Squarely in the action for pressing for investigations of the Biden family so far Republicans in the White House of largely dismissed other witnesses as only having secondhand information Susan Davis n.p.r. News the Capitol Democrats a c evening every lease a transcript of David Holmes has closed door testimony at home said He vividly remembers ambassador Songlines Conversation with President Trump because it was so distinctive a separate transcript from the interview with top State Department official David Hale has also been released tales to testify publicly wins day about the removal of memory of all of it as u.s. Ambassador to Ukraine with the impeachment inquiry into its 2nd week of public hearings House Democrats say they are not done examining the now closed a special counsel investigation into Russian election interference and the Trump campaign here's more from N.P.R.'s Bob Allen lawyers for the House of Representatives told an appeals court that they want to review the underlying evidence in the mall or investigation the Democratic controlled House Judiciary Committee says they are wondering if President Trump lied about not being aware that his 2016 campaign was in contact with Wiki Leaks Democrats say witness testimony from the Mauler probe needs to be examined in order to determine if the President committed perjury in his written answers to Pennsylvania now where the state prison system is agreed to change the policies that govern its 136 death row inmates Katie Meyer of member station w i t f reports for many years they've essentially been held in permanent solitary confinement for many years being on death row in Pennsylvania meant staying in a cell for up to 23 hours per day 7 days a week American Civil Liberties Union attorney Vic Walczak says in visits to state prisons he saw death row inmates lying in bed with sheets over their heads in the middle of the day he helped bring a lawsuit over the solitary confinement policy which he describes as a form of torture now that the u.s.c. Has agreed to a settlement that will give death row inmates at least $42.00 and a half hours a week out of the. Cell They'll also be able to eat and attend religious services with other inmates visit with family and have daily access to phones a department spokeswoman says the prison system has been gradually phasing in many of the changes over the past year for n.p.r. News I'm Katie Meyer in Harrisburg and you're listening to n.p.r. News the White House is trying to put to rest speculation about President Trump's visit to Walter Reed National Military Medical Center a trip to Walter Reed on Saturday was unscheduled and raise questions about his health in a statement issued earlier tonight the president's doctors said Trump has not had any chest pain nor was he evaluated or treated for any urgent or acute issues Hong Kong Leader Kerry Lamb says some $600.00 protesters have left the campus of the Hong Kong Polytechnic University at a news conference Lam said they include about $200.00 who are under 18 years old and about 100 students remain holed up their campus has been blockaded by police for the past few days the protests in Hong Kong now in their 5th month with universities the latest battleground the number of international college students in the u.s. a Set an all time high but the growth in students from abroad is slowing Kirchherr a peasant from member station w. G.b.h. In Boston has details the increase is driven by visa programs that allow international students to stay in the u.s. To train after completing their academic programs that's according to new data out today from the Institute of International Education after a decade of rapid growth the number of 1st time students is declining slightly causing some college leaders to worry about losing tuition dollars specifically at public schools competing for a shrinking pool of students in this country for the 10 consecutive year the largest source of international students in the u.s. China and more than half of all students from abroad are studying science technology engineering and math for n.p.r. News I'm Kirk in Boston and I'm Joel Snyder in Washington. Support for n.p.r. Comes from n.p.r. 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From Nevada Public Radio I'm Joe Shannon in its stead of out up we're coming to you today live from the tone a park invention center northern counties about 200 miles northwest of Las Vegas and we're here because Tony in many respects is ground 0 for the serious issue of rural health care or the lack of it in Nevada but 1st a little background on Tony pause health care woes in these last few years in the fall of 2015 more than a decade of gross mismanagement closed the NIH Regional Medical Center leaving the towns 2500 residents and another 2500 people in the air general area without a hospital for about 100 miles in the interim renown health and a paramedic service called started providing primary and urgent care but gaps do remain and now the question is how can a frontier town 200 miles from any major city provide quality health care to its residents today's is the 1st in a special 3 part series on rural health in Nevada we're talking to people who have lived through the crisis and those who are part of the solution in Tonopah today and one of those people is just Scott Thompson she's a registered nurse and the director of the renowned clinic just cope Welcome to the program thank you for having me So Jessica the renown clinic opened in 201610 months later. The this was I should say this is 10 months after the closure of the hospital you were at the hospital when it closed and the clinic when it opened but there was that period this 10 months when there was no formal clinic here no real you know formal health care what if you could describe what that was like it's almost a year. Well to put it into words it was very scary for the community. We all didn't know what was going to happen it was a lot of unknown we had never been without health care in our area I was born here raised here this was the 1st time that I've