Jacquelyn Martin / AP file (2016)
A patient has eight teeth extracted by a volunteer oral surgeon during a Remote Area Medical clinic April 29, 2016, in Smyth County, Va. The clinics provide free medical care for low-income people and those who do not have health insurance. Specializing in free dental, vision and medical care in isolated and poverty stricken communities, the group sets up mobile medical centers.
Sunday, April 30, 2023 | 2 a.m.
The sun was beginning to set when residents started lining up at the doors of Tonopah High School for Nye County’s first volunteer pop-up medical clinic in the town.
Stacy Smith, CEO of the Nye Communities Coalition, could see young and old residents joining the crowd despite the medical truck not opening until 6 a.m. — about 12 hours after the line started forming.
Some of those in line hadn’t seen a doctor in more than 15 years, and many had severe injuries or untreated medical conditions, Smith said.
This is a normal sight for the pop-up clinic, she said, especially in an area where access to medical care can be a challenge.
The clinic is, Smith said, “a huge benefit to us because one of our biggest issues is primary care, health care, mental health care, specialty care. And so, there are many people that are using our events as the primary care not just because of lack of insurance coverage, (but) because of lack of providers.”
The partnership between the coalition and Remote Area Medical began in 2016, and Smith played an integral role in bringing the pop-up clinic to Nye County and its roughly 50,000 residents. Since then, the organization has hosted a clinic in Pahrump annually — except for 2020 because of the COVID-19 pandemic — and expanded its reach to Tonopah this pastMarch.
During the two-day clinic, volunteers from the Remote Area Medical team traveled from their base in Tennessee to set up an 18-wheeler equipped with tools to perform dental and vision exams, psychological and mental health assessments, screenings for chronic illnesses and women’s care.
From getting a new pair of prescription lenses on-site to pre-screenings for cancer, the pop-up clinic has become a “life-saving event” that people will wait the entire year for, Smith said.
Best yet: It’s a free service.
Medically underserved
More than 100 million Americans experience challenges accessing primary health care, according to a study conducted by the National Association of Community Health Centers. Smith said it’s a problem that has plagued rural Nye County since she moved here 30 years ago.
Most of Nevada’s rural counties are considered medically underserved areas — a term used for counties that lack access to primary care services, according to the U.S. Department of Health and Human Services.
Southern Nye County — as well as neighboring Esmeralda and Lincoln counties — are all classified by the Health Resources and Services Administration as medically underserved areas.
In the University of Wisconsin’s annual County Health Rankings, which were released at the end of March, Nye County was ranked among the least healthy counties in Nevada in 2022. It exceeds the state average for residents with poor or fair health, poor physical health days, poor mental health days and low birth weights.
There is also a severe lack of health professionals, according to the study, with one primary care physician for every 3,430 people and one dentist per 5,350 residents.
Smith believes there are three factors at play in this shortage of health care professionals: a lack of interest in rural life, the belief that there is no pay equity in rural communities and small populations that would make it harder for providers to have a steady flow of income.
These make it harder to attract health care providers and keep them in cities, since most will eventually leave for better opportunities in metropolitan areas like Las Vegas, Smith said.
Pahrump is home to Nye County’s only emergency hospital, Desert View Hospital, which provides 24-hour emergency care. Pahrump, in the southernmost tip of the county, is about 60 miles west of Las Vegas.
“Because there’s not adequate primary care, a lot of people do end up at our emergency rooms and into our urgent care, but even (that) has struggled,” Smith said. “Our emergency room at the hospital here ends up taking on some of the burden of medical issues that should be taken on by primary care.”
But, according to Smith, there are no services for residents needing specialty care, and the lack of regular health care providers — like dentists — has been a persistent issue in the county.
Many Pahrump residents must seek specialists in Las Vegas. Other residents in areas like Tonopah will drive almost two hours across the border to Bishop, Calif., for services like dental care, said Dr. Jay Morgenstern, a professor at the UNLV School of Dental Medicine.
This can be an issue for older residents who may not be able to drive, which Smith said makes up a sizable portion of Nye County’s population, or those who can’t afford the trip.
Legislative fixes
In the ongoing Nevada legislative session, bills have been proposed to help with the health care shortage in rural areas. Assembly Bill 277, for example, would establish rural emergency hospitals across the state for underserved communities.
