Emergency-room needs tax small towns. RURAL HOSPITALS FIGHT COSTS

Many small towns in the rural northern Rockies are scrambling to find new ways to keep hospital emergency rooms open. Bonners Ferry is a prime example. Here people earn their living logging, mining, and working in sawmills. Industrial accidents are not uncommon.

But here, as in other small communities, there are few physicians to share emergency room duty - especially on weekends - and less money to pay for expensive equipment. Patients who live in the area tend to be under-insured and sometimes cannot pay at all.

In these rural communities, general practitioners take emergency-room duty in return for hospital privileges.

But in many small towns there are not enough of them to staff emergency rooms around the clock. Physicians drawn to the region in search of small-town living and the great outdoors say they have found themselves in a rural emergency-room rat race.

Rural hospitals don't have the option of simply closing emergency rooms. That would be illegal, explains Idaho Hospital Association president John Hutchison.

``A lot of our hospitals are having to pay physicians to come in on weekends to relieve our physicians, who just can't take it,'' he says.

This happened at Newport Community Hospital in northeastern Washington, where two doctors were on call 15 days a month, 24 hours a day. Last November they gave the hospital board a month to find other physicians to take weekend emergency-room shifts.

Several physicians from outside the area agreed to take the weekend duty. But the hospital has to pay some $1,000 a weekend for room, board, malpractice insurance, and salary.

Here in Bonners Ferry, at the northern tip of Idaho, four doctors share emergency-room duties at the Boundary County Community Hospital. They, too, are seeking relief.

``For the most part, the utilization of those rural emergency rooms is relatively low,'' says Burnell McGlocklin, an accountant with the Spokane, Wash., firm of Lemaster & Daniels.

With hospital clients in Idaho, Washington, and Oregon, he is familiar with the problem. Among hospitals he serves, Mr. McGlocklin explains, those that are not suffering under the burden of emergency-room service either have a wealthy benefactor to support the added burden or are able to pay the cost by levying special taxes.

But in Boundary County, the hospital is partly supported out of the county's general fund.

So far, County Hospital officials and staff are still only talking about how to relieve the emergency-room schedule, since little money is available.

In Newport and in Libby, Mont., a partial solution has been the hiring of physicians' assistants or nurse practitioners, who handle routine emergency duties but call in a doctor when the problem exceeds their training. But there still must be a doctor available.

A few towns, like the ski resort and arts community of Sandpoint, Idaho, are able to attract medical school graduates who want to practice specialty medicine but are willing to take emergency-room shifts in return for hospital privileges.

Most of the rural towns in the northern Rockies, however, are unable to support such specialists.

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