use the same N95 mask, with a surgical mask over it, for the 12 hours that I work. Over my 48 years, if I would have done that, (hospital administration) would have fired me. Any hospital would have said, ‘You’re endangering the patients. This is not right. You cannot do this.’ Now, everybody goes from patient to patient and has the same PPE and the same N95 mask in front of their face for the entirety of their shift. Granted, all the federal agencies are saying that this is OK now—but why was it not OK for 48 years, and now it is OK? This is the question I ask as a health-care worker.”

Thomas said she’s concerned not just for herself, her co-workers and her patients; she’s also concerned for her friends and family away from work.

“When I come home (from work), I strip all of my clothes off in the garage,” she said. “I try not to touch anything and take a shower immediately. I’m trying to make sure that I don’t take anything home to my family, but also out into the community—and I’m not the only one. Everyone does this. So we want to make sure that the provisions in our pandemic/epidemic clause state that there has to be enough PPE to do what we were supposed to do for the last 48 years.

“There has to be enough PPE (on hand) for 45 days. If they’re stocking enough, then why is there not enough? Now we’re six months into a pandemic, and we’re still doing the same bullshit, excuse my language. It’s like, ‘Come on! Give us a break. Why can’t you guys pick it up here? How can you expect us to come to work and do our job? Why can’t you provide us with the safety we need to protect our lives?’”

According to Burke’s statement: “We can safely care for our patients with the supplies we currently have. Our team is actively sourcing around the world for additional supplies. We are committed to protecting the health and safety of our patients and staff.”

Thomas said that while she understands hospital administrators are dealing with an unprecedented pandemic, her frustration has grown over the last months—especially regarding a lack of transparency.

“I’m sure that (Tenet administrators) have their own frustrations and issues in terms of providing us with the PPE that we need,” she said. “But unfortunately, Tenet is not dealing with their health-care workers in a forthright manner. They don’t even let us know who among our co-workers have caught COVID-19. So, some of us have been exposed and had no idea until we get sick.”

One may assume that she and her co-workers get tested for COVID-19 on a regular basis, given they’re in close contact with infected patients, but Thomas said that’s not necessarily the practice at the local Tenet facilities.

“There is an option available for us to get tested, but they don’t really encourage us to get tested,” Thomas said. “Unfortunately, once you are tested, if you test negative, and then later on you have some symptoms, they don’t like to re-test. Or, if there’s somebody who tests positive and has been out, when they need to come back, there’s no more re-testing. After 10 days (of self-quarantining) it’s like, ‘OK, you should be good. Just come back to work.’”

Thomas voiced cautious optimism that the local recent picketing actions staged by both the SEIU-UHW hospital workers and members of the California Nurses Association would eventually result in improved working conditions.

“At the Desert Regional (picket on Thursday, Aug. 27), we were hoping to get a least 100 to 150 people out on the line,” Thomas said, “and we had over 200 union members come out, along with some doctors and nursing staff. We (in the SEIU-UHW) are all the other essential workers, like respiratory therapists, EMTs, lab techs, certified nursing assistants and the transporters.

“We will fight for our rights. At this particular time, I don’t know how that will work out, but we will continue to speak out and speak up, because that’s what we need to do. We can’t just sit back. Hopefully, we’ll come to a mutual agreement in the near future—and if we don’t, then we’ll have to go from there.”

Published in Local Issues

Happy Monday, everyone. There’s a lot to cover, so let’s get right to it:

The coronavirus is spreading locally. According to the just-released Riverside County District 4 report, the local positivity rate—the percentage of tests that come back positive for the virus—is a too-high 14 percent. (The state wants that number kept below 8 percent.)

The numbers of cases keep going up. At first glance, the recent case numbers always look deceptively low on this report, and here’s why: The dates reflect positive cases based on when the tests are taken, not when the results come back—and since test results can take 3-5 days to receive, sometimes longer, we don’t have a lot of results back yet from last week. Just look at the numbers from May 25 on, and you’ll see the mess that the Coachella Valley is in.

• COVID-19-related hospitalizations, after being somewhat stable for the last week, have gone up substantially in recent days. County-wide, as of the weekend, 98.7 percent of our hospitals’ ICU beds were taken. However … according to the Los Angeles Times, that’s not the big problem, believe it or not; apparently, even in non-pandemic times, local hospitals frequently run out of ICU beds (!). Even now, there’s enough space, and plenty of ventilators. The problem is the number of medical professionals. Key quote:

Michael Ditoro, chief operating officer at Desert Regional Medical Center, said the facility hit ICU-bed capacity “well prior to COVID. Year after year.” The medical center’s surge beds are equally equipped to treat patients as regular ICU beds, he said.

