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Hello.

Thanks for joining us for sustaining us here on KLCS PBS I'm David Nazar.

We're about to bring you part two of a special two part series, Our Health Care Crisis.

As we ask the question, is there a solution on this second part of our brutally honest investigation of why our U.S. health care system is failing us?

We dissect this issue from all angles.

Doctor care, hospital care and patient care.

As we re introduce you to my guests so we can continue our uncensored discussion with part two of health care crisis.

Is there a solution?

And joining me now to discuss all of this is an esteemed panel of experts.

Dr. Corey Waldman specializes in internal medicine and is a board certified cardiologist.

Dr. Waldman is the medical director of a Los Angeles hospice company, and he is currently in private practice, which includes a hyper specialized practice for concierge patient care.

We'll learn about that.

Also joining the panel is Dr. Alon SHAPIRO.

Dr. SHAPIRO was a representative from Mexico as part of the World Health Organization and the W.H.O.. Dr. SHAPIRO is a board certified pediatrician, and he's currently a community physician working as a chief health correspondent and medical affairs officer with Ultimate Health Services, Outpatient Care.

And also joining the panel is my great friend and former news colleague Elizabeth Espinosa, who was a reporter in Los Angeles for years with KTLA, Fox, CNN, and PBS.

She walked away from an amazing and accomplished news career to devote her entire life to take care of her special needs brother, her mother and her father almost single handedly.

Thank you all so much for being here as we continue our discussion from last week on the health care crisis.

Dr. SHAPIRO, let's begin with you.

Thank you, Dr. Waldman.

And Elizabeth, I'm Dr. SHAPIRO.

You represent communities that are underserved.

Now, truth be told, whether you're underserved, you're middle class, you have a lot of money.

Health care costs a fortune and and it's tough for everyone.

But let's talk about poor people because that's what they are, poor.

Forget the politically correct low income term.

Poor people need help.

They need your health care.

Dr. SHAPIRO, when you deal with an underserved, impoverished community, what are the challenges that you are met with these days?

Because obviously the system is failing and then talk about low income folks, but then obviously everyone else on the financial spectrum, because getting adequate health care, it's not there anymore.

David They may be.

When I see my patients, they come to my clinic.

I see them as on owner for me.

And let me tell you why we need to see where they're coming from on the community.

They probably have 2 to 3 jobs.

You know, they are probably actually at that moment because they are outwardly.

There is not getting paid and they're coming to our clinics to be served.

And that means that they needed to earn a lot money or time for a care, making sure that there was gas on their car, if they have a car or at least make sure that they are on time for the appointment.

Because of public transportation, then there's a lot of barriers around them.

In order for them to get to the clinic, let alone be healthy for the other side.

I tell them the truth and they know the truth that we need to be healthy and need certain things vegetables, certain mean things.

Go out there and do exercise.

And at the end of the day, when they go out on the community, there's a couple of things.

When they go to the supermarket, they have a choice to actually get the green stuff or fight against hunger.

They have the option to go exercise and they go, Well, maybe there's not not a green space or the green space out there.

It's not safe for them or their families to actually do some exercise or actually be out there.

Then there's a lot of buyers and social determinants of health opportunities there that we can start managing.

Then at the moment, and that's just the structure that we have around this, you need to have culture.

You need to have language barriers.

You need to have also the other part us as physicians in our health care system, that when we're not used to actually taking care of diverse populations, well, that culture that touch it's way different.

Why?

Because one thing is, you know, you can tell the same thing about diabetes.

It's the same thing for diabetes for everybody else.

But taking away, for example, a tortilla from from on this panel, Mexican family, well, that's probably not the best way to talk about it.

Maybe we need to tweet, tweet, go around.

Although they are dietary things that we can actually improve.

Then putting everything together to cater underrepresented communities is extremely important, especially right now that we have all the things that are happening with the nation, with Medicaid.

And here in California, our medical what's happening also with kids.

Then if we are not taking care of all of this populations well, it will become a public health problem.

