SHADOW MEDICINE

	November 29 , 2004
	Jeffrey Kaye of KCET-Los Angeles reports on practicing medicine underground.

JEFFREY KAYE: They readied their weapons, strapped on bulletproof vests, and went over tactics. Law enforcement agents, many undercover, who gathered in a parking lot in Long Beach, California, last July weren't preparing to bust a murder suspect or drug dealer. Their target was a dentist, or, more specifically, a man suspected of practicing unlicensed dentistry in his apartment. MAN: I told him I had a toothache. I told him my right lower molar was hurting. He said, "come on in, I'll check it out." JEFFREY KAYE: Minutes after their briefing, the agents, accompanied by personnel from the Los Angeles County Health Department, arrived at the suspect's door and went in. What they found inside was a bedroom converted into a makeshift dental clinic-- a pretty well-equipped one at that, said Theresa Lane, a supervising investigator with the state of California's dental board. THERESA LANE: California Dental Board: He can do endodontics surgery. He has the dental high-speed hand pieces. He has the water irrigation. He can do fillings, he can do root canals. He has all the materials here to do anything he wants to do and be mobile. JEFFREY KAYE: This backroom dental clinic wasn't nearly as bad as some that Lane has seen in her 13 years as an investigator, as she told producer Saul Gonzalez. THERESA LANE: I've seen everything from somebody operating in their garage next to motorcycles, filthy, smutty floors, having water lines that go from the irrigation-- to a patient's mouth for the water line. Going from a toilet into the outside to be drained. I've seen that. We've seen instruments that are absolutely not sterile. They're wiped off with alcohol. And of course, if you're going to inject, and you're injecting something that's dirty or putting something in it, it's just going to build the bacteria, and can cause even death. JEFFREY KAYE: Authorities say illegal dentistry is only one facet of a growing public health care and law enforcement challenge. In largely immigrant neighborhoods, a vast medical underworld offers customers everything from illicit pharmaceuticals to medical care to plastic surgery. DANIEL HANCZ: From a health perspective, it's a very significant problem. We have people that are unlicensed-- and they are oftentimes untrained-- providing medical care to residents of LA County. JEFFREY KAYE: Daniel Hancz is a pharmacist as well as an investigator with a five-year-old LA County unit called HALT. That stands for the "Health Authority Law Enforcement Task Force." It comprises health care and law enforcement personnel, and investigates and cracks down on illegal medical activity, whose consequences can be lethal. DANIEL HANCZ: I think you need to look at the reason the task force was started, specifically one case that involved an 18-month-old child, Celine Sigora Rios, who was treated at a toy store. And she was given injections, and she was reassured by the clerk of the facility that the child would be fine after receiving the injection. The problem was, the baby had significant medical problems, and it was the delay in care, combined with the medication that was administered, that resulted in the patient's death. JEFFREY KAYE: Much of HALT's work involves investigating the distribution of illicit pharmaceuticals by unlicensed medical practitioners. DANIEL HANCZ: We get patients that are getting the wrong drug. They're getting the wrong dose. They're having delay in medical care. They're oftentimes receiving drugs that are sub-potent or super-potent, they haven't been stored properly, drugs that have been banned by the FDA, or they're gray market, potentially counterfeit drugs. So there's a wide gamut of health-related issues that do come into play. JEFFREY KAYE: In a storage room in the basement of the LA County Health Department, Hancz showed off just some of the pharmaceuticals his unit has seized in recent raids, medication that was sold in swap meets, private residences, even in backrooms of retail stores. DANIEL HANCZ: Here we have antibiotics potentially that could cause a severe allergic reaction, Sulfadiazine. JEFFREY KAYE: So are these counterfeit, or are they the real thing? DANIEL HANCZ: Well, we don't know. We haven't tested them to be counterfeit. But these are drugs that are not approved by the FDA, and they're not authorized to be sold here in the United States. JEFFREY KAYE: And people went to the shoe store to get drugs? DANIEL HANCZ: People went to the shoe store to obtain their pharmaceutical needs, yes. JEFFREY KAYE: To alert the public to the dangers of illegal medicines, the health department sends out social workers, such as Connie Sarinana, to schools and community centers. CONNIE SARINANA (Translated): Our children die because we take them to places that are not safe. Why? Because we like to think that we know best. But we don't. It's better to go to a public clinic or doctor with a license, so you can stay safe and stay healthy. JEFFREY KAYE: Sarinana points out the dangers of using prescription medication and untrained clinicians. But many immigrants who lack insurance and are often afraid to go to public hospitals say they have little alternative. DINA MORAN (Translated): Insurance is very expensive, and a lot of us can't afford it, so we look for solutions that are cheaper. That's why we go looking for medicine without prescriptions. JEFFREY KAYE: The man targeted in the raid on the bedroom dental clinic said he was providing an affordable alternative. Juan Jose Losa defended his illegal practice by saying he had been a licensed dentist in his native Mexico, and was offering a service to people in need. JUAN JOSE LOSA (Translated): The people here, the majority of the people here, just don't have insurance. They don't have the money to go to the clinics. The clinics can be very expensive. So that's why they seek out our services. We charge very little. Ninety to 95 percent of the people out there just don't have insurance or the money to pay. THERESA LANE: I think it's a rationalization. I don't think there is much to that. He is not providing anything to the community. How could he? He has unsterile conditions. He doesn't have an autoclave. He doesn't properly sterilize his instruments. I think he's putting the public at risk, greatly at risk. I don't think he's doing any service whatsoever. JEFFREY KAYE: Social worker Sarinana says if poor people need medical care, they can get it. She suggests they go to county facilities or private clinics which treat the uninsured. CONNIE SARINANA: We do have the PPPs, our private partnership with the private facilities the county has, and so people can go there, too. The county has given a certain amount of money so that people can have access to this, maybe low-cost or maybe free, depending on their money coming in. JEFFREY KAYE: Since it began, LA County's HALT team has investigated nearly 900 cases of illicit medical services. They are limited only by time and resources. For all their successes, they say, the problem of underground medicine is growing, as health care costs and the number of uninsured rise.