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Hello.

Thanks for joining us for Sustaining US here on KLCS PBS.

I'm David Nazar.

We're about to delve into the world of health care in the United States for a special two part series as we explore our health care crisis.

And we ask the question, is there a solution?

We're going to discuss this vital issue, which affects all of us from every angle possible.

A comprehensive discussion with some leading healthcare experts.

First, some context.

There is no question the US has, well, some of the finest and most brilliant doctors and hospitals in the world in every field of medicine, every discipline, amazing cutting edge technology, incredible life saving surgeries, techniques, protocols, procedures.

That is just a fact.

With that said, the health care system, the system itself in the US can be miserable for many.

That is also just a fact.

There are so many things wrong with our health care infrastructure today.

Patients constantly complain about things like being lost in the shuffle, lost in a myriad of health care system, complications, poor hospital care, poor doctor care, the skyrocketing costs, the insurance premiums, the lack of services.

Physicians not listening to you, not being there for you.

Health care can be a never ending struggle.

These days.

Why is that?

What's wrong with the system?

Is there a solution?

We're about to find out in a brutally honest, uncensored discussion as we bring you Part one of our two part series.

Health Care Crisis.

Is there a solution?

And joining me now to discuss all this is a great panel of experts.

Dr. Cory Waldman is a board certified cardiologist specializing in internal medicine.

He's also the medical director of a Los Angeles hospice company.

And as part of his private practice, Dr. Waldman also specializes in what's known as concierge patient care.

We're going to talk about that.

Also joining a panel is Dr. Ilon Shapiro.

Dr. Shapiro was a representative for Mexico as part of the World Health Organization and the W.H.O.. You've heard of that.

Dr. Shapiro is a board certified pediatrician.

He's involved with community engagement and special programs that really help connect the community with health care.

And Dr. Shapiro is currently a community physician working as chief health correspondent and medical affairs officer with Ultimate Health Services.

That's a federally qualified health care outpatient center.

And also joining the panel is my great and amazing friend and former news colleague Elizabeth Espinosa.

Elizabeth was a reporter in Los Angeles, here in Southern California for years with KTLA, Fox, CNN, PBS.

The list goes on.

Believe me, everyone in SoCal knows Elizabeth from the news.

Now, what many do not know as Elizabeth walked away from an amazing and accomplished career, really to devote her entire life to taking care of her special needs brother, her very ill mother and her father taking care of them almost single handedly.

Elizabeth, honestly, she is a warrior.

She puts her family before anything.

So thank you all so much for being here.

I'm honored to have all of you.

Thank you for.

For another day.

Elizabeth, you're the best.

Now, Elizabeth, I have to begin with you.

You know, I have so much respect for you.

I know your story.

The public does not.

So.

Take a few minutes.

Share as much as possible with our audience, which then helps begin the discussion about health care with our panel, with our great doctors.

Go ahead, Elizabeth.

Thank you so much.

And it's such an honor to be with this panel.

So, you know, Dr. Shapiro, Dr. Wiseman, thank you.

Because, you know, the truth is we need our health care professionals that walk along with us as patients and caregivers side by side.

And there's so much that we have to exchange information so that we can fix the system randomly.

Take a look.

I feel like I'm reporting I'm in the hallway on the seventh floor, the cardiovascular floor here at UCLA in Westwood.

Ronald Reagan.

And I'm sorry, the camera shakes a little bit and it gets a little loud, but it's just, you know, here we are.

My mom, unfortunately, we tried so hard to keep her away from kidney failure and it just happened.

We don't know where it came from.

But my mom, unfortunately, her kidney function just went kaput.

Fancy terms, right?

And yesterday, it was very scary.

My mom had to have surgery to get a catheter in, hoping that she was going to qualify for that, because her mom also has Dr. Waldman congestive heart failure.

So there's a lot of it's very resistant and her blood pressure is awful.

You know, it's always like stroke levels, it's frailty.

So the kidney function and a failure has not helped.

And so now my mom needs a kidney transplant.

So I'm putting that out there as well.

But, you know, we're starting a long time ago as David Ship.

I'm a special needs sibling.

Unfortunately, my brother suffered hypoxia, lack of oxygen at birth, and now I'm at a hospital right now.

But the truth is, it was a medical malpractice suit.

And so my mother, we did we found out we just had a two year that he was not going to be able to meet our milestones.

And so Christian just turned 40 years old, which is amazing.

But he is nonverbal.

