CVIndependent

Sun02182018

Last updateWed, 27 Sep 2017 1pm

On June 27, the California Department of Public Health issued its first data report on residents’ participation in the new End of Life Option Act.

The law was signed by the governor in 2015 and took effect on June 9, 2016. The report reveals that 258 terminally ill California patients—diagnosed as having less than 6 months to live—started the process as called for under the law, as of Dec. 31, 2016.

Of those 258 patients, 191 were prescribed the life-ending medications, by 173 unique physicians. The report states: “111 patients, or 58.1 percent, were reported by their physician to have died following ingestion of aid-in-dying drugs prescribed under EOLA, while 21 individuals, or 11 percent, died without ingestion of the prescribed aid-in-dying drug(s). The outcome of the remaining 59 individuals, or 30.9 percent, who have been prescribed aid-in-dying drugs, is currently undetermined, as there has been no outcome reported for these individuals within the time period covered by this report.” (Full disclosure: One of the 111 patients who passed away using the new law was my mother-in-law; see “Annette’s Story,” posted at CVIndependent.com on Dec. 20, 2016.)

Kat West is the national director of policy and programs at Compassion and Choices, a national support organization for medical aid-in-dying patients and their cause. The organization just released its own, independent report on the law, covering activity through May 31 of this year.

“We were actually very encouraged by the data that came out of the state, because it showed that (the participation rate) was in keeping with our previous experience in the other authorized states,” West said. “The one piece of data we were very happy to see was the ratio of the number of different doctors prescribing the drugs compared to the group of patients requesting. That was a really good indicator that medical aid-in-dying is being what we call “normalized” and basically mainstreamed into end-of-life care.”

According to the Compassion and Choices report, the organization knows of 313 prescriptions that were written for medical aid in dying in the first five months of 2017. Meanwhile, 498 health-care facilities and 104 hospice locations have adopted policies supportive of patient choice, while about 80 percent of private insurance companies have covered the cost of the medications, including Blue Cross Blue Shield, Kaiser Permanente, Sutter and all Medi-Cal plans.

“The additional 313 prescriptions issued (thus far in 2017) were only the ones that we know about,” West said. “There are plenty of doctors who did not reach out to our organization, and there are plenty of terminally ill people who did not reach out to us. As a result, we don’t know of all of the prescriptions that may have been written in the state of California.”

Not all of the news is good for proponents of medical aid-in-dying protocols. The federal House Appropriations Committee recently voted to block funding to implement a new medical aid-in-dying law in Washington, D.C.

In California, a Riverside County Superior Court judge allowed the Ahn vs. Hestrin lawsuit, which challenges the End of Life Option Act, to move ahead into the courts, although an injunction request to put the law on hold was rejected by the judge.

John Kappos, a partner at the O’Melveny and Myers law firm, is representing proponents of the law. He said he is not too concerned about the lawsuit.

“What I find most concerning is the fact that a purely voluntary procedure like medical aid in dying causes some people to try to impose their will on others,” he said. “People can decide that they want to do it, or they can decide that they’d prefer not to do it and just die of natural causes. There’s no one here who is telling the people who do not want to participate in medical aid in dying that they need to, or have any obligation to do so. It’s very concerning to me that there are people in California who feel that they need to tell others … they have to suffer at the end of life, and potentially die an excruciating death.”

Kappos said it could take a year or longer for the case to be resolved. “It’s hard to guess at these kinds of things, but in my view, these are purely legal issues, and eventually, that will come to light, and the case should be resolved on a motion (in the defendant’s favor).”

Here in the Coachella Valley, Eisenhower Medical Center continues to deny its staff and doctors permission to write medical-aid-in-dying prescriptions for its terminally ill patients.

“I try to take the long view, and that is that change is hard,” said West, of Compassion and Choices. “But look back 20 years as an example. If you were to bring up the subject of hospice care with a group of medical professionals, it would clear the room. That’s how taboo the topic of death and end-of-life care was then. Now, of course, hospice is completely mainstream, and everyone thinks it’s great. So it’ll be the same trajectory for medical aid in dying, especially now that California has authorized it.

“Eisenhower is just going to find itself out of step with the community’s needs and desires. It’s going to find itself out of step with its own doctors’ feelings about the issue, and eventually, it will change its policy. The community clearly wants it, so it’s just the administrators. The community is already stepping up their demands, and internal champions within Eisenhower are also calling us and letting us know what they think.”

