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WHO CARES: CHRONIC ILLNESS IN AMERICA GRAPPLES WITH OUR NATION’S

MOST CRITICAL HEALTH CARE CHALLENGE AND CONSIDERS THE DIFFICULT

CHOICES MADE BY MILLIONS EVERY DAY

A Fred Friendly Seminar, hosted by journalist John Hockenberry,

premieres November 11 at 10 p.m. on PBS

(Check local listings for October airdates preceding the premiere.

Times and dates will vary.)

National Outreach Campaign in communities across the country will engage the public in dialogue about meeting the challenges posed by chronic illness.

A teenaged girl with asthma and her family are stuck in an unending cycle of life-threatening attacks, emergency room treatment from harried doctors, and missed days of work that they can ill afford. A stroke victim is released from the hospital into the custody of his frightened, bewildered wife who must care for him on a daily basis without adequate help, training or money. A man suffering from both depression and diabetes arrives in the emergency room nearly comatose, but doctors can’t treat him safely because there is no way to find out what medications he is taking.

People with serious chronic illnesses are America’s most costly and fastest-growing group of patients but our nation’s health care system remains focused on acute care, which constitutes a significantly smaller percentage of medical care. Coping with long-term chronic conditions like asthma, diabetes, arthritis, Alzheimer’s or heart disease, millions of people are faced with agonizing decisions every day as they struggle with a health care system not designed to meet their medical needs or provide necessary care giving. While the list of chronic illnesses is long and diverse, the people who suffer from them and their families share many common problems.

In probing the Socratic dialogue format pioneered by Fred Friendly, Who Cares: Chronic Illness in America explores the challenging scenarios that are playing out in homes and hospitals every day as families and health care professionals deal with chronic illness. John Hockenberry, correspondent for Dateline NBC, moderates the one-hour program, which premieres on PBS on November 11 at 10 p.m. (Check local listings for October air dates preceding the premiere. Times and dates will vary.) The program brings together a diverse group of doctors, patients, caregivers, and experts who get to the core of the complex factors that have thrown the American health care system into crisis and complicated the lives of families dealing with chronic illness. Under Hockenberry’s direction, the panel draws on their personal expertise to role play in hypothetical situations that reveal the urgent and often desperate problems that can arise when chronic illness bumps up against the limits of the medical system.

Adding a new dimension to the classic format, a series of brief, dramatic vignettes throughout the program frame the issues and set up the hypothetical situations that have always been the signature of Fred Friendly Seminars. This edition of the classic PBS series also debuts a redesigned set that provides a bright and contemporary context for the discussion.

In the first scenario, a low-income family without health insurance must make impossible choices when it comes to caring for their daughter’s asthma condition. Time and again, she winds up in the emergency room after an acute attack. The E.R. is all they have, but it’s only a temporary remedy. “I know she’s going to be in here again soon,” says Eleanor Thornton, director of community outreach for asthma care at Howard University’s College of Medicine, who role plays the distressed mother. “We can’t get the appropriate care we need for her. I know that the emergency room is just a quick fix, but that’s what we have to do.” Worse, with every attack, the parents must leave work to go to the hospital, risking their jobs in the process. As they scrape to pay for their daughter’s medicine, this family is on the verge of collapse from stress and fear. “What do you think your daughter’s future is, going from E.R. to E.R. to E.R.?” asks Hockenberry. “I’m scared,” answers Thornton. “I know this can take her life from her. I’m terrified.”

In the next scenario that Hockenberry sets up, doctors determine that a stroke victim’s vital signs have stabilized, and he must be released. The hospital bed is needed. But that leaves his wife and family scrambling for answers. “All they want to do is shove you out as fast as they can and then you’re on your own,” says Suzanne Mintz, president of the National Family Caregivers Association, who plays the role of the patient’s wife.

“There’s nobody there to give you ongoing advice. There’s nobody to come in and watch and see if you’re doing it right.”