He's diabetic, his attention.

So imagine having to care for somebody that can't tell you they have a migraine or they have left arm pain or that their eye that you're trying to see and accepts.

And that means that he was going blind.

So his retina detached.

And so he did go blind in his left eye and and now my father, unfortunately, you know, he's had diabetes for many years, but now it's only gotten worse because what that can lead to, as the doctors will tell you, is vascular dementia.

So my father's now challenge with that and that requires 24 hour care, a supervision that requires make sure they eat well, make sure they're taking their medications.

My phone is blowing up as we speak right now.

You know, Dr. Connie, I'm trying to learn now peritoneal dialysis.

We're going to try to do this dialysis that people do at home now, as opposed to the in center for the most part.

Thankfully, she was able to do this.

I mean, I'm on 2 hours of sleep, so no makeup yesterday.

And God knows when daylight or but, you know, we do this because we love our families.

Right.

And I think that I want to thank the powers that be, regardless of your religion.

You know, we prayed you, but for me, God has been so amazing to hold this up and have people like David and yourselves, doctor, here to, you know, understand that community.

We need this.

You know, I'm a journalist and I ask hard questions, I think, anyway.

And sometimes once, not always.

And it's still a challenge and there's still barriers and it's still hard and it's scary.

So I can't imagine for families that don't have some of those tools and the tool bag, right, to get through the system and navigate these waters, I mean, it is credibly challenging.

So I'm really I'm excited about this conversation because I think that together is how we find those answers.

And I will tell you, I only have a better, a more educated, if you will, opinion about the way the system should function, especially for folks with disabilities, dementia, the elderly, the digital gap that exists, the cultural gap that exists, and really empowering our young doctors to not just look at the monitors, the clinical presentation, go look at the whole picture.

So I'm very, very sad about that.

And thank you for this opportunity to speak with you and Elizabeth, so well said.

Your story is amazing.

You're amazing.

So let's go to Dr. Waldman.

Dr. Waldman, you heard the story of Elizabeth Espinosa, her family.

The reality is, no matter how great you doctors are, no matter how great hospitals are, we've got a problem.

Let's take patients to begin with, Dr. Walsh.

And they've gotten so lost sort of in the shuffle today.

You know, medicine seems to be a business, I'm going to be honest, uncensored here, sort of profits over patients to a degree.

And the doctor patient care sometimes seems like a thing of the past.

You know, there's not that personalization anymore.

Dr. Waldman, can you talk about this sort of dynamic?

And then obviously you as doctors, are dealing with things as well?

Dr. Waldman It's the floor is yours.

Yeah, No, I completely agree.

You know, part of the reason that I do what I do, which is more of a hybrid practice, which is kind of a blend between the traditional model of medicine and more boutique care or concierge care or direct primary care.

It goes by a bunch of different names these days is to basically eliminate those burdens, add mostly administrative burdens and hassles that are impeding good health care.

You know, a great example is I mean, I was recently looking at some statistics and in major metropolitan areas, if you were to go call a doctor's office and say, hey, I need an appointment, new patient could take easily a month.

That's assuming you get a phone call back.

In the case of, you know, specialists, like, for example, you know, Elizabeth, your father needs very advanced care, getting an appointment with an apologist or a cardiologist.

I hear examples of people saying, yeah, I called the office and again, a week, two weeks go by.

They get a phone call back.

next available appointment.

Four months.

Yeah.

Which is a.

Do, which is insane.

I mean this is, this is not a model of health care that sustainable.

It's not sustainable for patients.

And, you know, frankly, a lot of us who are actively engaged in health care, we're doing this for the patients and we are getting handcuffed by the current system.

I have the feeling with Dr. Waldman and the reality and especially the community that I serve sometimes, you know, getting access is just a dream.

I work with underrepresented communities where finding a doctor that has linguistically and truly concordant opportunities to communicate with a patient are almost nonexistent.

Then we know right now in space after COVID 19 that we are losing a lot of doctors and sadly we are not creating enough.

And some doctors that are international make our graduates are not being able to actually help the system.

Then we have a lot of barriers out there.

Then it compounds that problem of seeing the patient as a number.

And also, you know, we are not creating enough opportunities to sustain our current system.

Then as a patient, you want access, you want healthcare.

And sadly, a lot of the times you end up just using the E.R.

and sometimes especially right now, that a lot of patients are being dropped by Medicaid.

It's a problem.

Yeah.

