Rural health clinics fill health care gap
By ROY A. JONES II
Regional Editor
While the Big Country encompasses more rural area than much of the rest of the state -- and not all of its counties have hospitals -- everyone should have access to health care.
Forty-eight rural health clinics dot the area landscape, filling the health care gap in counties that lack a hospital and complementing the hospitals in others.
Some communities, like Throckmorton, have found the establishment of a rural health clinic to be a win-win proposition: It offers quality medical care for patients who don't require hospitalization, and it is one way to get more federal dollars -- and that helps keep the hospital doors open.
For more than two years, the administrator of the Throckmorton Rural Health Clinic was a veterinarian. That's right -- a veterinarian.
Dr. Kirby Gober didn't see human patients, of course -- although he admits he took some ribbing about it -- but rather viewed his service as a community obligation. He also served as hospital administrator at one time.
"I grew up here. We just have a little county-owned hospital and clinic and we've been through some pretty rough times with the oil (bust) and all. We just all do all we can to hang on," Gober explained.
"The county still has to subsidize the hospital and clinic both, but we don't want to lose them," he added. "There are lots of folks walking around Throckmorton County today who probably wouldn't be here if we didn't have a good hospital and clinic."
According to records obtained from the Texas Department of Health, only two counties in the Big Country -- Scurry and Stephens -- do not have a rural health clinic, but each of them has a major hospital.
In fact, taxpayers in Scurry County recently turned down a multimillion-dollar proposal from a large, out-of-state corporation to run their county-owned, Cogdell Memorial Hospital, opting instead for local control even if it costs them more.
Stephens Memorial Hospital at Breckenridge took on a larger area of responsibility earlier this year when the Albany hospital closed after nearly 50 years of operation.
Albany now has a rural health clinic, First Med of Albany, one of fivearea rural health clinics operated by Hendrick Health System, but the Breckenridge hospital operates the Shackelford County emergency medical service out of the old hospital.
The rest of the hospital is vacant, except for the business office which will continue to operate until the debts that finally closed the hospital are all paid.
Excluding Taylor County, which has two major Abilene hospitals plus four rural health clinics at Merkel and Tuscola, Jones County offers the most access to health care in the Big Country. Jones features hospitals at Hamlin, Stamford and Anson, plus two rural health clinics each in Anson and Stamford.
Comanche County has hospitals in De Leon and Comanche, plus two rural health clinics in Comanche and one in De Leon.
Eastland County, which suffered the loss of hospitals at Cisco and Ranger over the last decade, still has a strong, growing, Eastland Memorial Hospital in Eastland, plus rural health clinics in Cisco, Eastland, Ranger and Rising Star.
Callahan County lost its hospitals years ago, but has two rural health clinics in Cross Plains and two at Clyde. Runnels County has hospitals in both Ballinger and Winters, plus a rural health clinic in Winters.
Kent and Coke join Callahan and Shackelford as the only counties in the Big Country which have no hospital. Kent has a rural health clinic at Jayton and Coke has two, one each in Bronte and Robert Lee.
Here's the health care situation in the rest of the Big Country counties:
n Howard -- two major hospitals in Big Spring, plus three rural health clinics. (Big Spring is also home to Big State State Hospital, for people with mental illnesses, and the Veterans Administration Hospital, which treats only veterans).
n Knox -- hospital at Knox City; rural clinic at Munday.
n Stonewall -- hospital and rural clinic at Aspermont.
n Haskell -- hospital and rural clinic at Haskell.
n Fisher -- hospital at Rotan; rural clinics at both Rotan and Roby.
n Mitchell -- hospital at Colorado City; rural clinics at Colorado City and Loraine.
n Nolan -- hospital and rural health clinic at Sweetwater.
n Erath -- hospital at Stephenville; two rural clinics at Dublin.
n Coleman -- hospital and two rural health clinics at Coleman.
n Brown -- hospital at Brownwood; two rural clinics at Early and one at Brownwood.
n Mills -- Hospital and two rural health clinics at Goldthwaite.
n Palo Pinto -- Hospital at Mineral Wells; rural clinic at Gordon.
Rural health clinics have become an important component of the Texas health care system, expanding care in some geographic areas that were previously under-served and improving access to health care for Medicare and Medicaid enrollees, said Laura Jordan, executive director of the Central for Rural Health Initiatives.
The center, headquartered in Austin, was created by the Texas Legislature in 1989 to address serious rural health issues affecting 3 million residents in 196 of the 254 Texas counties.
During that time rural hospital closures have dropped from 11 in 1989 to only one in 1997 (unfortunately, in Shackelford County), and more than 440 rural health clinics have been established, she said.
In addition, the number of primary care practitioners in rural areas has increased by 18 percent since 1994, nine times the rate of increase in rural population.
Coleman County got a new physician earlier this year through a program in which it paid the doctor's way through medical school in exchange for a promise that he would practice medicine in their community upon graduation.
As of the last count, 67 rural counties in Texas (34 percent) had two or fewer practicing primary care physicians. Four of these were in the Big Country -- Shackelford, Fisher, Stonewall and Haskell.
Albany solved its shortage with a husband and wife team for awhile, but the doctors left after a disagreement earlier this year and it may take the courts to determine who owes whom.
The number of counties with no physician assistants has decreased from 97 in 1994 to 63 this year, Jordan said. All of the counties in the Big Country have at least one physician practicing in the county; many of them have one or two physician assistant working with the physician, who serves as medical director.
"Before 1989, rural health in Texas was given no priority by any state agency or entity," Jordan said, adding that the Center "has not only addressed these problems, but has been a major factor in solving them."
One of the programs which significantly upgrades the quality of rural health care is Tex-Link, through which rural clinics can be linked to major hospitals by closed-circuit television.
Eighty rural hospitals in Texas are now so linked, and it is just a matter of time until rural health clinics can be on the network, too, Jordan said. That would make it possible, for example, for a physician's assistant seeing a patient at a rural health clinic in Gordon or Jayton, to consult by way of television with experts in Abilene, Lubbock, the Metroplex, or even Houston.
"There are a still some issues that need to be addressed, like patient confidentiality," before telemedicine capacity spreads throughout the Big Country and the rest of Texas, Jordan said.
All told, Abilene Regional Medical Center and Hendrick Health System operate 12 primary care, or rural health clinics outside of Abilene.
ARMC operates clinics at Clyde, Cisco, Coleman, Comanche, Ranger and Merkel, while Hendrick operates clinics at Albany, Clyde, Cross Plains, Early and Merkel.