By Lowell Quenemoen M.D.
Winchester is the county seat of Clark County named for George Rogers Clark and formed from portions of Fayette and Bourbon Counties, parts of the original Virginia Land Grant. Winchester was founded in 1792 and currently has a population close to 18,400 people with a county population of 35,620. Winchester’s proximity to Lexington means that a significant number commute to work each day and use Lexington services as well as medical services.
Within the county, medical services are provided by a number of primary care physicians, nurse practitioners and physician assistants as well as local subspecialists and visiting subspecialists serving outreach clinics. More than 100 providers are included on the local hospital roster. Public health issues are covered by a large county health program which includes both the health department as well as home health services,
The medical center for the community is Clark Regional Medical Center, a new facility completed in 2012 and part of the Life Point Health Group. Eight other Kentucky hospitals are part of Life Point which is headquartered in Brentwood, Tennessee. These include Versailles, Paris, Georgetown, Mayfield, Somerset, Russellville, Maysville and Lebanon. The local hospital was established in 1917 and was acquired in 2010 by Life Point as a for-profit facility. In 2011 Life Point joint ventured with Duke University to form Duke Life Point, a service organization providing advanced academic medicine from non-profit Duke and operations strengths and capital from Life Point. As a national presence Life Point now is affiliated with 64 hospitals and Duke Life Point with 11. The joint venture mirrors other name brand facilities such as Mayo Clinic, M.D. Anderson and Sloan Kettering who are involved in similar partnerships.
CRMC is approved for 79 beds and provides essential services including Emergency Care, Diagnostic Imaging, Surgery, Critical Care and Rehabilitation. Women’s Services has been expanding with additional Ob/Gyn coverage and over 700 deliveries this past year. CRMC CEO, Cherie Sibley, states that two other areas cardiology and oncology are also enlarging.
In cardiology two local cardiologists, Richard Dinardo and Charles Salters provide diagnostics and care with invasive cardiology (caths and stents) performed in Lexington at St. Joseph’s and UK. Dr. Salters notes that chest pain and suspected coronary insufficiencies can be monitored in Winchester but protocol mandates that any s/t wave elevations on EKG prompts emergent transfer to Lexington. Cardiac rhythm disturbances are monitored locally with in-hospital monitoring, followed by Holter monitoring or longer duration event monitors. Pacemaker/defibrillator placements are done in Lexington.
In addition the new medical building contains a 6 bed infusion suite where IV chemotherapy can be provided in a local community setting reducing travel time and discomfort for patients.
In the ER emphasis has been placed on prompt efficient care provided by Team Health with 5 rotating physicians along with experienced nurses, technicians and staff. Current wait time averages 21 minutes with average Within the ER tele-neurology is now available for early stroke diagnosis.
Future plans include the addition of another 45,000 square foot addition which will mirror the current Medical Plaza Building completed in 2012. This will provide further clinical space as well as consolidating other hospital departments and services currently located off campus.
Katy Hedge, Director of Marketing, also pointed out the acquisition of a mobile clinical unit which will service outreach screenings and possibly clinical services on a scheduled basis in some of the more remote rural areas.
Inpatient mental health and substance abuse/detoxification are available thru a sister Life Point facility, the Bourbon County Community Hospital’s affiliated Stoner Creek Behavioral Health Center.
Public health services are provided by the Clark County Health Department which includes the health department as well as home health services and is directed by A. Scott Lockard. Unlike traditional medical services which focus on the health of the individual patient these services are directed at the health and quality of life of the community as a whole. The State Department of Health which oversees local health departments is part of the Cabinet of Health and Human Services. Local health departments are one of three types: Independent, such as Fayette, District which serve multiple counties or Single County where Clark County falls.
The range of services provided include broad classes such as physical environment (air and water quality), social and economic factors effecting the basics of survival and clinical elements which involve the whole community. In the first group issues of pollution, wells, sewage systems and inspections of food and health facilities fall. In the second are disaster preparedness and response, housing support and food assistance for families. In the third are included specific health screenings, vaccination programs, contagious infectious disease monitoring, family planning services and the HANDS program providing guidance and care for families with prenatal needs up to two year olds.
New pressures on the community health system have included marked increases in HIV and Hepatitis C as evidenced in rural Indiana and attributed to shared needles in IV drug users. This was addressed in Kentucky with Senate Bill 192 funding needle exchange and now awaiting local approvals.
As with much of medicine there has been a major shift in financing in public health. Mr. Lockard has noted 13 recent budget cuts and with the Affordable Care Act has seen further cuts in federal funds. To make up deficits local health taxes have been increased. Specific services are now being billed directly to Medicare, Medicaid, VA and to private insurances. Also more private and federal grants are being sought.