Dr. Shapiro, you know, piggybacking on what you were just saying, I recently saw some numbers that at least on the physician side, 50 to 70%, give or take, a little bit of doctors are completely dissatisfied and, you know, in quotes, burned out, which is astronomical.

So we are, you know, losing health care providers and those who are capable of such services a lot greater than we are generating them.

And a lot of this is the documentation burdens insurance companies.

There's other numbers out there that for every minute a physician spends with a patient, 2 minutes are devoted to the electronic medical records, the administrative tasks, the significant burdens that have absolutely nothing to do with providing good quality care, which we know at the end of the day, it's just a function of spending time with a patient and family.

That's true.

And I want to just say, David, I mean, one of the things, too, that you and I have talked about with our family members is on this side, right?

Is that like, for example, you go to any emergency department right now, it's for good luck getting a bed.

It used to be where you could wait, you know, 5 hours.

It's was a big deal, Right.

But you'd get a bed that night.

I've spent three days in the emergency department here at UCLA because they don't have the plastic of the traumas coming in.

So everything backs up.

Well, guess what happens?

Somebody that aspirate.

My father, sadly aspirated a lot, which means that, you know, doctors gave a better explanation of that.

But basically, you catch pneumonia and you can die from that.

So I bring him in because it's oxygen is tanking and sure, they'll help him right away.

But then he sits in an emergency department without a support person.

And even if they give you a support like a sitter, call it those that don't know what to talk about.

And I will tell you, I said, you don't know him.

You don't know what it's like to give you a toddler putting some stranger says, I have a certificate to look at.

I don't care.

You don't know this person.

Act what this means.

And so what sets them off or what triggers them?

So I have to sit in that ad with her, the emergency department, E.R., and I am one floor.

And I understand their liability concerns.

I get it.

But what's what's happening is that they're coming in sick and they get sicker.

You know why?

Because they're sitting there.

They can't like they can't make them sit.

They won't let them sit up or not sit up a walk around the E.R.

because at some stage you've got a lot of germs.

I understand that.

But there's got to be a way around it because it's like it's there are studies speaking to even some of his doctors and said, yeah, a lot of elderly folks into the E.R., the example, it's like a crash.

You come here and you get sicker, the car crash and you don't survive and they don't come out of the hospital, get sicker and you should be able to call your doctor and get an appointment and see somebody within a I'd say a three week period, not six months.

I'm the poorest person when it comes to that, because I will not, you know, talk to me, call me in six months.

I'm like, no, that's, I think, too late for the class because it feels like everybody's checked out.

Even some secretaries, you know, administrative staff.

I say I'm sorry if I if I see them in six months ago, they'll be dead.

They'll be dead by then.

We got to do something about it.

We don't think outside the box.

We'll, like, create new spaces, figure out alternatives.

I mean, we're going to the International Space Station 2023.

How is that?

We can figure this out.

Dr. Shapiro You know, I hear Elizabeth.

I hear her so loudly and clearly.

So with everything Elizabeth has said.

Dr. Shapiro, what Dr. Waldman has said, why is, in your opinion, the health care system failing?

I mean, listen, something is wrong here.

And the health care system, as Elizabeth said, it can be frightening.

It can be disastrous for too many people.

That is just a fact.

I'm not walking it back.

Some of you doctors are to blame.

Some of we patients are to blame, but the system is miserable.

Is there a fix?

Dr. Shapiro?

Baby, I believe so.

I do not know if it's going to take us 400 years or a couple of years to actually make that change.

But the moment that we start redefining the way and the priorities that we all have, understanding that all of us as humans, we actually want to be healthy and we want to be part of a system that takes care of us.

And right now, a lot of the efforts, especially after COVID 19, we saw the importance of preventive services.

Why?

Because we saw that we were overweight, we had high blood pressure, we had diabetes and other chronic problems.

We had more problems when we had COVID 19.

And they took us to the ICU and other complications like that.

And not only that, that the preventive part of the healthcare system is not well funded, then, you know, we're trying to fix with Band-Aids a lot of the diabetes cases that we have, a lot of the struggles that we have with mental health, then it goes on and on.

The question is here how are we training each other as physicians?

Are we creating enough doctors that understand the importance of talking with our patients, being there with the community, not just being subspecialties, but actually primary care, internal medicine and family docs, pediatricians, or would you answer that?

Actually, are the bulk and most important part of, you know, preventive services and also prevention.

What's happening with our community?

