RX for Change: Confronting the health care crisis in Kansas

Dec. 4, 2005

By TIM VANDENACK

The Hutchinson News

The pace of life in rural Kansas might be idyllic and more relaxed than in the state's larger cities.

Far from the urban centers and hospitals replete with specialists and the latest technology, however, it can be a little bit more dangerous, as well, at least in an emergency medical situation.

“Inherently there is the distance issue,” said Michael Kennedy, assistant dean for rural health education at the University of Kansas Medical Center in Kansas City, Kan. If you live in a rural locale, “then there is some decreased access to care.”

That's not to call into question the quality of doctors or hospitals in rural Kansas.

But because specialists and the most expensive technology are generally in big cities where the patient load and demand is higher, rural Kansans can end up far from the expertise and equipment they need in an emergency or after a car accident, stroke or heart attack. Just getting to the local hospital can even be a long trip if something happens in a rural setting, heightening the demands on emergency medical services providers.

In an emergency, “time is of the essence,” explained Beverly Glass, at Dodge City's Western Plains Medical Complex, which will introduce helicopter service to ferry patients in southwest Kansas more quickly to the care they need. “It can make the difference between someone living and dying.”

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Even in non-emergency situations, the gap between urban and rural offerings manifests itself. Some don't bother to seek out care because it's inconvenient or too costly to travel to the big city hospitals where they obtain the specialized attention they need.

“Rural people, because of the distance, because of other factors, often put off health care until it is a serious problem,” said Alan Morgan, the head of the National Rural Health Association.

Expansion in recent years of air ambulance service, available in all corners of the state, and telemedicine goes a long way in narrowing the urban-rural gap. Moreover, rural hospitals, physicians and EMS providers typically can handle any situation thrown their way or access the needed help.

“I think your small, rural hospitals strive to care for all the situations that might arise,” said Mickey Thomas, administrator of Meade District Hospital in southwest Kansas. “I think they're all prepared to stabilize patients and, if necessary, transfer them to facilities where they can get definitive treatment.”

Nonetheless, some of the fixes are works in progress — including efforts to train more medical professionals in advanced life support techniques — and shortcomings persist.

“I suppose there is more risk involved in living in a small town and not having every specialist,” Thomas concedes.

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Sandy Cameron, administrator of Kearny County Hospital in far west Kansas, is a big booster of rural health care. For one, the lower patient count allows for increased attention from nurses. Then, there's the intangible of a doctor actually getting to know patients.

Small town doctors “take care of people they live with and work with and are friends with every day,” Cameron said.

Small town hospitals might not have all the technology of their big city counterparts, but the difference in many places is narrowing. Kearny County voters recently approved a $9.2 million bond issue for hospital upgrades, and the Meade hospital was recently rebuilt with a whole new array of diagnostic equipment, including a Computed Tomography, or CT, scanner.

Wilson County Hospital in Neodesha in southeast Kansas will be replaced with a brand-new complex, with groundbreaking set for next year. Medicine Lodge Memorial Hospital in south-central Kansas, for its part, put in a new CT scanner and ultrasound equipment nearly 18 months ago, increasing its diagnostic capabilities.

Deanna Pittman, administrator of the Neodesha hospital, thinks updating hospitals goes a long way in drawing in physicians and other health care professionals, perhaps the biggest shortcoming in rural medicine. Reconstruction plans there were one of the factors that figured in the hospital's ability to lure a family practice doctor from another community.

Meanwhile, new diagnostic equipment helps shore up other gaps. Before, a hospital without a CT or ultrasound might have transferred a patient to another hospital. But now, the new equipment allows hospital staff to diagnose the person in-house and potentially provide treatment.

“It's becoming more typical," Thomas said. "More and more of the small hospitals are getting (CT) scans and ultrasound.”

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Even if a hospital doesn't have technology onsite, there's the option in some instances of telemedicine, which accesses experts via electronic connections — visual, audio and otherwise.

Bob Cox, medical director of the Hays Medical Center, is a big proponent of such technology and says it can help with diagnoses, post-operative care and in deciphering X-rays.

“I think it's critically important,” Cox said. “It's technology. It's a tool.”

Among other things, the technology allows the Hays hospital to offer rehabilitation services for heart patients in 12 smaller hospitals. Recovering patients go to their local hospital, connect to an electrocardiogram machine that can be read in Hays and talk with an expert from the Hays hospital via phone while exercising.

Many health officials acknowledge the potential of telemedicine. But numerous factors seem to hinder its widespread use, at least for now, including the training necessary to use the requisite equipment and the difficulty in arranging an appointment with a specialist on the other end, health officials say.

“It's the exception to the norm right now, but in five years, I think it might be the norm,” Thomas said.

Whatever the case, the dynamic between small town and big city hospitals, though undergoing constant transformation, likely will continue to be key in many facets of rural health care going forward.

“We know what our limitations are,” said Pittman, of the Neodesha hospital, alluding to situations when patients require the attention of experts elsewhere. “We're going to stabilize them and ship them out as quickly as possible.”