From staffing shortages to lack of guidance, the pandemic made Texas’ rural health issues worse, providers say

Since the start of the COVID-19 pandemic, health care systems and hospitals in rural Texas have had to scramble to meet the needs of patients with limited resources, Lorenzo Serrano, the CEO of Winkler County Memorial Hospital, said in a Wednesday panel with health care providers moderated by Texas Tribune CEO Evan Smith.

“The standard of care in rural hospitals — it's the same as your urban markets,” Serrano said. “We just have to figure out how to do that with less staff, less resources, less financial resources.”

Winkler County Memorial Hospital has nearly 100 employees and serves a county population of about 9,000 Texans. The hospital was already facing staffing shortages that the pandemic exacerbated, Serrano added. He said the hospital incentivized staff to work double time by agreeing to match the pay rates that staffing agencies were offering.

At Coryell Health in Gatesville, tertiary facilities that doctors would often transfer patients to were also facing staffing shortages, exacerbating the overall strain on resources, said Diedra Wuenschel, a doctor of osteopathic medicine.

“They no longer have beds when they have a staffing shortage, which means that we're having to keep patients that we normally wouldn't keep in our rural communities and take care of them,” she said.

At the height of the pandemic, there were no available beds in the intensive care units, Wuenschel said.

On top of that, medical providers were stretched thin. Serrano said Winkler County Memorial Hospital also had to meet “burdensome” reporting demands from government officials at the state and federal level. Wuenschel was getting calls from local schools and day cares for guidance on whether their COVID-19 metrics indicated they should shut down operations.

“It was me helping them to decide if the day care needed to close. We were helping everybody navigate this,” Wuenschel said. “It was our duty to help them keep everyone safe within the school district as well.”

Health care systems also had to overhaul some of their operations in response to the pandemic. Winkler County Memorial Hospital, for example, implemented drive-thru clinics and a telehealth system to mitigate the spread of the virus, Serrano explained.

But telehealth worked to a certain extent, Serrano said. Some communities did not have sufficient broadband access.

“We tried to do telehealth in our traditional way. Unfortunately, we quickly learned that it just wasn't going to work,” he said. “So we switched over just to phone visits.”

The pandemic also affected the providers’ bottom line. From 2020 to 2021, Winkler County Memorial Hospital experienced about a $4 million decrease in patient care revenue. Federal funding through the CARES Act and grant funding at the state level helped rural health providers offset revenue loss.

Health care leaders said another challenge was addressing vaccination hesitancy in rural communities. Grady “Sam” Hogue, interim head of the Department of Primary Care and Population Health at Texas A&M College of Medicine, said vaccination efforts were met with skepticism, particularly among Black and Latino Texans, because of distrust of institutions.

Providers tried to tackle that distrust by visiting religious spaces. Hogue, for example, went to a vaccine clinic at an African American Baptist church.

“If you ask them, ‘Why are you getting a vaccine?’ the large majority were getting the vaccine because their loved ones died. I can't tell you how distressing it was,” Hogue said. “We need to regain our trust in our patients. We need to listen to them, not dictate to them. We need to have physicians leading health care, not politicians.”

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