By Rachel Crumpler and Rose Hoban

Obtaining an abortion in North Carolina will now be more challenging after Republican state lawmakers overrode Gov. Roy Cooper’s veto of Senate Bill 20, a bill that adds new restrictions on women seeking the procedure, limiting access after 12 weeks and imposing new requirements. 

In a night filled with drama at the General Assembly, both chambers of the legislative body accomplished the override, voting along party lines. After the vote in each chamber, observers in the galleries above lawmakers erupted in screams and cries of “shame, shame,” as they were herded out of the chambers. 

Senate Bill 20 adds an additional in-person appointment at least 72 hours before a procedure, requires that abortions be performed at hospitals after 12 weeks and implements new reporting requirements.

While the outcome was not a surprise, there was no shortage of drama as constituents and fellow lawmakers rallied support for their side and hectored lawmakers perceived to be on the fence with visits, calls and emails. The drama was enhanced by the defection of Charlotte Democratic Rep. Tricia Cotham, who made a switch to the Republican Party in April, sealing a Republican supermajority in the House of Representatives. A supermajority had already existed in the Senate after last November’s election.

At the legislative building in downtown Raleigh on Tuesday afternoon, supporters and opponents of the new restrictions filled the upstairs galleries of the legislative chambers and the space outside, under the rotunda. Many brought both hand-lettered and printed signs reading, “Vote Pro-Life” and “Bans off our bodies.” While members of the two groups mingled mostly peacefully, at times some jostled and tempers flared.

The override means that North Carolina will join the ranks of Republican-controlled states that have moved to impose new restrictions on abortion after the Dobbs decision last summer overturned the longstanding Roe v. Wade decision that had opened up access to abortion. The new restrictions also mean that North Carolina — which had become an abortion refuge for many women in the South — will become less of an access point for people seeking abortions.  

Tense debate in the Senate 

Both protestors and supporters of the override began arriving at the legislative building in the early afternoon and by the time the Senate convened at 4 p.m.,the galleries above that chamber were filled. An overflow crowd stood outside the gallery windows holding up their signs during the debate. 

“Nothing else you could do will erase the harm that this bill will do to women and girls — our health, our status in society, our ability to plan our families and our careers,” Sen. Natasha Marcus said during her turn during the debate. “It undermines our ability to trust that you care about what happens to us.”

Marcus described growing up in a political family in which her father was an elected Republican who believed in personal freedom and refused to vote to restrict abortion access. By passing SB20, she argued Republicans in North Carolina no longer stand for the principles of personal freedom.

At times the Senate debate became testy, as Democrats asked leading questions of the majority Republicans, trying to pin them down on details of the bill that some say are ambiguous. 

“People in this chamber are saying that I am somehow doing something inconsistent with what I said during the election cycle,” said Sen. Mike Lee (R-Wilmington), who was peppered with questions from Democrats after other Republicans refused to yield to questions. “The politics of this, saying that people made promises, I wrote an op-ed and said exactly what I was going to do. I didn’t promise anything to the people in this room.” 

“This isn’t political theater here today. It may be to you. It’s not to me,” he said. 

In the end, the Senate voted 30-20 along party lines. After the vote tally, several Democratic senators promptly held up matching signs reading, “Politicians make crappy doctors.”

“I think we’ve ended up in a place that is supported by the vast majority of folks,” Senate leader Phil Berger (R-Eden) told reporters after the vote. “I think what we’ve done is put North Carolina at a place that shows respect for life, shows respect for women and shows the interest of this General Assembly in trying to assist in those ways that we can assist if someone has a pregnancy that they carry to term and worries about some of the things about how to take care of a child.”

House vote seals override 

Then it was the House’s turn to vote. After a dinner recess where observers stayed seated in the gallery to keep their places, House representatives returned to the chamber to debate. 

All eyes were on Cotham, who wore a bright pink dress, a color that’s been associated with supporters of Planned Parenthood. For the entirety of the proceeding, she sat silently.