Bed capacity might not be their biggest challenge, Ditoro said. Instead, it’s scant staffing.

“You don’t really have a centralized area with the beds all around it where it’s really quick to get to them. Instead, you may be in a longer hall unit where you need staff closer to each room,” he said of the surge units.

• Because of the increasing numbers, Gov. Gavin Newsom over the weekend cracked down on 15 counties, either ordering that they close bars—or strongly suggesting they do so. As a result, bars here in Riverside County—many of which had already voluntarily closed—will need to shut their doors tonight. Loophole alert: Bars can remain open if they serve food, and mandate that customers purchase food with their drinks. It’s also worth noting that Newsom said more closings could be ordered if things don’t improve.

The county Board of Supervisors meeting will take place online tomorrow, and parts of the County Administrative Center were closed, because several county employees tested positive for the virus

Los Angeles County is closing beaches over the July 4 weekend, since we, as Americans, are collectively proving that we’re incapable of wearing masks and social distancing and simply being intelligent in general.

• Cocktail break! Here’s Alton Brown’s refreshing mint julep recipe. If you don’t partake in spirits, here’s a non-alcoholic recipe.

• In Arizona, one of the COVID-19 hotbeds in the United States, Gov. Doug Ducey today ordered that bars, gyms, movie theaters and water parks close for at least 30 days, starting this evening. He also pushed back the planned opening of schools there by a couple of weeks. Weirdly enough, there’s still NOT a statewide mask order in the Grand Canyon State.

All Broadway shows have been cancelled through the rest of 2020 due to the pandemic—which has also led Cirque du Soleil to file for bankruptcy.

• However, in some places, the show is going on. CBS News looks at how some smaller theater companies are planning on presenting socially distanced plays.

• Oh, great. There’s more evidence this damn virus has mutated to make it more contagious. Just great!

According to this BBC News lede: “A new strain of flu that has the potential to become a pandemic has been identified in China by scientists.” OH COME ON YOU HAVE TO BE KIDDING ME.

• I don’t think we’ve ever taken two cocktail breaks in a Daily Digest before, but it seems necessary today. So, compliments of Independent cocktail scribe Kevin Carlow, here’s the lowdown on the history of the mai tai—with delicious recipes included.

Gilead has set the prices for remdesivir—the one drug sorta proven to help really sick COVID-19 patients—and it’s definitely not cheap.

• Maybe good news: According to The Conversation, SARS-Co-V-2 attacks cells kind of like some types of cancers do—but that means some cancer drugs may help battle the virus, too.

• We’ve often warned in this space that stories on scientific studies need to be taken with massive figurative grains of salt. CNN’s Sanjay Gupta isn’t wild about what he calls science by press release.

As a result of a screwed-up prison transfer, more than 1,000 inmates at San Quentin State Prison—that’s a third of the prison population there—have COVID-19.

• “Screwed up” can also describe the state inspectors’ response to COVID-19 outbreaks in nursing homes, which have killed thousands of people in California alone. Key quote from this Los Angeles Times piece: “Time and again, inspectors sent to assess nursing homes’ ability to contain the new virus found no deficiencies at facilities that were in the midst of deadly outbreaks or about to endure one.

• Finally, after all of that crappy-ass news, take 3 1/2 minutes, and let Randy Rainbow offer you a laugh or two—because he’s back with a new, mask-related ditty.

I think you’ll agree that this is more than enough news for the day. Please, everyone, wash your hands. Wear a mask. Social distance. Be kind. If you have the ability, please consider becoming a Supporter of the Independent, so we can keep paying Kevin Carlow to write about mai tais. (And so we can do other quality local journalism, too.) The digest will be back on Wednesday, barring something humongous happening tomorrow. 

Published in Daily Digest

The federal government now requires hospitals to publish online its “charge description master”—a list of what the hospital charges for various services and items.

When this new policy, which took effect Jan. 1, was announced last year, it was heralded as an overdue move to promote fairness and transparency within our country’s expensive and often-confusing health-care system.

Unfortunately … that’s not how things have turned out.

