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Rural Health Crisis BY DAN CARNEY Washington WHILE MUCH HAS been made of the economic problems faced by rural hospitals in Texas and elsewhere, a crisis of a different sort seems apparent in data published recently by the U.S. Department of Health and Human Services. Eighteen Texas hospitals had general mortality rates at or above the upper limit of the projected range in the HHS study, an exhaustive look at every hospital in the country that takes Medicare patients. Of the 18, 17 were in small towns. They were in places like Grand Saline, Eastland, Snyder, Rotan, Borger, Brady, Colorado City, Carthage, Hearne, Marlin, Del Rio, Wylie, Brenham, Alpine, Weatherford, Liberty and Memphis. Hall County Hospital in Memphis, St. Jude Hospital in Brenham, and Yettie Kersting Memorial Hospital in Liberty, have recorded mortality rates at or above predicted levels since 1986, the first year that comprehensive mortality data was collected. “It doesn’t take a genius to figure out that there are serious problems in the delivery of health care in rural America,” says Bruce Fried, Executive Director of the National Health Care Campaign. The Medicare Hospital Mortality Information report, as the mortality report is called, attracts a considerable amount of criticism. Since it was first compiled in 1986, hospitals and medical groups have protested, sometimes with justification, that the mortality rates limited to Medicare patients are misleading or downright incorrect. Military hospitals, for instance, sometimes have mortality rates for Medicare patients as high as 100 percent because the only Medicare patients they accept are extreme emergencies. Others complain that the study doesn’t take into account the large numbers of deaths that will always occur if a hospital has a trauma center receiving the most serious cases. But even taking into account some of these problems in reporting, the numbers reveal a grim track record for Texas’s rural hospitals. In the study, each hospital is assigned a range of predicted mortality based on factors such as the age and type of patients the very same factors opponents say aren’t adequately considered. And while some individual hospitals might not think they got a fair shake, the overwhelming number of rural hospitals outside of the range is clearly Dan Carney is a writer for States News Service in Washington. more evidence of problems faced by these institutions as a class. For example, HHS says the 1988 mortality rate at the Golden Plains Community Hospital in Borger should be between 6.4 and 18.8 percent for Medicare patients. The actual mortality rate was 20.4 percent. The 1988 mortality rate at the Heart of Texas Memorial Hospital in Brady was 20.3 percent for Medicare patients, although its HHS predicted range was between 7.5 and 18.6 percent. The 1988 HHS predicted mortality range at Mitchell County Hospital in Colorado City was 9.4 to 21.1 percent. The mortality rate was 22.2 percent. Dr. Albert Randall, Texas state Deputy Commissioner of Health for Rural and Community Health, says that part of the problem is getting quality professional staff to come and stay at small-town hospitals. Many doctors and nurses grow up in large cities or suburbs and look forward to living in these centers as adults. Some come to small towns early in their careers but just long enough to get some good on-the-job training before moving back to the city, he says. Worse still is that increasingly the people living in rural areas are the very young and the very old two groups with strong needs for quality health care. The people in between these two groups are more often in big cities where employment opportunities are more abundant. “When you move out there \(into the about health care,” Randall says. “You don’t always have the same things you have in bigger cities.” There is both good news and bad news on the horizon for rural health care. The Texas Legislature has passed a number of laws aimed at improving health care in rural and low-income areas. And both the Legislature and Congress have raised the income requirement by which people qualify for Medicaid. Congress also passed legislation directed at decreasing the disparity between Medicare payments to rural and urban hospitals. Right now, urban hospitals get 12 to 13 percent more than rural ones. That would be decreased to 8 percent this year, and eventually there would be no disparity, says a spokesman for Sen. Lloyd Bentsen, the chairman of the Senate Finance Committee, who helped draft the legislation. On the other hand, Congress repealed its catastrophic health care plan after a clamor from wealthier and more politically active elderly citizens, an action which could be catastrophic to some hospitals at a time when both elderly and rural populations are expected to grow, Fried says. “I would think things are going to get worse,” says Rosie Torres, Field Representative for the Texas Alliance for Human Needs, an organization in favor of a national health care plan. WHEN PRESIDENT Bush decided to invade Panama, most in Congress joined his band wagon. With Americans being killed, most chose to rally behind the flag. Not so in the case of Rep. Henry B. Gonzalez, the outspoken San Antonio Democrat, who after 29 years in Congress has emerged as one of its most powerful members. “I’ve said for years that our policy in Panama was a disaster,” Gonzalez said. “Today’s action is simply the culmination of a bankrupt, failed policy of using and abusing Panama. ” “The problem is not merely to get rid of Noriega,” Gonzalez said. “It is to remember that Panama is an artificial thing wrenched from Colombia as a convenience to us. Governments there have been treated as vassals to us. That has to end.” Panama seceded from Colombia in 1903 with the backing of the United States. The U.S. was interested in building the Panama Canal. Since then the United States has taken a keen interest in Panamanian affairs. Noriega himself was on the payroll of the Central Intelligence Agency from 19831986 before serious charges of drug trafficking were leveled against him. Gonzalez said a better approach would have been to seek other Latin Americans’ support for a quarantine against Panama. Rep. Albert Bustamante, Gonzalez’s colleague from San Antonio, also said he was concerned about the implications of the incursion, though an aide said he was “cautiously supportive” of Bush’s actions. “Noriega has been trying to lure us into a confrontation,” Bustamante said in a statement. “We want to get rid of this drug dealer, but I am not sure that this is the way to do it.” “Our Latin American neighbors view us as constantly interfering in other sovereign nations’ business,” Bustamante said, “and this move plays into that view.” complete personal and business insurance ALICE ANDERSON AGENCY 808-A East 46th P.O. Box 4666, Austin 78765 28 JANUARY 12, 1990