That was different from a now-notable 2015 incident, when Cotham spoke during a debate on the House floor about receiving care to terminate an ectopic pregnancy, making her a champion of abortion rights supporters at the time. 

This year, that mantle passed to Rep. Diamond Staton-Williams (D-Harrisburg), who gave a heartfelt testimonial of choosing to terminate a 2002 pregnancy after much consideration with her husband when she was a young wife and mother of two.

“It was not an easy decision at all,” she said. “It was not made lightly or frivolously … I knew that in order for my family to prosper and to continue with the opportunities that we had in front of us, this was the best decision for us.”  

Staton-Williams also shared that she had two additional unviable pregnancies that required medical intervention.

“When I read this language of Senate Bill 20, all I see is the removal of the God-given right, for myself and folks like me, to make decisions for ourselves,” she said.

Shortly after Staton-Williams spoke, debate concluded with Rep. Kristin Baker (R-Concord) having the last word for Republicans. Baker, a physician, argued that the bill “protects the integrity of the doctor-patient relationship.”

That statement drew a howl of protest from the galleries, where observers — including physicians who were there in protest — had been largely silent, waving their hands in the air to applaud statements they supported and giving the thumbs down when they disagreed.

The observers were admonished by House Speaker Tim Moore (R-Kings Mountain), who told members of the audience to stay silent or leave.

Only minutes later, the House vote to override the veto came. Cotham voted with her new caucus for a final vote tally of 72-48 along party lines.

Once again, observers in the gallery erupted into shouts of “Shame!” This time loud and continuing. Moore ordered the General Assembly police and sergeants-at-arms to escort protesters out of the building. 

There were no arrests.

Second successful veto override

Cooper rejected the bill with his veto stamp only three days ago during a rally across from the Legislative Building in downtown Raleigh that drew a crowd of close to 2,000 people.

This marks the second successful veto override this year. In March, Republican lawmakers voted to override Cooper’s veto of a controversial bill repealing the permit requirement for handgun buyers.

Cooper had urged people to contact four Republican lawmakers — Lee, Rep. John Bradford (R-Cornelius), Rep. Ted Davis Jr. (R-Wilmington) and Cotham — all of whom said on the campaign trail that they’d support fewer restrictions on abortion than the bill dictates.

Ultimately, that advocacy — walking the halls of the legislature, emails, phone calls — proved unsuccessful. The abortion provisions of the bill will go into effect July 1.

In a statement released after the House vote, Cooper said that Republicans had argued that the bill is less restrictive than Democrats have warned. 

“We will now do everything in our power to make sure that’s true,” he wrote. “North Carolinians now understand that Republicans are unified in their assault on women’s reproductive freedom and we are energized to fight back on this and other critical issues facing our state.”

Tears, celebrations

Abortion rights supporters say the override deals a devastating blow to abortion access in the state.

“It’s heartbreaking,” said Susanna Birdsong, general counsel at Planned Parenthood South Atlantic, who choked up as she spoke. “It’s gonna make so many people in our state less safe.” 

Cora Field and Loretta Pfeiffer came to Raleigh from Chapel Hill and said they cried when they found out the lawmakers overrode Cooper’s veto. At age 16, they said it’s disappointing to see abortion access diminish. They don’t know how the changes could affect them if they one day ever need an abortion.

“I’m witnessing a really sad day in history,” Pfeiffer said. “I feel like my rights are being taken away and I can’t do anything about it.”

The General Assembly’s actions ignore overwhelming opposition to the bill from the medical community, including the North Carolina Medical Society, the North Carolina Obstetrical and Gynecological Society, the North Carolina Academy of Family Physicians and the NC affiliate of the American College of Nurse-Midwives.

In contrast, pro-life supporters celebrated the passage of the new restrictions.

“Thousands of babies will have their lives,” said Tami Fitzgerald, executive director of NC Values Coalition. “Their lives will be saved and women will be supported when they encounter an unplanned pregnancy with all the funding in the bill — to help them with childcare, with paternal and maternal leave for state employees.”

