ELK CITY — Eileen Murray did not want her daughter loaded into an ambulance headed for Oklahoma City. The family already had driven 45 minutes to get Madelyn to the Elk City hospital.
But an emergency medicine physician was worried Madelyn had damage that could cut off circulation in her arm.
The hospital’s orthopedic specialist was consulted and found all Madelyn had was a broken arm, suffered when the 10-year-old girl was bucked off a horse at a friend’s house.
“We were 45 minutes from the nearest anything, so we had to get in the truck and drive” to the hospital in Elk City, Murray said.
“Longest drive of my life. Every time we’d hit a bump, she’d scream and scream, but it would have been hard to explain for an ambulance to get there and wait for an ambulance.”
Madelyn’s family members were relieved to stay at a hospital near their home in Willow.
The family is among a large percentage of rural residents who stay in their community for hospital care.
Sixty percent of rural residents who were hospitalized in 2010 went to a rural hospital, rather than an urban facility, according to a recent study from the Centers for Disease Control and Prevention’s National Center for Health Statistics.
The share of rural residents’ hospitalizations that take place in urban versus rural hospitals has been an area of interest for a number of years, and those who go to urban hospitals have been described as “bypassing” rural hospitals.
Many rural areas are medically underserved because of physician shortages, especially for specialists such as cardiologists, orthopedic doctors and neurologists.
This is true for Oklahoma, a state with 67 counties and regions that lack enough doctors to treat the population, according to the state Health Department.
Rural hospitals often are small, with a low volume of services, and have difficulty remaining financially viable under the regular hospital prospective payment system, according to the CDC study.
Corey Lively, the CEO of Great Plains Regional Medical Center in Elk City, is working to change that.
Lively started at the Elk City hospital in February. Since then, he has listened to the concerns of the community and focused on how the hospital can remain financially stable.
For example, over the past six months, Lively worked to replace all physicians who worked in the ER with board-certified emergency medical physicians, a request of community members who wanted a better quality emergency room.
Before the shift, the hospital had only a few of these specialists.
“If you come in our emergency room, a physician trained in emergency medicine will treat you,” Lively said. “Before, we couldn’t always say that was the case. We occasionally had that. We occasionally had family practice physicians who would moonlight in the ER, and that’s one of the areas that our community said, ‘We would like to see this in our hospital.’”
Lively also is working on how they can transfer fewer patients to Oklahoma City and instead treat them in Elk City, close to home.
Last year, the hospital took about 300 patients to Oklahoma City hospitals. This year, they’re looking to cut that in half.
Madelyn Mitchell is an example of a patient who likely would have been transferred last year.
“In the absence of that orthopedic surgeon, she would have probably gone by ambulance or helicopter to Oklahoma City because he was fearful she had compartment syndrome, which can cause the loss of the limb,” Lively said.
Challenge for older hospitals
About 100 miles northeast of Elk City, Shelly Dunham faces similar challenges.
Dunham, the CEO of Okeene Municipal Hospital, said people perceive an old hospital as not a good hospital, a challenge that many rural hospitals face. For example, Okeene hospital is in a building built in 1951.
Dunham said through an analysis, hospital leaders found that without renovations, they wouldn’t be able to remain financially viable.
“We were not going to be able to get physicians to come to our facility,” Dunham said.
“As physicians we had were retiring, we would not be able to replace them, and that’s a scary thought.”
In 2007, the hospital trust spent almost $8 million to renovate — a significant amount of money for a small hospital.
Thanks to the renovations, the hospital has a new emergency room and lab and new patient rooms, among other changes.
“If you have modern updated facilities, there’s that perception of better care,” Dunham said. “You still have some people who think the bigger place is the better place.”