Elizabeth, you know, one of the observations I've made being in the emergency department very often with my family in clinics, in hospital settings, is that our underrepresented communities, they show up and they show up very sick.

They show up and they would need a heart transplant.

They show up or they need a kidney transplant.

They don't get it.

They're done.

It's and I think it's also one of the other challenges, like we have this.

I would argue that law enforcement also has to do a better job at is it goes back to communication.

You have to be a good storyteller.

I know you sign up to be a journalist, but you have to tell people, Let me tell you why kidney function is important.

Do you know why your blood pressure goes up?

Because if not, you know, like you have to, like, see them through the line because people don't understand.

They say, well, I got diabetes, but you know that that'll be fine because I don't feel anything right now.

Well, you don't feel it today, but every day that you don't control your blood sugar, you're killing little veins.

That then means when you see that guy without a leg amputated, that's because he didn't control his sugars.

It's the baby.

It's everything.

But really, explain to people the full rainbow.

You know, it's incredible.

That's why I'm really proud of this.

Doctor Rastogi here is a neurologist at UCLA, and he has this core kidney program where they have folks from all ages who've suffered, you know, kidney disease about I got transplants or living donors, which we really want to make a push for as well.

Right.

Organ donation.

But it is an incredible group because they're out there trying to explain to people why it's so important that peer mentorship really explains it.

So it's interesting, my mom with her kidney failure now, we happened to just go.

We were in the city of Lenox just a couple of days ago before this surgery, and we went to a Salvadoran restaurant, my mom's Sharm El Salvador, and we walked in there and my mom starts talking to the owner.

And while I'm paying, I look over at my mom, who's petrified, petrified of going on dialysis.

Right.

And about to have the surgery.

She's like to months ago, this woman, you know, she's like 57.

She's so young.

She looks so much older because she's in kidney failure, her GFR.

So you learn these things.

GFR Right.

Doctors, that means their your kidney function is at 6%.

And instead of what is your follow point of your day project, she said, Jan, this is in November we're talking about she I said, You're going to be dead in a month.

At that rate, you're going to your heart is going to stop because your kidney is going to funct It's going to affect and you guys speak to that and I'm trying to the doctor here, but.

Right.

It's going to affect your heart and do all these things.

You got to understand why it's important to take action now, right.

So I think we have to explain it to you because I will sit there because I am a reporter, Right, David?

Like you and I can hear when doctors are explaining sometimes to my parents, you know, things and I'm like, okay, take it another step.

You got to, you know, to have to explain to them why that's important.

What does that mean if you don't do that?

Like, we're all it's like back to the first grade when you get diagnosed with something that you've never been diagnosed with.

you know, talk smiling in my heart because the things that you're saying is so true.

And I have a phrase that actually I understood during COVID 19 is that we need to translate medically to an actionable language for our community.

That's extremely important, especially for anybody.

It doesn't matter your language, your color, your your obstacles, your religion, having that conversation is so important and also connecting the dots.

And you're mentioning something that actually came eventually triggering me and that's the word that I'm using, because at the moment that we do not have information, one thing is having information and not acting upon it.

But if you do not have the choice, even to understand what's happening, there's no way that you can do anything.

Then at the end of the day, if you vaccinate or not, that's not you.

But at least you have that balancing act based on evidence based information to act upon it.

Then giving that chance is so important.

Dr. Raul think that there's you know, there's three pivotal, crucial elements here.

One is patient education.

Two is distrust of information.

And three is time.

The two, to me, the primary issue is a lack of time that a physician has to build a rapport with a patient and a patient's family to gain the trust needed to make appropriate medical decisions.

so.

Yeah, I think you need to go on dialysis.

That's a hard thing to hear.

I mean, I was crying for weeks, you know, and my mom, too.

But I said, Mom, let's not die before we die.

Let's don't be paralyzed by fear.

We got to do this.

And you know, to your point, Dr. Wallman, drive to medicine is a problem.