Twenty-year-old Abigail Griffin drove two hours with her family to be at the legislature to witness the override and show her support for cutting the window for abortion access. 

“I believe that every life is a gift from God and that life begins at conception, so anything we can do to protect that sanctity of life is perfect,” she said. 

Vowing to continue care

While abortion providers did not want new restrictions to come to fruition, they said they’ve been preparing for the possibility since Roe was overturned last summer.

Planned Parenthood South Atlantic spokesperson Molly Rivera said her organization’s preparation has included hiring specialized staff who are trained to help patients navigate hurdles within their home state or those of traveling to another state. With new abortion restrictions coming in July, there will be much to adjust to in North Carolina.

“We will have work to do to prepare our North Carolina clinics for this new reality,” Rivera said. “Figuring out how we can keep our doors open, figuring out how we can help as many patients as we can within the state and then how we can connect patients to the care they need out of state.”

Amber Gavin, vice president of advocacy and operations at A Woman’s Choice, an abortion provider with three clinic locations in the state, predicted that North Carolina will see fewer people coming from out of state.

Gavin emphasized that it’s difficult to provide abortion in an ever-changing landscape of state laws and court rulings, including recent challenges to the abortion drug mifepristone.

“We absolutely intend to continue to provide care,” Gavin said. “Obviously, working with our attorneys and our colleagues to make sure that we are in compliance with the law but still providing really compassionate and patient-centered care.”

The post With veto override, 12-week abortion restrictions now law in NC appeared first on North Carolina Health News.

At just 5 weeks old, Waylon Williams is a trailblazer. He’s the first baby born in Primary Care Centers of Eastern Kentucky’s new women’s residential center. The facility, called Beacons of Hope, offers temporary housing for women confronting substance use disorder.

That recovery housing for women is available in a rural, financially challenged community is noteworthy. That it’s available for women with babies is remarkable. Equally so is the fact that Primary Care Centers of Eastern Kentucky (PCCEK) is a rural health clinic (RHC), and recovery housing is not among the services rural health clinics typically offer. A men’s residential center is soon to open.

Beacons of Hope is an extension of PCCEK’s Pregnancy & Beyond, an addiction-treatment program that offers obstetrical services, medication for substance use disorder, prenatal education, pediatrics, and counseling – services that in so many rural communities nationwide are in critically short supply or entirely absent.

The town of Hazard, where the largest of PCCEK’s four clinics is located, is in Perry County. Perry County ranks 117th among Kentucky’s 120 counties in health outcomes. Life expectancy is 67, as compared with 78.5 for the country.

Addressing such challenges requires the full force of a health care ecosystem that includes hospitals, clinics, private practices, public health agencies, and a range of support services. Rural health clinics play a critical role in this ecosystem. “They’re an important part of the primary care landscape,” said John Gale of the Maine Rural Health Research Center.

RHCs are safety net providers whose original mandate was primarily to increase access to care for those on Medicaid or Medicare. They provided primary care and perhaps a few other services. But the Rural Health Clinic program has evolved over the years, and some clinics, like Primary Care Centers of Eastern Kentucky, have expanded their roles quite considerably.

Among the health care services, PCCEK offers are dentistry, a diabetes center, a women’s health center, extensive radiology and imaging, a range of behavioral health services, a pharmacy, and a hospice care center. It offers a sliding scale for fees.

PCCEK has nurses in each school in the county system. It has an event space where it hosts maternity fairs and Easter, Halloween, and Christmas gatherings, and which in the wake of the region’s catastrophic flooding last July served as a distribution center for food and supplies.

And with such a wide array of services, CEO Barry Martin contends, PCCEK is addressing arguably the greatest challenge to rural health care: a shortage of health care professionals.

Gale said the projection is that there’ll be a shortage of 50,000 or more primary care providers nationwide by 2032, and that the majority of those available aren’t likely to want to practice in rural areas.

It’s taken some time, Martin said, to impress upon newly minted health care professionals that Perry County is a promising place to build a career, but his message appears to be resonating. He’s especially focused on enticing young people from the region to head back home and hang a shingle at PCCEK.

