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Telemedicine Clinic Blooms Among The Lilies and School of Smith River It took months for Smith River Elementary School students to choose a name, but Blooming Lily Telemedicine Center needed only 30 minutes to make a difference for its first patient, 5-year-old Isaac Mignon. By next fall, it will be making a difference for the entire Smith River community. The clinic is the latest in public-private partnerships to bring access to rural areas by incorporating telehealth technology into the normal workflow of the school and nearby Del Norte Community Health Center. “I would have had to bring him into Crescent City,” came Erica Herrera’s words as her face danced on the video monitor in the exam room at Smith River School. She was physically located at the Del Norte health center 20 minutes away by car while her son sat perched on the exam table with licensed vocational nurse Tirsa Croy nearby. “Every time I talk to someone, I give an explanation of what it’s about, how we see the doctors through a camera and they see the children and patients through another camera,” the bilingual Croy said. “Everyone talks and it’s very neat.” The Blooming Lily clinic is located in a portable building less than 20 yards from Mignon’s Head Start classroom. A giraffe adorns the door to the exam room while a zebra and other animals decorate the waiting room walls. The exam room is like any other, except for $50,000 worth of video technology linking the school to the Crescent City clinic, its stable of health care providers, or specialists as far away as San Francisco or Boston. “(This appointment) would have taken a half-day of work and school,” Herrera said shortly after hearing Dr. Alexander Wade’s diagnosis. He asked Croy to point the camera lens on Mignon’s leg sore, peppered Croy and Herrera with questions, then prescribed antibiotics. The pediatrician went on to his next patient in Crescent City; Herrera went back to her receptionist dutie, and Mignon to class, all smiles after seeing his leg and mom on television. “Isn’t that something?” asked Frank Anderson, Director of Telehealth Development for the Open Door Community Health Centers. “It’s been a long project, but seeing it come together makes it all worthwhile.” Smith River Principal Paige Swan was beaming. A self-described momma’s boy, Swan says his family has been in Crescent City “I don’t know how many years – back to my great-grandparents at least.” He knows the importance Smith River residents attached to having their own clinic, but he also understands the laws of economics. When the Open Door system joined up with Del Norte County residents in the construction and administration of the new wellness center, it changed the health care dynamics in Smith River, which is an agricultural area with a sizable Latino population. What used to be one medium-sized clinic in Crescent City and a small one in Smith River would be no more. “It worked OK when we were past our capacity in the old Crescent City clinic,” Open Door executive director Herrmann Spetzler said. “People were more than glad to drive the 20 minutes to Smith River.” But once the Del Norte Community Health Center opened in 2007, the Open Door system doubled its size in Crescent City and no longer shipped overflow clients to the small clinic it operated in the world’s capital for Easter lilies. “The opposite happened,” said Spetzler. “Sometimes Smith River would see only six or eight patients a day and that’s an economy of scale that doesn’t lead to survival.” “What sounded the alarm was the notice that they were closing the clinic,” Swan said. “We’ve got a lot of older folks in the community, a lot of them without transportation. We felt pretty strongly there was a need.” Swan said his K-8th grade school of nearly 300 students already sported an attendance rate about 1.5 percent below the state average, a statistic he figured would get worse if health care access became more difficult. “If we had a kid getting sick and we called for a parent, they would be gone all day,” he said. “Many of our parents work 12-hour days, sunup to sundown. If their child comes down with any kind of health issues, I have to call the employer, the employer gets on the radio and figures out where in the middle of nowhere they are and then has to bring that parent from the middle of nowhere to here. Everything took much, much longer.” With a signed permission slip ahead of time, sick children can be seen at the school by Croy, a doctor can be reached in Crescent City or anywhere else with telehealth capability, and the parent never leaves work or loses pay. “We’re talking about using doctors already at work somewhere else and sprinkling cases into their day rather than taking a doctor at $100,000 a year and putting him somewhere he can only work at 30 percent capacity,” Anderson said. “It became clear that providers in remote areas are at such a premium that you have to put them where they deal with the most need,” Spetzler said. “But we wanted to continue to have a footprint in the Smith River because there was a real concern in letters from the community and the principal about how difficult it would be if they lost their clinic.” Spetzler presided over the opening of the Visiting Specialist and Telehealth Center in Eureka at the end of 2006. With the exception of the schools, rural areas lack the infrastructure capability to make use of telemedicine. Spetzler and Anderson needed the school to be part of the equation. “At first, I was hoping to let this pass and go somewhere else. We didn’t have the space,” school district superintendent Jan Morehouse admitted. “But they liked the possibility of telemedicine and the school districts are the ones with connectivity. We are the only show in town for that.” All the north coast schools are linked through the Humboldt State University network, Morehouse said. “There was such despair about the clinic closing that I went back to the board. We decided we weren’t able to pass this off and maybe we shouldn’t have wanted to anyway. “We don’t think we are involved other than providing space so our kids can have access to health care. We don’t see providing that space as conflicting with what we do. And not a dime has come from our budget. This has been paid for by Open Door.” Anderson said the California HealthCare Foundation gave Open Door the resources to outfit the school-based clinic. “It is our first experiment in trying to reach out to the most remote sites,” said Spetzler, who charged Anderson with getting it up and running. The funders visited in June. Plans are afoot to extend service this fall to other community members, who are part of a targeted outreach campaign that began over the summer. “Telemedicine is so new few people know what it means or its capabilities,” Shaw said. “It’s impressive. We can work with a doctor in town and that’s great. But if we need a specialist in Stanford or San Francisco, it’s another touch of the button and an opportunity to save time and money.” Croy is the clinic constant, working in the old and new settings. She’s lived in Smith River for the past 19 years. With three daughters, eight grandchildren, and several years of work in obstetrics, a nursery and pre-natal care, Croy is no stranger to children. She doesn’t want anything to do with retirement, however. “All my children are gone. My grandchildren live far away from me. What am I going to do at home?” asked the 65-year-old. She will celebrate 50 years of nursing in 2010 and may well be the most familiar face in Smith River health care. “They change secretaries, providers, location – they change everything except me,” she said. “Everybody knows me and I know everybody.” Blooming Lily Telemedicine Center, Smith River School Clinic, Open Door, or Tirsa’s clinic – the name isn’t as important as the service it provides and standard it sets. “It’s very hard to reach out if you don’t have a community that’s reaching back,” Spetzler said. “In Smith River, it’s been a true partnership from the very beginning. It took a while to make sure everyone was comfortable but everybody -- once they had a chance to talk about it -- saw it as worthwhile.” Carol Harrison is a free lance journalist commissioned by the Open Door Community Health Centers and the North Coast Clinics Network to write stores about rural health care.
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