ever experienced not having a hospital here locally it was very emotional I worked in the e.r. For 20 plus years I know what happened in this area I know the cases we took care of the people we saved so I knew what was going to happen to those that needed medical care here and there was none to be had so like I said it was very emotional and a very scary time so we didn't know which way it was going to go it was a huge story at the time were to where did people go what did they do. Well we do have local E.M.'s it was all volunteer so we were relying on them a lot and because they are volunteer they most of them have full time jobs it took a huge toll upon them we've seen a lot of people drop out people weren't responding you know because now what used to be a 10 minute run was turning into 6 hours 8 hours it depended on where they had to travel to the closest e.r. To us now was an hour and a half away one way so you know and those were to other small rural communities they were not to the big trauma centers and whatnot so a lot of people even though they could make it to a small e.r. An hour and a half way they were still having to travel on to Vegas Serino for further care. Really kind of the last thing on that interim period you know today people they get the flu and they'll go to the doctor for that which I wonder if that seemed at the time like people didn't have the luxury to do the people just dealt with it themselves they did a lot of people would probably wait to the bitter and when they were beyond ill to seek medical care and in some cases they waited too long. A lot of our older folks in the community do not have the transportation to get them to health care an hour and a half away and if they did get there they would find themselves without a ride home so a lot of people tried to take care of themselves by themselves at home doing the best they could and once again a lot of these medical conditions what evolved into something that could have been treated easily in the beginning to something that was now untreatable in your mind I mean just hearing something of us do you think there are people who left things go or had to let things go that that cause their death Absolutely I do. So 10 months isn't really seem like a long period of time you're talking about some pretty tough circumstances but 10 months isn't doesn't seem like a long time to get a whole clinic up and running how is we're now able to do that well renowned. Came into the picture prior to our hospital closing so when we were getting ready to shut the doors of NY Regional Medical Center we reached out to just about anyone that would listen to us you know within the state of Nevada you know we're small hospitals large hospitals and renown actually was one of the very few that responded and came down and met with the staff and with the c.e.o. And you know started discussing things prior to our closing so they showed interest . Probably a month 2 months before we close our doors and they stayed involved with us until they opened the doors in June of 2016. I've seen the clinic it's it's really nice you know it's a no more to say about it it's it's a kind of a basic structure but I want to talk about the kind of services it offers and maybe how it differs from the services that were offered when the hospital was here so when our noun came in we initially opened only with telehealth which was the patients would sit down in front of a computer screen and see the doctor our 2 physicians Well we had a physician and nurse practitioner that worked out of Reno at the time it wasn't a concept that was accepted greatly among the community because there was nobody knew 2516 it works they're still able to do a full assessment I'm their hands on the other and you know they can still you know do exams of their ears their eyes you know they can listen with a stethoscope so that's how we opened we opened it with a very limited service since then we have expanded quite a lot we still do tele health with an m.d. Her name is Suzanne's a close she works out of Reno she does primary care she specializes in internal medicine we also have onsite out of Las Vegas she is here 4 days a week doing on site visits for primary care and since then we have opened up our Och health department so. We can do what was that our health occupational health so we contract with a lot of the employers in the area we do their drug screening their breath alcohol testing you know randoms pre-employment post-accident we also do their physicals we do c.d.o. Physicals we do. Post injury is a bull's worker's comp we and we connect telehealth with occupational health clinic up in Reno it is sounds like it's pretty busy so if it sounds like there is enough I should say business or patients here for a clinic to actually operate and make money absolutely I believe so yes so the closure of the hospital as we said in the introduction really had a lot to do with the mismanagement and sort of a lot of the scandal that was involved that's been written about and reported on those many of those years ago correct yes so what if I go to your clinic Now what about health insurance does it take all health insurance what do you what do you have to do with how do people pay so we do take a full variety of health insurances you can come up and see us we can pull up you know what insurance you have there are a few Medicare Advantage plans that we do not take but we do take private pay patients we do accept medicaid medicare you know the big ones but I wouldn't say we accept them all but there are it's quite lengthy list that we do except what about uninsured patients what do they do so private pay yes we do see them there is a co-pay that we require upfront and they go on a fee scale for private pay it's an adjusted payments gal that they would pay on if you're just joining us we're beginning a series on health care and largely the lack of it in rural Nevada and we're Antonio this is 200 miles northwest of Los Vegas and we're here because the since this town 2500 has been through the health care ringer over the