“Come back here,” Martin urges them. “Look at what we’ve built. It’s not a double-wide on the side of the road.”

Meeting Needs, Steady Growth

The Rural Health Clinic program was launched in 1977 as a Carter administration initiative. The impetus was to make it more viable for rural providers to stay in business with a relatively heavy load of Medicaid and Medicare recipients and few patients with private insurance by offering higher reimbursement for those federal programs.

RHCs must be in a health professional shortage area. They must take a team approach to care: physicians working with a staff of nurse practitioners, physician assistants, certified nurse midwives, and others.

The number of RHCs has grown significantly over the past decade or so. In 2010, there were fewer than 4,000; today, there are 5,270. They’re in every state except Alaska.

RHCs differ from federally qualified health clinics (FQHC) in that FQHCs can’t be for-profit providers and must be governed by a board of directors of which the majority of members must be patients of the clinic and demographically representative of the community. FQHCs must offer primary care and preventive and enabling (such as case management and transportation) services. In meeting these stipulations, they receive higher reimbursement from the federal government.

PCCEK is a for-profit entity. It launched in October of 2003 in a 6,700-square-foot facility with 15 employees offering family medicine, pediatrics, simple X-rays, ultrasounds, and a lab. In 2008, it expanded into a 30,000-square-foot building, and in 2015 into its present Hazard location, a 60,000-square-foot complex, formerly a Kmart. It also has clinics in the nearby towns of Hindman, Hyden, and Vicco.

More than 39,000 unique patients came through PCCEK’s doors last year, Martin said, for a total of 180,000 encounters. The clinic employs more than 400 people.

‘Ease a Little Bit of the Burden’

“I like to say that we provide services from the head to the toe and the womb to the tomb,” Martin said. “And that is true.”

Care for diabetics is an urgent need in this region. In 2021, Kentucky had the sixth highest diabetes death rate in the country. The Kentucky Department for Public Health reports that between 2000 and 2018, the number of diabetes diagnoses had doubled. Perry County has among the highest incidence rates in the state.

PCCEK operates the Mary E. Martin Diabetes Center for Excellent (named in honor of Martin’s mother). It’s the only diabetes facility affiliated with the University of Kentucky’s Barnstable Brown Diabetes Center. It offers comprehensive case management.

“We try to ease a little bit of the burden,” said Martha Bailey, a registered nurse and licensed diabetic educator from nearby Letcher County. “We’re doing preventive maintenance. We’re talking to them about their diabetes.”

Before PCCEK opened its diabetes center, people routinely drove 250 miles roundtrip to Lexington to see a doctor. Many simply went unexamined, undiagnosed.

“They may come in here and have an ulcer they didn’t even know they had,” Bailey said. “We’ve had patients come in that had tacks in their feet. They didn’t know it until we did the exam.”

PCCEK is the only place in Eastern Kentucky offering pedicures specifically for diabetics. “When they do the foot care here,” she said, “That’s their time to be pampered.”

The center also provides $10 vouchers for the local farmers’ market. “With the people on fixed incomes, that helps them eat a little bit healthier,” Martin said.

Immersion in a Community

John Jones serves as PCCEK’s medical director and oversees the diabetes center and Beacons of Hope. He’s a Hazard native, and while he believes that being homegrown certainly helps in most effectively reaching his patients – “We just know each other. The trust is there.” – he hastens to add that trust can likewise be built in those who come from elsewhere, assuming you’re willing to make yourself known in the community.

“I think it’s a little different than the stereotype,” Jones said. “They’ll accept you with open arms. It’s just about being out there.”

Trust was of the essence after the July flooding. Jones tells of a father, mother, and daughter who were swept from their home, strapped themselves to a power pole, and hung on. The family now lives with relatives.

When it rains, Jones said, the child is terrified; she has nightmares and flashbacks. When he talks to the dad about exploring counseling, “I think he doesn’t hear that from me as a doctor; he hears it from me as a friend.”

