cure

In Alameda County, Sharon Ford, a Medi-Cal recipient, was turned away from two private hospitals last December while in labor, because a hospital computer erroneously showed that she did not have insurance. Hours later, her baby was born dead at Highland General Hospital in Oakland, the county facility.

The Alameda County district attorney decided against filing criminal charges in the case, but concluded “it is unmistakably clear that this transfer should not have been attempted.”

Economic Reasons

In San Bernardino last winter, a patient with a stab wound to the heart was sent to the San Bernardino County Medical Center after being examined and declared “stable” by a cardiac surgeon at another hospital, according to Dr. Max Lebo, the clinical director of emergency services at the county hospital. The patient arrived moribund, had a cardiac arrest and died.

In each case, the patient was shifted from one emergency room to another not for medical reasons, but for economic ones–the fear by the receiving hospital that it would not be paid for treating the patient.

Health care officials call such transfers hospital “dumping,” and it is a problem that is drawing increasing attention in California and across the nation.

Attention will be focused on the dumping issue Tuesday, when the state Assembly’s Health Committee meeting in Sacramento considers a bill that if enacted would give California one of the toughest “anti-dumping” laws in the nation.

“Lives are being lost every month this goes on,” said Assemblyman Burt Margolin (D-Los Angeles), who introduced the bill. “It is a violation of every code of ethical behavior one can imagine.”

The patients who are “dumped” are almost always the indigent, the uninsured and those on Medi-Cal. Hospitals are motivated to transfer them out of fear that the patients won’t be able to pay for their care or that the Medi-Cal payments won’t cover the hospital’s actual costs. In addition, some specialists, on call to back up the emergency room doctor, refuse to care for such patients.

The patients are usually transferred to public hospitals, where their unpaid bills are absorbed by local taxpayers.

The dumping problem has become more acute in recent years as competition among hospitals has increased and state and federal support for health care has been cut back. Margolin’s bill would supplement a federal “anti-dumping” law, approved by Congress March 20 as part of a deficit reduction measure and awaiting President Reagan’s signature. It details appropriate transfer procedures, mandates reporting of all violations and establishes stricter enforcement procedures.

The federal bill specifies civil penalties up to $25,000 per case against a hospital or doctor when patients are transferred inappropriately. Hospitals can be excluded from the Medicare program for violations.

Margolin’s bill, AB 3403, would require that all hospital emergency rooms in the state provide needed emergency treatment, regardless of the patient’s “insurance status, economic status or ability to pay.” A similar requirement would be imposed on individual doctors with hospital staff privileges.

Existing regulations specify these responsibilities, according to Margolin. But the possible penalties for abuses–a letter of reprimand or revoking the license of a doctor or an emergency room–are usually either too mild or too harsh, he said.

The Margolin bill would impose new penalties–including fines of up to $25,000 and jail terms of up to one year. A summary of all violations would be published quarterly by the state Department of Health Services and be available to the public.

The California Medical Assn. opposes the bill, according to a spokesman.

The California Hospital Assn. supports the “intent” of the Margolin bill, said C. Duane Dauner, its president, despite reservations about some of the provisions.

“Economic transfers are a way of life today,” according to Dauner, who characterizes dumping as just one symptom of a larger issue–providing medical care for the poor and uninsured.

The dumping problem was documented in a recently completed study by Lebo, the physician at the San Bernardino County Medical Center. It showed that in a three-month period last fall, 423 patients were transferred to the San Bernardino County Medical Center from other hospitals–91% for financial reasons. Of these patients, 31 were in unstable condition, including nine with stab wounds and three with gunshot wounds, Lebo said.

“The great majority of these patients were sent from hospitals that had the facilities to take care of them,” said Lebo, who declined to identify these hospitals.

One patient died during the study–a man in his 50’s, suffering from alcoholism, anemia and pneumonia. He stopped breathing in the ambulance after being declared stable for transfer by physicians at another hospital. “He might have survived if they had cared for him,” Lebo said.

Despite a regulation of the Joint Commission on the Accreditation of Hospitals that patients not be transferred until the receiving hospital has consented to the transfer, 40% of the transferred patients arrived unexpectedly.

“It is frustrating and exasperating,” said Dr. Francis Communale, the hospital’s medical director.

“Sometimes the receiving hospital would call up and we would tell them the hospital was full, but the patient would be sent to our emergency room anyway.”

Problems in 38 Cases

Even within Los Angeles County, which enacted widely praised transfer procedures in 1982, 87 inappropriate transfers were investigated between March, 1985, and February, 1986, according to Robert Karp, of the health facilities division of the county Department of Health Services. Problems were confirmed in 38 cases, he said.

