For many on Eastern Shore, health care means a long drive

The hour's drive from Chincoteague Island to Nassawadox is like a living postcard where seagulls glide over the marshy causeway. Head up the bridges over Cockle and Mosquito creeks, then down U.S. 13. This time of year, it's lush, green and beautiful.

But not if you're sick.

For people in South Hampton Roads, hospital choice has come to mean you can go to a facility run by Sentara Healthcare, Bon Secours Hampton Roads Health System or Chesapeake Regional Medical Center. In northern Suffolk alone, residents now have a choice of two emergency facilities less than two miles apart - one run by Sentara, the other by Bon Secours.

Tell that to Chincoteague residents, and they're liable to think we're a little spoiled on this side of the bridge. While there's a community health center and some doctors in town, for them, hospital choice means Shore Memorial Hospital in Nassawadox or Peninsula Regional Medical Center in Salisbury, Md.

One's an hour south, the other an hour north.

"Basically, there's nothing close by in an emergency," said George Lewis, a retiree who works part time at the Kite Koop bookstore in Chincoteague. A few years ago he had a heart attack and was taken by ambulance to Peninsula Regional.

"If it wasn't for the EMTs here," he said, "we'd be in trouble. Big trouble. They saved my life."

Shore Memorial Hospital, about 25 miles from the Chesapeake Bay Bridge-Tunnel, owes its existence to an emergency gone wrong in the 1910s.

A prominent resident who was "big with the railroads died from appendicitis," said Joe Zager, president and chief executive of Shore Memorial, an independent nonprofit hospital with 130 licensed beds.

Local doctors went to his widow and said, "If we had had a hospital here maybe your husband wouldn't have died." She and the community got behind a fundraising effort, and in 1928 the hospital's forerunner opened.

At the time it was a rarity for a rural community to have even one hospital, Zager said. Other similar areas would have to wait until federal initiatives kicked in after World War II.

Still, the challenges that have historically dogged rural health care continue today.

"The beauty of it is there aren't that many people," said Susan Alford, executive director of the Southwest Virginia Area Health Education Center. "But that comes with its own set of problems.... There are fewer and fewer places to work. People in rural areas are poorer, older and sicker."

In rural areas, it can be "two hours to find a cardiologist, maybe two hours to find an OB-GYN," Alford said.

On Virginia's Eastern Shore, about 40 percent of the population of 52,000 is considered poor based on federal guidelines - the third-highest rate in the state and higher than any South Hampton Roads city, according to Virginia Health Department statistics. And, like everywhere, Zager said, you don't have to be poor to struggle with medical bills. The Shore is not home to many "businesses that provide a rich benefit package," he said.

About 17 percent of Eastern Shore residents are older than 65, against a statewide average of about 11 percent. Poverty and aging are both associated with a host of health problems. The 52-mile Shore has some of the highest cancer and obesity rates in the state. About the only health problem in which the area is below the state average rate is asthma, a condition that more often afflicts urbanites who have to contend with higher levels of pollution.

Its narrow country roads are home to one of the state's highest traffic fatality rates - between 2001 and 2006, there were 111 deaths, according to Department of Motor Vehicles statistics. Norfolk, a city with more than four times the population, had 96.

"We see a lot of traumas," said Bonnie Enoch, the nurse manager of Shore Memorial's ER. "It's car accidents."

The most serious are stabilized there, then flown by Nightingale helicopter to another hospital, usually Sentara Norfolk General, she said. Last year, the Sentara-owned helicopter made 49 trips to pick up patients at Shore Memorial, a Sentara spokesman said.

For all their differences on the surface, Zager said rural and inner-city areas have a lot in common. Despite a relative wealth of health facilities and doctors, there are pockets of South Hampton Roads that are considered medically underserved by the federal government. The Shore is designated such an area based on population and geography.

"There are things we see on a weekly basis that'll break your heart," Zager said.

It would seem like a second hospital - or at least a free-standing emergency clinic of the kind that has sprung up throughout Hampton Roads - would help.

It's not that simple, Zager said.

For one thing, a hospital needs a population base to succeed financially. A population of 50,000 is enough to support one hospital, but "I would argue it's not enough to support two," he said.