Also, we are seeing the problems that are happening around the country.

A lot of the hospitals are closing, and especially in rural and underserved areas, that actually is closing.

A lot of the the you know, the system that we have for deliveries, the systems that we have for emergencies, trauma, emergency, anything or just we are procedures like a colonoscopy and patients are needing to actually run or actually travel hours to get them to a safe space to do the procedure, then making sure that our community clinics, that our public health system is working and also encouraging all of us to have better communication because technology is amazing.

But it depends how we using.

Yes, if we're using it in a positive way, that can make a huge difference.

though, you said something priceless communication there is not very good communication, whether.

Doctor talking to a doctor, a doctor talking to a nurse, a doctor talking to a caregiver, a doctor talking to the patient.

What are we losing?

Why are we so disconnected or was has it always been this way?

And it's just getting worse now?

Dr. Waldman Now I'm going to definitely jump in on this.

I think that the issue is, is that our current model is suggesting that we should be the doctor should be communicating with a computer and the computer should be communicating with the nurse or the other physicians.

We have lost the ability to pick up a phone and make a phone call and have a direct conversation.

And I do believe that's a huge impediment to health care in my practice.

You know, I have the luxury of if somebody comes in with the problem, I know whether it's a, you know, a foot problem, an ankle problem, I can sit there and send a very quick text message to one of my colleagues or friends.

Even people I don't know and say, can you do me a favor?

Can you take a look at this person as soon as possible?

And the answer I tend to get based on my model is Sure.

Have them come now.

Know they can't come now.

Help them come tomorrow.

That is a huge advantage for that patient.

is that part of the concierge medicine?

Dr. Waldman Or should it be implemented in all practices?

Because I was reading a little bit online about you, and you're not only a concierge doctor, you have practice, you have the hospice.

But I read something.

You're a hospitalist.

A hospitalist?

What the heck is a hospitalist?

I've never heard of that.

I want to know if Elizabeth heard of that.

But, Dr. Waldman, what is that?

20, 30, 30 years ago and don't don't quote me on these numbers, but your primary physician would manage your care while in the hospital.

The person that knew you medically would manage your hospital situation, whatever that may be.

Somewhere along the lines between the bureaucracy of a hospitalization, the paperwork, it became extremely complicated, where a private practice physician could no longer, in a reasonable way, navigate both their practice, as well as the management of a patient in a hospital.

Therefore, the concept of a hospitalist was born, which is essentially a the quarterback of a patient.

While they are in the hospital, they manage all of the acute care.

They're coordinating all the specialists, thus alleviating the burden of that for the private practice doctor, which frankly just doesn't have time anymore to manage the care of a patient in the hospital.

That is what a hospital says.

So think of it as your hospital doctor.

Elizabeth, I just want to get back to you because Dr. Dr. Waldman is talking about the managing the care.

How do you manage the care?

You've got, Christian, your brother, you've got your mom, you've got your dad.

You've got to be exhausted.

You've got to be physically spent.

You've got to be war weary, so to speak.

How do you do it?

You're sweet.

You know what I think that love is?

Love moves, mountains, rises.

That's just the reality.

I think when you love your family.

They did it for us, right?

I always think about all the challenges my parents have gone through to raise us and and not to mention, like the countless families that I've interviewed over the years that left me at all right in different communities.

So I don't look, I, I don't ask for pity party.

I just say this is what it is.

And I think it's so important that we empower ourselves with as much information as possible.

And this is the one thing I will say.

David, you asked me how one of the keys is.

I ask all kinds of questions.

You know, I'm like, I don't care if I look stupid.

I don't care.

I mean, how am I supposed to know everything?

I've not had kidney failure before.

I don't know anything about peritoneal dialysis.

Like, I have to go talk to the nurses.

We are my mom as a as a foreign object in her stomach right now.

And she was like, This feels weird.

She's, like, touching your belly right now.

I said, I know, Mom.

I said, We're going to find out where you'll learn.

You know, I think it's just by trying to really you know, it's one step at a time.

It's one baby step at a time.

It's asking as many questions as possible, is having friends and community.

And I would say, like if you know somebody who's a nurse, ask nurse, like ask the neighbor if somebody.

Pierce mentorship is everything.

I want to think the negative the family from somewhere that the core kidney program here at UCLA like they got a transplant here this will families impacted by kidney failure.

The mom was like in her 60 seconds a transplant.

So I said, mom, she was on or drive to Sylmar and you're going to meet with her.