And I've been through that and I've had to cut doctors.

I mean, I have no problem being, you know, a little bit more assertive like David, when we've had to be advocates for our family members to say, Hey, don't rush.

They're asking you a question they don't understand.

You got to break it down like you're talking to a two year old, because even I don't understand some things, right?

This isn't why I spent 20 years studying like you did.

Yeah, I have to to battle medical information that patients and patients families obtain off of tick tock that the the 16 year old who's promoting, you know, certain gummy a vitamin or this or that seems to have much more medical weight, much more medical weight than I do, which is baffling.

And, you know, this is the situation we're in.

There's another there's another thing I noticed.

Doctors Waldman and SHAPIRO, correct me if I'm wrong, maybe, maybe perception is reality.

It seems there is so much burnout in your field.

You guys, as doctors are burned out.

And I say that because it's complicated.

How do you as doctors navigate a system and I'm not going to walk back from about to say that's infested with bad doctors, insurance companies that are disgustingly greedy and lawyers who are even more disgustingly greedy ambulance chasers.

You've got to deal with all of this and you're dealing with it then affects every patient.

Can both of you talk about that?

Because health care system is failing, The system is broken, Yeah.

You know, Elizabeth, you mentioned the story of your brother.

You know, with regard to the cyst, you know, on, as you know, that had to be extracted and I don't think that story would happen regularly for the simple reason of of the doctors fear of legal action against them.

Right, right.

Right.

So it brings up in a whole discussion of tort reform and what can we do to take some of that, The threat of lawsuits against and away from doctors and health care providers know that.

And I think that's fair.

And I think that there has to be, you know, as families, like I always say, you know, so many times like we will be in a hallway or something and they'll say, well, we can't, you know, do the I.V.

started in the hallway because of hip hop violations and like releasing our hip on his behalf or, you know, my parents, like, we we need to get the health care.

We need to get that if that's the outcome, is what matters, not some law that somebody passed.

Right.

But to your point, I agree.

I as a family, I think there may maybe let's come up with a legal document says, look, you're taking a risk by doing this in your driveway, but you're willing to take that.

You've got to give the doctor a chance.

You can't just sue him, say, well, this just turned out wrong.

Well, there it was.

It was in good faith.

Everybody was working in good faith.

I think that's what matters.

So we got to we need to get some lawyers on this show and say, let's create that.

Let's get some legislate and say how are we creating loopholes for people that, you know, like I say, disability access within health care isn't just a wheelchair ramp.

It's not just a wheelchair ramp.

Right.

It's giving you guys access to so that you can see a patient not in the normal setting, because accommodations for people with sensory issues with autism doesn't mean a wheelchair ramp.

It means in the parking lot, it means in their car, it means in their house.

In that one space in the hallway.

What?

They will let you touch them like that's how unique it is and that's how patient centered we should all be.

When it comes to health care.

there's an even simpler problem.

And Elizabeth, I know in all of your years of reporting, I'm sure all the health stories you did, patients say the same thing to you.

And what I'm hearing when I do my health stories is we have to wait forever just to get an appointment.

Sometimes months.

We have to wait forever to get in May.

We have to wait forever to even find a specialist.

This is a joke.

Dr. Waldman and Dr. SHAPIRO.

Whoever wants to talk about that.

Go ahead.

The reality is that we love to have a decent way to answer what's happening right now on our health care system.

I can tell you for sure that it breaks my heart when I hear that it breaks my heart.

When grandmother comes with the kiddos with me, and I need to give them vaccines.

And I'm asking regarding, you know, everything.

And I see that she's limping and she tells me that story that she doesn't have access and she goes to the E.R.

and she doesn't know how to, you know, that she can get access to a healthcare insurance, but it's too much for her.

And she do not know doesn't know how to get, you know, the Affordable Health Care Act plans for her or she doesn't know where to go to community clinics.

And there's a lot of things are around what we have in our community that it's already there.

But somehow we're missing the point of communicating that we have certain tools out there.

