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Monday Rx: Standing For Justice Amidst A Pandemic

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Change is Coming

I begin this Monday Rx with a pain in my heart. The cardiologists who read this need not contact me for it is a pain brought on by bearing witness to multiple atrocities including the killing of an unarmed African American man, George Floyd, by someone in law enforcement. A pain expanded by the killing of an unarmed African American man, Ahmaud Arbery, who was simply jogging in a predominantly white neighborhood in Georgia or the senseless death of an emergency medical technician, Breonna Taylor in Louisville. The name Christian Cooper might not mean anything to you, but he is actually ‘fortunate’ to be alive today after he was accused of threatening the life of a woman while bird watching in New York City. Some of you may recall the “Searing Journey” event LACMA held in 2016 where close to 50 African American physicians shared their experiences with racism. As we all bear witness to the demise of human decency, I want to share that we will have a Monday Rx every day this week to share the thoughts and wisdom of our physicians. Perspectives from Dr. Sion Roy, Dr. Diana Shiba, Dr. C Freeman, Dr. Valencia Walker and Dr. Resa Caivano among others. But we need to hear from you! Share your voice!

Now the results of these and other cases have brought peaceful demonstrations and yes, mayhem, rioting, looting. The mayhem aspect further angers those who cast a wide swath of racist blame and reinforces their own stereotypes. In my opinion, there are “opportunists” on both sides: those who sweep into our cities to steal and destroy and those who already have a racist bent.

As Los Angeles, Minneapolis, Charlotte, Chicago, Denver, New York, Seattle, Las Vegas, Washington, DC and even Salt Lake City saw massive demonstrations and rioting in the wake of George Floyd's death, New York Times reporter Nikole Hannah-Jones was asked, “Do you believe African Americans believe in the best of America when witnessing the worst?”

“It’s very, very hard,” she replied.

Some perspective: The Affordable Care Act (ACA) has helped to ensure health care coverage for millions of Americans. The uninsured rate among African Americans declined after the law was implemented: of the more than 20 million people who have gained coverage under the ACA, 2.8 million of them are African-American. Yet, this population is still more likely to be uninsured than white Americans: as of 2018, the uninsured rate among African Americans was 9.7 percent, while it was just 5.4 percent among whites. African Americans were more likely to be covered through employer-sponsored or private health insurance: 55 percent of African Americans used private health insurance in 2018, while 41.2 percent were enrolled in Medicaid or some other type of public health insurance.

Despite coverage gains, remaining health care challenges exist that have a disproportionate impact on African Americans. The lack of Medicaid expansion in key states, health disparities, and health care provider shortages make it incredibly hard to address America’s health care needs in a comprehensive way. And while these challenges are factors that touch many Americans in various parts of the country, the gravity of them is uniquely seen in the South, and among the African American population.

Prior to the riots across America this past week, one third of African American children live in poverty. The US spends $23 billion more dollars on schools that serve predominantly white students than those schools serving African American and Latino students. Black women are three more times to die at childbirth than white women. African Americans have twice the unemployment rate than whites.

Now I am sure some of you will write to me, In fact, I can already see the subject lines in the emails:

“Why is LACMA talking about George Floyd?”

“Don’t all lives matter?”

“Why does it always have to be about race?”

“Why do we have to make one segment so special?”

As Leo Tolstoy once said: “Everyone thinks of changing the world, but no one thinks of changing himself.”

Race neutral policies simply haven’t worked. We need to have direct help, direct aid, direct love for the African American communities. Jobs. Wages. Education. Healthcare. And, if you're still inclined to debate me on LACMA’s role in the aftermath of the riots, I can only respond with the words of Maya Angelou:

“If you are not angry, you are either a stone, or you’re too sick to be angry. You should be angry. You must not be bitter. Bitterness is like cancer. It eats upon the host. It does not do anything to the object of its displeasure. So, use that anger, yes. You write it. You paint it. You dance it. You march it. You vote it. You do everything about it. You talk it. Never stop talking it.”

I am angry. I refuse to be a stone. I will continue to share, listen, and learn going forward. We must have a dialogue on issues like this. It impacts all of us. We need to support those business owners who lost so much during COVID-19 only to have a glimmer of hope wiped away by the events last week. We must acknowledge the segregationist past of our country and systemic flaws in society and institutions that continue to erode health equality, economic and educational opportunities, and fairness in the criminal justice system.