And it's been it's the Latina of I'm going to find y'all.

Don't push up.

You don't knows it makes a difference and makes a difference.

The age group and the Latina group.

Right.

And the ethnic group.

But if it's an Armenian Armenian person talking about and really, you know, getting that information in so that you empower yourself and you don't feel alone.

I mean, you know, so one thing I know, you know, and of course, Christian, you know, my brother, we've been in that fight for a very long time.

Christian just turned 48, which is unheard of.

And my challenges with him, I will tell you right now, my goal, my dream, my gosh, is to have a a hospital like a children's hospital one day for special needs individuals.

Listen carefully with behavioral challenges and sensory challenges, because it's not about calling security when he does want to sit in a room and, you know, he's yanking out his I.V.

and he's not going up with a face mask, is deciding that his oxygen is going down.

But he does want to be in space.

So you go by, right?

You put on the side, then you figure out ways like, okay, maybe it's it's like Jurassic Park Hospital, right?

Like, this is my vision.

You got to think outside the box like, you know, this is what we do for Kobe not to do.

And, you know, vaccines that are car blood draws in the car.

Well, I said to people, we've been doing that, you know, because I have had to be really creative with my brother.

Expression is going to be me, not because he's very popular social media.

I talk about him with Mr. Great bands, right at my Instagram at Elizabeth Espinosa.

Christian is six to like almost £300 at a linebacker.

And many times, you know, at UCLA we've been here and you know he he won't he will get in a gurney he he we have to put a big white sheet on a wheelchair to press a data because we have amazing relationships.

Our years with an anesthesiologist that will go outside of the E.R.

to give him a cocktail to sedate him.

And then in the wheelchair, he gets sleepy and then we kind of roll them in because he won't go to the back where everybody triaged.

He will get in a gurney, like literally, I have to get a bunny suit.

So like this type of thing.

And I have to go all the way into the O.R.

until they put him to sleep.

You sleep because, you know, he's scared, he's afraid, and he has this resistance.

So it's like, you know, it's thinking outside the box state, as I say all the time.

Like, don't feel weird about saying, Well, doctor, what if And I mean, there's so many examples, but another one is Christian had a really big cyst like sebaceous cyst on his neck and it was getting worse and I didn't know what to do.

And dermatology is like, well, if he doesn't come in the office, we can't treat it.

It was great.

But he doesn't even open his mouth to operate, to check his teeth.

Right.

The dental exam, thankfully, I have rings.

God bless him.

Thank you.

Rich, who is your medicine person?

And he was like, Let's go to the driveway.

Crystallizes Cindy's right in a car.

That's a safe space.

And we gave him a little bit of medicine just to make him sleepy.

He brought some light cane.

We put it on his neck.

We like that work its magic.

We pulled out a wheelchair.

I think it was my dad's because we don't have one for Christian.

So we pulled back to the driveway.

We sat him finally in the park.

They put the iodine on his back and we cut it and we took it out in the driveway of our house.

You might think that's crazy, but guess what?

We got it done.

Otherwise, I'm going to sedate this guy just for that.

Put him on a ventilator.

You know what I mean?

So how do we do that and replicate that?

Because Christian, my brother, is only one person.

There's so many people like it.

Right.

And I think Cobra really underscored how folks with disabilities and behavioral challenges didn't get access to health care and weren't even allowed their support staff to be in hot in some hospital settings which caused them their their like, you know.

Elizabeth, we are going to leave things there for part one of this special two part series where you're going to talk to everybody next week.

We're going to really delve into this.

We're going to do a deep dive.

I want to thank everyone, Dr. Cory Waldman, Dr. Ilon Shapiro, Elizabeth Espinosa for a great interview for part one of a two part series, Health Care Crisis.

Is there a Solution?

Part two With all of you is next week.

So for now, thank you all so much.

My pleasure as always.

Thank you so much.

We'll take it.

You guys are awesome doctors.

Thank you for your hard work and the nurses.

UCLA has been amazing to us.

David Nazar my God, you're priceless.

You're amazing.

Thank you.

Now for more information about our program, just click on KLCS.org and then click Contact Us to send us your questions, your comments, even your story ideas so we can hear from you or you can contact me @DavidNazarNews on X or just go to my YouTube channel, DavidNazarNews.

Contact me there.

You know, I'll get back with you and be sure to catch our program here on PBS or catch us on the PBS app.

Thank you so much for joining us.

I'm David Nazar