Critical condition: The crisis of rural medical care, Guns and Knives and Medicare!

d day257[1467]I wanted to start with this article because our rural area of Maryland is going through the same scenario. We had 3 hospitals serving the mid and upper Delmarva Peninsula but 2 of the hospitals were barely making ends meet. In fact, one of the hospitals will be closed down replaced by an enlarged Urgent care type of facility. Another needs to be shut down and reconfigured as a stabilizing/urgent care center. This last hospital sometimes has an in-hospital census of 1 or 2 patients. You can’t pay the bills with that census and how do you pay your staff, keep the heat and air conditioning and electric running?

Tonopah, Nevada, is about as isolated a place as you can find – 200 miles south of Reno, 200 miles north of Las Vegas, with one road in or out. But to those who call it home, this scenic dot on the desert landscape once had everything they needed.

Emmy Merrow had no concerns about living in such a remote place: “It had a store and a gas station, and I was fine!” she laughed.

Merrow has lived here for four years. She has a two-and-a-half-year-old, Aleyna, and a newborn daughter, Kinzley.

They moved here when her husband got a great job offer from the sheriff’s department. But six weeks before she found out she was pregnant with Aleyna, she also found out Tonopah’s struggling hospital, its only hospital was shutting its doors for good.

“I’m frustrated, I’m mad, I cry, I’m upset about it because we would live less than a mile away from a hospital,” she said.

It was all the more worrisome when, shortly after she was born; Aleyna was diagnosed with Dravet Syndrome, a catastrophic form of epilepsy. “She’s just like any other typical kid, and our day is just like any other day, except for when she has seizures,” Merrow said.

“And how many does she have a day?” asked correspondent Lee Cowan.

“She’s at about 400 now.”

“So, is there anybody within a reasonable distance that can help?

“No.”

When the seizures are bad enough, which is about every six weeks or so, Merrow has to make a mad, desolate dash to the closest hospital, which is across the border in California, some 114 miles away.

She’ll never forget the first time she had to do it: “It was in the middle of the night, so it was dark and I couldn’t see her, so I did stop quite often to just check and make sure she was still breathing.”

“That must have been terrifying,” Cowan said.

“Yeah, I was sobbing the whole way. It is the worst feeling in the world.”

Elaine Minges lives in Tonopah, too. She came here with her husband, Curt, for a high-paying job at the nearby solar plant, and thought they’d retire here one day. “We knew that there was a hospital here and there were a few physicians, and we felt comfortable at the time,” Minges said.

But after the hospital closed, everything changed. “They shut the doors and that was it,” she said.

“And they didn’t give you any warning?”

There were rumors, she said, but “we thought no, that won’t happen. That doesn’t happen. Look, we’re out in the middle of nowhere!”

Curt, who had diabetes, tried not to think about it until one night he suddenly fell very ill. Minges recalled, “He woke up and I thought he was having a heart attack. He was gasping for air. He tried to get up, but he was just too sick.”

He was suffering a serious complication from diabetes. It’s a condition normally survivable with prompt medical attention, but in this case, prompt meant getting a helicopter. “That particular night, the helicopter was 45 minutes out before they could get to the airport, and in that time, he went into cardiac arrest.”

Cowan asked, “Had the hospital here been open, would that have saved your husband?”

“I would like to think so, yeah.”

It’s a grim tale repeating itself all across the country.

Since 2010, 99 rural hospitals like the one in Tonopah have closed; that’s almost one a month.

“Basically about half of the rural hospitals are losing money every year,” said Mark Holmes, a professor of health policy and management at the University of North Carolina, who has been studying the decline for more than a decade.

Cowan asked, “Is there an end in sight?”

“Every time that I’ve said, ‘I think we’re through the worst of it,’ we’ve been surprised,” Holmes replied. “You always have to wonder, who’s next?”

A whole cross-section of America is now facing the very real risk of having no local hospital to turn to. The causes are varied; the population in some of those towns has dwindled to a size that can’t support a hospital anymore.

In others, the hospitals are either mismanaged or they end up as table scraps in mega-mergers. Medicaid expansion would have helped some stay open, Holmes says, but not all, and even so reimbursement rates are often too low for hospitals to break even. Whatever the cause, the impact on the community is almost always the same:

“The hospital closes, the emergency room dries up, all the other services that went with that – home health, pharmacy, hospice, EMS – they leave town as well, and now you’re left with a medical desert,” said Holmes.

