By Yvette Cabrera
Los Angeles Times, February 13, 1995

SAN JUAN CAPISTRANO — Back in the 1960s, after Mexican farm workers left the fields at each sunset, Dr. Monte McCanne’s office in this tiny agricultural town would begin to fill with laborers and their children. The doctor was always in, sometimes as late as 10 p.m., and he never rejected a patient who couldn’t pay.

Now in his 34th year of practice, McCanne, a primary-care physician who also provides obstetric services, says patients continue to come to him for medical care because he still welcomes all, even those uninsured, undocumented or unable to pay.

“I’ve always thought that…all I had to do was walk out the door and down the street and I’d find people in desperate need,” said McCanne, 60.

Former city planner Raymundo Becerra said: “I see Monte as a key player in the community who very humbly and quietly does his work. He is an old-town family doctor who has the love and respect of the Latinos here.”

About 75% of McCanne’s patients are Latino.

Even when Becerra arrived in San Juan Capistrano in 1973, he was surprised to meet so many people who were patients of Monte McCanne.

And now it seems like everyone has been delivered by Monte, “sometimes even three generations,” said Becerra.

Monte McCanne is not alone. His brother, Don McCanne, 57, is a San Clemente physician who also provides care regardless of his patients’ ability to pay.

“When other doctors wouldn’t take (obstetrics) patients without insurance, the McCannes would always accept them,” said Thomas E. Shaver, a surgeon at Mission Hospital Regional Medical Center in Mission Viejo.

“Despite financial hardships that go along with taking care of people without insurance . . . the (McCannes) have really committed their entire professional lives to caring for the Hispanic community in that area,” Shaver said.

At work, instead of typical medical garb, Monte McCanne wears one of the many guayaberas he has received. These lightweight cotton shirts are popular in Mexico’s coastal states of Veracruz and Guerrero.

“Between the two of us we’ve probably done (dubious number edited out – DM) worth of free work…But once you’ve eaten, how much money do you really need?” said Monte McCanne, who, like his brother, is married and maintains a modest lifestyle.

The McCannes are links in a family legacy that has provided for the less fortunate. Their grandfather, a real estate agent who owned orange groves in Pomona, delivered fruit to the mainly Latino residents of low-income neighborhoods in the south side of that city.

Their father, a former architect and schoolteacher who completed medical school while his children were growing up, opened two medical practices in Pomona in the 1950s to provide desperately needed health care. When he opened weekend clinics in San Juan Capistrano and San Clemente in the 1960s, his two sons–doctors themselves–took charge. (Don McCanne’s twin brother also followed in their father’s footsteps: He is an obstetrician for Kaiser Permanente in Fontana).

“We certainly filled a need. When we came here, nobody wanted to serve the indigent,” said Don McCanne, who arrived in San Clemente in 1966, five years after his brother settled in San Juan Capistrano. “But there are always going to be people who have difficulty in obtaining medical care.”

Slowly, word spread through the barrios about the brothers who never asked if their patients were documented residents.

Marcela Conde’s three daughters are the fourth generation of her family whom the McCannes have treated.

“The McCannes have great personalities. When I talk to them they don’t give me the run-around,” said Conde, 23, who was delivered by Monte McCanne and who had two of her daughters delivered by Don McCanne. “My whole family goes to them, from my grandmother and mother to my aunts and sister.”

Having a sibling who’s a doctor nearby has been a blessing for the brothers. They have rotated on-call duties since 1966 and have left town together only once, when their father died 20 years ago.

Though the brothers have the same desire to help the indigent, in many ways they are different. Don McCanne speaks limited Spanish while Monte is bilingual.

Don McCanne is active in his community, serving as chairman of the Mariners Bank in San Juan Capistrano and as a board member at Samaritan Medical Center in San Clemente, while Monte prefers to keep a lower profile.

Don McCanne said he is obsessive when it comes to following rules, while his brother is more casual and “warmer.”

Yet, when it comes to dosages of dedication, the siblings are like twins. Both work late into the evening and on weekends.

Some people object to the McCannes providing health care to illegal residents.

“Orange County is bankrupt. We simply do not have the resources to take care of the world,” said Nancy Thomson, coordinator of Citizens for Responsible Immigration, based in Orange. “These doctors do not have the right to give their services to people who” are here illegally.

