Wednesday20 September 2017

Poll Reveals Where People Go for Care

BY RACHEL COOK Californian staff writer This email address is being protected from spambots. You need JavaScript enabled to view it.

Two hours might seem like a long way to drive for an eye doctor appointment, but Taft’s Lizz Horton says it’s worth it for her.

Horton takes her 8-year-old daughter, Reanna Rowland, south for eye care and is planning to take her son, Jaxon Horton, 4, next month.

“When it comes to the eye, I won't ever take my kids anywhere else,” Horton said of traveling to UCLA to see her prefered ophthalmologist.

Horton isn’t alone in her willingness to travel several hours for health care. A telephone study of nearly 700 Kern County residents last year found that people head outside the county seeking treatment for a variety of aliments. The study was funded by The Californian along with a local hospital and health insurance provider.

Survey participants listed cancer, orthopedic issues and learning disabilities as the conditions for which they most frequently venture outside the county to find care. Nearly 30 percent said their family has sought care for cancer elsewhere, though one doctor said that number seems unrealistically high.

“Compared to before, the trend has turned. There are so many people staying here,” said Dr. Ravi Patel, managing partner and medical director of the Comprehensive Blood and Cancer Center in Bakersfield. “Very few people will think about actually going elsewhere.”

Cancer patients might leave town for a surgery or another opinion but, Patel said, most return to Kern for their cancer care.

“There's not 30 percent of the cancer patients that can afford (to leave the county for care) based on our insurance demographics,” Patel said.

Asked where they would go if they needed medical treatment at a facility outside the area, 75 percent of those who had sought care elsewhere said they would go to Los Angeles; one in three said Fresno.

Young, less affluent Hispanics were more likely to say they would opt for Fresno, while older, affluent, long-time Kern residents indicated a preference for Los Angeles, according to the study.

Survey takers were not asked one pressing question, due to time limitations: Why they head out of town. Follow-up studies to answer that are planned.

Whatever the reasons, Gary Frazier, Bakersfield Memorial Hospital’s vice president of strategy and business development, said a certain number of people will leave their immediate area for care in any city.

Others may need a specialist that isn’t available in Bakersfield or have multiple aliments that need addressing.

And then there’s the fact there are large academic medical centers — with prestigious names and reputations — just two hours away. Patients may think of those places when they first receive a diagnosis.

“Once we know that there's this (medical problem) — heart, brain, lung, you name it — our thought is, ‘We've got to go to the one place that can cure this thing in one full swoop,’” Frazier said.

But later, he said, people realize their treatment requires multiple visits and follow-up care and their mindsets change.

“Then you start thinking practically, is there a local option?” Frazier said.

He said one of the challenges to keeping people in the area may be lack of awareness about which speciality care is available locally, such as pediatric cardiology.


Several locals who faced serious illness said they traveled for medical care for different reasons, including poor experiences with local providers and referrals from local physicians.

Horton said that before she was referred to UCLA by a local doctor, a Bakersfield practitioner told her that Reanna, who was 5 at the time, was blind in her right eye and that couldn’t be corrected. Instead of being round, Reanna’s right pupil is shaped like a key hole and the iris isn’t formed all the way around it, a condition known as a coloboma.

But today, Horton said Reanna has 20/40 to 20/50 vision in her right eye with glasses, an improvement gained using an eye patch and glasses.

“She does competitive gymnastics right now and I don't know if she would have been able to do that if she was totally blind in one eye,” Horton said.

Horton has been striving to get her son seen at UCLA for a different eye problem. For a while it appeared the visit would not be covered by insurance, but Horton was still willing to make the drive and spend several hundred dollars out-of-pocket.

For special conditions, Horton said, she would rather go somewhere where doctors have seen a lot of something unusual in a more populated area than get treatment where doctors may only have seen the problem a handful of times. For primary care, her family travels a shorter distance to Bakersfield.

“I feel like there is good health care in Bakersfield,” Horton said.

Others don’t have the same confidence in local care. Another health care traveler, Cheryl Simpson, said she now leaves town for all her care, with the exception of dental and chiropractic appointments. She started traveling to Cedars-Sinai in 2009 for breast cancer treatment and has continued to make the trek for other treatments.

“(Traveling for cancer care) was hard and it was costly but I felt like the cost of not going was much more,” said Simpson, who is married to a Californian graphic artist.