The Independent decided to see how this new policy is working at the three Coachella Valley hospitals. I dove into my research enthusiastically, easily locating and downloading the charge masters, as these lists are called, from the Eisenhower Medical Center (EMC) and Desert Care Network (DCN) websites.

Then … well, I opened the charge masters. Just as I thought I was gaining useful information, I discovered the downloaded documents, practically speaking, are useless to any layperson who lacks a knowledge of oft-unintelligible medical terminology. It’s also nearly impossible to compare between hospitals, since each uses its own terms and formats.

Download the Eisenhower Medical Center Chargemaster here.

Download the Desert Regional Medical Center Chargemaster here.

Download the JFK Memorial Chargemaster here.

Oh, one more thing: If you have insurance, you and your insurance company aren’t paying the amounts listed on the chargemaster, anyway.

According to the Association of American Medical Colleges: “The hospital charge description master … represents 100 percent of services used by patients in a hospital setting. The use of charge masters began in the early 1950s with the advent of indemnity insurance products; in this environment, hospital rates were set based on billed charges for individual services. As the health insurance industry matured, hospitals moved to payments based on negotiated rates, and the billed charges expressed in the charge master remained largely as a rate schedule for those patients who were private pay or uninsured. … The process for updating the charge master is not intended to ensure that it is a comprehensive document for tracking relative prices. Instead, hospitals focus on adding new services and calibrating highly competitive services rather than updating rates for older services.”

Still … I wanted to ask why the charge masters from our local hospitals were so unwieldly, poorly organized and confusing.

I received no reply from Eisenhower, but I did speak briefly with Todd Burke, California director of communications for Tenet Healthcare, which runs the two valley hospitals within the Desert Care Network: Desert Regional Medical Center in Palm Springs, and JFK Memorial Hospital in Indio. He provided a corporate statement which read: “The hospitals of the Desert Care Network focus on providing high-quality, cost-effective care to all patients we serve. We understand that the costs of health care can be confusing. When looking at the charges posted to our website, it is important to know that the charges posted are a reference price and not the amount that patients or insurers actually pay. When inquiring about actual costs of care, we strongly encourage patients to speak with their insurance provider, or if uninsured or those patients who have Medicare or Medicaid, to speak with the hospital’s financial services department.”

Burke also suggested that I reach out to Jan Emerson-Shea, the vice president for external affairs at the California Hospital Association. So I did.

“You know, people often like to say, ‘Well, I shop for shoes, and I shop for cars, so why shouldn’t I be able to shop for health care, and look at prices ahead of time?’” Emerson-Shea said. “We understand the desire for that level of price transparency, and hospitals are always willing to do the best they can to provide that information. But it’s important for people to understand that these things are different, because you’re talking about a person’s individual health-care needs. So if I happen to have diabetes, and you don’t, we might be having the same health-care procedure, but mine might be more complicated and more expensive due to my pre-existing health condition. People have to understand that everything with health-care pricing is dependent on what your actual needs are as a person, and then it’s also dictated by what your insurance coverage is—and if you are uninsured, California has a decade-old law that limits how much you can be liable for in terms of your hospital care. Depending on your income level, this state law says that hospitals are required to give you either free or discounted care based on a sliding scale. So, really, no patient ever winds up paying the dollar-cost amounts that are shown on any charge master list.”

In other words … all the hospitals in the United States are complying with this requirement to post their charge masters because they’re required to do so, yet everybody involved knows that the charge masters are of no use to anyone in the patient population?

“Yes. That’s exactly right,” she replied.

Where does this leave the discussion about cost transparency within the health-care industry?

“Legally, we are complying with what the laws and regulations require,” Emerson-Shea said. “Is it fair to say that hospitals understand that this information is not very useful, and that we’re looking for ways to make it more useful? Yes. This is not an easy discussion, but I can certainly say that our association is working with our member hospitals to figure out what other options there may be. There are some hospitals in the state that have looked at new technologies to see if there’s a way to put a price estimator on their website that allows patients to go in pre-surgery and enter their information. I think it’s certainly fair to say that there’s a live conversation going on.”

She them summed up the puzzle facing all parties involved.

“If you’re faced with having a procedure done at a hospital, you’ll be going to the hospital where your doctor practices, or you’re being taken to one by an ambulance. … Are you really going to shop around for prices in that situation? I know the California Health Care Foundation has done some research on this question, and they found that, for the most part, consumers are not shopping for health care in that way. … It is not similar to shopping for any other type of a consumer product. Still, I think it’s fair to say that hospitals are looking at how to make this information more useful for patients.”