Under Los Angeles County regulations, a medical alert center, staffed 24 hours a day at County-USC Medical Center, must approve all transfers from private hospitals based on guidelines developed in conjunction with the Hospital Council of Southern California.

Violations are reported by emergency room doctors to the county Department of Health Services for investigation. If neglect or abuse is found, the offending hospital is contacted and asked to submit a plan to correct the problem.

In the last year, five cases were also sent to the state Board of Medical Quality Assurance, which licenses physicians, according to Karp.

The county system is credited with cutting the number of inappropriate transfers by more than half, according to Geraldine Dallek, of the National Health Law Program in Los Angeles, who has investigated the issue. Of about 80 transfers arriving each day at County-USC Medical Center, more than 90% receive prior approval and meet all protocol requirements, she said.

But a National Health Law Program study also pointed out the county system’s weaknesses. “Hospitals which violate transfer provisions know that the penalty for doing so is light,” it concluded. “The county has no authority to fine a hospital and the likelihood of a license revocation is almost nil.”

A National Trend

The California bill reflects a national trend toward legislation to ensure that the poor receive adequate emergency care. In addition to the federal bill, both South Carolina and Texas enacted tough “anti-dumping” laws in 1985. Alameda County is preparing transfer procedures similar to those in Los Angeles County.

The California Hospital Assn., however, asserted that the larger issue of so-called “uncompensated care,” must be tackled as well. Uncompensated care exceeds $1 billion out of the more than $12 billion spent on hospital care in the state each year, the association’s Dauner estimated, with 12% of the hospitals bearing 60% of the burden.

To provide relief for these institutions, the hospital association has proposed the creation of a fund, to be jointly financed by the state and federal governments and the hospitals.

Supporters of Margolin’s bill, however, believe the transfer issue should be dealt with on its own terms. “I want to get the whole damn thing stopped,” said Lebo, who was on duty the night the patient stabbed in the heart died.

Olivia Rodrigo has officially begun her new era, and this time she invited her fans to experience it alongside her.

To celebrate the release of her latest album, “You Seem Pretty Sad for a Girl So in Love,” Rodrigo collaborated with American Express to re-create the set of her music video for “The Cure.” The pop-up event, which opened last Thursday and ran until Sunday at Mica Studios, featured props from the video, storyboards, exclusive merchandise and several photo ops for fans.

With a beating felt heart and lab beakers to pose with, the pop-up transformed an industrial studio space in the Arts District into a pastel-painted cardboard hospital. Ahead of the public opening, Rodrigo surprised a small group of AMEX cardholders and select fans.

“I have an album that’s coming out today in about one hour, which is crazy,” Rodrigo said, wearing a blue “Nurses Do It Better” baby tee. “I figured since we’re all here, maybe we should just listen to a few of them together? Would that be cool?”

A little over an hour before the album’s release, Rodrigo played four songs from the album as the room brewed with excitement. She began with “Maggots for Brains,” a song about being so infatuated you can’t focus when your partner is away. Although it was their first listen, the song’s catchy chorus already had fans dancing along.

Banner for Rodridgo’s pop-up event hands above Mica Studios

(American Express)

Rodrigo explained that her next song, “Purple,” paid homage to the aesthetics of her previous albums, “Guts” and “Sour.”

“Obviously, this is my first non-purple album, but I just had to shout out purple somehow,” Rodrigo joked. “This song started out as a love song and sort of devolved from there, so I’ll let you guys be the judge.”

Playing off the somber vibes of “Purple,” Rodrigo played “Less” next. The piano ballad follows the dissolution of a relationship as the couple grows apart.

“I’ve been going back and forth on what the saddest song on the record is, but I think this one might be it,” Rodrigo said.

In a room full of fans, the song struck an emotional chord with many of the listeners. To bring the mood back up, Rodrigo finished the night by playing her new single, “Stupid Song.”

“This next one is a happy one, and it actually has a music video that comes out tonight,” Rodrigo said. “I love this song so much. It’s basically about having such an intense crush on someone that it drives you totally f— insane. I feel like we’ve all been there at some point in our lives.”

Rodrigo was all smiles at her event celebrating her latest album steeped in heartbreak and romance.

(American Express)

After Rodrigo previewed her music, “The Cure” music video exhibition was opened up to the fans. The showcase ranged from interactive photo ops to gallery walls featuring behind-the-scenes photos from the video shoot and Rodrigo’s nurse costume on display. The video’s props, which were primarily designed using cardboard and felt, were displayed in glass cases for visitors to admire.

