A mother of four, Christy Laxton has seen her share of broken arms, fevers and coughs.
There was the time when her then 8-year-old daughter broke her arm, the bone’s fractured parts nearly visible through her daughter’s skin.
The accident happened at their house at dusk, forcing the family to drive 50 minutes to the nearest hospital, in Beckley, for an X-ray then an overnight stay to get a cast.
That was the closest option for care.
There’s no medical care after 4:30 p.m. in Wyoming County, and that’s the way it’s been for decades.
“There have been many times after 4 or 5 o’clock that one of my kids has started running a fever or gotten hurt at home or practice, and we’ve had to go outside of the county to get care,” Laxton said, noting the extra cost for gas money on top of medical costs.
Health care access in Southern West Virginia is a longstanding issue due to hospital closures and a lack of specialty care. But a group of Wyoming County residents have set the ambitious goal of bringing in after-hours care to their community in a few years by pursuing a nontraditional model.
The county is one of the state’s unhealthiest, according to a report from the state’s Department of Health and Human Resources, with many adults living with fair to poor health.
“You’re only as good as the health of your people,” Landon Blankenship, a lifelong Wyoming County resident and chief nursing officer for Hospice of Southern West Virginia, said.
“We are really struggling in Wyoming County.”
‘We really need this service’
Wyoming County hasn’t had a hospital with an emergency room since Wyoming General Hospital, in Mullens, closed in 1988 due, in part, to a decrease in population.
It’s the only one of its surrounding counties — Boone, Logan, McDowell, Mercer, Mingo and Raleigh — that doesn’t have a 24-hour emergency room.
Depending on where you live in Wyoming County, a hospital could be about 25 minutes away, but more isolated towns could be more than an hour away from the nearest care.
“Geographically, it’s kind of nightmare,” Blankenship said.
The county faces a myriad of longstanding issues common in the state’s coalfields: an aging and declining population, limited specialty health care providers in local communities, and a lack of employment following shuttered coal mines. One-fourth of its residents are living in poverty.
There are a handful of daytime medical clinics: Family Healthcare Associates Inc., in Mullens, Oceana and Pineville; and Tug River Health Center, a children’s clinic, in Pineville.
Family Healthcare Associates closes its clinics at 4:30 p.m. Dr. Sam Muscari, who is one of four doctors practicing in the clinics, said the doctors take after-hours calls from patients.
The children’s clinic also closes at 4:30.
For Laxton and other parents, after-school sports injuries or middle-of-the-night illnesses mean packing up a sick child — or possibly the entire family — to drive for care.
When Laxton’s son, now 6, was just three weeks old, he began having trouble breathing late at night.
As she made the 50 minute drive to Beckley, her son was coughing and wheezing. She couldn’t see him because he was in his car seat facing the opposite way.
“It was three or four in the morning,” Laxton said. “You can’t see him and he’s having a hard time breathing. I stopped on the way to make sure he wasn’t gagging.”
It turned out her son had respiratory syncytial virus, or RSV, that required a week-long hospital stay.
“Things like that are just tough,” she said.
There are three ambulance services in the county; however, the average transport time tends to be 45 minutes.
Many county residents don’t live by main, easily-accessible roads, according to Stephanie Lusk, an extension agent with WVU Extension Service in Wyoming County.
“A generous amount of folks live up a holler or on top of a mountain. It’s a considerable amount of time if it was an emergency for an ambulance to get them,” she said.
Susan Stafford, director of Head Start for MountainHeart Community Services, in Matheny, regularly works with low-income mothers and pregnant women in the county. Her agency also serves individuals recovering from opioid addiction.
It’s one of a few nonprofits in the area, and Stafford said they sometimes offer transportation to doctor’s appointments limited to daytime hours.
“We’d love to see a MedExpress Urgent Care or something” she said.
When it comes to prenatal care or pregnancy issues late at night, she explained that sometimes the women she serves can afford to pay someone to take them to Beckley or another county hospital. But, sometimes they can’t.
“It prevents people or stops people from seeking care after hours, and that can be life threatening,” she said. “We really need this service.”
Blankenship pointed to the area’s recent tourism boost, as people travel to Mullens and Pineville to ride ATVs on the Pinnacle Trailhead of the Hatfield-McCoy Trail System. There’s also a push to build up the Guyandotte River Trail as a means of some income in the struggling former coal towns.
He said there’s a concern that something could happen on the trails that often see kids riding ATVs.
It could be “45 minutes to an hour” to get care, he emphasized.
Partnering for a possible solution
Recently, there’s been a growing push to bring some type of after-hours clinic to the area.
A group of residents, including Laxton and Blankenship, recognized that the odds of getting a hospital or something like an Urgent Care are unlikely, so the group is looking to partner with a nonprofit or university to bring increased medical care into the county.
Terry Bartley, a communities coach with the West Virginia Community Development Hub, has been facilitating conversations for a year among community members and potential stakeholders in Pineville.
The Hub, based in Charleston, helps communities across the state prioritize development and facilitate economic opportunities.
Bartley and the group of residents, who dubbed themselves “Healthy Wyoming County,” have set the ambitious goal of opening an after-hours clinic by 2021.
The clinic would likely be funded primarily by grants, Bartley said, pointing to McDowell County, where a grant recently funded a needed school-based clinic.
“It feels weird to be confident about it because I know how daunting the idea of getting a clinic open in a couple of years is, but at the same time, the funding is out there,” he said. “I think we will be positioned for this to happen.”
Bartley hopes to partner with Southern West Virginia Community and Technical College, in Saulsville, to locate the clinic on its campus. The school, which hasn’t yet been brought into the conversation, does not offer a nursing program at its Wyoming County location.
Blankenship reached out to Future of Nursing West Virginia, which offers an entrepreneurship course to nurse practitioners looking to launch a health-related business.
“It’s about finding the right person,” he said. “I have been in contact with them about possible nurse entrepreneurs in the area who are interested in starting a business or looking to expand a business opportunity in the area.”
There was a push about 15 years ago to bring after-hours care to the county, according to Wyoming County Circuit Clerk David “Bugs” Stover. A lifelong Wyoming County resident, he also serves as the unofficial county historian.
He said budgets are likely keeping the county’s clinics from extending their hours.
“It seems to me if you could make money, you’d be doing it,” he said.
There are no medical providers in the county on board at this time, Bartley said.
Muscari, who is part-owner of the biggest practice in the county and is also a county commissioner, said he doesn’t see the need for the clinic.
According to him, hospitals are “within a half-hour of pretty much anywhere in the county” and there’s a “good ambulance system.”
“It’s a difficult problem and hard one to solve,” he said. “I really can’t see that type of benefit for finances. The cost would outweigh the benefits.”
The county’s medical providers are key to the project moving forward, Bartley said.
“They’re the ones who are going to be driving health care in Wyoming County. They know these patients, and they know what they need,” he said.
There are other obstacles: the rural location, the less-than-ideal operating hours, the cost and the space — more than 90 percent of the county’s land is owned by outside entities.
Yet, the team is hopeful.
“I think in southern communities, we often get beat down, and we feel like things shouldn’t be better than they are,” Bartley, a Boone County native, said. “It doesn’t mean it has to be like that forever.
“I hope the people of Wyoming County will continue to be vocal and continue to be passionate.”