Pike County needs a hospital closer to home

Jul. 29--Editor's note: This story is the second in a two-part series exploring the demand for hospitals in northeast Pennsylvania. Catch up on the previous coverage in the Pocono Record or online at poconorecord.com.

STROUDSBURG -- As the number of sprawling healthcare facilities in Monroe County continues to grow, neighboring Pike County has yet to see a single hospital erected within its boundaries. That leaves some area residents with a drive of more than 20 miles to the nearest hospital.

Although a demand for certain services exists in those areas, several factors hinder the path for potential providers. In some of those cases, conditions are already improving.

Local economics

"The question of healthcare is a complex one," said Mike Sullivan, executive director of the Pike County Economic Development Authority. "It's partially held up by the very large amount of investment that must be made by a provider. They have to buy the land, build the buildings, get equipment, assign doctors -- it's a very large expenditure."

Of the limiting factors for economic development, one stands out in particular for Pike County: a lack of sewer service. That, coupled with already significant costs of staffing and maintaining a medical facility in a rural area, can prove prohibitively expensive for prospective healthcare providers.

"A hospital would need a sewer, and that's a big deal," Sullivan said. "Where we have a nursing home under construction right now, there was a piece of a land that had a sewer attachment. Once the seller found out the nursing home had to have sewer, the price went way up."

"So, a parcel of land selling on the market a couple years ago for $750,000 ultimately sold for $1.25 million. That was 7 1/2 acres."

Although a lack of infrastructure is a significant obstacle, it isn't insurmountable, said Bob Martin, senior vice president of the St. Luke's University Health Network. There are also other more daunting challenges for rural development.

"If you can't flush the toilets or turn on the electricity or water, you can't do much," Martin said. "That's also an issue in Monroe County, and so choices may be limited based on that. It's a very significant consideration in real estate development."

"However, I would say that's easier to fix than it is to find a specialist that wants to come to a more rural community. That's especially true when they've got unlimited number of options in a more urban area."

Construction of the St. Luke's Hospital -- Monroe Campus in Bartonsville cost the health network about $80 million. The decision to build there was not taken lightly, Martin said, but was instead reviewed by the network's Board of Trustees over a roughly 12-month period.

"While that $80 million is a lot, the cost of recruiting new physicians and sustaining services is also a significant investment," he said. "With construction, once that money is spent, it's over -- but the ongoing cost of recruiting physicians and advanced practitioners and subsidizing them is an ongoing expense and a significant one at that."

"Everyone wants a hospital close to home, I get that," he added. "But, they're expensive to build and operate. Even a small hospital, for example, that may only need one cardiologist, it can be hard to find one cardiologist to be in a community five to seven days a week."

"It'd be nice to have one in Pike County -- and I'm not ruling that out -- but we have to take all this into account. There is a shortage of physicians there, certainly within certain specializations. It takes careful development to make sure a new program is doing a level of quality service we're promising to the community. St. Luke's is recognized as one of the top 100 hospitals in America, so that's what people expect from us."

Geography

Three of Pike's five adjoining counties are located in New York or New Jersey, meaning that about half of the Pike County perimeter demarks the boundaries of the tri-state area. Those lines can be discouraging, said Sullivan, for regional health networks that are cautious about taking on an unfamiliar territory.

"If you were talking to a New Jersey or New York type of provider, they are hesitant to get involved in another state's regulatory problems," Sullivan said. "It's a whole new set of regulations. So, those types of things are practical inhibitors for people coming from other states into Pennsylvania -- they just don't want to deal with it."

The current spacing of hospitals creates a greater challenge for ambulatory services, which face rides of more than 20 miles for certain parts of Pike and Monroe counties. A limited pool of volunteers, on which many organizations rely, further adds to those woes.

It is struggle known to emergency medical service providers in rural towns throughout the country, said Debbie Kulick, president of the Bushkill Emergency Corps.

"There are ambulance services closing every day, particularly in rural areas," Kulick said. "It puts a strain on an entire system."

"Time and distance are critical factors," she added. "The closer you are at the start, of course, the better off you are. Unfortunately, there just is not enough funding to have people be close to everyone. Funding is a humungous challenge for every EMS provider."

Bushkill Emergency Corps provides services to Lehman, Porter and Middle Smithfield townships, as well as parts of Smithfield, Price and occasionally Delaware townships. Lehigh Valley Hospital-Pocono in East Stroudsburg remains the closest hospital for virtually all of those areas, although St. Luke's Monroe Campus offers a second option for some less urgent patients.

"The hospitals stay where they are," Kulick said. "For the EMS providers, who are the hospitals on wheels, without adequate funding, you have to work within certain constraints."

"Once we're called into upper Pike, we're gone for an extended amount of time. It creates a ripple effect going down through the layers of providers."

Even if healthcare providers were to construct a hospital somewhere in Pike County, depending on its location, that wouldn't necessarily negate all of the Bushkill-based EMS's challenges.

"I suspect it would depend where they placed it," Kulick said. "For us, if we're going further into Pike, it's a three-hour response turnaround before we're back into our service area -- at least three hours. Obviously if they build it somewhere like Honesdale, we'd be going much further. If they built it in Lehman, sure, we're coming back down sooner, but then it negates everything for people further into Pike County."

"I imagine that if a hospital did go up there, you might find another service that would take on that area. I just know that right now, it's not cost effective with the current situation for services to be running up there. Most of the services that way have depended on volunteers, and it's hard work to be able to have enough volunteers to sustain an organization. We're uniquely blessed to have both career and volunteers, and we work hard at that to keep the operation going."

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