Dealing with such issues – or dealing, on a day-to-day basis, with a patient who’s homeless with no way to refrigerate their insulin, or one with no transportation to make an appointment – such things aren’t taught in medical school. You learn through immersion in a community.

Martin trusts he’s creating an environment that will draw young professionals into his community.

A Continuum of Care

Nathan Baugh, executive director of the National Association of Rural Health Clinics, believes the RHC program isn’t well understood among decision-makers in Washington. FQHCs, he suggests, get more attention and are thus more likely to receive grant funding and be recipients of favorable policy decisions.

“It’s been a long-term struggle for us,” Baugh said, though he feels some progress has been made in the pandemic, with the two programs being treated more equitably for federal allocations and resources. “We were happy to see that. But we still have a massive granting and understanding deficit relative to the FQHC program.”

In Eastern Kentucky, Barry Martin believes the benefits of a comprehensive rural health clinic to a region and state are clear. Nearly 200,000 annual health care visits speaks volumes. Moreover, “The governor is looking for people like us to help develop a second-chance workforce,” Martin said, “and that’s what we’ll be doing with Beacons of Hope.”

The big-picture objective for all stakeholders is a continuum of care: health, housing, employment, well-being.

“I got lucky,” Brittany Williams said of finding a temporary home at Beacons of Hope for herself and her son Waylon. “They’ve taught me self-control,” she said, “and structure. They’ve helped me structure my life.” She’s hopeful about the future.

The post Rural Health Clinics with ‘Head-to-Toe and Womb-to-Tomb’ Care appeared first on The Daily Yonder.

Salvo algunas excepciones el aborto será permitido hasta las 20 o 24 semanas.

La entrada Por ley, Carolina del Norte restringe el derecho al aborto a 12 semanas se publicó primero en Enlace Latino NC.

Students and staff in rural Maine are using teletherapy to help access much-needed behavioral health services. 

Baileyville, Maine (pop. 1,318), was experiencing a youth mental health crisis in their community and a severe shortage of mental health providers. The problem reached a precipice in 2021 and 2022, said Kate Perkins, deputy director for U.S. program development at MCD Global Health. Of the more than 4,500 fully or conditionally registered clinical social workers in Maine, fewer than 4,000 live in the state, and fewer than 50 in Washington County, the easternmost county in Maine where Baileyville is located. 

“One of the things that we were seeing is the result of Covid,” Patricia Metta, superintendent of AOS 90 school district, which includes the Woodland Elementary and Woodland Junior-Senior High School, told the Daily Yonder. “We saw kids not returning back to school, many of them had gotten so used to being in their homes for at least a year, that their social issues, they couldn’t handle being social. They didn’t know how to deal with social issues.”

There were also several suicides, both within the school system and the community at large, she said. 

The country as a whole is grappling with a lack of physicians, but it is more acute in rural areas. A 2021 Association of American Medical Colleges (AAMC) study found that the U.S. could see a shortage of between 37,800 and 124,000 physicians by 2034. 

To combat the negative health effects, a collaborative effort coordinated by MCD Global Health now gives students and staff at Woodland Elementary and Woodland Junior-Senior High School in Baileyville, and across the county’s AOS 90 school district, access to virtual behavioral health services and other needed resources. A $500,000 matching grant from Point32Health Foundation helped the community get started on the initiative. Additional funding helped the program reach a total of $1.5 million in resources. 

Since the program began, 30 students have been matched with behavioral health providers in person and virtually. The program is on track to serve a total of 80 students by July 31, 2023. The school district has 380 students across four schools.

“We do see kids reaching out for help. They’re asking to see their provider. They’re asking for their teletherapy sessions,” Metta said. “We see them talking to people. And we do believe that eventually that will lessen their anxiety. And we are seeing kids come to school more. Attendance has really improved.”

The program started through a community assessment in August 2021 that found access to behavioral health resources as an urgent need, Metta said. Initially, officials put teletherapy equipment in both schools and weren’t sure what the result would be, she added. 