As it is, Shore Memorial, which had total operating revenue of about $66 million in 2006, has struggled financially, losing almost $2 million in 2005 and 2006, according to its annual report. On average, about half of its beds are filled.

"We made a little last year, and this year we're just above break-even," Zager said.

Beyond the money, research into health care quality shows that the hospitals that do a given procedure the most also do it the best, perhaps because they're the most practiced at it. For that, a hospital needs enough of a population base that requires the procedure, allowing health care professionals to "keep their skills up," Zager said.

That's why Shore Memorial doesn't do invasive cardiology treatments such as angioplasty and surgeries. There aren't enough people on the Shore who need them, and so those who do travel either north to Salisbury or south to Hampton Roads.

But since 2003, residents no longer have to leave the Eastern Shore for radiation cancer therapy. That's when Shore Memorial opened its cancer center a few blocks from the hospital. It's an example of a program where both the community need and the finances lined up.

Before the cancer center opened, people could get chemotherapy but not radiation treatments - a typical course requires five daily appointments a week for several weeks. It also requires expensive equipment.

For cancer patients, that often meant having to travel an hour or more each way - and in the case of Hampton Roads a bridge toll - to get treatment.

"In some cases they would say, 'I'm not going to fool with it' " and for go treatment, said Chuck Ward, the center's director.

Some people would rent an apartment in Hampton Roads, Zager recalled.

"But how practical is that for the average person? People can't afford that," he said.

A few years ago, Shore Memorial received $5 million in donations to build the center. While the Eastern Shore probably doesn't have enough people for the center to make much money, it likely won't lose much either, Zager said.

In fact, the smaller patient base - on average, about 14 patients a day take radiation treatments - means the medical staff is able to spend a little more time with patients than in more crowded urban centers where the equipment has to be on a tighter schedule.

"We can give the patients that time, if they have questions," said Ward, who trained in radiation therapy in Hampton Roads, "and not have them feel like they are being herded in and out."

It may well be that in the future, free-standing emergency clinics that supplement hospitals could prove to be helpful to rural communities, Zager said. But they're still too new in the health care landscape, and rural health systems need to rely on the "tried and true."

When the emergency department at Sentara BelleHarbour opened recently, less than two miles from Bon Secours Health Center at Harbour View in once rural northern Suffolk, both health systems - neither of which has a presence on the Eastern Shore - insisted there was plenty of business to go around. The facilities are surrounded by fast-growing and increasingly affluent suburbs.

In an area of multiple health facilities, you can afford to take a chance, Zager said. But a failed experiment on the Eastern Shore could well be disastrous for a hospital such as Shore Memorial.

"A miscalculation could have very unintended consequences for the viability of the whole program," Zager said. "It's not like putting another gas station on the corner."

So, that still leaves miles to go for the residents of the Eastern Shore.

"We're pushing that golden hour," said Nicole Simpson, a volunteer emergency medical technician with the Bloxom Volunteer Fire Department. The "golden hour" refers to the concept that trauma patients have "much better outcomes" if they can be treated in a hospital within an hour of the incident, she said.

For the Bloxom ambulances, which had 300 calls this year through the end of May, it takes 35 minutes to get to Shore Memorial, 45 to Peninsula Regional. The advantage of the ambulance is not only speed, but EMTs can get a head start on some emergency procedures, Simpson said.

"I think it would be good to have one more, at least on the upper side," said Crystal Englehart who was at Shore Memorial on Monday receiving care for a high-risk pregnancy. Englehart is a resident of Onancock, about 30 minutes north of Shore Memorial.

As it is, Englehart will still need to travel to Hampton Roads for some of her prenatal care, a burden that was considerably lightened when she learned there was a Chesapeake Bay Bridge-Tunnel Commission program for patients to help with their tolls, which typically run $12 one way. She's got a fuel-efficient car, so the gas costs should be OK.

Still, when the time comes - she's due in January - Englehart worries about being "stuck somewhere" without quick access to care.

"I worry about it every day," she said.

Nancy Young, (757) 446-2947, nancy.young@pilotonline.com