Dressed in fun fashion including light pink and polka-dot outfits, fans posed throughout the set, re-creating scenes from the music video as “The Cure” played overhead. Many had thrown on a piece of the Los Angeles-exclusive merchandise on sale at the pop-up, with shirts and hats reading “You Seem Pretty Sad for a Girl in Los Angeles.”

So while some fans teared up at her lyrics and others beamed with excitement, everyone was hyped to experience Rodrigo’s new album.

“I really hope you enjoy this little exhibition. It is so gorgeous, and I am so proud of it,” Rodrigo said. “Thank you guys for being here, and I really hope you love ‘You Seem Pretty Sad for a Girl So in Love’ as much as I do.”

What to do after writing some of this century’s most devastating songs about the torment of breaking up? Write some of this century’s most devastating songs about the ecstasy of getting together.

With her first two albums — 2021’s Grammy-winning “Sour” and 2023’s triple-platinum “Guts” — Olivia Rodrigo proved herself to be perhaps the most gifted of the many chroniclers of Gen Z romance to emerge in Taylor Swift’s wake. She could convey the hot sting of betrayal, as in her smash debut single, “Drivers License”; she could channel the injustice of watching an ex somehow carry on, as in “Good 4 U”; she could deliver a sick burn like somebody handing out Halloween candy, as in “Get Him Back!” (Because it deserves remembering: “He had an ego and a temper and a wandering eye / He said he’s six-foot-two, and I’m like, ‘Dude, nice try.’”)

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Yet on her thrilling third LP, “You Seem Pretty Sad for a Girl So in Love,” Rodrigo, 23, turns to the pleasure that comes before the pain — and, in a feat very few in pop music are ever able to pull off, ends up with a number of first-flush-of-love songs as potent as any breakup tune.

She opens the album with “Drop Dead,” in which she compares a guy in line for the bathroom at a bar to an “angel on the walls of Versailles” — an early sign of how high the emotional ceiling is here. In “Stupid Song” she cycles through a series of metaphors to describe her lovesickness — she’s a car without a brake, she’s a heart made of melting wax — before finding a simpler but infinitely more vivid way of getting her point across: “You should feel how I feel when somebody says your name.” (Chills.)

“Maggots for Brains” is a song about how useless she becomes “when my baby goes away,” and let’s just take a second to savor the fact that Rodrigo is putting that title into the world less than four years after she was still a working Disney kid. The album’s next tune, “U + Me = <3,” is its high point: a euphoric promise of devotion that sounds like Sixpence None the Richer reborn as a Midwestern emo band. It’s got two young lovers carving their names into car seat leather, and it’s got a girl trying to impress her boyfriend’s older sister with her cynical humor and her taste in yacht rock.

More important, it’s got these lines of pure poetry: “They say modern love’s a cruel endeavor / And to that I say, F— it, whatever.” Kurt Cobain would be proud.

Working with her longtime producer, Dan Nigro, Rodrigo has expanded her stylistic palette to accommodate these new emotions; “You Seem Pretty Sad” pulls in chiming folk-rock and synthed-up new wave and even has a gorgeous wine-bar piano ballad, “Less,” that might put the scare in Rodrigo’s pal Laufey.

The cover of Olivia Rodrigo’s new album.

(Geffen Records)

The album is structured to trace the arc of a relationship, which means that the second half dips into the heartbreak we’re used to getting from Rodrigo. But she’s writing about familiar scenarios with new wisdom, drawing sophisticated conclusions about why people in love do the things they do (and don’t do the things they don’t).

In “The Cure,” which rides a strummed acoustic-guitar pattern that strongly recalls Smashing Pumpkins’ “Disarm,” she realizes a boyfriend can’t fix what’s broken inside her; “Begged” examines the limits of one partner’s willingness to look past the failings of the other. After hearing these songs, the happier ones at the beginning of the album reveal bits of shadow that Rodrigo has built into them to presage what’s to come — to presage what always comes.

It’s fitting, then, that Robert Smith of the Cure — perhaps pop’s most jubilant gloommeister — hovers over this LP like a patron saint: nodded to in “The Cure,” of course, but also “Drop Dead,” where Rodrigo name-checks the Cure’s classic “Just Like Heaven.” Smith himself turns up in “What’s Wrong With Me” for a duet with Rodrigo in which the two learn to accept that love, in the end, might be what kills them.

“My head is spinning and my stomach is sick,” they sing, and neither sounds like they’d have it any other way.

South Korea is using AI-powered companion dolls to help tackle loneliness in its ageing population. The robots remind seniors to take medication, monitor wellbeing and call for help in emergencies. As AI expands, concerns remain over whether it can ever replace human connection.