last 4 years things are coming back but but it has taken a while when the Nye County Hospital close here in 2015 Marie Peterson was the Director of Nursing and now she's she's still practicing here Marie welcome to state of Nevada thank you thank you for for inviting me. Marie after the hospital closed you actually went back to school to become a nurse practitioner and that meant you could open your own family practice here. Why did you do that well I saw a great great disparity of services in tone a pa and I'm even just working in the hospital arena when I arrived here from Las Vegas there were not a lot of services other than the hospital and the small clinic that was there and so with that you know it really inspired me that we needed more and it was really difficult to recruit physicians to the area so I saw the struggles that we were having even getting your physicians into the car and that led to me going back into school so I actually started that process prior to the hospital closing it was already in flow but then dead didn't finish up after the nurse practitioners a lot of people don't know what they are what can and can't you do when you're seeing patients so as a feminist practitioner I'm able to assess diagnose right prescriptions really provide the primary care services a primary physician would provide so it can include everything from suturing simple sutures to evaluating and managing some of the cases of hypertension diabetes that's quite broad in primary care and the focus also is prevention and so that's really big and key in the rural areas where we don't have a lot of resources is to identify the issue when it's in the early phases to be able to intervene before it becomes a big problem so you can almost do everything. You can do what can you do. In primary care we do refer out things that are more complex so we utilize the telemedicine system it's here with renown quite a lot for and your knowledge the services your services there's quite a few areas but really when I look at the comparison between the 2 in primary care I don't really feel there's a lot for limitations you know it's interesting is you came here from Las Vegas this is a vastly different community than Las Vegas I want exactly call this a wealthy community but a nurse practitioner here is not going to make as much as you might in a bigger city I would think Anderson practitioners are in demand all of the country why stay here instead of going somewhere where you could make a lot more money well it is true that I did turn down quite a few offers in the Las Vegas area that I would have made a lot more money I would have to say it's because it's where the heart yes and I like being able to treat people as people and in a rural area you're in such need people are people there not numbers and in Las Vegas I found when I was working there even as a registered nurse prior many times the larger systems treat people as numbers. And to become a nurse practitioner schooling is not she did you get help from the state or the federal government knowing that you're going to be in a rural community once you've got your degree I did not participate in any type of government funding I had a few grants from you know if he or I should say a few scholarships grants and government funding I have not reached out for that. Now you're surprised as this is like a primary care a considered I think you do sort of a hub. But you do refer patients to other services around here what other services now exist here and Tony so we also have Beth Anis our community health nurse and she does provide women's health care services She also provides immunizations I've not found there's any need to duplicate any of the services and so I've not included that as part of primary care many practices will include vaccinations as part of that but utilizing your resources in a wise way in the rural areas are very very important we also have our pharmacy pharmacies open 4 days a week and that's a big resource that we definitely utilize for prescriptions they also provide vaccines in the area so referring out again I mentioned renown that I refer over to I refer out to about them as locally and then we look out to the larger areas such as Hawthorne or bishop looking for wherever we can obtain those additional services that we don't have locally so sounds like prenatal care might be something or the p.d. X. Are those kind of things needed here absolutely Yes prenatal care is a very very big piece obstetrics care is not something that we have here locally and that's an area that is definitely a gap that we could really use a feel on is that the thing you would want if you were given your choice right now to pick one immediately that could come or is that what you want. You know that's a tough question yes that is a one on the top of my list but the other would be urgent care for those situations that we need more assistance with the stabilization and moving people to a higher level of care. It just Thompson renowned renowned as you said has tele health and that's like I said a video call to a doctor located in Reno or Las Vegas they help of diagnosis and other things health insurance companies offer this and cover it but not everybody is sold on it we spoke to a Falls' a local mother for her 3 year old daughter got sick in January and she tried to take care of herself she rotated ibuprofen and acetaminophen she gave her daughter plenty of fluids cold cloths on her forehead but when the girl's temperature pushed 105 she went to the renown clinic and tell them it was used to contact a doctor and this is this was her experience I was so frustrated because when I went in there we didn't actually see a doctor it was tell a bed and I don't think I would have cared so much at the time if things had actually gone differently and I guess by that I mean the connection was terrible it was in a now and you know glitching I couldn't understand this lady that was on the other end and you know hearing my daughter's flailing and screaming in she's just. Miserable you know and they have an