By Jennifer Latzke.

Dalhart, TX, is the county seat of Dallam County, in the northwest corner of the Texas Panhandle, and a major agribusiness center for Texas, Oklahoma and New Mexico.

The community boasts cattle feedlots, a bottling plant, feed and meat processing plants and, in 2001, it received $41 million in new business investments. Meanwhile, the population is growing by leaps and bounds, with 7,500 citizens accounted for and more arriving every day.

Yet, despite the steady economy of the town and the healthy spirit of the area, the residents of Dalhart had one overwhelming problem. They could not keep their hospital staffed with enough health care professionals to offer the basic services the town needed. So, a group of concerned citizens gathered for the Texas Community Futures Forum, sponsored by the Texas Extension Service, where health care was identified as a key issue. The participants developed an Extension Action Plan to identify other issues in the Dallam and Hartley County District, as well as work toward solutions with the Coon Memorial Hospital board of directors.

"Doctors were getting older and retiring or otherwise moving on," says Kay Bezner, leader of the long-range plan and member of the Coon Memorial Hospital board of directors. "This hampered the services we could provide, because with limited doctors, there was no back-up if someone wanted to take time off. In fact, we couldn't even deliver babies anymore. Some folks began seeing doctors in Amarillo, and the closest emergency room was in Dumas, which is about 49 miles away." Emergency service to Amarillo also is expensive, with an average helicopter ride to the hospital for trauma patients costing nearly $4,000, as well as valuable time when a life is in the balance.

"The forum found the No. 1 task would be to retain doctors and we have worked to answer the challenge," she says. "We now can boast physicians in our ER, a surgeon and two general practitioners. We also staff our Rural Health Clinic, and we try to reach more groups with our services."

In the past three years, the hospital board and administrators have nearly brought their rural hospital out of a coma. The facility now has more doctors, with specialties ranging from obstetrics to physical therapy. In addition, it shares services and providers, such as radiologists, cardiologists, podiatrists and others, with 17 other small hospitals in the Panhandle area. And the board is recruiting more doctors, ironically, because of its small-town location--the same reason it was having so much trouble only a few years before.

"We are finding many new doctors like the small town atmosphere to raise their families," says Leroy Schaffner, chief executive officer and administrator, Coon Memorial Hospital. "We also have one international doctor who recently graduated from Texas Tech University and to keep his J-1 visa, he must go to an underserved area, which we qualify as. Still, another reason doctors choose to practice here is that they can have a more individual practice. In the big city hospitals, general practitioners or family practice doctors often cannot deliver babies or work the emergency room, because of hospital contracts with specialized doctors. So, a small town is ideal for a doctor who likes to do everything."

The hospital board recently signed two more doctors and is even helping one of its own townspeople get through medical school. The student agreed, in exchange for tuition, he would come back to Dalhart to practice medicine for a set period of time. Still, Bezner says it does take time to rebuild the community's confidence in the hospital and its providers, especially since many folks now go to general practitioners and specialists, in Amarillo or other hospitals.

"It is a constant battle to inform people of the services we provide," Bezner says. "Lots of times, our community does not even realize what we offer." One such unique offering, in Dalhart, is the Occupational Medical Clinic, which helps those recovering from industrial accidents regain use of limbs and return to work while they recover.

"The Occupational Safety and Health Administration hits agriculture hard," Schaffner says. "We have a lot of feedlots and other agricultural businesses in the area and so we discovered a major need for drug testing, Department of Transportation physicals and rehabilitation from accidents. Our occupational medical clinic lets patients work to develop muscles to do their normal tasks, like shoveling grain, so they can go back to full duty." With more doctors, there also has been an increase in the revenue brought in by the hospital. Schaffner says the physical therapy department brought in $300,000 just four years ago. Today, the same department brings in $1.1 million and has paid for a new state-of-the-art facility adjacent to Coon Memorial Hospital.

"There has been a shift in treatment styles, where we are more focused on preventative maintenance and occupational therapy," Schaffner says. "Employers value the fact that their employees can go to physical therapy here, in Dalhart, and only take off two hours from work, rather than a whole day to travel to Amarillo for the same therapy."

The new offerings at Coon Memorial Hospital were never more appreciated than recently, when a 26-year-old hospital nurse was critically injured in an accident as she went home from her shift at the hospital. Schaffner says the doctors on call were able to save her life, because of their close proximity to a fully staffed emergency room--doctors who were not working only a few short years ago.

"We cannot do open-heart surgery, but we now can offer basic first aid and stabilize our most critical patients for transfer to other hospitals," says Sieto Mellema, president of the hospital board. "With the local roads turning into four-lane highways, traffic will increase and with it, unfortunately, the number of wrecks that require ambulance service. At least now, we can provide a triage service for those that need it and save more lives.

Another major challenge facing Coon Memorial, and hospitals like it, is the changing political atmosphere to the health care industry.

"We really need the government to get out of health care or pay us more," Schaffner says. "The Amarillo hospital is paid 12% more with Medicaid and Medicare, and yet we have to pay the same salaries as they do to remain competitive, and offer the same services to our community on less money.

"Just like everything else, no matter how much we hate it to be so, we have to turn to the economics of the issue," Schaffner says. "We must be profitable to survive. When we file with the government, they in turn file a cost report, on which we base our price adjustments. We have to keep our costs to a certain break-even point, so we can get some money back from the government, in turn helping our community members with the rising cost of health care."

Schaffner is quick to point out the hospital takes care of all who need service, with or without insurance.

"We take care of everybody," Schaffner states. "These are our friends and neighbors and we work with them to develop a payment schedule that is workable for them. Right now, we have over 2,000 accounts that are making payments, some as little as $50 a month and that is fine by us. We are a community hospital, after all."

Right now, health administrators across the country are in the same boat. The new Bush Administration is working out the details of the "Patients' Bill of Rights" and other health care legislation. Coon Memorial Hospital and its administration is working to keep the community tax dollars in the area to provide services for community members, Mellema says.

"We provide more than just service," Mellema says. "We have one of the largest payrolls in the community, employing 230 people."

Part of that payroll works for the nursing home attached to the hospital. Dalhart, like other rural towns across the High Plains, is a typical aging community and the nursing home is filled to capacity. The facility was recently remodeled, has 81 beds and is looking to expand. The facility can host residents with minor to major physical needs.

Loree Elliott, a licensed nurse administrator, is in charge of the facility. She says she perceives the biggest problem in elderly care is yet to be realized by the public.

"The government is really not prepared for the number of aging people who will need services in the next 10 years," Elliott says. "So many are living longer lives, because of better technology. We will need more people to take care of older people, in the near future." She says Texas is making strides to improve elderly care. But the $20 per day per resident reimbursement from the state is not enough to really help, Elliott says.

While there are more challenges facing Dalhart's rural health care professionals, one thing is sure. The citizens of Dalhart and the surrounding area will keep working as a team toward a healthier community hospital.

Editor's note: This is the first article in a series about High Plains area health care and the problems facing rural residents.

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