Don McCanne responded by saying, “I’m a physician. I take care of people. And I know that offends some people, but every single person deserves adequate health care.”

He added that “the private patients pay the bills and keep us financially viable.”

Long hours, a progression of patients, low Medi-Cal reimbursement rates. Why do the McCannes continue this course?

“There’s a lot of gratification. It’s just the overall feeling of doing something good,” said Don McCanne.

https://www.latimes.com…

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Doctors Have Right to Serve Anyone

Los Angeles Times, Letters to the Editor, February 19, 1995

It was heartwarming to read in “Putting Health First,” (Feb. 13) about the two doctors, (Monte and Don) McCanne, who have committed their lives to serving the Hispanic community of south Orange County without regard to ability to pay or proof of citizenship.

When doctors are too often perceived as primarily concerned with their own bottom lines, it’s reassuring to know that these men give so freely of their talents.

In contrast, I was sickened by the outright meanness expressed by Nancy Thomson, coordinator of Citizens for Responsible Immigration, in her objection to the McCannes providing medical health care to illegal residents. Her position that Orange County’s bankruptcy somehow means that “these doctors do not have the right to give their services to people who” are here illegally is incredible. Is she so lacking in care for her fellow man that she would deny the doctors’ right to deliver their own services to whomever they please?

And what about Newt Gingrich’s position that private charity should replace government in caring for the needy? These doctors are reducing the county’s cost of caring for the indigent in emergency rooms. Their basic humanity stands in sharp contrast to the barely concealed bigotry of the anti-immigration groups.

A. McINTYRE
San Clemente

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Congratulations to the McCanne brothers. Their work and altruism is a true reflection of the Libertarian views. They are helping others without a law requiring them to do so and without any laws telling them they cannot.

ANNA M. APOIAN
Corona

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I am a middle-class, third-generation American. Thirty years ago, my daughter, Lisa, was very ill and none of the fancy doctors in South County knew what was wrong. Dr. Monte McCanne diagnosed leukemia and sent us to Children’s Hospital of Orange County for affordable care, as we had no insurance at the time. Dr. Monte remained our family physician for many years.

Nancy Thomson of Citizens for Responsible Immigration says: “These doctors do not have the right to give their services to people who” are here illegally. These doctors have the right to give whatever they like to whomever they like. Thomson is a disgrace to humanity.

JOAN DANIELS
Laguna Niguel

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Boos to Nancy Thomson for her position that “these doctors do not have the right to give their services to people who” are here illegally. Come on.

But kudos to Drs. Don and Monte McCanne for their medical services to the poor and indigent for long years, regardless of the ability to pay. These men have to be among the brightest luminaries in our community.

FATHER RICHARD WOZNIAK
Associate Pastor
La Purisima Catholic Church
Orange

https://www.latimes.com…

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Comment:

By Don McCanne, M.D.

Okay, this looks like kind of a weird Quote of the Day, but it seems to be appropriate for the very last day of a very difficult year. I had long ago forgotten about this article published a quarter of a century ago, but one of our sons stumbled on it yesterday through Google, and he sent it to us.

So what is the story behind this story? Simply, we believed that everyone should have health care and linking that care to the ability to pay frequently was just not right. I joined the practice in July, 1966, the month when Medicare and Medicaid were implemented. Medicare was great. It paid fair rates and opened up referral channels to specialized care. Medicaid helped to reduce our losses on care for the indigent, although we had to rely on other sources for our own (modest) net incomes. Even the uninsured were not there for charity. They paid their fees when they could, though it didn’t seem fair after seeing them labor in the agricultural fields. Private insurance worked well in the earlier years of our practice, but the managed care revolution erected significant barriers to care in the form of limited provider networks, higher deductibles and other cost sharing, and burdensome administrative excesses such as prior authorization requirements.

We became convinced more than ever that we needed a national health insurance program that covered everyone. What a pleasure that would have been to be able to just take care of the patients and ignore the payment issues. In fact, I began speaking and writing on a program that I called “UNIVERSAL MEDICARE – Health Care for Everyone.” I had red, white, and blue bumper stickers made up with this slogan. I read about Physicians for a National Health Program and immediately joined them, though California lagged the East Coast and Chicago in activating the organization.

