In the fall of 2015, the Nye Regional Medical Center in Tonopah closed, leaving residents with no hospital for 100 miles, and becoming a symbol of the nationwide crisis in rural health care.
Jessica Thompson is a registered nurse. She worked at the hospital for almost 20 years before it closed.
"It was very scary for the community," she said. The community hadn't been without a hospital before.
Thompson had worked in the emergency room and knew the people and the medical issues that would be left to struggle.
She said that during the 10 months the community went without a hospital, people left medical problems to the "bitter end" and some people, especially the elderly, waited too long to see a medical professional.
“A lot of these medical conditions would evolve into something that could have been treated easily in the beginning to something that was now untreatable,” she said.
In the intervening four years, Renown Health and REMSA have started providing primary and urgent care through a local clinic and community paramedic program. And several other small providers have stepped up to offer family medicine, mental health, physical therapy, and other services.
One of those providers is Marie Peterson. She was a registered nurse when she first moved to Tonopah before the hospital closed, but she quickly realized the town needed more medical professionals.
“I saw a great, great disparity of services in Tonopah even just working in the hospital arena when I arrived from Las Vegas,” she said.
Before the hospital closed, Peterson went back to school to become a nurse practitioner, which allowed her to take on the duties of a primary care physician.
Peterson can write prescriptions and diagnose illnesses like hypertension and diabetes. She does have to get help from a medical doctor when it comes to more complex cases.
While she could make more money working in an urban setting, Peterson likes the rural life of Tonopah.
“I would say it's because it's where the heart is," she said, "I like being able to treat people as people. In a rural area, you are in such need, people are people. They’re not numbers.”
It is that rural lifestyle that draws people to Tonopah and other rural areas of the state despite the lack of services that people in urban areas take for granted.
“People in Las Vegas, they can call emergency services and they’ll be there in a matter of minutes and they could be in a hospital in five or 10 minutes – here not so much,” said Tonopah resident Jeff Martin.
Martin loves living in a rural area but he's been flown to emergency services five times in the seven years that he's lived in Tonopah. He now owes upwards of $100,000 in medical bills and transportation costs.
In fact, he walked around with appendicitis for several weeks until finally having his daughter drive him to the hospital in Bishop for treatment.
“150 years ago, Doc Baker would come in a carriage and he'd fix you," Martin said. "And you would pay him with a chicken, but things have changed quite a bit.”
Transportation is a major issue when the closest full hospital is 100 miles away and the closest Level One trauma center is 200 miles away in Las Vegas.
Dawn Gudmunson is a volunteer emergency medical technician in Tonopah. She said people often can't get to the hospitals in Bishop or Hawthrone - and they can't make their way back if they're taken there by ambulance.
Dawn Gudmunson/Photo: Chris Smith/Desert Companion
“A lot of them are calling us because they really have no transportation to get them to their primary care," she said. "So they’re using an ER as their primary care."
That lack of transportation can have dire consequences.
“It’s traumatizing. Literally. We’re seeing our neighbors. We’re seeing our friends and family sometimes pass away,” she said.
Gudmunson's own aunt died in her ambulance.
Matt Othmer is a community paramedic. He lives in Reno but travels to Tonopah four days a week for a shift as a paramedic.
He said with lives on the line, he and the other emergency services personnel have to step up the care they give to the highest level possible.
Othmer is also part of a program that provides weekly or even daily primary care to patients. The community paramedic checks in with patients to watch their medical dosages and vital signs to make sure chronic conditions are being managed properly so they don't become full-blown emergencies.
He said the partnership between the volunteer EMTs and paid paramedics is filling some gaps in care.
“We show up, and we can do certain tasks and administer certain medications that the local cannot, that the EMTs cannot," Othmer said. "But at the same time, without their help, without their ambulances, without their services, without both of us kind of working together, we would be unable to provide the services that (people) need.”
But gaps do still exist, especially in the areas of obstetrics and urgent care, Peterson said.
There is some potential hope on the horizon. The Nye County Commission has created a hospital district, which is being funded by a property tax increase.
“We created the district in order to generate revenues for medical services needed here in Nye County, the northern region,” said Lorina Dellinger, Nye County Assistant Manager.
Dellinger said the tax increase wasn't really opposed by anyone, because almost everyone agrees money is needed to improve health care in Tonopah.
She said the goal of the hospital district is to get 24 hours a day, seven days a week care to the area.
“The hospital district is currently on a facility-needs assessment on the existing Nye Regional Medical Center, and hopefully that assessment will determine that the facility can be used once again,” she said.
The hospital may not be able to return to a fully functioning hospital, she said, it could be home to urgent care.
(Editor's note: This discussion originally aired November 2019)
Jessica Thompson, RN, Director of Group Practice, Renown Medical Group - Tonopah; Eljena "Marie" Peterson, APRN, Owner, Tonopah Primary Care; Dawn Gudmunson, EMS, Tonopah Volunteer Ambulance Service; Lorina Dellinger, assistant Nye County manager, Nye County; Jeff Martin, Tonopah resident