That’s exactly the fate residents of Pauls Valley, Oklahoma was worried about. The town, about 60 miles south of Oklahoma City, has only one hospital, but the previous management company had run it into bankruptcy.

The city brought in Frank Avignone to save it. When Cowan visited, Avignone was working the phones to find a generous donor to keep it open: “I’ve got 130 employees here that I’m going to have to tell they have no future,” he said.

“It’s literally day-by-day for this hospital,” Cowan asked.

“It’s minute-by-minute,” he replied.

“How much money do you have in the bank right now?”

“About $7,000.”

“Which gets you how far?”

“The next 15 minutes. I mean, it’s not enough to really make a difference.”

Townspeople rallied, especially those who had been treated here, like Susanne Blake. She and her husband pitched in half of their retirement savings – a gamble that to them, made some good-natured sense. “We got tickled about how much we should give, because he said, ‘Well, without a hospital, we don’t have to worry about as long a retirement!'” she laughed.

Employees were just as passionate. Linda Rutledge, who’s worked in the hospital’s cafeteria for nearly 20 years, baked over a thousand cookies – a bake sale with a lot riding on it.

Asked what will happen should the hospital close, Rutledge replied, “I’m going to cry. That’s just can’t happen.”

But it can happen. And last year, in response to the need for medical care, a massive free health clinic popped up at a fairground in Gray, Tennessee, set up by a non-profit called Remote Area Medical – originally founded to serve third-world countries.

But Chris Hall, the charity’s COO, says a rural hospital closure back in 1992 forced the organization to address the medical needs of the underserved here at home, too.

“Today alone, there’s seven states’ worth of patients that have come to this event,” Hall said. “People have gotten in their car and driven 200 miles to get here today just to be able to get a service that they couldn’t get in their local area, or [couldn’t] afford in their local area.”

Some who lined up overnight in the cold did, in fact, have a hospital; they just didn’t have the insurance to access it. But for others, like Leanna Steele, this is the closest thing they have to an emergency room. Her local hospital, which she used to go to when she got debilitating migraines, also closed.

Cowan asked, “So, what do you do now?”

“Mainly just sit and hope,” Steele said.

Usually, before a hospital closes entirely, administrators will try cutting back on non-emergency services, like maternity wards. That’s happened so often that more than half the rural communities in this country now no longer have labor and delivery units, leaving expectant mothers facing long drives at the worst of times.

  • But in Lakin, Kansas, population 2,200, they tried something different. The only hospital for miles decided to invest in obstetric care instead, the thinking being that babies can be a growth industry. They get patients in the door, and just as Kearny County Hospital’s young CEO Ben Anderson had hoped, they stay … and bring along the rest of the family, too.

“Moms came here and had a great experience, and they said, ‘You know, you’re gonna be my baby’s pediatrician, and you’re gonna be my women’s health physician, and you’re gonna take care of my husband as an internist. We’re all coming to you,'” said Anderson.

And that’s just what’s happened. Dr. Drew Miller has a bulletin board outside his office with pictures of the future patients he’s brought into this world – almost 500 in the last eight years, from all across the state.

“The most rewarding thing of what I get to do is to take care of families of multiple generations,” Dr. Miller said. “I could tell you stories of people I’ve delivered their babies, and taken care of their grandma or their great-grandma. That’s what I love about what I get to do here.”

And another thing: There are no high-priced specialists employed here, not even an OB-GYN. Instead, the hospital is staffed entirely by physicians trained in full-spectrum family medicine instead. “We determined we only have so many dollars to spend at a rural critical access hospital on medical care staff coverage, so it’s important that everybody is trained to do the same thing, and it’s important that everyone is willing to do it equally,” Anderson said.

A typical day for these rural doctors can include doing a colonoscopy in the OR in the morning and removing a skin lesion at a clinic in the afternoon. It’s a flexible, can-do approach to rural medicine that has kept these hospital doors open – at least for now.

“This last year we had the first profitable year in probably two or three decades,” said Anderson. “But we’re riding very, very close. We don’t have the margin for mistakes.”

It’s that razor’s edge that hospitals like the one back in Pauls Valley, Oklahoma, had ridden for too long. Cowan was there when CEO Frank Avignone brought the staff together to share some news: “You can only live on borrowed time so long,” he said. The hospital was closing, immediately.

“I’m not sure people really understand what’s going on,” Avignone told Cowan. “The story’s gotta get out. People have to see the faces of the folks in this community and the employees and what they’ve been through. People die because this hospital won’t be open.”