assistant comes in and tries to do their best to check the temperature you know check the blood pressure and all that and it's just it was so chaotic and. All the trouble that we went through for them to tell me to face it we keep doing what I was doing and had to wait it out Jessica Thompson you've obviously understand the frustration I could see it in your face the little girl situation combined with the bad connection some of the the lack of interaction with a human doctor right there probably intensified it for Schembri But what do you say to somebody like that to convince her to give the clinic another try. Well there are many factors that play into tele health obviously a connection is a huge piece of it if your internet is not working appropriately then you can't conduct your visit we've had issues in the past where we've lost connectivity and we've had to stop a visit and obviously during this visit we had issues as well since you know these issues we have upgraded our wireless connection so I knock on wood we have not had these issues currently where our connections are very strong you know unless we lose power to the whole town you know when everybody gets shut down that's it and I've heard it happens it happens at half it's Ok. We're talking to you live from the tone of vengeance Center were here because Tony Paul in many respects is ground 0 for the serious issue of rural health care or the lack of it in Nevada and I'm here with Jessica Thompson and Marie Peterson coming up we're going to talk about emergency urgent care this is State of Nevada you say he knowing n.p.r. 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About 51 tomorrow sunny skies highs around 76 Wednesday Harz around 60 with an 80 percent chance of rain. It's state of Nevada I'm Joe Shannon We're live in tone upon of Addison 200 miles northwest of Las Vegas because this community of 2500 has been ground 0 for an issue plaguing Nevada really for decades the lack of health care in rural parts of the state after the NY County after the NY hospital closed here in 2015 renown opened a clinic and others have stepped in to provide primary care but what about emergencies Joining us now are met a community paramedic with Ramsi and Don good Minson with the tone of Paul volunteer ambulance service Matt and Don welcome to the program thank you Joe Thanks for having us so we've heard from the people who do primary care here you to take care of the emergency ends of things as e.m.t. Is and paramedics don't what are the kind of things as of volunteer in t. That you can and can't do. But 1st 1st one of the things you do what do you respond to. We respond to anything from literally a stubbed toe to cardiac arrest pretty much everything in between so we get sick people we get diabetes we get broken bones we get car wrecks. Dehydration and just about everything and so a lot a lot of people are people that you know I assume Yeah many times and one of the kind of things so you respond to everything but are there some things you respond to that you you have to transport someplace else that you can't deal with your so you're as a volunteer Oh yeah most that most of our transports are to either Hawthorne or best shot or we fly them out and Matt. I wonder if your skills as a paramedic pick up where there is as e m t's leave off absolutely coming from Reno we have a certain amount of call volume and experience that we can bring to the community at the same time the local volunteers here have a huge amount of local knowledge and experience that. Only they can provide So it's very much a team effort when we're here. We show up and we can do certain tasks and administer certain medications that the locals cannot that the cannot but at the same time without their help without their ambulances without their services without both kind of working together we would be unable to provide the service that we need and by the way you live in Reno I guess so and you come down here honey days a week the standard shift is there are 3 full time paramedics and they come down for $44.00 days of time so the standard shift is a 4 day shift and then 8 days off and then another 40 shift so it kind of rotates through the year and by the way people been listening you probably heard this little beepers going off do you guys have a call Yeah both of you now I'm not on ha Ok so can you can you stay here for now I can you can met Yad So the the local e.m.t. Is will respond to this call and so kind of up to them I can hang for a minute or 2 if you like but then you know the sooner the better time to get over there Ok well really quickly then walk me through a person's experience in an emergency here somebody calls 911 and then what do you do both the volunteers show up and do you show up yes sir so we meet there we often show up together in the ambulance and then we treat the patient as needed request back up whether it's air support or ground support and then decide how we're going to treat the patients sometimes we fly the patient out as Don said using helicopters or fixed wings sometimes we drive them to Hawthorne or bishop which are about 2 hours away if you had to say one percent get transported somewhere else what would you say. Good question but it's it's over 50 percent for sure and as you said helicopter fixed wing or driving we're talking thousands thousands of miles you probably drive these people will be the standard ground. Transport is about 100 miles east. So over the course of a shift or or over the course of a week or a month yes we put a lot of miles on the on the regs but given transport off by by ground would would at most be a few 100 miles now they talk about what's called this golden hour in medical emergencies. Really briefly you know I'm talking about you know yes so because of the distance you have to take some people who are in serious condition maybe car wrecks. Do you miss that golden hour I mean is it how much easier would it be if you actually had a hospital here that could treat some of these issues certainly that's the biggest one of the biggest barriers