Sanford’s boom skips some rural areasKennebec closure highlights small-town woes.
By: Anna Jauhola, The Daily Republic
Sanford Health. In the Upper Midwest, the name has become synonymous with explosive growth and prosperity.
Fueled by philanthropist Denny Sanford’s $700 million in gifts in recent years, the health system is expanding its reach and visibility at a dizzying pace with acquisitions, construction of new facilities and heavy advertising.
“Sanford Health … is now the largest rural, not-for-profit health care system in the nation with locations in 126 communities in eight states,” Sanford’s website proclaims. “In addition, Sanford Health is in the process of developing international clinics in Ireland, Ghana, Israel and Mexico. Sanford Health includes 35 hospitals, 140 clinic locations and nearly 1,200 physicians in 70 specialty areas of medicine. With more than 25,000 employees, Sanford Health is the largest employer in North and South Dakota.”
The website goes on to extol Sanford’s health initiatives, including “global children’s clinics, multiple research centers and finding a cure for type 1 diabetes and breast cancer.”
So it was with great surprise that the people of Kennebec, a town of 244 residents in the rural midsection of South Dakota, encountered a different side of Sanford Health when the health system suddenly announced in August that it was not only closing the Kennebec clinic, but also planned to uproot the building and move it to a different city.
“They didn’t come to the community and say they’re closing or that they have a problem,” said local resident Gene Mertens. “Basically they said, ‘We’re done with you.’ We have nothing against the doctors or the providers. It’s the upper echelon.”
The situation highlights the continuing problem of vanishing access to health care in rural parts of South Dakota, even as South Dakota-based Sanford expands its reach around the globe. According to South Dakota’s Primary Care Task Force, 59 of the 66 counties in the state are federally designated as health-professional shortage areas.
For people in Kennebec, the nearest health care provider is a clinic 10 miles away in Presho. The nearest hospital is run by Sanford and is 30 miles away in Chamberlain. Townspeople in Kennebec want to have a clinic in town and have formed a committee to work with other health systems who have expressed interest.
“It’s not going to happen overnight,” said Mertens, one of the committee members. “But we had a community meeting the other night and there wasn’t an empty chair. They want health care.”
The committee is in talks with Sanford’s rival, Sioux Falls-based Avera, which has 300 locations in eastern South Dakota and surrounding states, and with much smaller Rural Health Care Inc., of Pierre.
The town has been “spoiled” to have at least part-time health care for years, Mertens said. Many of the elderly residents in town and on farms and ranches had come to depend on the access to routine procedures such as blood pressure checks. Businesses relied on the access to blood tests for random drug testing. Parents relied on the ability to bring children in for physicals, checkups, vaccinations and emergency care.
A physician assistant visited the clinic 2½ days a week and a doctor was there 1½ days a week.
Anger at Sanford
Mertens said the town is optimistic about getting a new clinic and providers.
Sanford Health, meanwhile, is adamant that a lack of medical professionals willing to practice in Kennebec was the main cause of the clinic’s closure.
When asked why Sanford is convinced it can’t find providers for Kennebec while other health systems in talks with the community apparently feel differently, Erica Peterson, chief financial officer and interim CEO of Sanford Chamberlain, said only that “It centers around the lack of clinicians in the area. There are no providers in the area.”
Peterson said the decision to relocate the clinic building was the most cost effective for Sanford.
“We don’t have a location yet, but there are multiple needs across our coverage area,” she said.
Sanford’s position doesn’t sit well with people in Kennebec.
“I’m disappointed in how they handled it,” said Rod Bowar, president of Kennebec Telephone Co. and a member of the town’s health care committee.
Bowar said the town has been fortunate to have had a provider and clinic with few interruptions in service. He is confident the town will be able to get another provider and start up a clinic. “We’re a get-it-done community,” he said. “We’re keeping positive we’ll get a clinic.”
He said many, if not all, residents are angry about the way Sanford left Kennebec hanging, but they plan to channel that anger into something positive.
Peterson said Sanford and the town of Kennebec are currently “in discussions” of Sanford gifting the land on which the clinic sits.
“It’s silly they’re moving the building,” said Tabatha Harmon, Kennebec.
“It was unexpected. They moved out so fast we were all caught off guard,” added Kristen Thomas, owner of Shear Illusions hair salon in Kennebec. “It’s like a part of our town died.”
The clinic closed the afternoon of Sept. 14. By Sept. 17, crews were at the clinic clearing out furnishings and equipment.
The two women were visiting about the clinic closing recently during a hair appointment. Harmon has three children, one of which needs an annual physical for sports. The women agreed the convenience of having a clinic in town will be missed. “It was here for emergencies like ear infections or if someone fell,” Harmon said. “It was nice to have, like if you had strep throat. You could go in there quick and get your medication in Presho,” Thomas said. Thomas particularly enjoyed the convenience of calling in the morning and getting an appointment that afternoon — and only having to give her first name for the receptionist to know her. “This is like losing our grocery store,” she said. “People are angry, devastated.”
Rural Health, Avera interested
Although Sanford claims there is a lack of clinicians, the town committee is in preliminary discussions with Avera and Rural Health Care Inc. to provide a clinic that would be associated with one of those systems’ existing facilities in Pierre, about 50 miles to the northwest.
Representatives from both entities acknowledge it is a challenge to provide health care in a rural setting but said it is possible to sustain a clinic in Kennebec.
“It’s really premature, but we’ve been contacted by representatives in Kennebec and we have an interest of looking at the possibility with them,” said Jim Hardwick, CEO of Rural Health.
