A Community in Need Suffers the Loss of a Vital Medical Resource

In the mid 1940s, after serving his country in WWII, receiving a GI bill that would pay for his education, graduating from medical school and completing an internship in a southern university hospital, a young man returned to his home town in the mountainous district of North Carolina which is known as Appalachia. The description of his place of origin (as it appeared in the journal entitled Medical Economics) puts one in mind of the town of Mayberry in the Andy Griffith TV series. The doctor, recently married to his high school sweetheart who had become a school teacher, set up a general, family practice and provided a much needed source of medical care to his boyhood, hometown neighbors, who were for the most part financially poor by most standards. His young bride began to teach in a local rural school until their first child was born.

As time passed the young couple had two sons and a daughter, the latter ultimately going off to college to study history and the sons eventually admitted to medical school following their completion of undergraduate degrees. The daughter, following in her mom’s footsteps became a teacher, the sons, after completing their internships went on to finish residencies; one in a med-peds program which involved a combined four year program studying internal medicine and pediatrics. The other brother spent four years in the mastery of general surgery. After carrying out their post graduate training the two brothers, like their father before them, felt a calling to return to their mountain home and attend to the medical needs of the country folks in Appalachia with whom they had been raised. The year was 1975.

The internist/pediatrician became a consultant for his dad when the problems in those areas of expertise extended beyond the father’s ability to diagnose or treat them. The surgeon handled the operative problems, both emergent and elective, which neither his dad nor his brother could manage. It was a complete clinic in every respect and they had two beds for extreme emergencies until transport to a distant hospital could be arranged. The only thing lacking in their clinical practice was a local hospital. The nearest one of those was fifty miles away and that was too far to safely travel in the midst of either a medical or surgical emergency. The only solution to that predicament was to finance and build a small hospital themselves.

Within a short time, having pooled their funds and taken out a construction loan, the three physicians planned and developed a 75 bed hospital, equally divided between pediatric, medical and surgical sections. They had a laboratory, X-ray unit, emergency room, laundry, central supply, hospital pharmacy, a small business office, a waiting room and operative suite. They did not get rich, but they were able to pay off their mortgage and periodically make the necessary improvements in their small hospital and upgrade to become state of the art as medical technology became more sophisticated. Managed care had not yet poked is bureaucratic nose into their everyday practice and the people of that community were more than pleased with the service afforded to them. It was 1980.

Before long, in 1990, the managers of the Joint Commission on Accreditation of Hospitals (JCAH) who had been working for a decade on changing the way larger hospitals in metropolitan areas did business, eventually found their way to this comfortable, little Appalachian community and decided that they knew best how to serve the locals as opposed to how they had been successfully treated by the dedicated dad and ultimately his well trained sons over the previous 45 years. Year after year the JCAH nit picked away at the methods by which the three experienced physicians delivered health care. The father gradually became so frustrated that he retired and the sons began to notice that the cost of complying with the JCAH coordinator’s rules and regulations were eating into their bottom line and affecting their ability to stay afloat financially. The proverbial straw that broke the camel’s back came in 1996. The doors to the operating suite were found to be non-compliant with the hospital accreditation manager’s, capricious standards. Those were the same doors that had been swinging in and out for 26 years as the surgeon with his immaculately scrubbed and properly gloved hands held high, his mask and gown appropriately affixed, pushed through to attend to a patient in need of his surgical skills. Those doors had been swinging in as the General Practice father enetered to deliver a baby and out again as he presented the newborn child to the proud father who’d been anxiously pacing up and down in the waiting room. The JCAH had summarily declared that those doors were to be no more than 1/32 of an inch apart when closed, but they were found instead to possess a 1/16 inch gap. The JCAH team demanded that the doors be changed, and if the brothers did not comply, their hospital would be shut down.

Frustrated, nearly bankrupt and quite angry, the brothers sadly and reluctantly closed their 75 bed hospital and sold it to a man who converted it into a nursing home. Now the folks in that small town and their two excellently trained and dedicated physicians must travel 50 miles to reach the nearest hospital. Time formerly spent treating their patients must now be expended driving the serpentine roads of their Appalachian mountain region, a journey that takes at least 90 minutes one way (in good weather) to visit their patients and make daily hospital rounds. 90 minutes in the face of a medical or surgical emergency, is a very long time. It can make the difference between the continued life and the untimely death of an extremely ill patient.

This sort bureaucratic nonsense and more is what we are in for if we continue to allow the business managers in HMOs, the JCAH and government bureaucrats to control the practice of medicine. That will be especially true under a national socialized, healthcare system as proposed by Senator Barach Hussein O‘Bama. There is a workable, time proven, alternative system of delivering health care and next week we shall look at that. Finally, having diagnosed the problem and having identified the disease causing agents, we are ready to implement a cure for our ailing system of providing health care to the citizens of America.