Published in Features

Gov. Jerry Brown signed the End of Life Option Act in October 2015, and the law went into effect on June 9, 2016.

But for many Coachella Valley residents who have been diagnosed with a terminal illness and given a prognosis of less than six months to live, the end-of-life option remains out of grasp—that is, unless they switch health providers.

Trust me, I know: I helped my mother-in-law through the end-of-life process last year.

No statistics are available yet regarding the number of Coachella Valley patients who have obtained prescriptions for life-ending medications since the law took effect; the initial annual report required by the law will not be issued until later this year. But according to patient, doctor and advocate feedback, the refusal of some major health-care providers in our valley to support the new law has been keeping those numbers down. Eisenhower Medical Center (EMC), with facilities located across the valley, and both Desert Regional Medical Center in Palm Springs and JFK Memorial Hospital in Indio (the latter two owned by Tenet Health, a company based in Dallas) have been refusing assistance to terminally ill patients.

However, this picture improved in mid-February, when Tenet Health informed Compassion and Choices—a national nonprofit “medical aid in dying” advocacy organization—that the company had established a “regulatory compliance policy to define the scope of permitted participation, documentation and notification requirements for Tenet entities” in California.

Compassion and Choices California director Matt Whitaker welcomed the news.

“Tenet confirmed that their physicians are indeed allowed to participate in the (End of Life Option) act,” Whitaker wrote the Independent in an email.

Curiously, the written policy just delivered by Tenet was dated June 7, 2016. What could have caused the eight-month communication delay?

“The good news is that they (Tenet) are going to allow individuals to have access to medical aid in dying,” said Joe Barnes, the Compassion and Choices California outreach manager, during a recent phone interview. “It sounds like they are probably still having challenges about whether or not to allow people who are being treated in their hospitals to be able to be in a private hospital room surrounded by loved ones and ingest the medication to end their pain and suffering.”

Barnes said many health-care organizations are still figuring out the logistics of dealing with the new law.

“It seems some health-care systems are still working out the internal mechanics of how they are addressing the needs of their patients,” he said. “Sometimes, one side of the hospital is not communicating with the other side, and then the patient doesn’t receive the correct information. But we try to follow up with health-care systems to see what their questions might be if they have any, and also to find out what their official policy is. If a health-care system doesn’t have a written policy, then they are automatically considered a supportive health-care system.”

While Tenet is taking steps toward assisting patients with the law, EMC is apparently not. I contacted Lee Rice, the media coordinator and public relations specialist at EMC, to talk with an appropriate representative regarding the End of Life Option Act. After several days, Rice replied that no interview could be arranged. He did, however, forward to me an official statement, which read, in part: “Eisenhower Medical Center carefully reviewed and discussed the requirements of the End of Life Option Act and elected the option under the act not to participate in the process. … Eisenhower will provide information about the End of Life Option Act upon request and supports each patient’s right to make decisions about care, including the choice to accept or reject treatments that might be available.”

Compassion and Choices’ Whitaker expressed disappointment with EMC’s stance.

“We would characterize Tenet’s policy as supportive, but not Eisenhower’s,” Whitaker said. “The line that (Eisenhower representatives) keep using is that their physicians are free to do this on their own time. That’s the framing they use to say that they’re not limiting access for patients in the area: ‘We (EMC) are only limiting it during the time that they’re employed by us.’ But the way that health care has consolidated, EMC has 40-something clinics that have affiliated with them in the area, so there are not a lot of sole practitioners out there—and for folks who work in a hospital or an outpatient clinic, they don’t really have the ability to do things on their own time. They don’t have their own medical-records system. Oftentimes, their malpractice insurance is through their employer. They don’t have the physical facilities available to care for these patients. So (EMC) is kind of a broken record when they just keep pushing back, saying, ‘Well, the doctors can do it on their own time.’ That’s not what’s needed. Patients who are being seen by doctors at these clinics need to be able to receive this treatment during the course of their care.”

In an effort to influence EMC’s stance, Compassion and Choices supporters and other valley residents are planning a rally at 11 a.m., Thursday, March 2, in front of the main Eisenhower Medical Center campus in Rancho Mirage.

