October 6, 2021 153 PM
PRESIDIO, TERLINGUA — A consortium of local entities are pursuing an ambitious $8.2 million project to grow healthcare access in Presidio and Terlingua. The Big Bend Regional Hospital District and Preventative Care Health Services are partnering, along with the City of Presidio and Terlingua Fire and EMS, in pursuit of a multimillion dollar United States Department of Agriculture impact grant to advance ideas and solutions for long-term sustainability of rural healthcare.
The project will request $6.6 million in grant funds and require a 25% match — meaning local entities will have to come up with $1.6 million to contribute, a hefty effort for the rural communities. Already, Presidio County commissioners threw their weight behind the project last week, committing $275,000 to the project over the next three years, should the grant funding come through.
BBRHD’s executive director, JD Newsom, has taken a leading role in the grant writing application and in the formation of the project’s goals. If the grant is given to the project, Newsom will also help seek support from area foundations to help alleviate the burden of the matching funds that will fall on the area’s small, rural communities.
This week, Newsom explained the four-pronged plan, which begins with preventative healthcare. In Presidio, that means supporting PCHS’ Presidio clinic during the day by adding a behavioral counselor to the clinic. In Terlingua, PCHS would begin operating a part-time clinic there for two days a week. Currently, there are no healthcare providers in Terlingua, forcing residents to drive hours to see a doctor.
The second prong is to extend clinic operations in Presidio to have after-hours care. When the clinics stop seeing patients at 3 p.m., Presidio residents have to rely on EMS for medical care, often resulting in long trips to see a physician at the hospital in Alpine, nearly 90 miles away. Hospital visits can be costly for patients, and the EMS department’s ambulances wear down and break down quickly when making so many trips. To replace a single ambulance, the cities, counties and the hospital district end up footing a bill that can run over $300,000.
“The EMS providers oftentimes are not equipped to determine if somebody needs to go to the hospital or not, so the default is to go to the hospital, because they’re not able to make that determination,” said Newsom. By having a clinic open and available, hospital trips could be reduced. “Hopefully with the after hours clinic the doctor or nurse could say it’s an ankle sprain, we’ll wrap it up for you and here’s a plan. You don’t need to go to the hospital by ambulance now,” said Newsom. “It’s about triage.”
The grant funding would allow PCHS to extend their hours and provide after-hours care Monday through Friday from 3 p.m. to 11 p.m., adding eight more hours of local medical care. While 24/7 care is ideal, Newsom said that they see the most need during the 3 p.m. to 11 p.m. hours, and for now, the project is more cost effective to rely on the hospital for overnight care. The Presidio clinic would also be open five hours every other Saturday.
The third prong is a telemedicine component, broadening access to telemedicine in both Terlingua and Presidio by purchasing equipment so people can see specialists that are otherwise in far flung cities like El Paso or Odessa/Midland. In Terlingua and Presidio, where not everyone has internet access, providing telemedicine in the clinics opens up access where it wasn’t before.
“The fourth prong, which I believe will be transformative and innovative, is around emergency medical services,” Newsom said. “What we’re proposing to do is establish a community paramedicine program in both the city of Presidio and with Terlingua Fire and EMS.” Paramedics already working in the area would be trained and certified as community paramedics, who could visit local residents’ homes to work one-on-one with people who need extra education and help managing their chronic medical conditions. Newsom said, “If we can help people manage their diabetes or blood pressure, we’re reducing the number of transports or ER visits.”
“We have a lot of elderly folks who have six, seven, eight prescriptions and need help understanding how to take those. Community paramedics are another layer of support for people who need that,” explained Newsom.
In Presidio and Terlingua, many agree that the needs are huge. “I’ve been working with people at the City of Presidio for five years to try to come up with a workable healthcare solution for Presidio,” said Presidio City Attorney Rod Ponton. “They don’t have any doctor who lives there and the family practice health clinic is only there for preventative care, not acute care.”
They’ve tried to come up ways to run a micro-hospital or bring in an outside El Paso company to open a facility for acute care, but “none of them would work,” Ponton said, “because there isn’t the money in the population to support a bigger effort such as a micro-hospital.”
“This will allow Presidio residents for the first time, to receive the first class medical care that they deserve,” Ponton said of the new project. “People in Alpine would not stand to have to drive 90 miles to Presidio to see a doctor, but that is what the reality has been for Presidio.”
Sara Allen Colando, a Brewster County commissioner for Terlingua, said she is cautiously optimistic about the effort to bring a part-time clinic to her town. She said even for just two days a week, having a clinic would be “absolutely transformative” for Terlinguans.
Terlingua residents are currently forced to drive to Alpine or further to get medical care, or else forgo care altogether. “Currently, parents have to drive one to two hours each way to take their kids to routine medical appointments in other towns. Not only does one child miss a school day, but because they have no guarantee that they’ll be back before the school day ends, parents may have to take all of their kids out of school for the whole day,” Colando explained.
“Of course our older residents often have medical conditions that require routine treatment and/or monitoring, but since they can’t get that simple care nearby they have to travel or simply ignore their medical needs, at their own risk,” the commissioner said. “Too many Terlingua residents have died from diseases that could have been treated and managed, if only they’d had the routine care which would have spotted it early.”
On top of improving healthcare access, the project will also add jobs in Presidio and Terlingua, areas where work can be hard to come by. The budget currently funds nurses, a nurse supervisor, a doctor, a nurse practitioner, a behavioral health specialist, an office manager, receptionist, medical records custodian and medical billing person. “They’ve got 16 positions in their budget,” said Newsom of PCHS’ requests from the project. “Some of those may not be new, maybe half of them are, and the other half are going to be supplementing or expanding current jobs.”
The grant application is due early next week, and while the consortium had hoped to bring in Texas Tech University’s Health Science Center in El Paso, the institution needed a minimum of 60 days to consider committing, and time was running out. Newsom said they would still be able to join in at a later point in the project.
The group is hoping to begin an EMS institute with Texas Tech’s Health Science Center, which will provide support and capacity that Presidio and Terlingua wouldn’t normally have access to. That includes training, continuing education, helping update Presidio and Terlingua’s medical protocols and acting as medical directors for the Presidio EMS.
Once the grant application is submitted on October 12, Newsom said it’s going to be “very competitive,” with an estimated 10 to 15 applicants getting funded nationwide. “But looking at the scoring matrix, the demographics of Presidio, I think, are going to give us an advantage,” said Newsom.
The USDA grant is part of the American Rescue Plan Act, where federal dollars are being allocated across the country to assist in COVID-19 recovery and improve healthcare access. If the Presidio and Terlingua application is successful, Newsom said, “We’re going to infuse $8.2 million into improving access to healthcare in a large geographic area. That’s going to be transformative.”
Even if the funding doesn’t arrive, Newsom said the concerted effort between each of the separate entities will lead to better outcomes going forward. “It’s been really amazing that you’ve got folks who haven’t sat down together in a long time, sitting down to talk about this issue,” including the hospital, the two counties, the City of Presidio, Brewster County’s emergency services district, Terlingua Fire and EMS and Texas Tech. “I think that that spirit is going to continue, as we continue to look for ways to bring resources to the region. I think it’s especially important to figure out how we can leverage our local resources to bring in these federal dollars.”
“I don’t think that we can solve any of these problems by ourselves or as single entities,” Newsom said. “I think it’s going to take all of us coming together to solve these really big healthcare problems. There’s grants and monies out there, and it’s going to take all of us looking at those, evaluating and exploring those opportunities.”