Health Care Issues Spur the Public to Speak Out

They participated in a coalition that successfully lobbied to have the county health services budget provide prenatal care for 500 more women a year.

They have conducted workshops on how to fill out the durable power of attorney for health care, a legally binding document that ensures a patient’s treatment wishes will be followed if he is incapable of deciding himself.

They have held educational forums on how other countries deliver health care, and they’re preparing a new series of countywide small group meetings that will focus on acquired immune deficiency syndrome.

When California Health Decisions-Orange County Project started two years ago, its goal was to seek public opinion--and recommendations--on the many difficult health-care issues that have emerged in reaction to life-prolonging medical technology and increasingly high medical costs.

The people have spoken: nearly 5,000 of them in a series of 12 town hall meetings and more than 200 small group meetings held throughout Orange County in eight months.

Study Implementation

And, since February, volunteer task force members have been working on finding creative ways to implement the public’s health-care recommendations.

“The task forces are very action oriented,” said Ellen Severoni, executive director of California Health Decisions. “They are the vehicles for taking the information we got from the small groups and from the subsequent (health care) parliament, and (for) getting that out to policy makers and health-care providers and other people in power who need that input in order to make decisions that reflect the community’s values.”

The lack of a community forum for discussing health-care issues provided the spark that generated the ambitious grass-roots project in 1985.

Modeled after a pioneer project conducted in Oregon in 1983-84, California Health Decisions-Orange County Project is the first such effort to be undertaken in California. It is one of 13 statewide projects seeking public opinion on health-care issues.

The Orange County Project, initially co-sponsored by the now-defunct Orange County Health Planning Council and the Center for Bioethics at St. Joseph Health System in Orange, is funded primarily through grants from the Prudential Foundation and the James Irvine Foundation.

The project allowed ordinary citizens a chance to voice their opinions on such difficult ethical questions as: Does everyone have the right to health care, whether they can afford it or not? Should life-prolonging technology be used in every case? What areas of health care should have priority in the allocation of tax dollars?

In February, four volunteer task forces of 15-20 members each were formed to find ways to implement the public’s top health-care recommendations, which had been voted on during the project’s daylong Health Care Parliament last fall.

First Summit Slated

On Wednesday, the Orange County Project will hold its first task force summit to discuss the group’s accomplishments and plan future activities. The summit meeting will be held from 6 to 8:30 p.m. at Loyola Marymount University, 480 S. Batavia, Orange. The public is invited.

Severoni, who is overseeing similar projects now under way in West Los Angeles, Sacramento County and the northern San Francisco Bay Area, views the Orange County Project as being open ended.

“What’s happening,” she said, “is the community is learning how to use the process to identify health-care needs, to focus in on their particular health-care concerns and to bring about change. As long as they need us as a vehicle for doing that, we’ll be here.”

In an office donated by St. Joseph Health System, Severoni, who supervises a California Health Decisions staff of three, provided an update on task force activities and a look at the the Orange County project’s upcoming events.

Volunteers are being sought to serve as leaders for the upcoming series of small group meetings on AIDS. For information about training sessions, call (714) 647-4920.

The new round of small group meetings, which begin Oct. 21, will be held in two parts. The first meeting will be primarily educational, with trained leaders using a discussion guide prepared by county AIDS experts. The second meeting will cover broader policy issues such as AIDS testing, alternative AIDS treatment centers and how the public wants its health-care dollars allocated.

“In the California Health Decisions spirit,” Severoni said, “citizens will be able to offer their opinions on these issues. Their recommendations will then be passed on to the appropriate people: legislators, hospital administrators and physicians.”

The Primary Role

That has been the primary role of the task forces since they began meeting seven months ago. Severoni said the volunteer members were divided into groups representing four broad categories:

- Access to Health Care:

Members of this task force chose improving access to prenatal care for pregnant women as their first activity, joining a countywide coalition for human services organized by task force member Marion Harloe, who is also a member of the Orange County League of Women Voters.

“This was a primary focus because about 90% of the people in the small group meetings believed that pregnant women should have access to prenatal care,” Severoni said.

The Orange County Health Care Agency, which provides prenatal care, last year was forced to turn away more than 1,600 women for a lack of resources, Severoni said. Another 400 women received inadequate prenatal care because they were either seen late in pregnancy or were unable to get appointments in the early stage of their pregnancy.

“Prenatal care is urgently needed early on in pregnancy and needed throughout the nine months,” said Severoni, a registered nurse. “Not only is it a humanitarian issue, but it doesn’t make good dollars and cents. It costs much more in the long run because so often these babies are born with a low birth-weight and they require intensive care treatment in the neonatal intensive care unit.”

The coalition met with individual members of the Board of Supervisors and other county officials. The result: In preparing the county budget in July, the county’s chief administrative officer, Larry Parrish, included an increase in prenatal care for an additional 500 women.

- Quality of Care and Allocation of Resources:

Working on the issue of hospice and home health care, this task force currently is conducting a survey on who provides hospice care in the county. The information will be put into a booklet which will be made available to the public and to hospital discharge-planning nurses and social work departments “so they can put their finger on what’s available in the community,” Severoni said.

Task force members also will identify organizations to help raise the money to publish the booklet, Severoni added.

- Individual Rights:

In response to public concern over an individual’s right to have control over his or her own treatment decisions, Severoni said, “we’re doing a lot of work with the durable power of attorney for health care, which is the best tool an individual has to be sure his or her treatment wishes will be followed.”

California Health Decisions staff members and trained volunteers periodically conduct workshops on how to fill out the eight-page document developed by the California Medical Assn. Staff members also will answer questions over the phone.

Severoni said the individual rights task force is trying to get insurance companies to distribute the document to policy holders. So far, she said, Pacific Mutual has agreed to distribute more than 200,000 descriptive booklets and the document to policy holders beginning in October.

- Health Promotion and Disease Prevention:

Severoni said the issue of promoting health education arose frequently in the small group meetings. As a result, the task force is working on a project called Adopt-a-School in which community hospitals would adopt a school in their area and provide experts on such topics as smoking, drugs, alcohol abuse, pool safety and nutrition.

Severoni, noting that the task forces are looking at creative ways to address the issues raised by the public, said she believes the task forces’ activities will have a “real impact on future policies and practices in Orange County and the state of California.

“I think that will be the impact we have: In helping people to understand the issues related to how our health-care dollars are rationed and to play a more active role in deciding where those dollars are spent,” she said.