“Ever since Eisenhower Medical Center announced that it wasn’t going to allow people to have access to medical aid in dying, there’s been an increase in the requests for presentations to community groups and organizations across the area,” Barnes said. “The question always comes up as to what the community can do, because that’s (one of the) the flagship hospitals in the area.

“We have thousands of people who are supportive of medical aid in dying in that area. They helped us pass the law in the first place by reaching out to their local legislators and holding events to educate fellow community members to the importance of medical aid in dying. So, the natural next step is that the folks want to have a rally in front of the hospital. Many of the people who will be at the rally are also donors to the Eisenhower (Medical Center) Foundation. They’re kind of scratching their heads, because they live in the community and donate to the hospital but can’t get access to medical aid in dying, and they really don’t understand it.”

Published in Features

Linda is my wife, my best friend. She’s the daughter of Annette, who had been battling cancer for years.

Fifteen months prior to this August 2016 morning, Annette, then 93, had come to live out her last days with us in our Palm Desert home. Now, Linda stood at the foot of her mother’s bed and spoke softly to our cat, who had stretched herself out across Annette’s lower legs.

“Lola, honey, come on now,” Linda cajoled. “You have to get up, sweetie. Mom-mom’s no longer here. She’s gone now.”

Lola stayed put with her chin on her crossed front paws. It seemed that nothing or no one could disturb this quiet, calm and peaceful scene.

Thanks to California’s End of Life Option Act, Annette had just left behind the painful captivity of the cancer that had progressively destroyed her quality of life.


This peaceful day came after one of the most trying 15 months of our lives.

“Mom was diagnosed as having six months or less to live, and was in hospice care when she came to stay with us,” Linda recalled. “At this point, she never had a day when she felt well. So, when the End of Life Option became legal in California,” on June 9, 2016, after being signed into law by Gov. Jerry Brown in October 2015, “she decided that she wanted to participate in it. I went online and did a lot of research.”

Linda quickly learned the process was not going to be easy.

“What I found was that none of the hospitals out here (in the Coachella Valley) were participating in providing their patients with the support to obtain the life-ending prescriptions,” Linda said. “And that meant that none of the doctors out here, as far as I knew, were participating.”

Linda has directed information-research departments for major media and advertising companies—so her online search skills are well-honed, to say the least. However, she could find no local leads for resources to contact on her mom’s behalf.

“Actually, that isn’t uncommon, because doctors don’t want to advertise that they participate in this program,” Linda said. “I had been in contact with people in Oregon and other states where (medical aid in dying) had been legal for a while. That’s where I started to see what had come before: Doctors don’t want to be seen as ‘Dr. Kevorkians’ or doctors of death, so there are no lists. Even in places where it has been legal for 18 years, there’s no list for doctors who are participating. You have to talk to your own doctor.

“During my research, though, I came upon the organization Compassion and Choices, and I contacted them,” Linda said. “I asked if they had any contacts in California who could help us access this option, and they said that the only thing they knew was that Kaiser Permanente was participating—which meant, to me, our only recourse was Kaiser.”


Amy Thoma, the director of public affairs for Kaiser Permanente, recently talked to me about Kaiser’s participation.

“We allow our physicians to participate in California’s End of Life Option Act,” Thoma said. “Physician participation is not mandatory. Also, we allow it in other regions such as Washington and Oregon, where it’s been an option for a while now. We encourage our patients to have thoughtful discussions with their loved ones, family and friends, as well as their health-care providers, about their end-of-life wishes so that they can have whatever dignified ending they choose.”

I asked what Kaiser does to “market” the fact that it allows patients and their doctors to participate in the End of Life Option Act.

“Health plans in general are not allowed to market the End of Life Option Act in California,” Thoma said. “It’s prohibited by (the End of Life Option) law, so we do not market it to our patients at all.”

Thoma referred me to Compassion and Choices for a broader discussion about medical-provider systems in California and their participation in the End of Life Option Act. Therefore, I reached out to Matt Whitaker, the newly appointed California state director for Compassion and Choices. We asked him whether the lack of support by the medical industry in our area was atypical.

“I would say that the Coachella Valley is pretty unique in the way that there is really no access to medical providers supporting the End of Life Option Act program,” Whitaker said. “In most of the population centers across California, you have the few religiously affiliated hospitals and organizations that made the decision not to participate, but you don’t see the majority of health systems choosing not to participate.”