Unfortunately, Monte developed a disabling neurological problem and had to retire. By this time a community health center was established in San Juan Capistrano, so we were able to close the practice knowing that our patients could still receive care. Our more affluent patients had no problem finding other physicians who were enthusiastic about practicing in an Orange County coastal community. Although we certainly missed our patients, we didn’t feel like we abandoned them.

It was at that point, over two decades ago, that I decided to devote my remaining productive years to advocate for health care reform, primarily as a volunteer for Physicians for a National Health Program (all of us at PNHP are volunteers, except for the small, highly dedicated staff).

So what is the point of today’s message? I look at Quentin, Jack, Bud, Bob and some of the other icons of the health care reform movement who have left us, and I realize that there is so much more work left to do, and it’s going to have to be done by you. I just hope that some of us can provide a modicum of inspiration to help move the process forward. We are so close. We have the policy worked out, but we still have to align the politics. 2021 is ripe for lighting that fuse. Liftoff time!

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Peter Lazes and Marie Rudden

The purpose of this book

As both of us have been occupied in our careers with what makes organizational systems more effective and have observed the central role of frontline staff and caregivers in this effort, we offer methods for restructuring healthcare systems in a way that makes collaboration and active communication among administrators, medical staff, and patients a key value. This book explores exactly what it takes to effectively engage staff and providers in improving the patient care shortcomings within their institutions. We do this by presenting case studies of institutions that have successfully implemented major systemic changes in this manner, by reviewing research findings and outcomes, and by conveying the direct words and experiences of staff who have participated in changing their healthcare organizations.

We have shaped this book around the specific methods that healthcare systems can employ in order to enlist their frontline staff in diagnosing and rectifying difficulties in providing high-quality patient care. This book not only is a manual detailing what can be achieved when frontline staff have a direct voice in controlling their practice environments, but also was written to provide a method for accomplishing transformative changes in how our hospitals and outpatient clinics work.

All Americans deserve and should have access to high-quality, affordable healthcare services delivered by professionals who know them and who have sufficient time and resources to care for them.

In sum, this book will inform you about the historical development of approaches for engaging frontline staff in job redesign and in the creation of more effective organizational systems. The book gets you under the covers, so to speak, exploring what it really takes to effectively initiate, implement, and sustain employee involvement activities. It demonstrates how Labor-Management Partnerships particularly can help organizations to evaluate the effectiveness of their current systems and to design more functional structures. We emphasize too the importance of establishing collaborative leadership processes to engage and sustain employee participation efforts.

Peter Lazes, PhD, a clinical and industrial psychologist, was the founder and former director of Programs for Employment and Workplace Systems and of the Healthcare Transformation Project, both at Cornell University.

Marie Rudden, MD, his wife and co-author, is a psychiatrist and psycho-analyst, an associate editor for the International Journal of Applied Psychoanalytic Studies, a member of the North American Editorial Board of the International Journal of Psychoanalysis, and a clinical assistant professor in psychiatry at Weill Cornell School of Medicine.

https://www.penguinrandomhouse.com…

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Comment:

By Don McCanne, M.D.

In a personal email communication, Peter Lazes writes, “In addition to a national payment system, I would suggest that it is critical to create ways for frontline staff and unions to become active partners in the creation of new structures and systems to improve access and coordination of care. Bills, administrative actions and some form of Medicare for All are important, but it is critical that we find ways to make use of the sufficient knowledge of frontline staff (from housekeeping staff to attending physicians) in order to achieve needed breakthroughs… structures themselves will not be sufficient nor will just “bold” leadership from management. Current healthcare management leadership has achieved only anemic improvements in improving the quality of patient care. And a national payment system by itself will not achieve reducing inequalities nor improve overall health outcomes. Systemic changes along with a national payment system is needed.”

It is absolutely essential that we replace the current dysfunctional health care financing system with one that ensures equitable, affordable health care for all – single payer improved Medicare for All. Although the financial realignment will certainly correct many of the deficiencies in the health care delivery system, it will also greatly benefit from continual oversight, analysis and improvement from those most important to the patient – the frontline staff and their patient-oriented organizations, such as the unions.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Though a state board rejected Mercy’s application to close, hospital officials are working to shut down by May 31. Activists want a moratorium on hospital closings and pressure from the city and state to ensure Mercy remains open.