Furthermore, the anger and fear we witnessed this past week is nothing compared to what the African American community has faced since the first African slaves were brought to the American port of Jamestown on a Dutch ship in 1619. I would offer a change to the anthem “Black Lives Matter” to “Black Lives Matter Now More Than Ever” because it's evident, after 400 years, that they really haven’t.

In addition to hearing from our leaders and members on this issue, I will share perspectives from like-minded organizations like AltaMed Health Services, a Federally Qualified Heath Center or FQHC (view here).

This is a time for understanding, dialogue, and leadership and ultimately a chance to heal. I was struck by one young person holding a sign during the lawful protests in Minneapolis which read:

“Racism hasn’t gotten worse in America. It’s just being filmed.”

So what are we going to do about it? Are we going to watch riots like we watch car chases? Are we going to create an initiative to make ourselves feel woke? (Meaning: “Alert to injustice in society, especially racism.”)

This topic cuts across health, social, economic and educational lines and LACMA will play an active role in change. Positive, impactful change will come in the form of supporting minority and women owned medical practices and those practices serving communities of color, help for minority medical students, expanded dialogue with African American physicians, civic and business leaders to find ways to change the course of history, both LA’s and LACMA’s with an added focus on racism and how it impacts health, access to health, and physicians of color. Dr. Diana Shiba, president-elect will launch breathtaking steps to both lead and participate in solutions. We will have an Rx every day this week to share the pain and some inspiration going forward.


The Virus Continues


The pandemic, which took the lives of 25 Los Angelinos in the past 24 hours (with over 1300 cases) and has killed nearly 2,400 and infected over 55,000, still haunts us all and LACMA will continue to help those practices needing help. That said, Governor Newsom’s proposed budget cuts are real and devastating and I wanted to share the voice of one physician on this topic:

"I am an Internal Medicine physician. After finishing my training I turned down an offer to take over a thriving practice in Beverly Hills and other similar opportunities, in favor of practicing in underserved areas. I felt that it was my calling to practice medicine where I was needed the most.

In the year 2000, I took over a failing clinic in El Monte, CA and turned it around. In 2004 I opened my second clinic in Montebello. From the beginning, we started accepting all insurances and treating any patient who needed our care. Naturally, we build up a large Medi-Cal patient base. As the years went by it became more and more difficult to survive on low Medi-Cal reimbursements. Finally, in 2016 we made the painful decision to close our Medi-Cal panels to new patients and gradually transfer our current patients to other clinics. A year later, because of proposition 56 we reopened our panels. We currently serve close to 3000 active Medi-Cal patients. Our capitation rates are between 8 to 16 dollars per member per month. It is only because of Prop 56 supplemental payments that we have been able to treat Medi-Cal patients.

If Governor Newsom's proposed budget cuts pass, I will be forced to stop accepting Medi-Cal patients and layoff providers and staff in order to stay solvent. I hope not to do this, it’s not my first choice. Please understand, with all of the challenges we are facing including increased costs of reducing risk of COVID-19, the cuts will add insult to injury. I wished the governor could tell me how he expects me to treat a patient for an average reimbursement of $12 per month. While the number of Medi-Cal patients are increasing everyday, thousands of physicians in the front lines like me will have to stop caring for them to keep their doors open. In addition to putting lives of low income patients at risk, reduced access to care will eventually and definitively cost the state more money.

I understand the current economic challenges the governor is facing. If cuts have to be made in Healthcare, I propose reducing supplemental payments to FQHCs. In addition to capitation payments, those clinics have been receiving very high payments for Medi-Cal visits, along with other financial and tax benefits not available to private practitioners. If cuts have to be made to Prop 56 payments, I propose reducing high payments for birth control devices like IUD/ implants. Cutting supplemental payments for patient visits should be avoided by all means.

Thank you for your consideration,"

Afshin Shawn Adhami, MD
Vistasol Medical Group



"Injustice anywhere is a threat to justice everywhere."
-Martin Luther King Jr

Gustavo Friederichsen
Chief Executive Officer
Los Angeles County Medical Association
“If it matters to our LACMA members, it matters to me.”