This entry was named an Honorable Mention.
Judges’ comments:
The problems with rural healthcare have been written about for decades. What made this series special, however, is the way it segmented those problems and then offered solutions. The information was clear and accessible, and the series already appears to be triggering some action. Hopefully David Wahlberg will continue pursing this topic – he’s providing an important service for his readers.
1. Provide the title of your story or series and the names of the journalists involved.
“Out of reach: The rural health care gap” by David Wahlberg
Photographer Craig Schreiner played a key role, as did editors Beth Williams and Teryl Franklin. Also contributing were page designer Jonathan Kleinow, copy editor Julie Shirley, graphic artist Jason Klein, multimedia editor Laura Sparks and Nick Heynen, who helped me analyze databases. I was awarded a Kaiser Family Foundation fellowship, which paid for the travel involved.
2. List date(s) this work was published or aired.
This 11-part occasional series ran from March to December, 2010. The dates: March 7, March 28, April 25, May 23, June 27, July 25, Aug. 29, Sept. 26, Oct. 17, Nov. 21 and Dec. 26.
3. Provide a brief synopsis of the story or stories, including any significant findings.
This series examined challenges and possible solutions to providing health care in rural communities, mostly in Wisconsin but also in Kentucky, Montana, New Mexico and Tennessee. Critical access hospitals, the National Health Service Corps, J-1 visa waivers and other programs have helped ease rural health problems, but many obstacles remain:
*Emergency care can fall short in rural areas, as emergency medical services rely mostly on volunteers and struggle to keep pace with today’s needs and expectations. A Madison couple faced treatment delays after a car crash in northern Wisconsin.
*The primary care doctor shortage is acute in rural places. The hospital in one small Wisconsin town has kept its medical director, even though he’s a convicted felon who isn’t allowed to treat Medicare patients, largely because it’s hard to find doctors.
*At least 44 small towns in Wisconsin lost their only pharmacy from 1980 to 2010, our analysis revealed. Telepharmacy and mail order services help, but the mostly elderly residents of one remote Wisconsin town must drive more than 40 miles round-trip for some medications.
*Nine of ten dentists in Wisconsin accept few or no Medicaid patients, and at least 10 rural counties have no substantial Medicaid dental care provider. One rural man contacted 20 dentists listed as Medicaid providers; none would take him. Statewide, 243 rural water systems have inadequate fluoride.
*A 12-year-old girl spent nine months in and out of institutions far from her rural Wisconsin home while on the waiting list to see the area’s only child psychiatrist, whose diagnosis of schizophrenia led to stable treatment. Mental health care is hard to find in rural settings, especially for children.
*A drug called Suboxone helps address the lack of addiction treatment in rural areas. But government limits on the number of patients providers can treat means long waiting lists to see some doctors. A rural Wisconsin man died from an overdose while seeking help. *Free clinics, key safety nets in many rural areas, might still be needed even after Health Policy is fully implemented. The role of community health centers will likely grow in rural communities because of additional funding the reform law brings.
*Kentucky Homeplace, a state-funded lay worker program that helps people navigate the health care system in a region with high poverty and low life expectancy, is a model that free clinic organizers in Wisconsin might try to follow.
*Montana, one of the most rural states in the country, faces challenges such as having a dearth of hospitals that deliver babies and the country’s highest traffic fatality rate. But the state is also a testing ground for solutions, including frontier hospital networks and community paramedics.
*It’s hard to attract obstetricians to rural areas. In some places, midwives help maintain maternity care. Midwives deliver a greater percentage of babies in New Mexico than any other state. The rate is growing in Wisconsin.
*Technology — chiefly, the two-way audio-video connections of telemedicine — can help bridge distance gaps and bring specialty care to rural areas. A prime example: telestroke, which could help rural stroke patients receive a clot-busting drug many now can’t get.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
This project mostly involved background research and lots of interviews. But I did request, obtain and analyze databases on pharmacies, physician recruitment and services provided by critical access hospitals. Some of this analysis resulted in online interactive maps and time lines. Reports such as the 2008 National Dental Summary, by the Centers for Medicare and Medicaid Services, helped put Wisconsin in context. The report said the state ranked fourth to last in the percentage of patients who received dental care, surprising for a state that generally ranks high in health care quality and access.
5. Explain types of human sources used.
For background and context, I interviewed many rural health authorities and attended several rural health workshops, seminars and conferences. Through these and other means, I found patient stories that illustrated key issues. The patient stories drive most segments of the series. Online videos and slide shows of patients and providers help further personalize the topics.
6. Results (if any).
The main goal was to give attention to rural health issues, which are often ignored by the mostly urban focused media. Based on the strong response from patients, providers and the public, this was achieved. A few specific examples: Wisconsin’s state Legislature passed a rural hospital tax in April to bring in more federal money to offset a state Medicaid cut and increase incentives for doctors and other health care providers to work in rural areas. Some health care officials give partial credit for the tax’s adoption to my stories, saying they helped educate legislators. After reading about the number of rural pharmacies closing in Wisconsin, a doctors’ group in Madison contacted me saying the group is exploring ways of supporting rural pharmacy services. A grassroots coalition in one small Wisconsin town, Richland Center, invited me to join mental health professionals in a panel discussion about access to mental health care in rural communities.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
I corrected one small error in the first segment of the series. Howard Young Medical Center is owned by Ministry Health Care, not also by Marshfield Clinic as the story stated.
8. Advice to other journalists planning a similar story or project.
If you want to cover a big topic by carving it into categories and bringing the categories to life through patient stories, start early. The biggest challenge of this project was finding the people to illustrate the issues sources or reports identified as important. In some cases, it took months. But by putting feelers out early and broadly, I was able to find the right people while maintaining the goal of publishing a segment of the series a month and doing other stories on my beat.