Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: FRIDAY, January 24, 1992 TAG: 9201240206
SECTION: VIRGINIA PAGE: A1 EDITION: METRO
SOURCE: CHARLES HITE MEDICAL WRITER
DATELINE: LENGTH: Long
38,000 LACK HEALTH CARE
DR. ANTHONY REMSON stopped practicing in Northwest Roanoke last summer, leaving a "gaping hole" in medical services to more than 38,000 people in that community. Local health officials say the area may be an ideal place for a federally subsidized health center.\ For years, Virginia Dixon visited her doctor at least every three months to get treated for a bleeding ulcer.
But after Dr. Anthony Remson left town this past summer, Dixon and other residents of Northwest Roanoke found themselves without a single physician's office in their community.
"I loved being able to walk to his office," says Dixon, a 77-year-old resident of Melrose Towers, a public housing project for the elderly.
"I really would appreciate it if we had a doctor on this side of town," she says. "Dr. Remson was the only one. Everybody started going to him. He built his practice up like wildfire. People on this side of the tracks got tired of going to the other side of the tracks."
Dixon found a doctor in Old Southwest. But she canceled two recent visits because her rides fell through. "With the bus I have to transfer, and then walk a few blocks. It's a little bit too much for me."
More than 38,000 people in Northwest Roanoke live within census tracts that have no physicians' offices.
Health care officials worry that this lack of doctors encourages many Northwest residents to postpone getting health care and forces some to rely on expensive and episodic treatment at hospital emergency rooms or urgent-care centers.
Medical and social conditions in this part of Roanoke are so critical that it meets state guidelines as a medically underserved area. More than a quarter of the population has an income below the federal poverty level; a large percentage of the population is elderly; the infant mortality rate is high; and there are a lot of unemployed workers.
Dr. Donald Stern, the city's Health Department director, says this part of the city also might qualify for federal funds to subsidize a community health center. Community leaders must support efforts to build a federal clinic if it is to become a reality, Stern says. He warns that a clinic alone does not guarantee residents in Northwest will have access to medical care.
"It would be nice to have physician services available in the area," Stern says. "But the problem is more complex than having a doctor around the corner. There are a plethora of social problems that contribute to medical problems there." Those include high rates of poverty, teen pregnancy and infectious diseases, Stern says.
There is a tremendous need for physicians to serve the Northwest community, says Dr. Maynard Law, a retired surgeon who opened an office in the area in 1935. By the late 1940s, 10 physicians practiced in the area, Law recalls.
"To think about the fact that we don't have any now. Well, it's hard to believe," he says.
Only three black physicians now practice in Roanoke, all of them specialists at Lewis-Gale Hospital.
A big factor in the lack of physicians in Northwest, Law says, was the integration of what had been white-only hospitals in Roanoke.
Until the late 1960s, black physicians almost exclusively used Burrell Memorial Hospital, a 92-bed facility on McDowell Avenue Northwest.
But when black doctors won the right to admit patients to white hospitals, the census at Burrell began dropping.
"It was as if you deny a group of people the right to own a Ford car and they become accustomed to that denial and then suddenly you announce it's OK for them to buy Fords," Law says. "There were many who bought a Ford just to find out what they had been missing. That's how many felt about the integration of the hospitals."
A decade later when Law retired from private practice, Burrell had less than 20 patients a day on average and only two doctors on its staff. Its emergency room closed. Then the hospital itself closed and converted into a home for adults. By 1980 it had filed for bankruptcy.
Law says the strain of a solo practice was too much for him. For years, he and other black physicians had informal arrangements to cover for each other. But by 1978 he felt alone, isolated and overworked. There were only three other black physicians practicing in the area and they were nearing retirement.
In the early 1980s, the board of directors of Burrell, which had been bought by the Carilion Health System, tried to recruit physicians for Northwest Roanoke. In 1984, Burrell struck gold. Dr. Anthony Remson, an internist, and his pediatrician fiancee, Dr. Cheryl Adams, agreed to set up practices in the former emergency room area of the hospital.