Back in Tonopah, Nevada, Emmy Merrow understands those risks firsthand after one excruciatingly long drive to a hospital with Aleyna that had irreversible consequences. “She fell into a seizure that lasted three hours long; it lasted the whole entire trip,” she said. “So, she has brain damage from that. She wasn’t breathing correctly, she lost oxygen.”

“I think people watching this are going to wonder if it’s that bad, and you’re so far away from a hospital, and you need help basically all the time, why not move?” asked Cowan.

“It would be great if we had the money to be able to move,” she replied. “We make enough to live, but not really enough to save up to be able to make that move.”

As for Elaine Minges, with her husband now gone, the rural life they loved so much is gone, too, and like so many who live in small-town America, she’s at a loss for what to do next.

Cowan asked, “Will you stay here knowing there’s not a hospital?”

“My home is here,” she said. “I feel my husband here.”

“What do you think he’d want you to do? Would he want you to stay?”

“No,” she said.

Right now, we all in our community are considering alternatives and more and more of our patients are going “across the bridge” to University or “better” hospitals. I suspect that this is going to be more of a problem in the future with more talk of Medicare for All.

These next two discussions are in response to a local senseless stabbing/murder in our small town. We were lucky that the murderer wasn’t carrying a gun or the deceased could have numbered in a much higher amount.

Angry young white men charged in America’s latest mass shootings

Annalisa Merelli noted that there have been 25 mass shootings in the US this year. Seventeen of the incidents were deadly and 11 killed three to five victims each—for a total of 45 fatalities.

Last week alone, 17 people (not including the shooters) lost their lives in four mass shootings. Three of the attacks were said to be carried out by 21-year-old white men:

  • Zephen Xaver allegedly shot and killed five women in the lobby of a SunTrust bank branch in Sebring, Florida on Jan. 23.
  • Jordan Witmer killed three in State College, Pennsylvania on Jan. 24.
  • Dakota Theriot has been charged with killing five: his girlfriend, her brother, her father, and both of his own parents in Livingston Parish and Baton Rouge, Louisiana on Jan. 25.

Investigators are still looking into motives yet it’s hard not to note some commonalities: All of these mass shooters were men, and they all targeted women. They had shown violent behavior and tendencies in the past or had been exposed to violence. None of this seemed to have stopped them from being able to acquire guns. It’s an all-too-familiar pattern in the US. The shooters’ identities are also consistent with the overall American trend: Mass shootings are nearly exclusively perpetrated by men, the vast majority of whom are white.

Xaver, ex-girlfriend Alex Gerlach told WSBT-TV, “for some reason always hated people and wanted everybody to die” and “got kicked out of school for having a dream that he killed everybody in his class, and he’s been threatening this for so long.” Gerlach said her warnings about Xaver were not taken seriously, even as he bought a gun it was not considered a warning sign. After the shooting, police chief Karl Hoglund described the targeting of five women a “random act.” Amongst Xaver’s interests were prominent right-wing figures such as Milo Yannopoulos and Alex Jones; when he was arrested, he was wearing a T-shirt with a print of the Four Horsemen of the Apocalypse, the New Testament figures of destruction.

Witmer, the Pennsylvania shooter, also took aim at a female victim. He was having drinks with Nicole Abrino, a woman identified a current or former girlfriend when the two argued. Dean Beachy, who was sitting across the bar, tried to break up the fight. Witmer shot him in the head, killing him, then fatally shot Beachy’s son. Witmer also shot Abrino, who survived. Witmer left the bar, later crashing his car and breaking into a home where he shot and killed a fourth person. He then killed himself. Witmer, who didn’t have a history of violent behavior, had recently returned from a three-year stint with the US Army. According to his family, he was planning to become a police officer.

Theriot, targeted his girlfriend of about two weeks, Summer Ernest, police said, and the murder in Louisiana seemed premeditated. The young man was living with Ernest and her family after he had been kicked out of his own home. He is said to have shot her dead, followed by her father and younger brother. Theriot then took the father’s truck, and drove to his parents’ home, police said, killing both of them. He was arrested as he tried to reach his grandmother, still carrying a gun. Theriot, his neighbors said, had a history of trouble with drugs and he had been arrested for minor drug possession. Though authorities say he didn’t have a history of violent behavior, some who knew him to seem to disagree. They say he had pulled a gun out on his mother, which was among the reasons he had been kicked out of the house.

ACCORDING TO THE FBI, KNIVES KILL FAR MORE PEOPLE THAN RIFLES IN AMERICA – IT’S NOT EVEN CLOSE

Columnist Benny Johnson noted that knives kill far more people in the United States than rifles do every year.

