TERLINGUA — Last Thursday, the Big Bend Regional Hospital District (BBRHD) signed a contract with Hamilton Health Box to bring one of the company’s signature “microclinics” to Terlingua. Pending approval from the Brewster County Commissioners Court, that clinic will be open five days a week for a variety of hybrid in-person and telemedicine services — hopefully within a year and a half.
Since 2019, Hamilton Health Box has pioneered the use of “microclinics” to fill big gaps in healthcare. The company originally started out making on-site clinics in blue collar workplaces — physically demanding jobs with long hours in a fixed location. Providing affordable healthcare onsite to workers and families ended up saving those employers more money than the cost of doing business with Hamilton. “It worked so well that we decided to go into the rural market,” explained President of Development Chris King.
The “box” in “Hamilton Health Box” refers to the actual, physical shape of the clinic — a prefabricated structure that the company sets up and operates. The box includes a wide array of diagnostic equipment and the necessary tech for telemedicine calls with a remote physician. Each Health Box visit is staffed by a flesh-and-blood medical assistant or nurse who serves as a kind of ambassador to the community and can administer diagnostic tests while the patient visits with the virtual doctor.
King said that there can be a learning curve for some patients skeptical of telehealth, but that skepticism usually doesn’t last past the first appointment once folks see how easy and accessible the service is — and that the patients themselves don’t need any tech savvy to get the services they need. “What we’ve seen is that people are hesitant the first time, and hesitation is human nature,” he said. “Because we’ve done this so many times already, we know how to overcome those barriers.”
The contract with Hamilton came on the heels of anxiety about the status of the existing fledgling clinic in Terlingua. In 2022, the BBRHD was awarded $5.5 million by the federal government to grow clinics in Presidio and Terlingua. Preventative Care Health Services (PCHS), which operates clinics in Presidio, Alpine and Marfa, was selected by the board to administer Terlingua’s new facility.
PCHS had hoped to offer service five days a week by spring 2024, but concerns mounted as time flew by and the clinic was still operating one day a week in a cramped space at the county-owned Terlingua Fire and EMS building. With a 2025 deadline looming to allocate funds, some board members became concerned that a rare opportunity to fund a functional, sustainable local clinic was slipping through their fingers.
At December’s board meeting, Reagan Reed moved to terminate the organization’s contract with PCHS, but was unable to get a second.
Last week, during an impassioned open comment period, Terlinguans showed up in force to call for the termination of the PCHS contract. Some worried that the grace given to the local nonprofit wouldn’t have been extended to an outside entity and that the community’s needs were being misunderstood and disrespected.
Linda Walker of Big Bend Stables said that the existing clinic was better than having no clinic, but many locals — especially those who had been there a long time — did not yet trust that it was a dependable resource. “In 35 years I’ve watched a dream come and die numerous times about us having reliable, dependable healthcare,” she said. “You cannot build the support of the community if they don’t know if [the clinic] is going to be there or not.”
With their contract still intact, PCHS is continuing to develop their clinic, hoping to expand into the Red Patillo Community Center in February. (Cynthia Esquivel, standing in for CEO Linda Molinar, did not respond to a request for more information from the The Big Bend Sentinel.)
Meanwhile, BBRHD will kick in $14,000 a month for an initial 36-month agreement with Hamilton Health Box, with optional year-long contract renewals. Because Hamilton is a for-profit business, BBRHD’s contributions will go to cover care for the county’s neediest via their indigent care program, while patients with insurance will help the company offset its initial investment in building and staffing.
Some of those patients would be tourist walk-ins — a population completely left out of the current clinic demographics. Folks from more affluent parts of the state are more likely to have private insurance, and being available to visitors helps divert traffic away from strained emergency services. “We want to take as many people as possible with sprained ankles away from vitally rare resources like EMS,” King said.
King anticipated a 12-18 month “on ramp” before the clinic could be considered officially up and running. “There is risk involved,” he told the board. “But we anticipate that this is going to be a successful venture.”
Hamilton Health Box CEO Toby Hamilton said that he felt personally called to Terlingua as a longtime visitor and native West Texan himself, and he hoped that Terlingua could be a testing ground for advancement in rural medicine.
Because his microclinics are so easy to assemble and disassemble, he hoped that Terlingua could be part of a larger network of rural clinics sharing resources that cut costs while providing a wider range of services. Gear for specialty diagnostics — like the equipment for mammogram screenings — could rotate through the network, and doctors could visit occasionally in person for patients who prefer a more personal touch.
Terlingua is a gamble for any business, but Hamilton said that his commitment to the project goes beyond his own bottom line. “I want to make this sustainable,” he said. “Leaving a legacy for this community and a model for how this should work in other communities — nothing would make me prouder.”