By Tom Deegan,
West of the Mississippi rural access hospitals dot the wide-open landscapes . . . a
few Intensive Care Beds, an ER, and a helipad. I lived in the San Luis Valley in Colorado
from 2000 to 2015. You’ve never heard of the San Luis Valley, but the valley itself is as big as
Rhode Island. It sits on the southern border with New Mexico with a population half Anglo and
half Hispanic. I used to drive down to Taos, NM, for lunch. At either end of the valley is a small
town, Alamosa in the southern end and Salida at the northern end. While I was there, the poor
economics of smaller hospitals had become apparent. They were eating up town budgets. Each
town handled the problem differently.
Alamosa kept their 40-bed hospital and also had a storefront Veterans Clinic. The area’s
demographics were skewed to vets and—as one myself of the Vietnam-era—I made use of the
VA clinic for flu shots and antibiotics for seasonal colds. Many of the guys had respiratory
problems—smoke’m if you got’m—was the call sign for, “take a short break,” in the US Army.
That America gave up smoking is still amazing to me. Of all our bad habits smoking was the
most widespread and socially acceptable. I still miss lighting up, myself.
To get back on task, I worked as a registered nurse in the Alamosa Hospital for a short interval as
a traveling RN. Well run, it was a typical full service rural hospital, with a surgical suite,
an ICU, an OBGYN department and an Emergency Room. The majority of our patients were on
Medicare or Medicaid, or Veterans Administration coverage. Medicaid is for the needy and
Medicare for the elderly.
Few and far between were patients on private insurance or employer coverage in that particular
community. A self-sufficient but very expensive way to deliver health to a rural community, this
one was with borderline poverty and none of the politically correct peer pressure of preventive
health. Your partner would not discourage you from lighting up in these parts . . . and, while you
were at it, she’d expect you to offer her a Lucky Strike.
At the other end of the San Luis Valley sat Salida, a recreational center known by sportsmen for
shooting the rapids on the Arkansas River. Tennis was a popular pastime, as was bowling. The
small town had the most beautiful indoor swimming pool you could imagine with thermal waters
pumped up from beneath the valley floor. Good restaurants abounded.
A hundred years earlier the Denver & Rio Grande Railroad had built a hospital for its employees there, a 14-bed arrangement with full accoutrements of an early 19 th Century hospital design: ER, Laboratory, ICU, OBGYN, a surgical suite, carpeted hallways and a gracious
reception area. The hospital deserved its regal name, The Heart of
the Rockies Regional Medical Center.
Recently I took a sentimental journey to visit with friends out there. The old building of
earthtone bricks still stands and is in use for community agencies. On the edge of town is a
new rural access hospital—basically a few ICU rooms, an ER and a helipad. Here in Salida the
patient payment base would be more skewed towards Medicare, private insurance, corporate
insurance.
The take away from this tale of two cities is that no single format fits all.
With guaranteed cash flow from government and insurance reimbursements, the health care
industry has been slow to innovate. Take a look at the more competitive enterprises of internet,
fast food, big box retail, and the other amenities of life that we enjoy in the 21st Century.
Healthcare lags . . .a virtual monopoly underwritten by stable financial sources but lacking in the
dynamics of change we see all around us.
In Maine, we have plenty of healthy hospitals on the I95 corridor, but, marginal hospitals in
outer communities that have lost population, in a culture that is producing fewer childbirths, are
on life support. The rural access format may be appropriate for some, but I believe that with sky-
rocketing health costs, combined with a shortage of doctors and nurses, we can do even
better. How about storefront clinics with a sophisticated transportation network of ambulances,
helicopters and an SUV fleet of medically trained drivers to rush more complicated cases to big
city hospitals. Convenient MD in Bangor is a good start.
OBGYN remains the service we need most to be close at hand for deliveries. Why not design
birthing centers as stand-alone structures, with local private practice physicians and off-duty
nurses paid to be on stand-by? We can call McDonald’s or Starbucks to find out how it’s done.
About the Author: Tom Deegan, The author was a nurse traveler in the South West for 15 years and wrote Healthcare . . . a View from the Trenches about his experiences.