West predicted change will come to Eisenhower sooner rather than later.

“I’d say they will change their policy within a year. I do believe that,” West said. “The administrators have to pay attention to what their community is asking for.”

West suggested that everyone engage in an end-of-life-treatment discussion with their own health-care professionals.

“Our big ask of everyone is to ask your own doctor now if they would provide the protocol legalized in the End of Life Option Act—whether she or he will support you if and when the time comes,” West said.

Published in Local Issues

The quiet bustle outside of Eisenhower Medical Center’s medical campus in Rancho Mirage was disturbed by the old-school call and response of an organizer’s bullhorn and a crowd of protesters on the morning of Thursday, March 2.

“What do we want?” shouted Joe Barnes, the California outreach manager for Compassion and Choices, a national advocacy group for terminally ill patients.

The crowd of 100 or so enthusiastic supporters of the California End of Life Option Act responded: “Access!”

Barnes continued: “When do we want it?”

“Now!” hollered the crowd.

The protest on the sidewalks alongside the Bob Hope Drive entrance to EMC was organized by, and for, Coachella Valley residents frustrated by the refusal of EMC administrators to allow any of their doctors, other professional staff members and facilities to participate in the new state law, which lays out the strict guidelines under which patients can obtain life-ending prescriptions, should they so choose. (Full disclosure: My mother-in-law utilized the law last year.)

Signs were waved; short and impassioned speeches were given; chants were raised; and then the group headed into the hospital building to meet with an EMC representative.

“We encourage members of our communities to speak with their doctors about what their priorities are at the end of their life, and really become a team with their doctors rather than accepting everything that the medical community just pushes out to them,” said Joan Stucker, the chairperson of the Coachella Valley Access Team for Compassion and Choices, to the Independent during the rally. “We have a hold-up (in patient access to End of Life Option services) with Eisenhower Hospital, because their doctors are employed by the hospital, and even though some of their physicians want to give their patients access, they (EMC leaders) refuse to let them do that. We want them to change that position.”

The other major-health care provider in our valley, Tenet Healthcare, operates the Desert Regional Medical Center in Palm Springs, the JFK Memorial Hospital in Indio, and the Hi-Desert Medical Center in Joshua Tree. These facilities will not be a target of pro-End of Life Option demonstrations, because Tenet administrators recently clarified publicly that they will allow their personnel, including doctors in their networks, to support a patient’s End of Life Act rights.

The newly released official policy statement stipulates that any Tenet personnel who choose to engage in the End of Life Option procedures must record patient interactions in the Tenet health records systems. While Tenet physicians may write prescriptions for the life-ending drugs described in the California law, patients may not fill those prescriptions in Tenet pharmacies, or take those drugs in any of Tenet facilities.

Tenet is clearly doing more to address the needs of the terminally ill patients than EMC, which refuses to cooperate with the California law on any level.

“It just doesn’t seem that they (EMC) are providing the good care that they claim to give,” Stucker said. “They’re supposed to give incredible care to their patients, and yet they’re refusing to let them have this option.”

Idyllwild resident and EMC patient Francoise Frigola turned out for the rally.

“I asked my doctor what her position was (regarding the End of Life Option Act), and she was furious,” Frigola explained while leaning forward in her wheelchair. “She was part of writing the law, and because she’s affiliated with Eisenhower down here, she cannot do anything.”

Barnes told the Independent that he spoke with an EMC representative before the rally and told her: “‘You know, if you did what you said you were going to do, then we wouldn’t have this rally here today.’ Last fall, Compassion and Choices spoke to EMC representatives, who told us that they would make public outreach efforts and hold a town hall-style meeting where patients could state their concerns. But they never did anything.”

We asked Stucker what steps would next be taken regarding the lack of End of Life Option access at EMC.

“We know that getting access to medical aid in dying takes time. We know there’s a certain amount of resistance,” Stucker said. “It’s very difficult, because physicians and hospitals have not really been trained in end-of-life care. They’re very uncomfortable doing something that they’ve actually been trained not to do. But Eisenhower Medical Center is such a major player in local health care, serving a lot of patients all over the valley. We think it’s only right that their patients have a chance to get access (to medical aid in dying assistance) with the physicians that they are seeing.”

Published in Local Issues

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