In the wake of the horrific school shooting in Florida last week, the debate over guns in America has surged again to the forefront of the political conversation. Seventeen students were killed when a deranged gunman rampaged through the Stoneman Douglas High School in Parkland Florida. Many are calling now for stricter gun laws in the wake of the shooting, specifically targeting the AR-15 rifle and promoting the reinstatement of the assault weapons ban.

However, recent statistics from 2016 show that knives actually kill nearly five times as many people as rifles that year.

According to the FBI, 1,604 people were killed by “knives and cutting instruments” and 374 were killed by “rifles” in 2016.

Annotation 2019-06-09 183738

The statistics match the trends seen in previous years, which show knife murders far outnumbering rifle statistics. In 2013, knives were used to kill 1,490 and rifles were used to kill 285. Handguns far outnumber both knives and rifles in American murders. There were 7,105 murders by handgun in America in 2016.

Handguns were not included in the assault weapons ban.

Writing on the issue of handgun violence, The Federalist makes this interesting point:

“But what about handgun murders?” you might ask. “They’re responsible for the majority of gun murders, so why don’t we just ban them and stop worrying about rifles?”

Easy: because gun bans and strict gun control don’t really prevent gun violence. Take, for example, Illinois and California. In 2013, there were 5,782 murders by handgun in the U.S. According to FBI data, 20 percent of those — 1,157 of the 5,782 handgun murders — happened in Illinois and California, which have two of the toughest state gun control regimes in the entire country. And even though California and Illinois contain about 16 percent of the nation’s population, those two states are responsible for over 20 percent of the nation’s handgun murders.

One of the difficulties in the FBI’s statistics is the pinpointing of the exact type of firearm used in the overall number of gun murders. In over 3,000 cases, the firearm is not “stated.” This means it could be a rifle, handgun or shotgun used in the crime.

Certainly, this could potentially add to the number of rifle deaths each year. However, if the ratios of weapons used in the uncategorized 3,000 number reflected the overall sample size, the number of rifle deaths would only rise by a small fraction, not nearly enough to surpass the number of knife deaths.

So, what next? Do we outlaw guns as well as knives? What do we use as cutting utensils……plastic knives????

And More About the Medicare Story!

For Medicare, the best progress was made thanks to Presidential candidate John F Kennedy. Kennedy along with Clinton P. Anderson of New Mexico, introduced a measure similar to the previous Forand bill in the Senate the summer of 1960. The measure was defeated in favor of the Kerr-Mills bill, but the Democratic platform contained a provision supporting an extensive hospital insurance strategy for the aged. Kennedy made this proposal a subject of his speeches during his stumping for the presidency and even before his administration took office a White House Conference on Aging again brought the issue of a government health insurance. They seemed to get more and more support, especially since Eisenhower’s Secretary of Health, Education, and Welfare was among several prominent Republicans who were in support of the enactment of a comprehensive measure.

Almost immediately following his inauguration, on February 9, 1961, President Kennedy sent a message to Congress calling for an extension of the social security benefits to cover hospital and nursing home costs. The bill would have covered 14 million recipients over the age of sixty-five was predicted to cost approximately a billion and a half dollars, but didn’t include the cost of medical or surgical treatment. It only covered for ninety days of hospital care, outpatient diagnostic services and a hundred and eighty days of nursing home care. Imagine the cost back then of adding on the medical and surgical treatment costs!

Because of Kennedy’s thin margin of victory in November, it was deemed expedient not to press for passage of the bill until the following year. But along comes the AMA creating the American Medical Political Action Committee, which was joined with the commercial health insurance carriers and Blue Cross-Blue Shield in opposing the bill and questioned the cost put forward by the administration. The opposition mounted a strong campaign against the King-Anderson using posters, pamphlets and radio, and TV extensively. The Association seemed to be angered by included fee schedule for hospitals, nursing homes, and nurses which could serve as a precedent should government insurance be expended to include.

There was a great deal of fighting as the Kennedy administration demonized the AMA, accusing the association of thwarting the public will with the interest of lining the pockets of its membership and of employing scare tactics against the government’s interest and only concern to extend to the aged and infirm needed medical benefits. The administration got support from organized labor and several new organizations which lobbied extensively in favor of the measure.

On and on went the supporters and the opposition until finally after Kennedy’s assassination when Congressional support for Kennedy’s legislation swelled, but that is for another day and next week.

And an impressive celebration of D-day. Thank you again Veterans who fought for us all!!

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