In particular, he focused on the fact that Eisenhower Medical Center, one of the major health-care providers in our valley, has chosen not to offer End of Life Option services—nor is Eisenhower permitting any associated doctors to participate.

“They are not religiously affiliated,” Whitaker said. “We know from our work in the community that they have a large number of doctors who want to participate and who were super-upset when the decision not to do so came down, because there wasn’t much stakeholder engagement at all prior to making that decision.”


Last summer, Linda began taking steps for Annette to move from her existing insurance plan and health-care network to the Kaiser Permanente universe.

“Mom had Medicare insurance, so what we needed to do was change her supplemental insurance to Kaiser,” Linda said. “Fortunately, if you are on Medicare, Kaiser offers open enrollment at any time, all year. … But before we joined Kaiser, I called them, and we went over everything. They told me that (providing End of Life services in California) was new to them, and that they were hiring an end-of-life coordinator for Riverside County who would take us through the entire process. So we cancelled Mom’s supplemental policy in the middle of the month, and by the first of the next month, she was on Kaiser. She got a senior (citizen) insurance plan that had no monthly fee to be paid.”

It became very obvious, very quickly, that the Riverside County end-of-life coordinator’s support was an invaluable resource provided by Kaiser. The two of them worked as a team on Annette’s behalf in the weeks ahead.

“Once I got in contact with the new and extremely helpful coordinator, she reviewed for me the criteria necessary for a terminally ill patient to qualify for the End of Life Option in California,” Linda said. “You have to prove that you are a resident of California; you need to have a diagnosis of six months or less to live; you have to demonstrate that you are in your right mind and not suffering from depression; and you must be able to self-administer the prescribed medications. Also, you must be able to confirm, both in writing and orally, that you are personally in agreement with the decision to follow this end-of-life course of action.”

The California law also stipulates that two doctors must be involved in the process of granting permission to obtain the life-ending medications.

“The coordinator told me that there would be a first-opinion doctor who Mom would see initially, and who would then evaluate her again at least 15 days following that initial in-person appointment,” Linda said. “During that interim period, she would have to visit another doctor in person for a second opinion.”

Because Kaiser’s operations in support of the End of Life Option Act in California were just beginning, there were no existing relationships with doctors in their network who had elected to participate in the program. Originally, the coordinator was able to find doctors—but they were hours away from Palm Desert. “I told her that Mom was in no shape to make those trips,” Linda said. “I explained to her that we weren’t in a rush, but that we needed to find doctors close to our home in Palm Desert.

“She found us the first-opinion doctor at the Kaiser Indio facility, and the second doctor was in Palm Springs.”

At this point, Annette was given a form that she had to complete in preparation for her initial doctor visit, and appointments were made for the first two doctor visits.

“When we saw the first doctor, it was not a long trip to Indio, and the visit was rather short,” Linda said. “(My mom) gave him the completed form, and he reviewed her medical history. Then he interviewed Mom to make sure that this was her choice, and that it wasn’t a case of anyone trying to talk her into it. He asked why she wanted to pursue this end-of-life option. She told him that she suffered from two types of cancer and never had a day when she felt well.

“Less than a week later, we had an appointment to see the second-opinion doctor in the Palm Springs Kaiser office. He asked her another bunch of questions: When was she diagnosed? What illness did she have? Was she in pain? He talked to her about other things to confirm that she was coherent and in her right mind, and that it was her choice to do this. Also, he asked if she was capable of self-administering the drugs.

“Finally, Annette had her return consultation with the first-opinion doctor. Shortly thereafter, he was able to prescribe the necessary medications.”

The cost of these medications to the patient can vary, depending on the type of insurance; in fact, the drugs can be quite expensive. However, Kaiser may be able to help a patient find financial aid if he or she can prove financial hardship.

At this stage, the coordinator made an appointment for Linda to meet with a Kaiser pharmacist manager for the drugs to be delivered into the possession of either the patient or his/her representative, and to review—in detail—the procedure for administering the drugs.

“In our case, I met him at the Moreno Valley Kaiser facility,” Linda said. “He explained that there would be three separate drugs to be ingested to complete the end-of-life protocol, and he described in great detail the procedure for taking them to ensure the intended result.”

Everything was ready for Annette to make a final decision. The process—from the time she joined Kaiser to the time when we received the life-ending drugs—took no longer than 60 days.