On the other side.

We need to see all the barriers that we have created.

You know that of course, you know, every doctor statistically will have some type of lawsuit at least drafted against them at some point in their lives.

That's something that, you know, if we did something wrong, we need to be punished and we need to take care of that and be honest on that one.

But also that we do a lot of over shooting with a lot of this things.

The third one is that the system, we have a lot of intermediaries.

The idea of actually having a primary care doctor in the old days and I love what I listen to what saying about, you know, my patients, I have no neurological conditions.

I love doing telehealth with them.

I love actually approaching in a different way because they get that they don't see the white coat.

They actually enjoy the interaction.

I get to see a little bit more about their house, and that's stuff that I used to do in Mexico.

I'm going to right now for the first time at least, I get like a little window of what's happening with them.

The kids actually maybe smiling, but not like terrified of running around in a different setting.

Not necessarily because he's medical, but it's not his hat or home.

Then there's a lot of opportunities there that the system can actually improve and go out from that box of the clinics of the healthcare system.

We need to move to social determinants of health.

We need to bring community healthcare workers to the conversation.

We need to make make sure that we have a nutritionist medicine that's as good as medicine.

That's a new thing that we need to be talking about.

And, Dr. Waldman, as we segway these stories, all of you have told her somewhat unbelievable.

Somewhat amazing.

With that said, let's let's take our remaining minutes.

We're now into our second part of this health care special.

In our remaining minutes for the remainder of this program.

What are the solutions?

How do we fix a broken health care system?

Let me give each of you about 2 minutes.

We'll go to Dr. and Dr. SHAPIRO and then Elizabeth, who's been dealing with it firsthand.

Yeah, I think at the end, to me, one of the biggest issues that the system is having is that we don't have enough time.

Physicians, health care providers just don't have enough time to provide patient education, which builds trust and rapport, which ultimately leads to better decision making for patients and families.

So if we can go after that time component, we say to ourselves as physicians, well, where is all of our time going?

And right now the vast majority of it is going to or it's documentation, which is frankly for medical billers and for lawyers.

It is really not for the patient, unfortunately.

If we can buy back some of that time, all of that time can be devoted back to patient care, we could probably legitimate at least double our effective health care workforce overnight by addressing the documentation burden and the bureaucracy.

More burden.

Dr. SHAPIRO, thank you.

Dr. Waldman.

It sounds good.

If we can implement it.

Maybe that's another story for a future broadcast.

Dr. SHAPIRO, your ideas about solutions.

Maybe we need to start creating more doctors.

We need to make sure that we are going and outreaching the underrepresented community and bringing doctors for many communities.

And by underrepresented is every color and favor that we have that will stay on the community and serve because that that creates an amazing pathway.

That means that from high school, a college, med school, and actually even residencies to make sure that that pipeline exists and we bring up the amount of doctors that we have out there.

If not, we will just be chasing something that we'll never achieve.

The other thing is something called value based care.

Right now, Dr. Waldman and also Elizabeth have mentioned the importance of quality interactions with our healthcare system.

And maybe it's not specifically physician and maybe some nutritionists, maybe some community health care worker.

We're making sure that we're creating a healthcare system that is humane, that it's actually for our patients, and it's the quality.

And actually that resolution of the problem and most importantly, the prevention of them, that is their key and crucial for the future of our community.

And finalizing with this, making sure that we continue translating medical insight to actionable opportunities for our communities, if not all the information.

Although this trust will continue to go along.

Elizabeth as great as the doctors are, no one better to ask than you.

You are in the trenches.

You are a caregiver and a reporter.

I guess you could say a journalist.

Give us your perspective on solutions for a broken health care system.

Well, you know what?

I want to thank Dr. Waldman, Dr. SHAPIRO, and all the doctors that are out there and nurses and Libyans and seniors and caregivers who care.

First, we got to care because I believe it is about caring.

It is about having a will.

You have to want.

You got to be have this desire to say, you know what?

We can change this.