“We thought, there’s a couple of kids that will take advantage of it,” she said. “Well, since then, we’ve lost our full-time provider. And every day we’re picking up more and more kids on teletherapy…And if they can’t relate well with the in-house provider, then they have the option of teletherapy as well. So it’s a win-win for everybody.”

Jessica Melhiser, children’s program manager at Aroostook Mental Health Services Inc. and care navigator for the program, said in a statement that the program has transformed health and well-being for students and families in the communities. 

“Students are getting the support they need and sharing the benefits with their classmates, their families, and others who need help. It brings hope to the hallways,” she said. 

Perkins said they haven’t solved all the problems, nor are they trying to. 

“What we have done is rebuild confidence and re-ignite belief that it can get better,” she said. “The early work was really slow. It took a long time to build trust. It took the local leaders seeing us deliver, in terms of getting matching funds or equipment, for them to believe us when we said that this or that was viable and could get funded.”

Metta said the program had initiated other positive movements, like creating a food pantry and a garden for students. 

“I think as a result of the teletherapy program, and the community, the rural community getting involved, that’s what it took, in order for this to be successful.”

The post Behavioral Teletherapy for Students in Rural Maine Brings ‘Hope to the Hallways’ appeared first on The Daily Yonder.

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Sandra Lane said she has been to the emergency room about eight times this year. The 62-year-old has had multiple falls, struggled with balance and tremors, and experienced severe swelling in her legs.

A paramedic recently arrived at her doorstep again, but this time it wasn’t for an emergency. Jason Frye was there for a home visit as part of a new community paramedicine program.

Frye showed up in an SUV, not an ambulance. He carried a large black medical bag into Lane’s mobile home, which is on the eastern edge of the city, across from open fields and train tracks that snake between the region’s massive open-pit coal mines. Lane sat in an armchair as Frye took her blood pressure, measured her pulse, and hooked her up to a heart-monitoring machine.

“What matters to you in terms of health, goals?” Frye said.

Lane said she wants to become healthy enough to work, garden, and ride her motorcycle again.

Frye, a 44-year-old Navy veteran and former oil field worker, promised to help Lane sign up for physical therapy and offered to find an anti-slip grab bar for her shower.

Community paramedicine allows paramedics to use their skills outside of emergency settings. The goal is to help patients access care, maintain or improve their health, and reduce their dependence on costly ambulance rides and ER visits.

Such programs are expanding across the country, including in rural areas, as health care providers, insurers, and state governments recognize the potential benefits to patients, ambulance services, and hospitals.

Community paramedic programs are operating in six cities in Wisconsin: Madison, West Allis, Racine, Menomonee Falls, Reedsburg and Greenfield, said Jennifer Miller, spokesperson for the state Department of Health Services. Eight others are working toward their community EMS provider licensure.

“Some of these programs have supporting data that shows positive outcomes while others are just getting their programs rolling,” Miller said by email. She said such services across the country “have proven success in a variety of patient care programs ranging from fall prevention to chronic disease management.”

Half of programs in rural areas

Gary Wingrove, a Florida-based leader in community paramedicine, said the concept took off in the early 2000s and now includes hundreds of sites. A 2017 survey of 129 programs found that 55% operated in “rural” or “super rural” areas.

Community medicine can be helpful in rural areas where people have less access to health care, said Wingrove, chair of the International Roundtable on Community Paramedicine. “If we can get a community paramedic to their house,” he said, “then we can keep them connected to primary health care and all of the other services that they need.”

Frye works at Campbell County Health, a health care system based in Gillette, a city of about 33,000 in northeastern Wyoming. Leaders of the community paramedicine program plan to expand it into two adjacent, largely rural counties dotted with ranches and coal mines on the rolling prairie that stretches more than 100 miles from the Black Hills to the Bighorn Mountains.

Gillette serves as a medical hub for the region but has shortages of primary care doctors, specialists, and mental health services, according to a community needs assessment. People who live outside the city face additional barriers.