“It’s important to note that the patient can change his or her mind at any time during this process,” Linda said. “Even if they have obtained the prescribed medications, they can change their mind. It seems that only approximately 30 percent of the people who receive the medications actually follow through and take them. … A lot of people change their mind.

“It gives you the option to control your own passing, and that is a wonderful thing.”


Dr. Wayne McKinny is a retired pediatrician and a resident of Desert Hot Springs. He’s also a hospice patient, diagnosed with terminal bladder cancer.

In the last six months, he has written two opinion pieces published in the local press. Both decried the refusal of our valley’s three major hospitals—Eisenhower Medical Center, Desert Regional Medical Center and John F. Kennedy Memorial Hospital—to participate in or allow any of their associated doctors to participate in End of Life Option medical support. He is currently working with Compassion and Choices on their efforts to get these large medical organizations to support the law—and their patients’ desires.

“Having this right available is emotional insurance for a dying patient,” Dr. McKinny told the Independent. “They know they have it, and that they won’t have any problem, and they can use it. Likewise, it’s emotional insurance for a person who does not choose this option initially, because they know that if they change their mind, they would be able to get the option somewhat easily.”

How can terminally ill and despairing patients in our valley get access to the right to choose the circumstances of their passing?

“The choices that have been made by Coachella Valley health-care systems are not reflective of the attitude of the people in the community,” said Whitaker, of Compassion and Choices. “That’s what we’re really trying to make sure those hospitals there know. Hospitals and health systems are a community resource like libraries, churches or community centers. They exist to serve their communities. For example, during the (statewide) campaign to get the End of Life Option Act passed into law, there was a huge amount of support out of the Coachella Valley. There were a lot of people who did organizing and advocacy to make the option available, and so I think that’s where a lot of the current community disappointment comes from. There’s this population there that clearly wants this option, but the bulk of the apparatus (of medical providers) that is there to serve the community isn’t doing it.

Whitaker said his organization has had several hundred people call Eisenhower Medical Center to voice their disappointment.

“We’ve tried to approach the issue with as much civility as possible, but it’s gotten to the point where people who are interested in pushing back should go to our website and sign up to volunteer and add their name to our list,” he said. “We will be holding rallies and community meetings. We have an organizer in Southern California, and the Coachella Valley is an area with a big bull’s-eye on it for him, because we need to get people out and empowered and making some noise about this issue.”


Neither Linda nor I will ever forget that August day when Annette, who had been sick and in pain for so long, chose to end her life

“On the morning that Mom chose to follow through on her decision, we sat her on the edge of her own bed in her own room,” Linda said. “We followed carefully the process the pharmacist had described. The first drug she took was an anti-nausea medication to ease the ingestion of the other drugs in the quantities prescribed. Then, about 45 minutes later, the second drug was taken; it was a beta-blocker intended to slow down the heart rate. Then about another 15 minutes later, Mom took a large dose of Seconal, which would cause death. We had opened up 90 capsules and mixed their contents into one half-cup of applesauce, which she ate. (It could be mixed into juice or other items that the pharmacist approves.) The pharmacist had emphasized that Mom had to follow the procedure closely, and that there was a certain timeframe in which the drugs had to be completely consumed to avoid any mishaps.

“After she finished taking the last of the Seconal, we helped her lie down on the bed and made her comfortable. I had an aide, who Mom had grown close to, helping me that morning, and it was a very good idea to have her there. It’s good to have someone there with you for support.

“Very quickly, like after 30 seconds, Mom closed her eyes and drifted into a peaceful sleep. Her breathing was a little labored, but that was pretty much normal for her at that point. And then in about 20 minutes, with no gasping for breath or anything, she just stopped breathing. And it was so peaceful. It was really incredibly peaceful. She had her favorite cat with her, and it was just a beautiful death. She wanted it to be very quiet. We had put her in very comfortable clothes, and it was very beautiful.

“It’s the way we all should die.”

To enroll in a Kaiser Permanente health plan and/or to receive information about their End of Life Option services, call 800-464-4000. For more information about the End of Life Option Act, visit www.compassionandchoices.org/california.

Published in Features

Zackary Davis always dreamed of becoming a nurse. The 26-year-old graduated from Cal State San Bernardino’s Palm Desert campus in June 2012; he was the first in his family to go to college.

He estimated that he has applied to more than 100 health-care facilities since. Davis said he has had five interviews—and no job offers. Today, he works as a valet at the Hyatt Regency Indian Wells.

