MKI: Mending kids in need


There was a 3 percent chance that the mole on 16-year-old Jacob Rubio’s forehead, which he had had since birth, might turn cancerous. When his mother, Juliann Castillo, noticed some lumps in it, she grew worried and requested a surgery to have it removed.

But Medi-Cal considered the procedure cosmetic and denied it, and Castillo, who is on disability, could not afford to pay for it herself, she said.

Then, on July 20, Jacob received the surgery he needed at no cost, thanks to a collaboration between the Burbank-based nonprofit Mending Kids International (MKI) and Cedars-Sinai. He was one of 18 children who benefited from surgeons who volunteered their time and $50,000 in donations for supplies.

Called a “hometown mission,” because it took place in the United States — MKI usually transports doctors abroad — this event served both domestic and international patients. MKI flew kids in from El Salvador, Ethiopia, Ghana, Guatemala and Kenya to undergo procedures at Cedars. 

MKI Executive Director Marchelle Sellers said the organization, which provides surgeries to children worldwide and has in the past brought foreign children to Cedars for treatment, had been questioned in the past about not helping kids in the United States who also need help.

“When we started looking around, we realized that was true. Kids were falling through the cracks,” she said. 

It’s hard to deny the need, even for some families who have insurance. One family helped by the inaugural hometown mission was unable to pay the $5,000 deductible required before their insurance would cover a procedure.

Children from other countries generally are referred to the program by parents, missionaries or visiting medical professionals. During their time in the Los Angeles area, the children stayed with host families who accompanied them to appointments and cared for them before and after their procedures, which were either cosmetic or urological.

Jacob and his mother, who live in Bell Gardens in Los Angeles County, were driven to the surgery and necessary appointments by an MKI sponsor, who helped them through the entire surgical process.

Dr. David Kulber, director of Cedars’ Center for Plastic and Reconstructive Surgery and a volunteer with the hometown mission, said the event was partly to give MKI donors a chance to see the organization in action. He called his work with MKI and other charitable foundations “the most gratifying thing I have done as a physician.”

Kulber said one of the biggest challenges is gaining the trust of children from other countries who may be experiencing culture shock after coming to the United States to receive their surgeries. 

“That’s the real challenge … to get them to trust you,” he said. “It’s really about building trust with the child.

“The beauty of medicine is we all speak the same language: It’s about the human body and how to fix it. … [This] trumps any other cultural differences we may have.”

Kulber belongs to Valley Beth Shalom in Encino and believes that his Jewish background has affected his medical philosophy.

“Treating everyone equally without any prejudice is a lot of what Judaism is about,” he said.

Although MKI provides all kinds of surgeries, including cardiac and craniofacial, the July 20 event focused on cosmetic and urological outpatient procedures. Performing these surgeries in the context of MKI can present challenges. 

Dr. Andrew Freedman, director of pediatric urology at Cedars, said many urological procedures traditionally depend on having access to a catheter. If those will not be available to children when they return to other countries, then he must arrange for their drainage to be different. 

“You’re relying on people who work in a very different system. … We can’t put them in a situation where, if something goes wrong, they will get really sick right away.” 

Freedman said he is grateful that MKI is generally “very sensitive” to follow-up issues and he looks forward to more such missions in the future.

“Helping complete strangers from the other side of the world … is very consistent with your Jewish values,” he said. “We hope this becomes a recurring event.”

The procedures may be cosmetic, but many of them will have enormous impacts on children’s lives. One patient could not move an arm because of contractures from burn scars. One boy, who is returning for his second surgery with MKI, had tumors removed from his hands so that he could regain some use of his fingers. 

The tumors and lumps removed from patients often were uncomfortable rather than dangerous, but as in Jacob’s case, the lumps must be removed and biopsied to know for sure.

Addelyn Del Cid, a 6-month-old dressed in pink and sparkling dot earrings, was brought by her family to remove a lump on her leg. Follow-up tests determined that she has a rare condition that currently poses no threat. The family said they would have been unable to afford the procedure otherwise.

The benefits of an MKI procedure can transcend the medical results. 

“We have a boy coming in who has a mass growing on [his] ear, but he is going into kindergarten. … His mom is just desperate for someone to remove it so he does not have to face a childhood of bullying,” MKI’s Sellers said. “Literally an hour in the operating room is the difference between having a normal childhood and one that would be filled with constant teasing.”

Such was the case with Jacob.

“He got bullied a lot,” his mother said, remembering classmates and even family members taunting him about his birthmark.

Castillo is glad that she will not have to spend her entire life worrying that her son might be sick — the biopsy found that Jacob’s mole was benign.

“I am just grateful and blessed we [had] this opportunity,” Castillo said.

Senior service providers wary as New Year approaches


They’ve weathered five years of economic crisis, relentless state budget cuts and growing demand for their services. Now, social service providers for seniors in the Los Angeles area are bracing for a new slew of challenges in 2013.

From federal budget negotiations and the looming “fiscal cliff” to state-level pilot reforms of Medicaid — known in California as Medi-Cal — these are uncertain times for seniors, their caregivers and the agencies that help them. 