“A lot of them, especially older people, don’t want to come into town. And basically, those tiny communities don’t usually have health care,” Lane said. “I think it’s just kind of a pain for them to drive all the way into town, and unless they have a serious problem, I think they tend to just figure, ‘Well, it’ll work itself out.’”

Not a ‘cookie-cutter’ operation

Community paramedicine programs are customized to the needs and resources of each community.

“It’s not just a cookie-cutter-type operation. It’s like you can really mold it to wherever you need to mold it to,” Frye said.

Most community paramedicine programs rely on paramedics, but some also use emergency medicine technicians, nurses, social workers, and other professionals, according to the 2017 survey. Programs can offer home visits, phone check-ins, or transportation to nonemergency destinations, such as urgent care clinics and mental health centers.

Many programs support people with chronic illnesses, patients recovering from surgeries or hospital stays, or frequent users of 911 and the ER. Other programs focus on public health, behavioral health, hospice care, or post-overdose response.

Community paramedics can provide in-home vaccinations, wound care, ultrasounds, and blood tests.

They can offer exercise and nutrition tips, teach patients how to monitor their symptoms, and help with housing, economic, and social needs that can affect people’s health. For example, paramedics might inspect homes for safety hazards, provide a list of food banks, or connect lonely patients with a senior center.

Transportation a barrier to health care

Paramedics and patients said some rural residents struggle to access health care because of long distances, cost, lack of transportation, or dangerous weather. Some hesitate to seek help out of pride or because they don’t want to be a burden to others. Some limit trips to town during ranching and farming crunch times, such as calving and harvesting seasons.

Delayed care can let health problems fester until they become an emergency.

Advocates say providing in-home care, resources, and education can help patients reduce such crises and associated costs. Fewer emergencies mean fewer ambulance runs and hospital patients. That could help ambulance services and hospitals reduce costs and the time patients wait for help.

A 2022 scholarly review found that more studies are needed but that data so far suggests these programs reduce costs. It also found links to improved health outcomes and decreased use of ambulances and hospitals.

For example, a pilot program in Fort Worth, Texas, saw a 61% reduction in ambulance rides, according to an academic study of 64 patients. MedStar, the operator, made the effort permanent and says its 904 participants needed 48% fewer ambulance trips, saving an estimated $8.5 million over eight years.

But rural ambulance services, especially volunteer ones, can struggle to staff and fund community paramedicine programs.

Kesa Copps, a co-worker of Frye’s, previously worked as an emergency medical technician in Powder River County, Montana, which has fewer than 2,000 residents. Some people there must drive more than an hour to reach the nearest hospital. The area’s volunteer ambulance service started a community paramedicine program in 2019.

Copps said the program reduced hospital readmissions and extended some elderly patients’ ability to live at home before being admitted to a nursing facility. She visited patients between ambulance runs and had to leave early when a 911 call came in. That’s different from the Campbell County Health model, in which community paramedicine is a full-time position, not split with emergency work.

Adam Johnson, director of the Powder River ambulance service, said the community paramedicine program shut down in 2021 after everyone with the necessary training left the area. Johnson said paramedics are signing up for training to restart the program.

Community paramedic programs spreading

States are increasingly recognizing and regulating community paramedicine, and some require licensed paramedics to obtain extra training to work in the field.

Some ambulance services and health care organizations have piloted community paramedicine programs with the help of state or federal grants. If they find the service saves money, they may decide to continue the program and fund it themselves.

Private insurance companies are increasingly covering community paramedicine, Wingrove said. Wyoming and several other states allow operators to bill Medicaid for the services.

Advocates are now pushing Medicare to expand its limited coverage of community paramedicine, Wingrove said. That would benefit Medicare patients and could spur more private insurers to offer coverage.

The Campbell County Health program’s home visits cost up to $240 per hour and are billed to Medicaid or Medicare, said Frye. That compares with more than $1,300 for an ambulance ride and thousands of dollars for a visit to a hospital ER.

