Rural hospitals desperate for $1 6B infusion

CORRY -- Dr. Jonathan Spaulding completes paperwork and patient charts on an empty gurney in Corry Memorial Hospital's emergency room because his desk is too small.
It works until a patient is brought in, and he has to clear it all away.
Spaulding and other staffers at Corry Memorial, nestled in rolling farmlands about 35 miles east of Erie, have learned to "make do" with what they have and do whatever it takes to keep their hospital going -- even if it means putting down a stethoscope and picking up a paintbrush.
When volunteers from the local Lutheran church offered to paint the emergency room's dingy walls, Spaulding, some nurses and other employees joined them. Another doctor bought pizza. The church paid for the paint and chairs to make the unit more attractive to the 11,000 patients treated there every year.

Later, they hung a plaque in a hallway to mark their three-day achievement. CEO Barbara Nichols sees it as a tangible sign of people working together for the good of the hospital and the community it serves.
"It's pitiful. That's our window to the world. They didn't bail because they want us to survive," Nichols said.
Survival can be a daily struggle for America's rural hospital administrators, who are eagerly awaiting passage of the 2007 Farm Bill because it is expected to include about $1.6 billion for 1,283 medical centers designated as critical access hospitals. The bill would replace legislation that expires in September.
It is vitally important in Pennsylvania, where there are more people living in rural areas than any other state, according to the Pennsylvania Rural Development Council. About 3.7 million of the state's 12.4 million residents live in rural communities, the council reported.
Many of Pennsylvania's rural residents receive medical care at one of a dozen of these 25-bed hospitals scattered throughout the state's forests, mountains and farmlands in tiny towns linked by winding, narrow roads.
They are part of a federal program created to help them stay open because they are so important to the isolated areas they serve. They receive government reimbursement for patient care at higher rates than those paid to larger hospitals. In return, they must accept Medicare patients, limit acute-care beds to 25 and offer 24-hour emergency services. The program is available to hospitals located more than 35 miles from another hospital or 15 miles over secondary roads or mountainous terrain.
For some patients, they are the difference between life and death.
"Following a farm accident, for example, or a heart attack, the time needed to reach the emergency room is very critical to the health of the patient," said James C. Alsop, the U.S. Department of Agriculture's deputy administrator for community programs within rural development.
Many of the hospitals themselves appear to be in critical condition.
Built decades ago, they are falling apart with leaking roofs, crumbling plumbing and outdated equipment. Despite the government's help, they scrape by with limited resources while trying to meet changing patient needs, upgrade technology and attract and retain qualified physicians.
Administrators say they don't even try to compete with hospitals with hundreds of beds or behemoth urban health systems, such as University of Pittsburgh Medical Center in Pittsburgh with its 43,000 employees, 19 hospitals, state-of the-art equipment and pioneering research centers.
They know their place in the hierarchy of the state's health care system.
Three hours from Pittsburgh in Blair County, Tyrone Hospital is tucked into a wooded campus not far from the center of town, where American flags and geranium pots decorate painted porches along the tree-lined streets leading to the American Eagle Paper Mills.
The two-story brick building billed as "a small hospital with a big heart" is the place to go for mammograms, colonoscopies and treatment for pneumonia or minor injuries, but not for heart surgery or chemotherapy, according to CEO Walter Van Dyke.
"We get a lot of people who are just plain sick," Van Dyke said. "We have an older population, and they feel comfortable coming here. It's close to home."
Van Dyke said places like Tyrone, where there are just three beds behind pink curtains in the emergency room, should not duplicate services offered by urban systems. Instead, they should form agreements with larger hospitals, focus on diagnostics and primary care, and send patients elsewhere for specialized care.
Tyrone treats 6,500 emergency cases and admits 1,500 patients a year, but major trauma and surgery cases and expectant mothers are sent to Altoona Regional Health System, Mt. Nittany Medical Center in State College and J.C. Blair Memorial Hospital in Huntingdon, Van Dyke said. Although the hospital fills a need, it was built in 1954 with technology that has "outlived its day."
"It looks attractive on the outside because it had a facelift in the 1990s. But it has its limitations," he said. "We don't need a new building, but our heating and air conditioning systems are marginal. ... We don't need a CT scanner. We need a roof."
Lawrence Baronner, state coordinator for the program in Pennsylvania, said many of the hospitals' buildings and equipment are so outdated they need to be replaced.
P.C. "Hoop" Roche, Corry's board chairman, insists his hospital is one of them.
Roche wants to build a new hospital to serve the 7,000 or so people who live in Corry and thousands of others in the surrounding area. He said the hospital -- particularly its emergency room -- is vital to the area that includes about 500 Amish who do not drive motor vehicles and find it difficult to travel to Erie, Cleveland or Pittsburgh.
"We can't deliver what we need to deliver to our community with a 50-year-old building," Roche said.
Although clean and well-maintained, Corry Memorial shows its age with warped floor tiles, sagging chairs and stuffy rooms where portable fans boost the power of an insufficient air conditioning system. The main nurses station -- a group of battered desks in an open hallway -- has been unchanged since 1967. The boiler, a rumbling metal giant installed in 1949, is the "oldest in Erie County," according to Jamie Jaworski, acting director of environmental services.
But there are operating rooms and units for outpatient surgery, nuclear medicine and geriatric psychiatric behavioral health. The hospital offers mammography and other radiologic services, physical therapy, home care, chemotherapy and hospice care.
Nichols said some new doctors joined the staff, and employees will get raises this year for the first time in several years. Local residents visit the hospital's cafeteria for daily meals because the food is good and clubs meet in a new conference room.
"We've demonstrated we can do a lot of things," Nichols said. "We've had lots of struggles through the years. We get a lot of stuff with grants, and we make do with what we have."

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