STAT

A Rural Hospital Thrives

 

It’s the heart of this West Texas community of 7,000. Babies are born here. Knees are patched up. Rattlesnake bites are treated. (2017)

(Direct link to article here.)

 

By Charlotte Huff

CHILDRESS, Texas — To get to the hospital, you drive. And drive. It’s 220 miles northwest from Fort Worth, along a flat landscape with lots of sky and lots of cows and lots of haystacks.

Childress Regional Medical Center is not particularly imposing: a one-story brick hospital with an adjacent primary care clinic. But it’s the heart of this community of 7,000. It’s the second largest employer (after the state prison) and a recruiting tool to attract teachers, businesspeople, retirees. Babies are born there. Knees are patched up. Rattlesnake bites are treated.

“Hospitals, schools, churches,” said John Henderson, the hospital’s chief executive officer. “It’s the three-legged stool. If one of those falls down, you don’t have a town.”

Rural hospitals around the country have struggled to stay afloat; at least 80 have shut down since 2010. Thirteen of those closures occurred in Texas, the most of any state, according to the data from the North Carolina Rural Health Research Program.

But Childress Regional, which has just 39 beds, is a case study in success. It’s solvent. It’s expanding its services. And in an era when medical care seems increasingly fragmented — with high-tech diagnostics and high-priced specialists called in for every ailment — it’s a reminder that the old-fashioned way can work, too.

‘Push, push, push!’

On a recent Thursday night, Dr. David Caldwell was working the overnight shift at Childress. That meant shuttling between patients. There was a shoulder injury awaiting inspection in the emergency room. And an impending delivery.

“Push, push, push!” The commands could be heard through the closed door in the labor and delivery room. So, too, could the yells from the mom-to-be. Outside the door, relatives paced.

These days, just 70 of the 162 rural hospitals in Texas still deliver babies. Childress, a public nonprofit, is one of them.

The next closest hospital for pregnant women in Texas is at least 100 miles away — in Amarillo, Lubbock, or Wichita Falls, cities which surround Childress like spokes on a wheel.

“We’re not in the middle of nowhere,” Henderson likes to say. “But you can see it from here.”

It’s a quote he credits to his dad, Dr. Mike Henderson, who is still practicing at age 67 — and who delivered his 3,000th baby in late 2015. (Mike Henderson still answers urgent calls from the hospital in the wee hours, explaining that he’s not yet ready to “go to my ranch and watch the cows graze.”)

Since there are no dedicated obstetricians on staff at Childress, nearly all of the eight family practice physicians take care of deliveries.

There’s no neonatal intensive care unit as backup, no teams of sub-specialists down the hallway. John Henderson recalls how one doctor, during his initial years at the hospital, would appear in the doorway of the CEO office after a particularly challenging delivery and ask: “Do we have to deliver babies here? Remind me why?”

Because someone has to, Henderson always replied.

Ideally, women with high-risk pregnancies will get prenatal care in a bigger city, like Lubbock. But hair-raising deliveries can’t always be anticipated.

Mike Henderson remembers one such situation from about a year ago, in which a woman late in her pregnancy came in, bleeding heavily. The placenta had begun to separate, a potentially life-threatening complication for both mother and baby. He performed an emergency caesarean section.

“They did fine,” he said. “They wouldn’t have done fine in an ambulance or a car.”

The limited staffing can occasionally lead to some tense moments. There’s just one certified registered nurse anesthetist on call at any time. (The hospital employs two, who alternate two-week stretches, living in a hospital-owned duplex on the property and trading keys and cellphones every other weekend.)

If a woman needs an emergency C-section while a surgeon and the anesthetist are working on a patient in the operating room, the logistics can get dicey.

Practice drills are in the works, John Henderson said, recalling one experience that was a bit too close for comfort: “Literally an ortho case was coming out of the room as a C-section goes in.”

Reaching out to distant specialists

To stay in the black, Childress has moved aggressively to both hold down costs — everyone in administration wears multiple hats — and bring in new services.

The arrival of an orthopedic surgeon in 2013 has been a help, both for the bottom line and for patients. “Before, if we had a 90-year-old grandma or granddad who fell and broke their hip, we’d stabilize them in the ER and put them on an ambulance and send them 120 miles down a bumpy road,” John Henderson said.

Also in 2013, Childress began bringing in an oncologist, who drives the 150 miles from Texas Tech University Health Sciences Center in Lubbock at least once a month to see patients. The oncologist also supervises a hospital nurse trained to administer chemotherapy. On a recent morning, three patients read and chatted in comfortable chairs during their treatments.

Previously, cancer patients had to drive two-plus hours to Amarillo, Lubbock, or another city to get chemotherapy.

“And then you drive that 2 ½ hours back home,” said Kathy McLain, who worked in various financial roles at Childress Regional for nearly 40 years, “and you’re sicker than a dog.”

In 2015, the hospital added telemedicine equipment to let doctors consult with specialists at Children’s Medical Center Dallas about high-risk deliveries or perplexing emergency cases, such as when 4-year-old Shane arrived this past July, screaming in pain. “He was blistered so bad it’s as if he had been thrown basically into a deep fryer,” said his mother, Amber Yoakum.

Yoakum, who estimates that she “probably did 95” covering the nearly 60 miles from their home to Childress Regional, said she struggled not to panic as doctors and nurses administered pain medication and examined her son. The reddish blisters were visibly multiplying, “almost crawling” across his skin, she said, his back turning from reddish to nearly purple.

The telemedicine cart was pulled next to Shane’s bed, the video was connected with a doctor in Dallas, and other equipment on the cart magnified the angry clusters of blisters. At that point, the primary question was whether the preschooler had suffered a burn — perhaps a chemical burn from swimming — and thus needed a burn center, or whether he should be seen by some other specialist, said SuLynn Mester, chief nursing officer.

“It was pretty soon that this physician on the other end actually said, ‘I don’t think this is a burn,’” Mester recalled. Shortly after, Shane was flown to Children’s Medical Center Dallas.

The eventual diagnosis: an unusual complication of a staph infection, called staphylococcal scalded skin syndrome, which creates toxins that can attack the skin’s surface. Five days later, after hefty doses of antibiotics and healing bandage wraps, Shane returned home.