A county health check-up

Service, funding cuts challenge providers

By Oscar Clevenger | Manor Ink

Sullivan County, NY – Access to health care in Sullivan County is becoming even more challenging. Garnet Health, which operates two hospitals here in Sullivan County and a hospital and trauma center in Middletown, recently announced significant layoffs and services cutbacks in its efforts to remain financially viable. EMS services, the county Legislature, the county Department of Public Health, nonprofit leaders and others are working to find ways to address Sullivan County residents’ needs.

Further federal cutbacks impacting health-care service providers are anticipated. “When you lose resources or services, it forces you to think about it differently. When you have a flood, you rebuild, but you might rebuild differently,” said Sullivan 180 CEO Denise Frangipane. “There is no one-size-fits-all solution, especially in rural health, because of the rural nature of where we live.”

Overcoming the long distances to get emergency help is a big concern. Sullivan County EMS Coordinator Alex Rau noted, “There’s always a clock that drives us to get the patient to medical care. Sometimes that may be going to Garnet Health-Catskills in Harris and stabilizing before we transport a patient further.”

Rau went on to explain how Sullivan County has primarily depended on volunteer ambulance services for emergency transportation. Crucially, this year, the county Legislature funded a new “fly-car” service to supplement volunteers. “Week one, we shaved 15 minutes off our response time overall throughout the county with fly-cars,” said Rau. “Our EMTs and paramedics can do 12-lead EKGs in people’s living rooms ... we’ve equipped them with all of the tools possible in an EMS system.”

The EMS system includes helicopters as well. “Our preference is always to have the helicopter come to the scene,” said Rau. “We have identified landing zones in our township. We will see air medical being utilized more frequently, especially if it’s a patient that needs neuro care.” However, he warned, “EMS and calling 911 is not for primary care. We need people to understand that and use it appropriately.”

Trauma Center downgrade avoided

In June, Oppenheim & Degen Neurological Surgeons of Middletown – a primary provider of neurosurgical trauma coverage for 31 years – formally notified multiple area hospitals, including Garnet Health, that it would cease coverage, effective June 30. Neurosurgery is a requirement for trauma centers, especially for patients suffering brain or spinal cord injuries. Without neurosurgical staff available, Garnet Health would be forced to downgrade its trauma center services, causing an upheaval in the health-care landscape of Sullivan and Orange Counties.

Facing a looming trauma care vacuum, Garnet Health negotiated a neurosurgical agreement in late July with Westchester Medical Center, ensuring continued access to advanced trauma services at its medical center in Middletown for patients in the Sullivan and Orange Country regions. Garnet will thus retain its important Level II Trauma Center ranking among the region’s hospitals.

Unfortunately, cutbacks to outpatient pulmonary rehabilitation services in Middletown and diabetes support services at both Middletown and Catskill facilities made in June will remain, forcing reroutes and longer commutes for those who rely on those programs.

New health initiative

But while institutional doors close, grassroots efforts are opening others. At a recent community gathering organized by a New York University health innovation pilot, 59 local residents convened at the Highland Senior Citizen Center in Eldred early last month to chart a new course. Leading the conversation was NYU educator Dr. Christopher Dickey, who summarized the main concerns discussed and targets for this initiative thus far. “Access to drugs, emergency care, mental health and family care really popped up a lot,” Dr. Dickey said. “Most of our neighbors have to drive one another around.”

Dubbed the Highland Health Access Initiative, this grassroots program is part of the NYU Applied Global Public Health Initiative or AGPHI, which focuses on finding solutions to public health access in New York and beyond. Dr. Dickey coordinates both AGPHI and the Highland Initiative. Sullivan180 is a main supporter, with the New York Health Foundation supplying a funding grant. This Highland program is exploring a mix of solutions – from deploying artificial intelligence to streamlining care coordination to empowering local “health champions” tasked with tackling community-specific issues on a village-by-village scale. It’s a bold experiment in resilience, built from the ground up.

When speaking about why this initiative was started Dr. Dickey referred to Sullivan County as a “healthcare desert,” due to the increased time and cost of its “very inefficient” rural health-care system. He continued by elaborating on what this initiative is at its core and how these new health services would be decided. “We’re not going to Garnet Health to ask them how to fix this ... we’re going to the community itself. They’re the ones who are going to help us build this.”

A ‘family doctor’ philosophy

This approach to rural health is different, as it seeks to “find a way to get to know you, the individual,” rather than addressing a patient as a list of symptoms and conditions. Dr. Dickey spoke with Manor Ink about a possible model. “Healthcare workers would be from the community. They would play the role that the family doctor played, in a way. They check in on people. They find out who hasn’t cleared their driveway, who hasn’t heard from their kid.”

An integral part of this approach is telemedicine, in which a non-local doctor would remotely have an appointment at their patient’s local hospital or a clinic. The long-distance doctor could then make a diagnosis and prescribe treatment for their patient. While weaving technology into medicine in this way can be disconcerting, Dr. Dickey said, “Telemedicine is absolutely a way to make health-care delivery way more efficient, and there are ways to do that without losing the humanity of personal communication.” He maintained that this system would not be entirely online. “We’ll have a doctor present, have a presence, you know, one day a week, or a couple days a month.”

In the same vein, artificial intelligence is something that will be integrated into this public health initiative. However, the goal remains focused on getting back to the family doctor model with people engaged in the community; AI will only be used as a tool for doctors, not the entire health service.

“If we prove this model for Highland and surrounding areas, then we can scale it to other communities,” Dr. Dickey said.

Medicare reductions coming

While this new initiative is hopeful, with this being the second cut in two years for Garnet Health, it seems likely there will be more, contributing to the troubles of Sullivan County and rural health voids overall. Furthermore, recently passed federal spending policies will impact rural hospitals, worsening an already challenging situation.

A case in point, Garnet Health was notified of a $16M reduction in Medicare reimbursement rates that will start in October, a Garnet spokesperson said. Impending changes of this sort to Sullivan County health care and health services in other rural regions place more importance on programs like the Highland Health Access Initiative, which look for new solutions tailored to the community, ones that will hopefully fix some of the very problems Garnet Health and other health services are now facing.

“The problem we’re really trying to solve is that people feel neglected by the health system,” said Dr. Dickey.

EMS to the rescue

‘Fly cars’ a quicker alternative

Sullivan County’s EMS system is in the midst of a major transformation, with the goal being better, faster, more sustainable care options. To that end, the county Legislature has devoted over $3M to funding four “fly cars,” above, vehicles that can reach emergency medical scenes and apply first aid while waiting for ambulances.

Unlike ambulances, however, fly cars can’t transport patients, so the Legislature has also added a SeniorCare-branded ambulance to supplement local EMS services.

Other means of transport

Temporarily filling the summer demand for EMS workers are numerous volunteers from dozens of Hatzalah EMS organizations, according to Eli Serebrowski, a captain with the Catskill Hatzalah crew. He stated their equipment is comprised of 15 ambulances which are stationed in the Catskills year round. “Aviation is different,” he explained. “Our airplane is available for long distance flights, and one helicopter station is used, mostly transferring doctors and equipment for support.”

Sullivan County EMS Coordinator Alex Rau said helicopters are increasingly essential in serious cases. “Our preference is always to have the helicopter come to the scene,” he said. “We’ll see air medical used more, especially when neuro care is needed.” LifeNet Air, an air transport service, supplies most of the critical-care flight team support from hangers located in Harris and Wallkill.

Rau also stressed that volunteers for EMS crews are his most pressing need. “What keeps me up at night is, you know, who’s going to do this?” he said. To volunteer, call him at 845-807-0508.