“I’ve basically let go of the chance of getting the ER or ICU like I want,” said Davis, who lives in Indio. “I’m sure there are a ton of stories that are just like mine. It’s cruddy, but I’m trying to stay positive about it.”

He’s not alone.

A 2011 survey by the National Student Nurses Association found that 36 percent of newly licensed registered nurses did not have jobs four months after graduation.

It’s worse in California. About 46 percent of newly licensed RNs were without jobs up to eight months after graduation, according to a recent California Institute for Nursing and Health Care survey.

The survey also found that more than 90 percent of those without a nursing job blame their lack of experience, and nearly one in four were employed in non-nursing jobs.

New grads say who you know is as important as passing the board exam.

“Honestly, I only got hired because I knew somebody,” said Candice Eckstrom, 33, who graduated from the College of the Desert’s Registered-Nurse Program in May.

She began working at an Indio rehab center in October.

“Was it my first choice?” Eckstrom said. “No, but everyone in nursing knows that you have to get experience wherever you can get it, because there are no jobs for new grads right now.”

After years of investments in building up the nursing workforce, the challenges new nursing grads face is a growing concern.

“The valley has spent a lot of money developing these students, and if they don’t get a job, they may drop out,” said Betty Baluski, assistant director of COD’s nursing program. “That’s our biggest fear—that we lose them in the future.”

The nursing shortage of 10 years ago that triggered enlistment campaigns and big signing bonuses sent students into nursing programs by the droves, with the promise of secure employment.

And then the recession hit. Nurses who might have gotten out of the workforce after having a child decided to keep working. Nurses who might have retired decided to put off retirement.

“The big thing that happened was the change in the economy,” said Wayne Boyer, COD’s director of nursing. “We’re still in the throes of that. Ten years ago, they were giving $10,000 incentive bonuses and all kinds of bells and whistles and promotions. You don’t see that any more; they just went away.”

With the aging of the U.S. population and the graying of the nursing professional—the average nurse nationwide is 46 years old—the recession has masked the demand, at least for now. The Bureau of Labor Statistics projects that by 2020, more than 1.2 million RNs will be needed to shore up the workforce.

“When times were good, nurses retired,” said Kristin Schmidt, assistant chief nursing officer at Desert Regional Medical Center in Palm Springs. “When the recession happened, they all ended up having to go back to work to support their families. In the next 10 years or so, we’re probably going to be hurting for a lot of nurses.”

Ann Mostofi, Eisenhower Medical Center's chief nursing officer, agreed.

“We have really had no need for new nurses coming into the workforce,” Mostofi said. “As the economy improves, what’s going to happen is we’re going to have a drastic removal of nurses from the workforce.”

Nationwide, there are more than 2.6 million nurses practicing in hospitals and other settings. California has about 392,400 working nurses, while Riverside County has 18,500, according to the state Board of Registered Nursing.

Historically, hospitals have been the largest employer of nurses and new graduates. But that is likely to change when the Affordable Care Act, known as “Obamacare,” is fully implemented. As more people have access to health insurance, some nursing jobs will move to clinics, rehab facilities and specialty centers, such as those for diabetes and orthopedic surgery.

“It’s challenging to get nurses to think outside a hospital setting for their first job, but I think that’s going to be what’s called for in the future,” Schmidt said.

The valley’s three hospitals—Desert Regional, Eisenhower and JFK Memorial Hospital—employ about 1,800 nurses. Hospitals typically have a 14 percent annual turnover rate, according to national statistics.

In the past three years, Eisenhower has hired 95 new grads—nearly the same amount as those with experience, Mostofi said.

With about 100 nursing students graduating each year from COD alone, the competition for local jobs can be fierce. Each of the hospitals has a nursing program designed to give hands-on training to new grads—but it’s difficult to get in to those programs. Desert Regional had more than 300 applicants for its 24 slots this fall.

Next summer, COD will sponsor a mentor program designed to help ease new graduates into the workplace.

“It might be hard to find their first job, but once they get their first job, they’re pretty golden; they’re very marketable,” Mostofi said. “I would say that even the new grads shouldn’t be too disheartened.”

Meanwhile, Davis continues his 18-month-long nursing-job search.

“I’ve always wanted to be a nurse,” Davis said. “It’s going to happen eventually.”

Published in Local Issues