Rural Health runs the clinic in Presho and many residents from Kennebec already use the pharmacy in Presho. The clinic there also has a full-time provider who is a long-time resident of Presho and went to college specifically to come back and serve the community.
“She’s a rarity,” Hardwick said. “It’s a challenge to get providers to a rural area. Finding the right person to embrace that is hard to do.”
But Rural Health is willing to discuss whether Kennebec can fit into the company’s business plan.
“Whether that means a provider a few days a week, nobody has any idea right now,” he said. “Most of our clinics were in scenarios like this where whoever was sponsoring the spot stepped away from it for whatever reason.”
In the meantime, Hardwick said the Presho clinic has plenty of capacity to take on all the patients from Kennebec.
Avera is also discussing the possibility of starting a clinic in Kennebec, said Daryl Thuringer, vice president of marking and public relations. He also said discussions are in the early phases.
“Providing health care to rural communities is core to our mission,” he said. “We do things like the Kennebec clinic all over Minnesota, North Dakota, South Dakota, Nebraska and Iowa.”
Avera has helped small communities like Kennebec by providing eCare services connecting a clinic with other Avera providers through video links, and by using partnerships to provide medical personnel at rural locations.
“I hope we can find a way to fill that void,” Thuringer said.
Herb Sundall, a local lawyer and member of the committee, said the community is still in discussions with Sanford about gifting the land to the town.
The committee is “optimistic about the chance of Avera opening a clinic in Kennebec sometime next spring,” Sundall added. During a recent meeting with Avera, Sundall said, the committee talked about terms with which Avera would be able to open a clinic in Kennebec. Sundall told the town during a community meeting last week that the town would have to provide an ADA compliant clinic building and Avera would lease the building.
Avera would provide equipment, technology and health care workers. Telemedicine would play a part in providing health care in the community, Sundall said in an article in the Lyman County Herald.
The committee is looking into the cost of a Governor’s House, built to specifications for a clinic, rather than remodeling an existing building. The Governor’s House program puts prison inmates to work building modestly sized, modestly priced houses.
Finding physicians in South Dakota is not a problem. Enticing them to practice in rural areas of the state is the issue.
Dr. Robert Allison, president of the South Dakota State Medical Association, said community size has a lot to do with getting doctors — young and old — to a rural setting.
Many medical professionals now specialize in certain areas rather than focus on family practice, which narrows the practice area, Allison said. He added that challenges like Medicare and Medicaid reimbursement and meeting productivity quotas can turn medical personnel off from practicing in rural settings.
“The biggest challenge to get providers to rural South Dakota is the spouse,” Allison said. “If the wife or husband doesn’t have a job, or wants different amenities, better schools, doesn’t want to live in a small town, then recruitment can be difficult.”
Allison said family practice physicians are paid the lowest and are required to do the most paperwork, coordination of care and primary care.
“Their friends in big cities are laughing at them because they’re working so hard,” Allison said, noting one more reason doctors are opting out of rural practice.
Allison is a member of the Governor’s Primary Care Task Force, which Gov. Dennis Daugaard formed in May to expand educational capacity to train more primary health providers for rural areas.
According to the task force, all but seven of the counties in South Dakota are federally designated as health-professional shortage areas. Allison said many of the medical professionals in rural areas are aging and near retirement while the number of younger people in rural areas continues to decline, leaving fewer medical students to draw back to rural areas.
In 2008, 114 of the state’s 490 physicians were 55 or older, and there will be a predicted 11 percent drop in high school graduates between 2001 and 2018.
Allison said the task force has figured in order to keep meeting rural patient needs, 21 medical students must be recruited for rural service each year for 10 years.
So what is being done to combat the loss of health care and providers in rural areas?
There has been a push to expand the University of South Dakota Sanford School of Medicine, which added four spots recently.
And, starting in 2014, up to six students interested in providing primary care in rural areas will be sent to study for nine months at Platte, Parkston, Winner, Milbank or Mobridge, through the Frontier And Rural Medicine program.
The FARM sites were chosen based on several factors, including a population of 10,000 or less, the ability to provide several medical services and the opportunity for the medical students to be involved in the community.
“The hope is that they see a patient from day one. Maybe watch a baby be delivered, follow through with well-baby checks, or see someone with cancer and help them through that time,” Allison said. “It’s kind of a fully developed experience.”
Dr. Susan Anderson, a family physician who lives and practices in Canistota and teaches at the School of Medicine, has been involved with the development of the FARM program. She is also on the Governor’s Primary Care Task Force.
“When discussion of a rural track started, I was very interested,” she said. “I live in Canistota and even though we’re between Sioux Falls and Mitchell, there are still health disparities in a community of 700. Not everyone can get to Sioux Falls or Mitchell, so I have an outreach clinic here.”
The basic goal of the program is to give students an appreciation for small communities and what they have to offer.
“The ultimate goal is to immerse themselves and develop a relationship with people in the community,” Anderson said. “This will let them see this is a viable option for them to come back and practice in a rural South Dakota community. I think a lot of times students feel these communities are isolated and aren’t able to provide the kind of care a larger community might. But that’s not the case.”
She used Winner as an example.
Although the city of about 3,000 is fairly isolated in the West River region, medical school officials were impressed by the amount and kind of patients treated in the Winner health care system, Anderson said. Not only that, the technology and resources are impressive as well, she said. Students who participate in the FARM program in Winner will have a “great opportunity to see a variety of patients,” she added.
At the same time, the recreational and other opportunities all five towns offer — including hunting and fishing, and proximity to the Missouri River — will give FARM students the ability to fully immerse themselves in the communities.
“We’re very excited about it,” Anderson said of the FARM program. “It’ll be a great opportunity for the students, the communities and ultimately for the state of South Dakota.”