that we face here. If we have a critical patient more or less that the fastest we can get them to definitive care is definitely over an hour whether that is by helicopter or fixed wing or or by ground so. It adds challenges to the process and certainly there have been negative outcomes as a result of us being in such a rural environment what I mean negative outcomes I can't. Tell you specific story at the moment but certainly if you look at that history of tone of I.M.'s. Certain patients have probably been more seriously injured or even. Not survive because of the distance they are from a trauma center or just full scale hospital. How does that I guess as a somebody who's really dedicated to providing health care to people to getting them services how does that play on you. It kind of forces us to step up our care a little bit and take the job all that more seriously and just really do the best we can train as much as we can and also do our best working with our medical or our medical supervision to try to get as advanced protocols as we can to enable us to give as high a level of care here as we possibly can before getting these patients to definitive care and Don you live here and you know a lot of people as you said people you've probably been a car x. People serious injured that you've known and if you can't get them someplace so quickly enough I just wonder what it's like to live here and then in the aftermath of something like that let's let's say somebody is more seriously medically they're worse off than if somebody if there was a hospital here what it's like for you it's traumatizing literally you know we were seeing our neighbors were saying or our friends and family you know sometimes passed away my aunt actually passed away in my ambulance so. It does happen and it's very unfortunate and. I think that a lot of those could be helped or could have been saved if we would have had a hospital here. So. Very very very tough situation and met I want to go into one of the thing here you also do some kind of primary care work if you talk about the short so part of our role here is is as a community paramedic and so this is a program that started in Reno it allows us it gives us broader protocols and the ability to choose reet patients with chronical chronic illnesses such as you know p.t. And congestive heart failure on a kind of longer time scale and so it's a bit of a different scenario where a patient has to get referred by their primary care provider or another organization or another health care provider and then we're able to see these patients on a weekly basis or even daily basis if need be and give them kind of preventative care and monitor their symptoms and illness as much as we can with the goal of keeping them from having to get to that higher level of care. As quickly more as how long you've been doing this I've been in the community community paramedic program for about your have 2 years and how's it working in terms of as you said you're sort of giving this care to prevent people from needing emergency services I mean do you see it working little bit for sure we've had a few patients here in town that we've had good outcomes with you know can be just things as simple as just. Helping patients understand it in Minister their home medications you can imagine if somebody has a new diagnosis that is a very serious serious health problem. They they can be loaded with so many medications that it's hard to understand when they have to take them and hard to keep track of a lot of that especially a lot of these patients are older you know they're they can have other issues of mobility and just. Just cognition that can make things more difficult so just giving them some home health care and giving them a framework that they can understand as well as checking up on them on a regular basis to make sure that all of that is going well can make it difference in their ability to care for themselves and their place to get that sort of certification you have to be a paramedic 1st or could other people in town do that yes you have to be a paramedic and then you go through for the training to to get a state community paramedics education and we are talking about transporting them urgencies that come up here in total Again this is a frontier town I would call 200 miles from Reno 200 miles from Las Vegas 100 miles from a hospital in Hawthorne transportation for emergencies is a big issue and but it's not just a problem for emergencies we spoke with Roger Hooper at the senior center here Hooper has a brain injury so he goes out of town for frequent special appointments and here's what he told us about that. That's why we have here we have no transportation so if we don't have a vehicle ourselves or can I sort of drive it we can make it one of the c. a Bus will we'll run to. Elko to go to Reno and Fallon if you're a senior and I'm not a senior so I have to have a theatre to go with me I do go hey you know for a theater go it's pretty easy to do but if I want to go. So he has to find somebody who doesn't have to go to him or. To see to go with him just so that he can get a ride back it's almost an unreal series of hoops that you have to jump through in a circumstance like that and Don Goodman. Are there other transportation options out that. People like Roger can use no not really we still have a Greyhound bus here and that closed quite a while ago and so it's become quite the challenge for us in emergency services because once we get them to these hospitals they have no way to get home so and a lot of them are calling us because they really just have no transportation to get them to their primary care so they're using an e.r. As their primary care. Which is burdening the system even farther you know you know this is I would call this you know this is a small talk appeared to Las Vegas but it is 5000 people is a sizable number of people I wonder if if the people in Tijuana Paul are. Pushing or doing something to try to get more of those emergency services here or even a hospital to help renown grow into a hospital I think that's the primary reason why they made the hospital district. Is to help bring in some of those services and I know they've done a great job of bringing in mental health and you know some other things that we really needed we are talking about rural health care this is the 1st of a 3 part series we're doing and we are talking in Tonopah because this is really ground 0 for the rural health care issue in Nevada or the lack of health care in the rural areas and I am here with Matt awesomer and Don good Minson who are both Dawn is a volunteer emergency medical technician and Matt is a paramedic Matt and Don thank you so much for talking with us that you're up next we're going to talk about the hospital district and what it's done for this community this is State of Nevada. But News $809.00 k. N.p.r. Supports 4th of our public radio comes from a.j. 