“We’re not really sure how it’s going to play out,” said Paul Castro, CEO of Jewish Family Service of Los Angeles (JFS). “We try as best we can to anticipate and plan, but it’s a very uncertain environment and there’s so many parts to it.” 

At the top of most agencies’ watch list is the “fiscal cliff,” the dramatic concoction of federal spending cuts and tax hikes slated to take effect Jan. 2, unless Congress agrees on an alternative. Programs in line for automatic cutbacks include nutrition services for the elderly, funding for in-home care providers, low-income heating assistance, and social and legal support for the vulnerable. The sum of these reductions — $55 billion for all nondefense spending — could have devastating consequences for millions of older Americans, providers fear.

In Los Angeles, JFS says federal cutbacks, if they go ahead, would hamper the agency’s ability to help seniors, particularly those living in poverty. The organization receives federal dollars for numerous programs, including in-home nursing care for the sick and frail; community dining and home-delivered meals; and free transportation services for seniors who need help going to medical appointments, meal sites and elsewhere.

Of those, nutrition services are the most critical for low-income seniors, many of whom rely on the agency for their meals, JFS public policy director Nancy Volpert said. If automatic cuts go into effect, the agency will be unable to feed 83 seniors out of the 1,040 it serves daily. 

“If someone loses food, that is an existential problem,” Volpert said. 

Barbra McLendon, public policy director for the California Southland chapter of the Alzheimer’s Association, said state budget cuts over the past few years have already caused programs to shrink and sometimes even shut down, including adult day care facilities for people with dementia. 

“There’s no more fat to be cut,” she said. “They would be cutting into direct services that people depend on.”

Still, McLendon and JFS officials said they remain optimistic Congress will strike a deal before Jan. 2. They also pointed to positive news at the state level. Voters’ approval in November of Proposition 30, which cleared the way for temporary tax increases, should prevent more funding cuts for senior services in the state budget, they said.

Assemblyman Bob Blumenfield (D-Van Nuys) agreed the budgetary outlook for the state has improved with the passage of Proposition 30. Nevertheless, ongoing shakeups of health-related programs affecting seniors, including a new effort aimed at keeping ailing elderly people in their homes, will need to be monitored closely, he said. 

And if big cuts kick in on the federal level, the system could come tumbling down.

“If the feds take us over the cliff, that could cost us $5 [billion] or $6 billion, and we’re back to the drawing board,” Blumenfield said.

Even if federal lawmakers stave off an immediate fiscal catastrophe, the long-term outlook for programs critical to seniors — including Medicare, Medicaid and Social Security — remains shaky. With the nation facing an unwieldy $1 trillion deficit, large social programs are a conspicuous target. 

Republicans, who control the House of Representatives, have already proposed smaller annual increases in Social Security payments, capping Medicaid spending and raising the Medicare eligibility age from 65 to 67, or turning it into a voucher program.

Jim Specht, spokesman for U.S. Rep. Jerry Lewis (R-Redlands), said the congressman believes reforms to Medicare and Social Security are necessary to avoid the programs’ financial collapse in the future.

“Both the entitlement programs, particularly Medicare, are on a course now to run out of money over the next 10 years or so,” Specht said. “Mr. Lewis believes you cannot just allow that kind of a fiscal problem … to continue.”

The fiscal cliff, and the automatic cuts it would imply, pose a greater threat to current seniors than proposed entitlement reforms, Specht said. Changes to Medicare and Social Security supported by Lewis would not affect people now over 55. For younger people nearing retirement age, reforms would be phased in, he said.

Lewis “is not interested in reducing any benefits for current seniors,” Specht said.

Still, U.S. Rep. Henry A. Waxman (D-Beverly Hills) said,“Seniors ought to be worried and aware of proposals that have been put on the table. I’m hoping that President Obama will be able to push back hard enough not to get them into law.”

Meanwhile, Los Angeles senior service providers said they are uneasy over another critical issue dependent on action by Congress: reauthorization of the Older Americans Act. The almost 50-year-old legislation authorizes federal funding for a wide range of senior services, including Meals on Wheels and home-based care programs, which is funneled through the Administration on Aging to state and local entities. It was due for renewal in 2011 but remains in limbo.

“It should have been done months ago. It has been introduced, but it’s just not going anywhere, which is a problem,” Volpert said. 

Failure to renew the act means agencies that receive federal funds to help seniors are not sure how to plan for their future, McLendon said. 

In California, another development is adding to the cloud of uncertainty, although there is hope it could bring about positive change. The state is one of 15 across the country participating in a federal pilot project that aims to shift so-called “dual eligibles” — people who qualify for both Medicare and Medicaid — into managed care. Officials say the change will reduce costs while providing beneficiaries with better-quality care.