Community paramedicine may soon expand in neighboring South Dakota, another largely rural state.

South Dakota ambulance services have experimented with community paramedicine and lawmakers recently voted to authorize and regulate it.

‘You’re not alone’

Eric Emery, the state representative who introduced the bill, plans to start a program on the sprawling, rural Rosebud Indian Reservation, where he works as a paramedic. He said the operation will focus on diabetes and mental health care.

Emery, a Democrat, said some people struggle to pick up their medication and attend appointments because they lack vehicles or gas money and there’s no public transportation to the hospital. He said some parents and grandparents raising children also struggle to find time to drive to appointments.

“They’re putting the needs of the younger generation or their grandkids before their own,” Emery said.

Back in Gillette, Frye also checked in on Linda Quitt, a 78-year-old facing diabetes, depression, and a lack of social support after her husband was hospitalized with dementia. Quitt said her husband was her walking buddy and helped care for her.

“I had him to wait on me, and now I have nobody,” Quitt said.

Frye said he would see if he could help start a senior walking group that Quitt could join. He told her that socializing can improve health.

“You’re not alone,” Frye told Quitt.

Wisconsin Watch’s Dee J. Hall contributed to this report published by Kaiser Health News.

No emergency needed: Community paramedics in Wisconsin, elsewhere visit patients at home is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Madera residents from Punjabi Sikh and Indigenous migrant farmworker communities have been heavily impacted by the Madera hospital closure, according to results from surveys conducted by two community-based organizations. 

The surveys had about 300 respondents and came out of a partnership between Centro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO) — which serves Indigenous migrant farmworkers — and the Jakara Movement — which serves the Punjabi Sikh community. 

“All of the surveys were conducted in a language other than English,” said CBDIO’s Executive Director Sarait Martinez. “I think that is the importance of our survey, because it is beyond the political conversations and many times our voices are not included in those conversations.”

The survey results reveal the following:

• 91% of survey respondents indicating the Madera hospital closure had a direct impact on them. 
• About 80% of all respondents said they were “highly concerned” about the closure’s impact on their health and family. 
• More than three quarters of all survey respondents said other hospitals are too far, they’ve experienced longer wait times if they do get to a hospital in a neighboring county and they’ve experienced limited access to preventative and diagnostic health exams locally in Madera. 

Of the 151 Indigenous migrant farmworkers surveyed, more than 60% said they did not even know about the Madera hospital closure, and just over half said they do not have reliable transportation to access medical care in a neighboring county — demonstrating the compounding impacts of shrinking health infrastructure, language barriers and lack of affordable transportation options. 

Of all survey respondents, about 17% said they didn’t know where to go in the case of a medical emergency. For those who said they have accessed care at a hospital outside the county, a majority of respondents said they received emergency services, specialty care, primary care and even got diagnosed for illnesses. 

Naindeep Singh, the Jakara Movement’s executive director, said both community-based organizations are hoping Gov. Gavin Newsom will sign AB/SB 112, a bill that would create a loan program for distressed nonprofit and public hospitals — and potentially help with reviving the Madera hospital. 

He added that community voices, including those from Punjabi Sikh and Indigenous migrant farmworker communities, need to be included in ongoing conversations about health care in Madera and the future of the hospital. 

“What we have is actually an opportunity to bring communities that have been traditionally shut out to actually come together and make sure that we’re raising our voices as a united Madera,” Singh said. 

He also called for a task force to be convened, to study the deeper issues impacting health access in rural communities and hospitals across the state — an effort that he said should go beyond the popular discussion around Medi-Cal reimbursements.

Mohammad Ashraf, a cardiologist whose office sits across from the dormant Madera Community Hospital, also spoke at the press conference, emphasizing the need for Madera residents to sound the alarm on health infrastructure needs in the county. That also extends to making sure Gov. Gavin Newsom signs AB/SB 112.

“This is really bad and we can do something about it if we work together,” Ashraf said. “The government will help, but government is slow. They take their time, but it’s our problem, it’s our issue.”

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