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It's state of Nevada I'm Joe Shannon an hour or we are live today in Tonopah we're at the top of our convention center because this is ground 0 in many ways for the issue of rural health care or the lack of it in Nevada Tony has gone through a lot of up evil in the last 4 or 5 years their hospital closed in 2015 and since then a clinic has opened there have been other primary care providers who have come here so things have picked up but there is still still a lot needed. And with us right now is Dylan sure she's the assistant Nye County manager and part of the reason we're talking to her is because after some of these issues came up a special hospital district was set up here and we're here to talk about that welcome to the program thank you for having me so let me know for those who don't know what is the hospital district the hospital district is made up of 7 taxing districts within one county and mostly it's in the northern region and this was this district was created by the Board of County Commissioners but each public body had to have a representative vote because it took part of their taxing right from their own districts so we created the district in order to generate revenues for medical services needed here in a county the northern region is the tax come from property taxes yes how much is it I believe it's point $0.02 per taxpayer point $0.02 per $1000.00 evaluation. What was it a tough fight to get that you know so people really did realize the need for it and it wasn't much of a debate they just do it absolutely. How much revenue would you say that it generates in about a year 1.1000001.1000000 and what costs and programs does that $1100000.00 cover it. The hospital district has entered into contracts with and with renown and I believe each of those run about 402500008 year and they do have a consultant that they have contracted with and he is assisting with the technical assistance grant that we worked with my communities coalition to perform in needs assessments moving towards a facility assessment So those are the 3 main expenses I would say that the hospital district has and cumbered they are in negotiations with another group to bring emergency 247 care to the area and that definitely depends on proper licensing of the facility the commissioners recently approved to donate that facility to the hospital district so that's what we were just talking about a little bit earlier instead of having to transport people for some these emergencies it would actually be here that is the goal of the hospital district either you know to minimize that transport so that we or our community members you know can get their care here in town rather than transporting and being stranded in another location so yes the 247 care is the goal of the hospital district and to hopefully utilize the facility is there a timeline a potential even hoped for a period when you might be here I do not know what their timeline of. Between tone upon the surrounding small towns in this area it's about $5000.00 people $1100000.00 It's a lot of money but really for all the sort of services for nurses to tell him that all that stuff it doesn't sound like a lot is not enough money for all the needs that are here it's not and that is why we search for grants to subsidize the fun's. And also you know the the groups that are coming in we are I think the last one that recently came on board was the physical therapy and they have asked for a small subsidy but I do believe that that eventually will go away and they will be able to sustain their own business and that's the hope for all medical services here so you apply for these grants people get the grants that you think is drawing other providers to the area. Well so far the grants aren't for services they are for the technical assistance grant that we recently was awarded so in order to attract the groups I would say the goal is to be able to upgrade our facility in order to have a facility to provide the services right now that is a big roadblock not having not open having that it. Does have some areas of emergency medical care covered and actually Jeff Martin is a top our resident who has unfortunately had several medical emergencies since moving here in 2012 so he's been seeing this from the patient's point of view and how everything works Jeff Martin welcome to the program thank you so just. Real briefly and you've given us permission to talk a little bit about this you've been flown out of Tonopah for medical emergencies 5 times in 7 years and I'm kind of curious I think people are curious about what that experience is like it can be nerving completely nerving you know when it 1st started there was a hospital here. So it was a little more comfortable you go in. They could kind of diagnose you and if if they felt that they couldn't treat you here then they would fly you out so the 1st time was in 2013 and I was flown to Las Vegas I had they did an m.r.i. And I had some sort of valid struction or abscess that had perforated and it was serious enough for them to fly me out and I spent probably week in Las Vegas basically high dose antibiotic. In 2014 I woke up in the middle of the night and I