Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
7 November 2001

“What is Rural Health, Inc.?

     There was a day when Gettysburg had three physicians who lived in the community and served the very fine hospital that is there now.  Once upon a time, there was a physician who lived in Highmore, one who lived in Murdo and one who lived in Onida.  Fortunately, Dr. Crandall still lives in Kennebec and serves the Kennebec-Presho area.  But, of those five community areas, Kennebec-Presho is the only one that still has a physician in residence.  The economics of medicine, the pressures of managed care, the onus of paperwork from Medicare and the lure of the big city has essentially gutted small rural communities in South Dakota in regard to physicians who live in those communities.  Yet the medical needs of these areas are not diminished.  If anything, the medical needs are greater than they were as the average age of the population continues to increase.

    In the mid-1980’s, the Federal Government acted on its awareness of this increasing problem.  The Federal Government made great money available to organizations which would provide care to small medically underserved communities. In 1987, Murdo and Highmore already had clinics in place that were financially strained and receiving financial support by St. Mary’s Hospital.  With the availability of increased federal funding from Federal grants to support these clinics, a separate entity and corporation was begun.  It was called Rural Health Care, Incorporated.  Its stated mission was to provide “access to quality medical care” is small rural communities and serve as a conduit to more specialized care as needed.  A strong emphasis was placed on preventive considerations including well-baby care, adequate immunizations for children, high blood pressure control, cholesterol control and intermittent programs such as screening for skin cancer.  The staffing of the local clinic in Murdo and Highmore included a physician’s assistant or a nurse practitioner who would be sponsored and assisted by a physician.  In addition, a nurse would be present in the clinic and one individual to attend to administrative considerations.  Jim McNeely is a nurse practitioner who has staffed the Murdo Clinic for many years.  He is a resident of Murdo. Now Cindy Erwin is the physician’s assistant who staff’s the clinic in Highmore where she lives on a small farm.

    By 1994, Onida qualified as an underserved area and a physician’s assistant in residence became available to Ms. Marvel Buehler.  In 1999, Gettysburg qualified as an underserved area according to Federal guidelines and the clinic there now has two nurse practitioners, Ms Rena Robbennolt, and Ms. Kasey Hanson.  These four clinics in Murdo, Highmore, Onida, and Gettysburg are now administered through Rural Health Care, Incorporated.  Mrs. Rita Wagner is the executive director and is the person instrumental in holding this group together and writing the grants for federal support. Ms. Darcy McClelland is a physician’s assistant who coordinates the medical aspects of care and sees to the medical needs of each clinic.  Ms Pam Moody is the financial officer for Rural Health Care, Incorporated and makes sure the bills get paid. Currently, a board of several individuals from each of these four communities oversees the corporation providing governance and directors with input from the members of the community.  The board members from Highmore are Dean Matre, Mike Mason, Rod Domke, and Mary Alger who is the President of the Board of Governors. From the Murdo area, there is Jacquie Erikson, Catherine Patterson, Donna Eckert and Dorothy Melcher.  The board members from Onida are Arne Johnson, Elmer Mosiman, Ed Carr, and Wendy Ramler.  From the Gettysburg are, the board members are Brenda Gray, Ellen Logan and Dr. Steven Buechler.  There is one vacancy open on the Gettysburg board for an interested individual.  These board members are individuals you should contact for concerns about the clinic services and how to facilitate community care.

    These community clinics not only provide daily staffing with nurse practitioners and physician’s assistants but in addition, they schedule physicians into the clinic on a weekly basis to provide added support.  Specialty clinics including surgery, obstetrics, cardiology care, orthopedic care and ophthalmology care which are available through these clinics.  In keeping with the Federal mandate and stated mission for Rural Health Care, Incorporated, “to provide access to quality medical care”’ financial considerations are also important.  It was recognized that in small rural communities many farm workers and others do not have insurance coverage and medical expenses can provide a significant burden.  Therefore, the Federal government required that a sliding fee scale schedule be provided.  Thus those with lessor incomes can be seen in these clinics with a lessor financial expense.

    Lastly, as an additional incentive to make these clinics accessible to the public, they are open late one night per week for those whose work schedules do not allow daily visits.

    Thus an answer to the question “What is Rural Health Care, Inc.?”, it is something wonderful.  It is something somebody finally got right.  It is a provision of access to quality medical care in the small communities around Pierre, SD.  It is supported by the physicians in Pierre who drive to those clinics on a weekly basis to provide services to support and sponsor the nurse practitioners and physician’s assistants.  It provides medical care at the lowest cost possible and yet with very high quality.  I can speak personally for the excellence of the physician’s assistants, nurse practitioners, nurses and administrative personnel who staff these clinics.   They manage those medical problems that can be managed in a facility such as these and seek the help of physicians or hospitals as needed.  They provide a conduit from local care to more specialized care as needed.  Most importantly, they are local resident healthcare providers who care as much about their community as you do.  To those of you that have yet to experience these clinics, you are going to second best, paying more and taking longer to get there.