Emergency Room Dr. speaks up

Editor:

I am writing to express my heartfelt support for Cedar County Memorial Hospital, its leadership, co-workers, RNs and Medical Staff. I strongly urge all citizens of Cedar County to support their local hospital, and vote “YES” on the upcoming tax levy for the hospital.

Cedar County Memorial Hospital is a vital, essential, life-saving facility. It is a local facility that is owned and managed locally, in a day and age when many hospitals are owned by a national conglomerate that really has no local ties. The leadership and staff live in the community and have a stake in the care of the patients and success of the hospital. There is absolutely no greater honor than caring for your neighbors and friends. The hospital staff treats patients, visitors, and each other like family and friends. The loss of a local hospital can decimate a local community’s economy.

Hospitals are typically one of the largest employers in a community. It has been estimated that a community that loses its local hospital, will lose many more jobs downstream in the local economy. Each single hospital position has been estimated by past experiences (such as the Joplin tornado experience) to support 5-7 downstream jobs at grocery stores, gas stations, car dealerships, restaurants, convenience stores, pharmacies, department stores, etc.

Communities often cannot recruit new companies or industry to the town if there is not adequate medical care. For a community to ever survive, thrive and wish to grow, they must have local medical services. This is even more important in times such as the current Coronavirus pandemic and the economic shutdown occurring nationwide. Over 110 small, rural hospitals have closed their doors since 2010. Those closures had detrimental downstream outcomes for those communities, and they may never recover.

CCMH has services not available in many rural areas. The Emergency Department is staffed by physicians with Emergency Medicine Residency training, and Board Certification in Emergency Medicine, and/or many years of experience in high volume Emergency Departments. The physicians who care for patients in the CCMH ED have expertise in and are specially trained in Emergency Medicine; have experience in high volume Trauma Centers such as Cox Springfield, Freeman West, Mercy Joplin and other Trauma Centers in Oklahoma; and bring that experience and life-saving procedures to Cedar County. Many of the local Emergency Physicians are teaching faculty for Medical Schools, have been voted by other physician colleagues and won awards repeatedly as being “Top Docs” in the 417 area code, and provide customer service in the top measurements of the nation. Many small hospitals cannot recruit physicians, much less true Emergency Physicians to their small towns. CCMH has had stable staffing of their Emergency Department, staffed by the same core group of Emergency Physicians for over 10 years. Many hospitals of all sizes cannot maintain adequate, stable staffing for years like CCMH has accomplished. Many EDs have to patch together their staffing and do not have a stable situation over the long term. One Emergency RN recently told me they work at a facility within an hours drive of CCMH that had gone through 54 different physicians in a year to try and staff their Emergency Department. That is not that uncommon. CCMH’s ED remains fully staffed and stable, ever available to treat patients with minor or life-threatening conditions.

CCMH is a Level-III Certified Stroke center. You would have to be transferred to a facility as far as Harrisonville (1hr 12 min), Joplin (1hr 18min),  Springfield (1hr 24min), or Belton (1hr 25 min) to receive that Level-III Stroke Care or higher. These driving times are based on good weather and traffic conditions. Often, patients or ambulances will have longer transport times due to traffic, rain, ice, or snow. Helicopter transport is an option with good weather conditions, however, many flights are declined by the helicopters each year due to rain, snow, fog, ice, or winds. You cannot always count on timely transfer. Those 76-plus minutes to another Stroke Center, are minutes that a stroke patient does not have to spare. Time is brain. A patient ideally must seek care within 3 hrs. (180 minutes) of the onset of stroke symptoms to be treated with tPa at a Stroke Center and have a better chance of regaining function. The NIH literature shows that only 28.9% of patients will recognize stroke symptoms rapidly and seek care within that 3 hour window. That means 71.1% of patients will not even arrive at their closest hospital within the ideal 3 hour window. Similarly, a patient that arrives at a Stroke Center within 60 minutes of symptoms onset, is approximately twice as likely to leave the hospital able to have the ability to perform functions of daily living. Should that patient have to drive another 76+ minutes to another Stroke Center, they will greatly diminish chances for timely treatment. The Stroke Center certification means a Hospital has undergone a voluntary application and has met the stringent requirements for planning, training, staffing, treatment, and quality improvement to be awarded this certification.

Only hospitals fully prepared and willing to undergo the financial, education, training and time expenditures necessary will achieve such approvals. Additionally, life-threatening conditions of heart rhythms, airway/breathing, or major traumatic injuries may literally only have several minutes, not hours, to seek life-saving care. Any other hospital with any capability is at a minimum of 25-47 minutes away from CCMH.

The ED physicians at CCMH are trained in life-saving procedures that are often not performed in small hospitals. While patients can often be stabilized with life-saving care and procedures, it is true that not all patients can be admitted at CCMH and will have to be transferred to a large, tertiary hospital. That is true in almost all communities with less than 150,000 residents. However, many patients, young and old, are saved each year by the care in their small, local hospital, then may have to be admitted in a large hospital in a bigger city for specialty care. This occurs in all small cities. National data shows that if a community loses its hospital, the 30-60 minute transport to the next local hospital for initial care can increase risk of death for all patients by approximately 6% for everyone, and could be up to 20-50% increased risk of death depending on the exact emergency situation. Many patients simply cannot wait for care “down the road”. Patients with strokes, a heart attack, respiratory arrest, anaphylactic allergic reactions, and other immediate life-threatening conditions may not survive the extra transport time to drive to another town. Minutes truly do count. Towns that lose their hospitals, often wind up losing their local physicians and medical clinics as they choose to relocate where hospital services are available as well.

   CCMH leadership, staff and physicians continue to prepare for patient care even in the current Coronavirus Pandemic. They have undertaken training and preparation to not only care for the typical Emergency and admitted patients, but even those stricken by the Covid-19. CCMH’s ED has prepared to take care of all who seek care. They have special airway equipment available for providing oxygenation to the sickest of patients, training in life-saving procedures, bedside ultrasound for emergency procedures; items not available in many small hospitals. The Emergency Physicians and an admitting Physician have purchased their own Powered Air-Purifying Respirators (PAPRs) to be ready to care for Covid-19 patients if called upon. The Ed physicians donated a PAPR for the nursing staff assigned to such patients. The hospital has services available by consulting physicians that bring their care to the local community such as Cardiology, General Surgery, Podiatry, Ophthalmology, Neurology, and Rheumatology. This saves the patient and family from having to travel for this care.

Cedar County Memorial Hospital is blessed to have admitting physicians, Dr. Casey and Dr. Wyant, who live in the community and have traditional admitting practices at the hospital. This means the patient can see their own personal physician in the office and be admitted by that same physician for hospital care. This physician-patient relationship from the office to the hospital is a rarity nowadays. In 2020, most hospitals will admit patients to a physician whom they have never met and do not share an established Physician-Patient relationship.

I encourage everyone to get out and vote “YES” on supporting the tax initiative for CCMH. There has not been an increase in the levy rate since 1961. The original levy of 0.2000 in fact decreased to the current 0.1528 due to the 1980 Hancock Amendment. What other company, store, or service do you use that has not had an increase in cost since 1961? I suspect your car, electric, gasoline, milk, travel/vacations, cigarettes, clothing, and any other item you use costs more in 2020 than it did in 1961. Please extend that same logic to the costs of having life-saving medical care available locally for your family, friends, and community. Thank you.

Submitted respectfully for your consideration,

D. Sean Smith, D.O., FACEP

Board-Certified Emergency Physician

Business Address:

Cedar County Memorial Hospital

El Dorado Springs