The Shape of Health Care to Come in Orange County

Taking her place behind a makeshift podium, Sister Corrine Bayley scanned the crowd of more than 200 Orange County residents jammed into the Costa Mesa City Council chambers.

“This is not just the beginning of a meeting,” Bayley said, “but the beginning of a movement that I think could be for the ‘80s what civil rights was for the ‘60s.”

Thus began the first public meeting of California Health Decisions--Orange County Project, an ambitious, countywide project sponsored by the Orange County Health Planning Council and the Center for Bioethics at St. Joseph Health System in Orange.

Beginning this fall, it will begin seeking public opinion--and recommendations--on the many difficult ethical issues in health care that have emerged in the wake of life-prolonging medical technology and increasingly high medical costs.

Those issues include such questions as: Is it appropriate in every case to use life-prolonging technology? Do people have the right to health care? If so, how much? What areas of health care should have priority in the allocation of tax dollars?

Modeled after a pioneer project conducted in Oregon in 1983 and 1984, California Health Decisions--Orange County Project is the first such effort to be undertaken in California.

“We are on the ground floor of a movement that can shape the future of health care,” observed Bayley, director of the Center for Bioethics and vice president of St. Joseph Health System. “We have an opportunity to take part in what is becoming one of our most crucial domestic issues: health-care rights and choices.

“How the issues are decided will affect us all.”

California Health Decisions--Orange County Project calls for a series of public meetings to be held throughout the county over a seven-month period.

As outlined at the Tuesday night kickoff meeting by project director Ellen Severoni, more than 200 small group meetings will be conducted between October of this year and February, 1986. Those will be followed by at least 12 large town hall meetings to be held between February and May.

Will Examine Data

In October, 1986, delegates who have been nominated at the meetings will meet in a Citizens Health Care Parliament. They will examine all the data collected at the meetings, debate it, refine it and prioritize it.

The result, Severoni said, will be a series of health-care recommendations that will be passed on to policy makers and health-care providers.

“Not so many years ago, a project like this one would have been unthinkable and that’s because the health-care choices and the costs we face today were also unthinkable not so many years ago,” Bayley said.

In the past few decades, she said, “we have witnessed the development of amazing medical technology and sophisticated forms of treatment that are now in widespread use. If you think about it, we are really living at a time when human beings have an almost unprecedented control over life and death.”

Indeed, she said, it is an age in which “we can start a failed heart; we can keep people living long beyond the time they would (previously) have died, with such things as coronary artery bypass surgery, organ transplants, ventilators and neonatal intensive care units.

“We have artificial hearts and artificial kidneys and research is proceeding on artificial livers, lungs, placentas, and the list goes on. We can conceive human life outside the womb and we can transplant an embryo from one womb into another. Research is proceeding on cloning, on extending the life span, on genetic engineering and freezing bodies for some future resurrection. . . . “

Bayley said she agrees with a philosopher who declared, “Never has so much knowledge been coupled with so little guidance for its use.”

“And where,” she asked the audience, “will that guidance come from?

“We’re hoping it will come from people like you--people who are interested enough to come out tonight, people who are proud of what our health-care system has done but who are aware that there are significant areas that need improvement.”

Among the 228 Orange County citizens who turned out for the project’s introductory meeting were doctors, nurses and other health-care professionals, representatives of city governments and at least 70 ordinary citizens--people like Gloria Davenport of Orange.

“I think it’s about time for the public to be involved,” said Davenport, a counselor and instructor at Rancho Santiago College in Santa Ana, who described the project as “an opportunity for the public to be awakened to the need to look at whether we can live or die with dignity.

“I have a deep concern that something be done to make the public free to make decisions without getting legal repercussions,” she said. “I’m excited tonight in seeing the interest in professionals and the lay public.”

Equally Excited

Project director Severoni, a registered nurse, was equally excited at the conclusion of the meeting, which resulted in more than 60 volunteers signing up to serve as group leaders, who will be trained to facilitate the public meetings.

“I’m really pleased as punch,” Severoni said. “The momentum is here, the issues are timely and the community is concerned--and that’s what I think I saw tonight.”

Until now, Severoni said, “The public hasn’t been involved in health-care issues” because they haven’t had a formal mechanism to influence how health care is delivered.

Although Orange County is currently the only area involved in California Health Decisions, Severoni said she has received commitments from health planning agencies throughout the state to replicate the Orange County Project.

As a result of the Oregon Health Decisions project, Severoni said, five other states also are now conducting projects of their own, and the Prudential Insurance Foundation has begun offering grants for “local decision-making in bioethics.”

California Health Decisions, a nonprofit organization with a 37-member advisory board, recently received a $15,000 first-year grant from Prudential. Severoni stressed, however, that the grant is only seed money for conducting the project and that other grant applications are being made. She added that more than $4,000 in donations also has been raised from local hospitals.

Although Severoni noted that legislation may come as a result of the California Health Decisions’ recommendations, she told the audience that “we as a community can begin to make some decisions for ourselves that will not require legislation. Our hospitals are in need of some guidelines on how we expect these (ethical) decisions to be made.”