By Maxwell Evans
Block Club Chicago, December 22, 2020

A coalition of activists are demanding elected officials maintain pressure on Mercy’s ownership to keep the hospital open or sell to someone who will.

The activists held a vigil Monday, a week after a state board unanimously rejected Mercy Hospital’s request to close. Board members agreed closing the Near South Side institution would negatively impact South Siders, especially in the middle of the coronavirus pandemic.

Mercy Hospital leadership announced in July the city’s first chartered hospital would shut down, citing monthly operating losses of $4 million and shifting trends in the field of health care away from inpatient services. The news came two months after a billion-dollar plan to consolidate the hospital with three others on the South Side fell apart.

Despite the Illinois Health Facilities and Services Review Board’s rejection of Mercy’s request, the hospital still has options for shutting down — and intends to take advantage of them.

If local leaders don’t take action, organizations within the coalition will mobilize against them in their next elections, Bennett said.

Coalition members include local representatives of the Kenwood-Oakland Community Organization, SEIU Healthcare Illinois, National Nurses United, Physicians for a National Health Program, White Coats for Black Lives, and several other groups.

While keeping Mercy open is the coalition’s focus for now, its battle for health equity reaches further.

Members are also organizing to address the dependence of safety net hospitals on Medicare and Medicaid reimbursements, “a racist system that in its structure is guaranteeing hospitals don’t have what they need,” said Jitu Brown, board president of the Kenwood-Oakland Community Organization.

Hospitals lost 13 cents on every dollar spent caring for Medicare and Medicaid patients in 2017, according to the American Hospital Association. Three out of every four Mercy Hospital patients pay through Medicare or Medicaid, according to a 2019 report.

The battle the keep Mercy open is part of a decades-long struggle to maintain critical health services throughout the South Side.

But health care has continued to shrink, shift or disappear altogether in the South and West sides for years.

https://blockclubchicago.org…

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Comment:

By Don McCanne, M.D.

How could shutting down a safety net hospital in a region struggling to maintain critical health services advance the cause of health equity? It can’t.

So what reason is being given for the efforts to close Chicago’s Mercy Hospital? They are losing money, they say. How can a busy hospital lose money? They say that it is because three-fourths of the patient population is covered by Medicare or Medicaid, and the American Hospital Association claims that hospitals lose 13 cents on every dollar spent on these patients.

Wait a minute. If your home catches on fire, doesn’t the fire department show up to put out the fire? You have fire insurance on your home so that insurance is used to pay the fire department for its services? No. The fire department provides a public service that is funded by the government. We pay taxes to cover that service. We don’t call that a “loss.” We don’t call care and maintenance of our parks a “loss.” We don’t call highway maintenance a “loss.” They are strictly essential services most appropriately provided by the government.

How is health care different? Shouldn’t it also be a public service funded by the government? Well, it partially is through government programs such as Medicare and Medicaid, so we do acknowledge the legitimate role of government in health care financing. But because of the fragmented, dysfunctional method we have of funding health care, we allow tremendous waste in administrative excesses and we have a failure to set prices appropriately, and thus the government appears to underpay for services in comparison to the private commercial insurers (though the concept of cost shift has been refuted by Austin Frakt). When the dependence of safety net hospitals on Medicare and Medicaid can be legitimately labeled a “racist system,” clearly we have an intolerably dysfunctional health care financing system.

The point is that, although we spend more on health care than any other nation, we clearly are not spending it equitably. Though government funds are the major source of Mercy Hospital’s revenues, the amount by which Mercy comes up short in paying its cost of care is not a “loss,” rather it is failure to enact an adequate, comprehensive health care financing system that will meet legitimate costs while, most importantly, providing health care equitably to everyone.

Regular readers know the bottom line here. We need to replace our unjust health care financing system with a well designed, single payer, improved Medicare for All program. Under such a system, with regional planning, Mercy Hospital would be reinforced or replaced to help meet the needs of South Chicago’s residents. In no way would that be a “loss.”

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.