The panel moves on to consider the issues surrounding patients who suffer from more than one chronic condition. These people are often treated by different doctors and hospitals over time with no centralized record of their care. When such a patient arrives in an emergency room in a coma or unable to speak, the doctor has no efficient way to learn the patient’s medical history or find out what medications have been prescribed. And it becomes a balancing act with other patients’ needs on the scales. “The amount of effort and time to coordinate these things takes you away from seeing ten other patients,” says Dr. Pedro Jose Greer, Jr., assistant dean at the University of Miami Medical School, explaining the typical doctor’s dilemma. “Who is going to go out there to call the five different doctors to get all the information?”

Finally, the panel brings home the importance of the discussion to every viewer. Even if we are perfectly healthy today, none of us can escape the effects of this crisis. “All of us will be facing these conditions, either for ourselves or for our parents,” says Dr. Charles M. Cutler, chief medical officer for the American Association of Health Plans. “And I think everyone has a stake in making the system better. If you think it doesn’t affect you today, it doesn’t mean it won’t affect your parents or your children or you tomorrow.”

The panelists are: Dr. Keith Ablow, a psychiatrist; Richard J. Bringewatt, president of the National Chronic Care Consortium; Terrell Cannon, a home health aide and instructor; Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania; Dr. Charles M. Cutler, chief medical officer for the American Association of Health Plans; Andrea C. Davis, caregiver, television writer and producer; Susan Dentzer, health correspondent with The NewsHour with Jim Lehrer; Rev. Will Dublin Jr., project director of Interfaith Volunteer Caregivers; Dr. Pedro Jose Greer, Jr., assistant dean for homeless education at the University of Miami Medical School; Suzanne Mintz, president of the National Family Caregivers Association; Rachel Mont, a high school senior who has chronic asthma; and Eleanor Thornton, director of community outreach for asthma care at Howard University’s College of Medicine.

In conjunction with the PBS premiere, WHO CARES: Chronic Illness in America will be used as a catalyst for community-based dialogues about meeting the challenges of chronic illness. Working with local chambers of commerce, union organizations and community-based health care institutions, the campaign will promote civic engagement ranging from discussion groups to public forums. Planning is underway for intensive

“Community Day” outreach in Tampa (October 18), Chicago (October 25), Portland (November 7) and Pittsburgh (November 13) to engage businesses, healthcare providers and institutions, and civic organizations to focus on their specific community needs. Major national organizations have joined the campaign as partners including the Allergy & Asthma Network - Mothers of Asthmatics, American Association of Homes and Services for the Aging, American Diabetes Association, American Geriatrics Society, the Asthma and Allergy Foundation of America, Faith in Action, Family Caregiver Alliance/National Center on Caregiving, Family Voices, Foundation for Health in Aging, Fresh Angles, Howard University School of Medicine, March of Dimes, National Association of School Nurses, National Business Coalition on Health, National Chronic Care Consortium, National Family Caregivers Association, National Health Council, National Multiple Sclerosis Society, National PACE Association, National Partnership for Women and Families, Older Women’s League, Partnership for Solutions, Rosalynn Carter Institute for Human Development, the Shepherd’s Centers of America, The Chest Foundation of the American College of Chest Physicians, U.S. Chamber of Commerce, WE Media, Inc., and Columbia Scholastic Press Association, whose members include high schools across the country.

Now an extensive companion Web site complementing the program can be accessed via PBS Online at fredfriendly/whocares. The Web site includes additional information and perspectives on chronic illness as well as a program discussion guide and other materials that can be downloaded for use by community groups.

Funding for WHO CARES: Chronic Illness in America was provided by The Robert Wood Johnson Foundation, making grants to improve health and health care for all Americans.

The program is a production of the Fred Friendly Seminars at Columbia University Graduate School of Journalism in association with Thirteen/WNET New York. Executive producer: Richard Kilberg. Producer: Megan Cogswell. Writer: Joan I. Greco. Broadcast producer/director: Mark Ganguzza. Editor: Jonathan Fein. Executive director: Barbara Margolis. Editorial advisor: Ruth Friendly. Thirteen/WNET executive-in-charge: Stephen Segaller.

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