Health Issues Project’s Ready for Next Step : With Public’s Views in Hand, Organizers Plan a Forum Tonight

California Health Decisions--Orange County Project, the ambitious grass-roots effort to seek public opinion on ethical issues in health care, has heard from the people--nearly 5,000 residents--and is now ready to begin acting on their recommendations.

Organizers are inviting the public to attend a forum tonight at 7:30 in the Costa Mesa City Council chambers, 77 Fair Drive. Project director Ellen Severoni and Sister Corrine Bayley, director of the Center for Bioethics at St. Joseph Health System in Orange, one of the nonprofit project’s sponsors, will discuss ways individuals can work toward implementing the health care recommendations voted on during the project’s daylong parliament in September.

At the parliament, 180 delegates--who included representatives selected during the community meetings, legislators and community leaders in business, medicine and education--voted on the issues most frequently raised in a series of community meetings.

Over an eight-month period that concluded in June, 12 town hall meetings and more than 200 small group meetings were held around the county to discuss critical issues in health care.

Major Issues Mentioned

Among the 35 issues deemed the most important by majority vote:

- Everyone in California should have adequate health care regardless of ability to pay.

- Preventive services such as prenatal and well-baby care should be covered by health insurance.

- Hospitals should establish a mechanism whereby patients’ and/or families’ desires to forgo life-prolonging treatment can be discussed.

Severoni said that on the day of the parliament, 60 volunteers were recruited to form task forces to analyze ways of implementing the recommendations in Orange County.

Tonight Severoni will discuss the task force reports, which she received in mid-December. They contain 32 recommendations that fall under four broad categories: access to health care, quality of care and allocation of resources, individual rights and health promotion/disease control.

She said one recommendation states that all health care consumers should receive information and appropriate forms about living wills and the durable power of attorney for health care, a legal document that allows people to designate someone to speak for them concerning their health care decisions if they cannot speak for themselves.

Severoni said the task force suggested contacting hospitals, physicians and insurers to discuss developing an educational packet that would include these forms and information about their use.

Severoni said, however, that the task forces were unwilling to recommend all the issues for action--such as the one advocating that those on Medicare who can afford to do so pay a greater share of their medical costs.

“They decided those options really needed to go back to the public for further input,” Severoni said, adding that those issues will be addressed through a new series of small group meetings beginning in mid-February.

Severoni said the task forces will continue to operate, “but now we’re going to be recruiting some new people to work as task force members . . . to plan . . . activities.”

The small group meetings will be conducted differently than were the wide-ranging group discussions held last year. They will focus on one of the four specific issues addressed by each task force.

Choice of Subjects

“People will have the choice of choosing a small group meeting that they’re most interested in,” she said. “When people call and say, ‘I really care about the fact that I’m unable to see the doctor because I don’t have any health insurance,’ we’d encourage them to organize a small group meeting around ‘access to health care.’ ”

At that meeting, run by a trained facilitator, Severoni said, they will learn about access to health care in Orange County, the task force’s recommendations and how to become involved in implementing the strategies.

Severoni said California Health Decisions has begun planning for three educational forums to be held this year. They will address the one specific issue raised most often during the first phase of the project: how health care is delivered in other countries.

The project will also begin conducting workshops on the durable power of attorney for health care in mid-February.

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

Since the Orange County Project was launched, California Health Decisions has formed a statewide task force to replicate the project throughout the state. Similar projects are now under way in San Diego, Santa Monica, San Francisco, the north Bay Area and Sacramento County.

Other Projects Under Way

Nationally, California Health Decisions is one of at least 11 statewide projects seeking public opinion on health care issues. In 1985 California Health Decisions was awarded one of six nationwide grants by the Prudential Foundation’s Local Decision-Making-in-Bioethics Program. Since then, the Robert Wood Johnson Foundation has funded projects in three other states.

Severoni said she has been asked by state Lt. Gov. Leo McCarthy’s office to discuss ethical issues in health care and California Health Decisions at an educational conference in Sacramento next fall for key legislators and heads of professional organizations such as the California Medical Assn.

Severoni said she is pleased with the progress that has been made with the Orange County Project.

“We’ve involved nearly 5,000 people up to this point in our efforts,” she said. “Those are strong numbers, so I think it speaks well for people caring about these issues and for people wanting to have a way of assessing their outcome.”

When the project got under way in the summer of ‘85, Severoni said she often was asked if California Health Decisions had a “hidden agenda.”

“I just think the more people are involved with us the more they realize we’re not advocating any one position,” Severoni said. “We are not an advocacy group. We’re looking for creative solutions (to health care problems) and our goal is really just to provide a forum for all of the participants in these (medical) dilemmas to sit down and come up with these solutions.”