Why do people act like just because this is the way it's been?

It's going to be this way forever and it's going to stay broken.

No, let's have that, Will.

I think, Dr. Wallman, you talked about you know, you do home visits, right?

Concierge Right.

So I think it's about accessibility.

So it has to be.

Let's, let's how do we fix this?

There is a solution.

There are solutions.

Maybe not overnight, but they're baby steps and there's little solutions every day.

So, for example, UCLA has a program now that I think is great.

It's called extensive its program.

So people that are chronically ill.

So the way you try to keep them out of the hospital setting is you give them longer appointments with a doctor, a primary doctor that instead of spending 15.

Right.

You think it isn't doctors?

15 minutes usually is what you get with a patient.

You get 40 minutes.

Woo!

Who?

Right.

Still not a time, but 40 minutes with a patient that's got a lot of complex medical needs.

So that help a lot.

Let me tell you.

But then it's also about fixing.

So your point about home health, making it accessible.

Why do we send everybody to the emergency department?

Because they hurt themselves.

It's like they need IV fluids.

Let's get it easy and set up through home help.

It should be an app.

Like, why are we thinking about that?

We got to think outside the box.

Patient centered care means let's make it.

Let's make it accessible.

Because I think part of the problem is people go to try to get medical attention and it's everything is an act of Congress.

Even when I leave the hospital and I get a home, help, you know, order the doctors.

God bless them, they like Elizabeth.

I wrote all the orders.

I put A, B, D physical therapy in O.T.

And by the time the home health agency calls me and I see you're nodding your heads because you know what I'm talking about, Right?

And so let's make it simple.

Let's make that faster, quicker.

You know, even at the county level, there's a program called In-Home Supportive services.

Right?

That program is supposed to help get caregivers.

We need it.

We need also fund for caregivers, because that's going to help people not get sick and end up in the hospital.

Right.

And need all these specialists and and, you know, more doctors is a solution.

But it's got to be also quality over quantity, right?

Like you that you care.

And I think going back to the agencies comment, I was in that office the other day and I met a woman who has stage four pancreatic cancer.

She had to go in there with her eight because they can't even make a phone call to get through to the social worker.

So the woman gets paid because of the woman is a get paid.

She's like, I got to leave.

I got to go find other job and she'll find another job.

But guess who won't find another staff that quickly?

The woman with stage four pancreatic cancer and that those are underrepresented communities are impacted the most.

So I think private practice needs to make things more accessible and generally are better at it anyway, but also programs that are funded by government, Medi-Cal, you know, Medicaid, they've got to make it more accessible and easier.

And yes, I think that making doctors do all this paperwork is taking away from spending time with patients and really saying, this is what you need and this is how we make it work faster.

So I think if we just all sit down and say, let's take top five, top five, let's fix this, this, this and this and start with that, we can do this.

I am going to end the show by saying this.

Elizabeth, you said probably the key word caring.

It may sound cliche, it may sound simplistic.

However, what I do know on this special two part series we just produced together, Dr. Waldman is a caring doctor.

Dr. SHAPIRO is a caring doctor.

And Elizabeth, you are a caring sister.

You are caring daughter who has really helped kept your family alive.

So I hope we can do this again in a few months later this year.

If I invite the three of you back, will you be on this broadcast so we can further delve into this very critical situation of the health care crisis in the United States today.

Thank you.

Thank you all so much.

Caring is the take away.

Thank you so much, Dr. Corey Waldman, Dr. Alon SHAPIRO and Elizabeth Espinosa for a great interview.

I don't know how to thank the three of you.

It meant a lot to me.

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 Hi, I'm David Nazar, host of Sustaining US.

Thank you so much for watching KLCS.

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You can support KLCS by calling 888-998-KLCS or simply visit KLCS.org.

Again, thank you so much for watching KLCC US PBS.

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

Dr. Corey 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. Alon 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.

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.

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?

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 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?

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?

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. Corey Waldman, Dr. Alon 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.

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