couldn't breathe I actually thought I was having a heart attack the hospital was still open and I went down at about 2 in the morning the nurse on duty knew exactly what was going on my blood pressure had dropped to 62 over 48 I was septic for whatever reason she put 3 to 4 I.V.'s in my arm probably saved my life and then flew me out and then the next time there was no hospital service here there was only ambulance service and got up in the morning severe abdominal abdominal pain and I could hardly get up the we called the 911 The ambulance came out and they said well we could take you to Hawthorne I said I could take myself to Hotham so my wife drove me to hospital and by the time I got there I was in pretty bad shape I really don't even remember. Hot Florence sent me to Reno and what had happened was that. Abscess bowel had perforated it had actually raptured and. I was flown to Reno they immediately removed probably 18 inches of the bell and. You know I was in the hospital for probably close to 3 weeks and. Every time you do this how much is the cost. A flight out of Tonopah to Vegas or Reno is a approximately $40000.00. You have insurance I do have insurance but the 1st time I didn't I didn't we just got in here so you're still paying on that I'll be paying on everything probably for the rest of my life how much do you think all of these emergency transportations have have built up in terms of what you owe Oh well probably well around $100000.00. You know I don't get too personal here but do you work oh yeah yeah I'm going to or guy to put the money part so does that I know you probably have a lot of bills difficult to pay that off you do what you can you know you are responsible for your own medical bills you know so now you know when you had the hospital here as you said you went in the one time the nurse knew right away what to do what's it like now where do you go when you have an issue so when the when that clinic came in you know a lot of people Bock at it and to me I thought it was a good idea you know all the girls that work there live in the community so you can go to dinner just about anywhere sometimes and see them you know and know that they're here and know that they care so going into the clinic where they have the telemedicine. It's not it's really nice it's really nice you're able to sit and talk to your doctor in Reno and. They spend time with you you don't feel like your cattle being rushed in and rushed out you know they spend time with you which which is really nice so it doesn't matter if the person is actually there physically as long as they're there and they're spending time with you talking about your issue correct so you know it sounds like you had a much different experience than the woman recording we played earlier have have you had any serious issues lately oh yeah yeah so you would think with all the issues that I had with the with the with the bells that they would have taken my appendix out when they were doing it but they didn't and. Earlier this year I had appendicitis and I probably walked around with it for a couple months and then eventually you had a. You walked around appendicitis for yeah. Or did you go find the go for help so I went to Bishop and but how do you get there my daughter drove me why didn't you take an ambulance I've been through it you know I didn't feel like I was to the point where I needed an ambulance you know I I'm still paying on so much service that it would just be easier for me to get myself or have my daughter drag me. I think people listening and maybe other parts of the state would find it. This isn't like the old West out here but to walk around in the penicillin just for a couple months seems almost unreal Well it happens you know you get used to some of that uncomfortable feeling and you don't think it's anything really serious so you just really kind of work through it you know yeah 150 years ago Doc Baker would come in in a carriage and he would fix you and you would pay him with a chicken you know so it's you know things have changed quite a bit. And leave a villager your assistant county manager for Nye County. The Nye County Commission the commissioners mostly in parampara I wonder how much of a concern what's happening here in tone about which is the county seat is to the commissioners most of again who are not from the city the only one of them is from Tony is a big you know the we've talked to people here some people wonder how much the commission really cares about them here. I could see why appearance of them not caring is there but they do I can honestly say that they do care. You know with with every day business and a lot of activity happening in Perth there is a lot of focus there but the interests of the northern one county residents are definitely there with the commissioners and Jeff Martin you've had all these issues $100000.00 of debt after insurance for the transportations Why do you stay here. It's rural Nevada it's a different way of life people live in rural Nevada because they like the feeling of. Not big government you know you're free to go 15 minutes out and shoot your gun you know I can walk 10 minutes from my house and be behind a mountain and I can't even see the town so it's just it's just a rumor that it's really a neat place to be every way Jeff isn't the only one worried about emergency medical services here at the Tonopah senior center we talked to Reverend Tina Snyder who echoed some of Jeff's concerns I'm fairly concerned about the people in this town because the. The possibilities for emergency care are so slight in this area and the people that we have here both people from are now and people from tone apart primary care. Just spend over backwards to try and take care of us but when we don't have sufficient facilities there's no possibility of doing what really needs to be done for people in the sinewave matter so I'm hoping there are politicians Well I understand that even though for rural area and we do not have a high census we're people we need help. We need help. Obviously it sounds like in terms of