By most accounts, Remson and Adams had busy practices. A couple of years after coming to Roanoke, they relocated to an office on Melrose Avenue that had housed the area's remaining black physician, Dr. William Foster. With Foster's retirement, Remson and Adams were the only black doctors serving Northwest.
Adams, however, gave up private practice and became a student health physician at Virginia Tech. She continued to see a few patients on occasion in Roanoke.
Remson announced last summer that he was closing his practice to pursue training in public health administration.
Efforts to reach Remson in Louisville, Ky., were unsuccessful. A few months before he left Roanoke, he complained he was so busy he didn't have time to attend the funerals of either of his grandmothers. He said he looking for a partner.
Remson's departure "left a gaping hole" in medical care for Northwest Roanoke, says Dr. Al Hagy, director of the family practice training program for Carilion.
For more than a year, Hagy promoted the concept of a mobile medical unit that would serve the Northwest and other medically underserved areas. The state would provide money to purchase and equip the van while family practice residents, Health Department workers and even retired physicians would staff it.
State Medicaid officials liked the idea and proposed that $400,000 be included in the 1992-94 budget for the mobile van. But the project didn't make it into Gov. Douglas Wilder's budget.
"It's back to the drawing board," says city Health Director Stern, who believes the best solution for providing basic medical care in the Northwest now lies with a federally subsidized community health center.
Several years ago, when he was health director in Danville, Stern helped establish such a center in Sandy River, a rural community about 20 miles north of the city. The center not only brought a physician to the area, but it also got involved in broader community issues and the promotion of healthy lifestyles, Stern says.
Officials with Carilion, parent company of Roanoke Memorial and Community hospitals, say they want to do everything they can to help attract physicians to Northwest as part of their mission to promote appropriate, cost-effective care.
"We feel there is a need in that community," president Thomas Robertson said. "We need to get primary care physicians over there."
Part of Carilion's interest is self-serving: The better the care patients in that area receive, the less likely they will show up as patients in crisis at Carilion's emergency rooms or outpatient clinics, two areas that are traditionally money losers.
"We see a lot of people who should have gotten prompt medical attention but didn't," says Dr. Paul Dallas, director of ambulatory medicine at Roanoke Memorial. He knows of two of Remson's former patients who ended up in the hospital. They probably could have avoided hospitalization if they had established a relationship with another doctor, Dallas says.
Lera Martin, 62, put off going to the doctor more than six months after Remson left town. Her next appointment is early February. She often saw Remson twice a month for diabetes and high blood pressure.
"He was so convenient," Martin says of Remson, whose office was a quick bus hop or a short walk from her home on 17th Street.
Anita Price, an elementary guidance counselor who lives in Northwest, says her family now goes to an urgent-care center when someone gets sick. They have no regular family physician.
"It's kind of left us hanging," she says of the departure of Remson and Adams. Price and her husband went to Remson, while her three children saw Adams. "They were always accessible. We never had any problems getting to see them."
People without a family doctor worry Stan Hale, a member of the Burrell board who helped recruit Remson and Adams.
"When people don't have a family physician, there is a tendency for them to use the emergency room or an urgent-care center," says Hale, a former patient of Remson. "That's not a good substitute for primary care. You tend to put off seeking help until a medical problem becomes really serious."
Tom Garland, a pharmacist at the Econo Drug store on Melrose Avenue, can tell by looking at prescriptions that many of his customers don't have regular doctors. Their prescriptions come from the hospital or Health Department clinics or from the Bradley Free Clinic. Many customers used to be patients of Remson, whose office was next to the drugstore.
"A lot of these people don't have a doctor. It's a sad situation," Garland says. "Many have to go across town. It's difficult for them. Many have to pay someone to take them or take a cab. It's difficult to do by bus. The bus service on Melrose isn't that great."
Memo: CORRECTION