Los Angeles is among five counties setting up the plan, which affects some of the poorest and sickest Californians, most of them elderly. About a third of the state’s 1.1 million dual eligibles live in L.A. County. Under the project, expected to start some time next year, local health plans L.A. Care and Health Net would be in charge of financing and delivering both medical and social services to dual-eligible patients. Currently, individual providers, such as JFS, are compensated directly by the government based on the number of services they provide.

Castro said JFS and other organizations in Los Angeles that run programs for seniors are anxious to ensure the transition doesn’t wipe away the current infrastructure and leave the elderly without access to services they’ve depended on for years.

It’s “a dramatic change in the service landscape,” he said. “The question is how much money will the state fund the health plans to do this kind of work, and how much will the plans be willing to spend on these clients, particularly those who are most fragile and imply the most cost?” 

Blumenfield echoed those concerns.

“We’ve really got to watch the implementation and make sure it helps seniors and doesn’t harm them,” he said. “The devil is in the details.” 

Budget Woes


One year ago, Gov. Gray Davis was calling for across-the-board cuts in every state department except the prisons, mass layoffs of workers and huge bites out of most programs for the disadvantaged.

Davis’ budget-slashing plan of January 2003 was ignored by the legislature and pilloried by the media. In the end, Davis failed to meet the fiscal crisis and lost his job because of it. Now, a year later, some critics are saying Gov. Arnold Schwarzenegger’s budget is little more than Davis redux.

In fact, the Schwarzenegger plan represents a significant departure from business as usual, and offers a template for fundamental change in the capitol.

This is not to say that Schwarzenegger’s proposal is free of the familiar. Just as with the Davis plan, it would hurt local service agencies that rely on Medi-Cal. Although the idea is being challenged in court, such service groups face a proposed 10-percent rate cut.

Paul Castro, executive director/CEO of Jewish Family Service of Los Angeles, which serves 60,000 people a year, said $600,000 would be cut to providers of services like the Multipurpose Senior Services Program.

"Seniors stay at home for about half the cost of putting them in a nursing home, so cutting money to this saves on one side of the ledger but costs more on the other side," Castro said.

Molly Forrest, chief executive for the Los Angeles Jewish Home for the Aging, said she coped with last year’s cuts by trimming expenses and increasing private fundraising for the home that serves 800 residents.

"The governments are not prepared to deal with the fact that people are living much longer," said Forrest, whose fundraising is up 7.8 percent.

But for every idea borrowed directly from Davis, Schwarzenegger and his team came up with fresh principles for saving money that have some Sacramento observers buzzing with hope.

Assemblyman Joe Canciamilla, Democrat leader of the Moderate Caucus, a group enjoying new respect, told me, "This budget is a worthy attempt to correct the craziness that has unfolded here. I would cut even more."

Kim Belshe, new secretary of Health and Human Services, says that of the $13 billion explosion in spending since 1999, half came from programs in her department on which there were no cost controls. Unlike Davis, Schwarzenegger "is not proposing wholesale rolling back of programs, but controlling costs while maintaining services to those most in need."

Schwarzenegger intends to wean California’s legislature away from its taste for Cadillac programs that most other states offer as mere Fords. Think of the governor as repo man.

For example, unlike the basic Medicaid programs created by other state legislatures, Sacramento’s legislators decided Medi-Cal should be better than most private health plans. On the taxpayer’s dime, they created a program that even includes free acupuncture, and they offered the plan to many non-poor. One in five Californians qualified. The result was skyrocketing costs that are unsustainable.

State Finance Director Donna Arduin told me all 6.8 million people will still be eligible, to avoid Davis-style slashing. But costs will be controlled. The non-poor "may be asked to contribute toward their care, or the package of benefits they are offered may be modified." The changes will take two years, while California seeks federal approval. Other states already have these controls.

It’s just sensible stuff. But while Schwarzengger pushes for cost reforms, it’s extremely unlikely he will approve new taxes.

A strong anti-tax mood has settled across the nation. A recent poll in California shows voters willing to accept new taxes only on smokers and the rich — two populations that have dwindled so drastically that Chief Legislative Analyst Elizabeth Hill says taxing them would produce only a fraction of the several billion dollars needed to plug the deficit.

Democratic and Republican consultants and strategists tell me that Schwarzenegger and the Republicans won’t bend on taxes unless the governor suffers a big defeat in March.

In March, the governor wants voters to approve a $15 billion bond that refinances $12 billion in legally questionable bonds approved by the Davis-era legislature to finance its overspending last year. That $12 billion is milk that’s already been spilled. However, Schwarzenegger’s package ensures that those bonds are legal, avoiding potential fiscal chaos.

It’s going to be a tough year. Yet the governor has said that everything is on the table, and if alternatives to his cuts can be found, he wants to hear them. Unlike Davis, he has targeted the prisons for massive cutbacks. Worthy programs like the Multipurpose Senior Services Program still have a real chance to make their case, and people like Castro say they intend to do so.

In the end, however, everyone should hope Schwarzenegger gets much of what he is seeking from the Democratic-controlled legislature. It’s true fiscal restraint, but it’s done with decency.


Jill Stewart is a syndicated
political columnist and can be reached at