I note with interest the front page OBSERVER articles on health care. We can all read the handwriting on the wall that the days of rural hospitals are numbered. Efficiencies created by advances in technology now require that the miracles of modern medicine need to be practiced in large urban medical centers.

The unsolved problem that remains is how to evaluate and treat people experiencing possible life-threatening emergencies to stabilize them and, on a timely basis, transport them to urban medical centers before the “golden hour” for successful treatment runs out. On the same front page, we read about the consequences of this problem being dumped on local ambulance companies that are now cutting back on the coverage areas, becoming paid rather than volunteer entities.

These ambulance companies suffer from the lack of trained local community volunteer first responders to assist them, they are often unavailable due to ambulance runs to distant emergency rooms where they are required to standby sometimes for hours leaving the local community uncovered hoping that the “fly car” EMT will show up. Helicopter ambulances are sometimes grounded due to equipment and weather condition problems.

Perhaps what might be on the horizon for Brooks and the communities in the Erie-Cattaraugus-Chautauqua Tri-County area is a freestanding emergency room set up, rather than a hospital. The only one that I know about functioning like it in Western New York is the Mercy Ambulatory Care Unit in Orchard Park operated by the Catholic Heath Care system. Here, patients can be stabilized before being transferred through the urban sprawl into the city medical centers.

If hospitals are no longer affordable, what would make better sense would be to provide freestanding emergency room coverage in all directions, to include more people living in geographically isolated communities. This can be done by establishing freestanding emergency rooms in Gowanda as well as one in Fredonia. The Fredonia unit could well cover emergencies in the Silver Creek-Irving area in a timely manner being less than 15 miles from the Lakeshore Hospital site, connected and quickly served by Routes 5 and 20 as well as the Thruway.

The question remains as to why some rural hospitals like Springville and Westfield and Jamestown manage to survive. What is crucial is the larger network they are connected with and their network’s assessment as to whether they can make money or not. The Catholic Healthcare Network works with Springville, along with Mercy Ambulatory Care to funnel patients south of Buffalo into their big urban hospitals for the complicated medical procedures they can make money on. In conversation with a Catholic Health administrator, the importance of finances was brought home to me when I was told, “Even the nuns have to work on a margin.”

Westfield Memorial Hospital owes its existence to the fact that it found a network center that would work with them: Saint Vincent Hospital in Erie that escaped being swallowed up by the University of Pittsburgh medical Center(UPMC) which controls Erie’s other hospital Hamot.

UPMC, Pittsburgh’s largest employer, the medical monolith was the entity assigned to administer Gowanda’s Tri-County hospitals finances after it was destroyed by the flood. They quickly concluded that Tri-County could not be rebuilt because, despite the local need for a hospital because the community was relatively “medical insurance poor” and it would not be financially viable. When it comes to making money, the non-union UPMC apparently feels that working with Jamestown is a better financial prospect than with the unionized Brooks-TLC.

In another OBSERVER article from the same issue, Mary E. LaRowe, now the current Brooks-TLC chief executive officer clarifies the current situation further by stating that the Kaleida network is not in a position to subsidize Brooks-TLC losses and goes on to identify “economic pressure from insurance companies” as a major factor in small hospital financial woes, citing the recent closure of several Niagara County rural hospitals.

This issue of medical insurance companies has been brought up in the current presidential campaign where a dirty little financial secret is now being highlighted by one of the candidates: “Last year the health-care industry made $100 billion in profits” A health-care news fact checker labeled this assertion true and went on to say that it is probably a low estimate. (If only the Buggy whip factory manufacturers had this much money to work with!)

The medical insurance industry has morphed into an unnecessary, unaffordable, and corrupt sacred cow that other advanced countries in Canada and Western Europe have long learned to live without quite well; while in this country: it is having a paradoxical effect as we see it destroying of the critical health care safety net for poor rural communities in Western New York.

Hopefully this November, we will all have a vote on a different approach to solve this. For the health of our rural communities, it cannot come soon enough.

William Cain is a Gowanda resident.