Baker County residents suffer from serious lack of medical services

People like to say they stay in Baker County because of the quiet, relaxed way of life it offers. That it does, with its quaint small towns and everyone-knows-everyone atmosphere. But behind the picket fences lies a life-and-death struggle: a lack of health care infrastructure. It’s no secret that seriously ill people have to go elsewhere to receive care; in most life-threatening situations, the county’s lone emergency room functions more as a referral service. Still, health advocates were stunned when they ran the numbers recently and saw just how many people were fleeing the county for medical care.

“Holy crap!” was Dawn Emerick’s initial reaction, she recalls. The agency she leads, the Health Planning Council of Northeast Florida, stumbled on the phenomenon as it studied where people on the First Coast get treatment for illnesses notorious for triggering hospital readmissions. Ninety-seven percent of Baker residents stricken with congestive heart failure, heart attacks, pediatric asthma or pneumonia had to be hospitalized in another county in 2008. In the vast majority of cases, that county was Duval, although a handful went to Clay, Columbia and other neighboring counties.
No other county in the Planning Council’s seven-county analysis came close to that percentage. Second, with about 59 percent, was Nassau, which also has one emergency room.

But the problem, as Emerick sees it, isn’t with Baker County’s only medical center. The hospitalizations at the heart of the analysis could have been prevented, or at least treated, in a less-costly venue. Which suggests that Baker is lacking in nursing homes, home health care specialists and family doctors — the net of support that typically catches patients after they leave the hospital. “They’re going back to a county that has no care coordination,” says Emerick, whose agency is directed by state legislative decree to monitor health care service usage on a regional level. Baker is the only Northeast Florida county the federal government has designated as medically underserved. Because of a dearth of services or health insurance conflicts that prevent residents from accessing it, many have to drive 45 minutes for care. “It’s a barrier when we’re talking about access to care,” Emerick says. “You have to rely on transportation. If you don’t have transportation, you’re choosing not to have health.” Extend the scope beyond Northeast Florida, and Baker County is far from alone. Nationwide, rural communities have always struggled with getting adequate medical care. Although one-fourth of Americans live in rural areas, only about 10 percent of doctors practice in those areas, according to the National Rural Health Association. In addition, rural residents tend to be poorer, older, have higher rates of high blood pressure and are more likely to die or suffer serious injuries in vehicular crashes than their urban counterparts.

Health care reform efforts in Congress have stirred mixed reactions in rural communities, as elsewhere, but for different reasons. Many rural health advocates laud the expansion of affordable health insurance. But some rural doctors have expressed concern that there won’t be enough physicians to care for the newly insured patients. “Though most of the debate has focused on ensuring access to coverage, the greater problem in rural America is access to a provider. Being insured makes no difference if you do not have a provider,” the National Rural Health Association said on its blog last month. At present, Baker’s providers aren’t overwhelmed. For example, Mark Hardin, a primary-care doctor and medical director of Macclenny’s Ed Fraser Memorial Hospital, said he has openings to accept more patients. The hospital has beefed up its outpatient services during the last number of years, adding a physician building staffed by specialists who practice in the small town one or two days a week. That has made available specialties not seen in many small towns, such as cardiology, neurology and gastroenterology. But it has scaled back its less profitable inpatient services. As a result, the hospital’s 25 beds sit empty most of the time, and patients requiring further care must go elsewhere. Outside the hospital and its physician building, options are few. Because of this scarcity of doctors, the Baker County Health Department is the primary provider for nearly half of the county’s 25,000 residents. It is the only option for obstetrical and gynecological services, and it is home to the only pediatric dentists who accept Medicaid, the state and federal insurance for the poor.

There are few easy cases in Baker County. On a host of health problems, the rural county is among the worst in the state in terms of the age-adjusted death rate. To name a few, it ranks No. 2 for chronic obstructive pulmonary disease death rate and No. 3 for stroke, pneumonia and all cancers. To what degree those statistics are influenced by the quality of the county’s health care is unclear. But what is known is that health care isn’t the only factor. Like many people in the South, Baker County residents eat too many fatty foods and don’t exercise enough, said Kerry Dunlavey, the health department’s administrator. Despite ever-decreasing overall funding, the health department has waged a long-standing battle against diabetes. It hosts a weekly class that teaches diabetics about the condition, how to eat and how to monitor their blood sugar. In 2008, there were 64 participants. Terrenia Staier, the health department’s administrative services manager, admits she didn’t take very good care of her Type II diabetes before entering the program. She said, “I would eat something and not eat something for six hours and then have spikes of highs and lows.” Now, her blood sugar hovers at a more normal 120 to 130, and she feels better. Since 2005, the county has plummeted from the highest diabetes death rate in the state to No. 7. “That,” Dunlavey said, “suggests to me we’re finding people more.” But some, she acknowledges, are tough to find, particularly those who live in the county’s more-distant quarters. People like Callie Blue, a breast cancer survivor. The 73-year-old retired hairdresser lives in Sanderson, a 15-minute drive outside Macclenny. That’s too far to walk into town and certainly too far to her oncologist in Orange Park. When she couldn’t find a ride last summer to go to Clay County for her annual checkup, she said, “I just didn’t go.” Emerick says the key to Baker’s health services problem is getting other counties to share their resources and to encourage better communication among health providers. A number like 97 percent, she adds, is too hard to ignore.

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