emergency care facility that my becoming is what about a hospital one of the things maybe might are in the works here and this really fronter town of Tonopah. The hospital district is currently working on a facility needs assessment on the existing and eye Regional Medical Center and hopefully that assessment will determine that the facility can be used once again I don't know if it will be used as a full hospital with operating room like it had in the past but I do know that the goal is to at least open up some sort of 247 urgent care might there be a need to perhaps boost the mill rate the property tax rate to. To provide more money so that that kind of structure can be built and maybe to draw M.D.'s or other health care providers in a perfect world but the tax capped the tax is capped again what about incentive programs for medical providers and I mention this because the state did this year approve a program where they're going to get matching funds from the federal government that will pay off the student loans of medical providers if they move to rural parts of Nevada and stay there for at least 2 years is nigh County interested in trying to find and to working with the stay on that program yes and as a matter of fact just in Zimmerman he's the trustee for the hospital board we've had that conversation and they've been trying to put together agenda items to discuss incentive programs and that one in particular so absolutely open to that opportunity Jeff Martin what would you think if I mean do you think things would be that much better because you talked. Pretty positively about telling that how much different you think it would be if they had you know they we talked to Mary Peterson who is a nurse practitioner but if they had a m.d. Here a medical doctor how much difference would that make to you but I think you make quite a bit of difference I think people when you when you live in rural Nevada or anywhere in America the Traill we've got to be a little more proactive in your own health health care you know what's the 1st thing they do when you when you go in they check your blood pressure and your temperature do that at home you know it could tell you a lot the other thing I'd like to say is from Las Vegas to Reno there are more electric car charging stations in there are health facilities something to think about do you do you have some of those books like a blood pressure Cup at home I do I do you know when you can buy them for a few dollars you know and they work. Effect I mean is that what you have to do in a town like this to survive do a lot of people do that here i know i do it and you know it's when I start feeling down I'm going to check my blood pressure and temperature you know if it's up or down I'm kind of know which way I'm going so you see me pretty relaxed right now I am really. I've been through it so I know. It is the Health District tracking health care outcomes you know since they approved the tax the $1100000.00 that's coming in to provide more care is there are there statistics being gathered or is that something that the county is thinking about doing. The hospital district I believe they are with their needs assessment they have been conducting workshops on the needs assessment so they're working on those on those trends. And the county fully supports the county itself is not conducting those types of. Studies but the hospital district part of the reason I asked that question is obviously we're from out of town but we talked a lot of people here and one person we talked to said he could count maybe 11 deaths that he thought would have been prevented had they had a hospital here is that the kind of thing you people talk about Jeff Martin. You know a lot of concern about out on the road you know people in Las Vegas you know they can call the emergency services and they'll be there in a matter of minutes and they could be in a hospital in matter of 510 minutes here not so much I live 150 yards away from the fire station it's a volunteer fire department It takes a while so just kind of those things to think about. There is a future for health care into an appalling in northern I counted and we have been talking live with patients and providers here at the tone of our convention center you can find a link to this program and we're going to be doing additional ones because we are focusing on rural health care in Nevada over a series of radio segments in the coming weeks you can find these all at k. Npr dot org I want to thank everybody including Loreena Dillon Ger Jeff Martin for joining us today next week tune in for more on the state rural health care in Nevada with a focus on changes in policies and laws and looking ahead this is State of Nevada. You see here 9 k. N.p.r. In Las Vegas Sunday point 3 in chaos show you St George 917 Carolyn Arpan Akon and Katie ph Tonopah 887 k.w. P.r. Lundy Lee 893 Ok I'll pay our Alco 891 k. V. N.v. Some valley Reno and k. Npr dot org with classical music on h.d. 2 in jazz on h.d. 3 about a public radio from the campus of the College of Southern Nevada there are a lot of shows were saying in Las Vegas and you'll find a few of them in the online box office at k. Npr dot org When you purchase a ticket from us to price you pay stays right here to help keep the news and information on here and tickets are specially priced there are no added fees and there are no taxes depending on the availability in the box office or find a Vicks a veteran performers and a newer acts performing at venues all around the city find all the details that k. Npr dot org Darwin's 9 and he's a kid who I know people just give him stuff I mean my coworker of evil he was playing with a soccer ball somebody gave him getting a taco somebody else gave him and I went to Mama's explaining on this as a member muscles you know well that look I have. But can you just describe what just happened let me err I have no idea she says a man as you're talking about people does give him things like buy and give you to give you yes yes. Yes but 10 places you put a good deal is why they give you that.