Simpson said she spent time in a Bakersfield hospital for polymyositis, a painful muscle disease, earlier in 2009 before she learned she had cancer, but doctors didn’t diagnose her cancer during her hospital stay. She later visited her doctor a couple times for a pain in her left armpit before a biopsy eventually revealed the cancer.

A co-worker recommended Cedars-Sinai and Simpson decided to undergo all aspects of her treatment there, including a double mastectomy, reconstruction surgery, chemotherapy and radiation. The hospital’s treatment plan gave her hope and Simpson said she had confidence in her providers there.

Before she had cancer, Simpson said she didn’t have any reason to question her doctors because she went to the same physician from birth until he retired. Now, she researches her doctors thoroughly and isn’t shy about telling others where she would and wouldn’t recommend getting medical care.

“It’s like when you go to a restaurant and the food’s really good, you tell everybody. When you go to a restaurant and the food’s really bad you tell everybody,” Simpson said. “When I go to some place and they don’t treat me well in the medical field, I tell everybody.”

Chris Bailey, a registered nurse, said the three local physicians she visited for a painful back problem gave her names of doctors that were out of town.

“We had trouble finding a physician that was covered by my insurance and then finding somebody that was recommended,” Bailey said.

Last year, she traveled to Torrance to have back surgery by a doctor with whom she had previously worked. Bailey has had other medical procedures done in Bakersfield and said she doesn’t doubt the quality of care here, but that in this case traveling seemed like the best option.

“From everyone I talked to, most people who have good results leave Bakersfield to have back surgery,” she said.

Several local cancer patients said a collaboration between academic medical centers and Bakersfield doctors provided them the right mix of treatment.

“Instead of it being about ego or control, it was about doing what's best for the patient,” said Bakersfield resident Tim Ross, whose wife, Donna, was treated at Comprehensive Blood and Cancer Center.

The Rosses decided to move back to Bakersfield from the Bay area last year after Donna underwent treatment for a cancer that impacted multiple organs in San Francisco last spring.

They said they were told by an oncologist at the Bay area facility that Donna wasn’t strong enough for a more intense treatment and that nothing else could be done. The hospital referred them to CBCC, which coordinated a treatment plan with USC.

“I think the reason she's still alive today is that Dr. Patel thought she was strong enough to receive aggressive treatment,” Tim said.

Donna had surgery out of town but did her chemo in Bakersfield, a treatment the Rosses described as so taxing she wouldn’t have been able to travel for it.

Tim, who grew up in Bakersfield, said times have changed since the 1970s and ‘80s when there was a feeling that if you were really sick, you were better off going to Los Angeles, Santa Barbara or San Diego to get care.

“The old joke was, you know Bakersfield has good medical care if you're not too sick,” he said.

Now, Tim said, Bakersfield has also become a medical destination.


Hospital executives from north and south of Kern said patients come to their facilties to receive care for complex illnesses and multiple conditions that they might not be able to find in Bakersfield.

Santiago Munoz, chief strategy officer for UCLA Health System, said UCLA often provides services including opthalmology, bone marrow transplant, oncology and solid organ transplants for Kern patients.

“On any given day, we likely see a few patients from the Kern County area and they’re likely receiving specialty services that many folks travel for,” Munoz said. “It’s certainly no reflection on communities like Bakersfield and Fresno.”

Parents of children in need of specialized care may also find themselves traveling to get to the right specialists in the Fresno or Los Angeles area. Kern County children make up about 10 percent of the total volume of inpatient days at Children’s Hospital Central California in Madera, said Steve Cade, the hospital’s director of business development. The children’s hospital serves a region ranging from southern San Joaquin County to Kern, so many of its patients travel for care.

“We definitely see more children come in from that entire 45,000-square-mile area than we did 10 years ago,” Cade said.

From 2000 to 2010, the hospital saw about a 17 percent increase in the number of children seen from Kern County, a jump that the hospital’s public relations manager, Jill Wagner, said could be following along with population growth or the specialists the hospital offers.

The out-of-town hospital administrators were quick to compliment the care available in Bakersfield and say that many people do stay close to home for their care.

Cade said there’s “a great health care system down there” and that the hospital tries to partner with health care providers in Bakersfield so children don’t have to travel. He pointed to the example of one of the hospital’s pediatric gastroenterologists who goes to Bakersfield three days a week to see patients there.

But executives also pointed out that very specialized care is costly to provide, requiring a large population center, research and staff to support it; so it makes sense to centralize those kinds of services.

“We wouldn’t have the resources to support transplant programs in every city,” Munoz said.