ATLANTA -- In large areas along a stretch of the state from Macon to Milledgeville and on to Augusta, it can be a long drive for people having a heart attack to get to an emergency room. And pregnant mothers living far from a hospital correlates with higher rates of premature births.
Rural residents are more likely to die of heart attacks that could be stabilized or stopped in the right kind of facility. And unless a would-be mother drives as much as an hour or more, she will not get regular prenatal care either, part of what leads to risky early births, health officials said.
But rural health care is not generally a money-spinner. Rural populations tend to be poorer, older and sicker than residents in more metropolitan areas, meaning they are less likely to be able to pay for the care they get.
Those are issues that are starting to get attention.
State Sen. David Lucas, D-Macon, has started studying rural issues since being elected to a Senate district that covers all or part of seven counties. He was surprised when he looked into access in Twiggs, Wilkinson, Hancock and Washington counties. Washington County does have a hospital.
In rural Georgia, youve got hospitals that have already closed. You have more that might close, he said.
He has filed a bill that would make it easier to open what hes calling stabilization centers: tiny three- or four-bed facilities to aid people in emergencies before sending them on to a hospital.
The bill would exempt such centers from proving to the state theres a demand for them, and they could keep afloat by getting a certificate of need.
A hearing on the bill is likely next week, but it has run into opposition and questions about how to pay for it.
We support his concept. ... We want to try and accomplish the same thing via license, said Monty Veazey, president and CEO of the Georgia Alliance of Community Hospitals, a statewide network.
He said Lucas bill is too risky because of a parliamentary oddity: If there is debate on Senate Bill 338, theres space to amend other facilities into it and exempt them from the unpopular certificate of need process. Veazey said he doesnt want that to happen.
Veazey said he thinks its possible to allow such tiny ERs without changing the law, and he said he has asked attorneys to come up with a draft proposal.
Either way, the next step would be finding money if such centers are opened.
Texas and Alabama have such tiny centers, but those are run by companies that seek affluent areas to make money, said Lucas. Thats not what he wants to enable.
This bill doesnt come with any money, he said, adding that it might be possible to tap the USDA. The federal agriculture agency actually spends a lot on rural development.
Georgia has a maternal mortality problem: women dying due to complications of giving birth.
On average from 2004 to 2007, some 18.3 of every 100,000 pregnancies ended in maternal death during pregnancy or within six weeks of birth, according to the March of Dimes, which has set a goal of reducing that to 11.4 or less by 2020.
Causes in Georgia include postpartum depression, poor cardiovascular condition and poor gynecological care before or between pregnancies, said Pat Cota, executive director of the Georgia OBGyn Society.
We have a severe shortage of OB-GYNs in Georgia, particularly in rural counties, said Cota. Forty counties have no such specialist at all.
A total 26 labor and delivery units at hospitals have closed in Georgia since 1994, by her math. Being a rural obstetrician doesnt pay well, and uncompensated care is more common in poorer, rural populations than in larger cities.
If it means an hours drive to Athens or Macon for prenatal checkups or annual exams, many women wont or cant keep up.
All this is leading to an access-to-care issue for women in general, particularly for women in rural Georgia, Cota said.
Georgia women who deliver prematurely live an average of 40 minutes from their birthing facility, while Georgia women who deliver at term live an average of 32 minutes away, according to an Emory University report cited by Cota.
What to do?
Meanwhile, on a recent morning in Atlanta, Dr. Anne Patterson was inspecting an ultrasound scan on an 8-foot-tall projector screen in front of the Georgia House.
Patterson runs a telemedicine practice in Atlanta and came to demonstrate her craft with a patient in Albany.
Telemedicine can provide her with care shed otherwise have to travel miles for, Patterson said of the Albany mother. It can be done in hospitals, clinics or any medical facility that has the right equipment: a cart loaded with cameras, sensors, scopes, instruments, web access and a technician to operate it all.
Among general practitioners and specialists, there were some 130,000 telemedicine consultations in Georgia in 2013, according to state Rep. Winfred Dukes, D-Albany.
Telemedicine could be part of the whole rural health solution, Lucas said.
But theres no clear parallel to the tiny rural ERs he is seeking, beyond a few pilot projects in parts of rural Alaska.
People are still looking.
This year, the federal government started collecting grant applications for pilot rural health projects in five big Western states with the sparsest populations. The government aims to figure out ways to provide both acute and regular care in the country. It will start selecting projects in May.
The Georgia Senate recently approved Senate Bill 273, by physician state Sen. Dean Burke, R-Bainbridge, which creates a Maternal Mortality Review Committee that would try to find ways to lower that rate. The committee could start work as early as March.
Theres also talk of a rural health study committee for this summer.
And as state tax collection recovers from the recession, some new funding in years to come is not out of the question.