“Rural hospitals in Nevada and throughout the nation are facing a crisis,” AB 277 co-sponsor Assemblyman Greg Koenig, R-Fallon, said in an Assembly Committee on Ways and Means meeting about the proposal. “In recent years, many of these facilities have been struggling to maintain their operations and meet the needs of their communities. … It is a domino effect that impacts the entire community.”
The bill, which has bipartisan support, would designate rural emergency hospitals as a type of medical facility licensed in the state, authorize them to receive endorsement as a crisis stabilization center under a set of specific criteria, and require the state’s Department of Health and Human Services to increase reimbursement under Medicaid for certain services provided.
Blaine Osborne of the Nevada Rural Hospitals Association said since Congress greenlighted the emergency rural hospital designation in 2020, 10 states have licensed them. If AB 277 becomes law, 13 critical access hospitals — each of which have fewer than 25 beds — will qualify for the designation in Nevada.
With AB 277, emergency rural hospitals will be allowed to close their in-patient departments to allocate more support toward other areas like their outpatient units or radiology services, according to Osborne.
“This is essentially another tool in the toolbox to keep access to care in rural communities as it gives hospitals another chance before they close to try this model,” Osborne said.
Assembly Bill 120 would also help with opening the doors for medical volunteers by eliminating restrictions on the amount of time a health care volunteer would need to practice medicine professionally before donating their time.
For operations like the Remote Area Medical pop-up clinics, health care providers can only volunteer in Nevada if they have a valid professional license or certificate, are practicing the service they specialize in, are not accepting money in return and have practiced in their profession continuously for at least three years prior.
By removing the last requirement, Smith said this bill would make it easier for recent med school graduates and retired health care professionals to participate in these clinics.
“One volunteer, when they’re a medical professional, can make a huge difference,” Smith said. “It was just heartbreaking turning these people away that were experienced volunteers. … So that AB 120 is a big one for us.”
AB 120 has already won unanimous passage in the Assembly and is being considered in the state Senate.
Smith is hopeful that the health care provider shortage in Nevada will be addressed by the state’s leaders as more people grow familiar with this issue but said her team would continue to partner with Remote Area Medical, Morgenstern and local businesses in Nye County to meet the community’s health care needs.
The Nye Communities Coalition is expecting to serve around 300 people at its next pop-up clinic in Pahrump in October, Smith said.
“I think that we will continue to provide this for as long as we can get the partners together and as long as there is an interest (and) a need,” Smith said.
Volunteering their time
The need for health care solutions seen in Nye County is what motivates medical professionals and students in medical schools to donate their time, Smith said.
These volunteers — alongside the donated medical equipment — make it so that residents can be assessed and receive treatment on the same day. Many local businesses pitch in too, offering housing and food for the workers, Smith said.
Morgenstern organized the partnership between UNLV and the Nye County pop-up clinics when he began teaching at the university in 2018. He got involved with the Remote Area Medical team through one of his daughters, who volunteered for the organization in Tennessee while she was attending college and wanted to use this as an opportunity for student outreach at UNLV.
He took 10 students in his first year but has since added two more to the annual group.
Patrina Allen, a fourth-year dentistry student at UNLV, volunteered at the last two clinics in Tonopah and Pahrump. It was familiar territory for her as someone who volunteered at pop-up clinics in Virginia while studying dental hygiene as an undergraduate.
“It’s free dental care for people who are in need, and it’s just good experience for the students because we get to learn,” Allen said. “(And) the patients … they’re just very appreciative of what we do, so it makes us feel good.”
Most of the work she did during those clinics was tooth extractions, which can be necessary when a cavity becomes too severe to repair. Many who sat in her temporary dental chair not only struggled with access to care, but money to afford it as well.
The lack of dental care that many of these patients arrived with can be dangerous, even if it seems small, and putting off treatment can be even more costly, Morgenstern said. During the two-day clinic in March, Morgenstern’s team saw 200 patients and performed 289 total procedures — including extractions — that would’ve amounted to around $47,500 total in care costs, he said.
“The mouth is part of the body, and so, it is costing us as a society more medical care bills and more medical issues because of the fact that dental conditions do lead to further medical complications at some point,” Morgenstern said.
