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FEATURED: Alberto H. Gutiérrez, MD, Assistant Medical Director, DHR Health Hospice. Gutiérrez, through the use of the live Internet video broadcast known as Zoom, on Tuesday, October 5, 2021, testified from the Valley before the House Committee on Public Health, which was meeting at the Texas Capitol Complex in Austin. ‘We are growing economically, we’re getting there, and all I ask is you keep us in mind when you promote new programs, new ideas, and bring us from the bottom of the list to the top at times, and help us not only in health care issues, but in other things.”

Photograph Courtesy DHR HEALTH

FEATURED: Alberto H. Gutiérrez, MD, Assistant Medical Director, DHR Health Hospice. Gutiérrez, through the use of the live Internet video broadcast known as Zoom, on Tuesday, October 5, 2021, testified from the Valley before the House Committee on Public Health, which was meeting at the Texas Capitol Complex in Austin. ‘We are growing economically, we’re getting there, and all I ask is you keep us in mind when you promote new programs, new ideas, and bring us from the bottom of the list to the top at times, and help us not only in health care issues, but in other things.”

Photograph Courtesy DHR HEALTH

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DHR Health proposes ideas to House Committee on Public Health to help improve medical and health care needs for Texas-Mexico border region

By DAVID A. DÍAZ
[email protected]

Health care in the Rio Grande Valley is still out of reach for too many hardworking people who suffer from poverty, do not have enough education, and lack affordable or dependable transportation to get routine medical check-ups and medications that can help prevent chronic diseases, according to Alberto H. Gutiérrez, MD, Assistant Medical Director, DHR Health Hospice.

Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases such asheart disease,cancer, anddiabetes are the leading causes of death and disability in the United States. They are also leading drivers of the nation’s $3.8 trillion in annual health care costs.

https://www.cdc.gov/chronicdisease/about/index.htm

Health care – two words – are the specific things that people do: see a patient or prescribe a medication, etc.

Healthcare – one word – is a system. Healthcare is an industry, the system by which people get the health care they need.

https://isilanguagesolutions.com/2019/10/15/health-care-vs-healthcare/

Gutiérrez, through the use of the live Internet video broadcast known as Zoom, on Tuesday, October 5, 2021, testified from the Valley before the House Committee on Public Health, which was meeting at the Texas Capitol Complex in Austin.

He and other health professionals in the public health system were among a number of witnesses invited to testify before the House Committee on Public Health.

The public hearing, whose subject matter was titled “Issues involving access to health care along the Texas-Mexico border”, also featured Rep. R.D. “Bobby” Guerra, D-McAllen, who serves as Vice Chair of the House Committee on Public Health.

The public hearing is available online by logging on to –

https://house.texas.gov/video-audio/committee-broadcasts/

then scrolling down to –

10/05/21 • 10:03 AM • 04h 27m Public Health

– and click that link.

Gutiérrez’ presentation begins at 38 minutes and 30 seconds in the video.

Gutiérrez, an Edinburg-based physician who during his 50-plus year medical career has treated more than one million patients, shared his experiences and knowledge about medical treatments and health care with Guerra and the other 10 members of the House Committee on Public Health, which is led by Rep. Stephanie Klick, R-Richland Hills, who serves as Chair of that legislative panel.

In addition to Guerra and Klick, the other members of 11-person House Committee on Public Health are:
• Rep. Steve Allison, R-San Antonio;
• Rep. Elizabeth “Liz” Campos, D-San Antonio:
• Rep. Garnet Coleman, D-Houston;
• Rep. Nicole Collier, D-Ft. Worth;
• Rep. Jacey Jetton, R-Richmond;
• Rep. Tom Oliverson, R-Cypress;
• Rep. Four Price, R-Amarillo;
• Rep. Regge Smith, R-Sherman; and
• Rep. Erin Zwiener, D-Driftwood.

“The high poverty rate, high uninsured rate, and physician shortages faced in the Rio Grande Valley create significant obstacles to accessing healthcare, which in turn results in many patients seeking care while in crisis at hospital emergency departments with advanced manifestations of disease,” Gutiérrez testified. “Lack of medical providers, and the high percentage of indigent families in the Valley are in dire need of additional funding, more reasonable prices for medications, and better access to medical help.”

In his presentation, Gutiérrez provided both spoken and written testimony, which will be used by Guerra and other committee members to develop proposed legislation for action by the Texas Legislature when it returns in January 2023 for its 140-day regular session.

Legislation is a proposed or enacted law or group of laws.

“I don’t know how you can conquer poverty,” Gutiérrez told the committee’s lawmakers. “Education probably is one of the best ways to do it. Getting people better jobs, educate them.”

From his written testimony, he noted that the Rio Grande Valley is one of the most economically-disadvantaged regions in the nation.

The Rio Grande Valley – Hidalgo, Cameron, Starr and Willacy counties, with an estimated combined 1.4 million population – regularly ranks in the 10 most impoverished counties.

But Gutiérrez also pointed out that education also includes teaching, learning, and putting into action, healthy lifestyles and access to foodstuffs – groceries such dairy products, meats, and produce.

“Dietary needs, nutrition, are very, very important,” he explained.

“Health is not all about medical care, but about prevention and making the right choices. Due to a lack of education regarding nutrition or simply a lack of affordable healthy food options, and food insecurity, there is a pandemic of chronic disease linked to obesity,” Gutiérrez stated. “The lack of affordable healthy food options is a significant concern – approximately 30 percent of children in the Rio Grande Valley are food insecure, and most often, the cheapest food available can be categorized as junk food.”

Junk food is food that is high in calories but has low nutritional value, typically produced in the form of packaged snacks needing little or no preparation.

https://en.wikipedia.org/wiki/Junk_food

“While I have laid out some serious healthcare access challenges we face on the border, not all is bad,” Gutiérrez reflected. “We have been making significant strides over the past several years in closing the gap. We want to ensure that all of our residents have access to the healthcare services they need.”

He said DHR Health is dedicated to improving access to healthcare in deep South Texas.

“To that end, DHR Health has and is investing millions of dollars in becoming the largest teaching hospital in the Valley, training 130 (medical) residents and fellows in 12 Graduate Medical Education programs in partnership with the University of Texas Rio Grande Valley,” Gutiérrez reported.

A resident doctor is a medical school graduate and doctor in training who is taking part in a graduate medical education program.

Healthcare facilities commonly refer to resident doctors as “residents”.

Graduate medical education refers to the period of training in a particular specialty (residency) or subspecialty (fellowship) following medical school.

DHR Health is the flagship teaching hospital for the University of Texas Rio Grande Valley School of Medicine and encompasses a general acute hospital with the only dedicated women’s hospital south of San Antonio, a rehabilitation hospital, a behavioral hospital, more than 70 clinics Valley-wide, advanced cancer services, the only transplant program in the Rio Grande Valley – and as of Wednesday, September 8, 2021, the only 24/7 Level One Trauma Center south of San Antonio.

A Level One Trauma Center provides the highest level of surgical care to trauma patients.

A Level One Trauma Center is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries that result from falls, motor vehicle collisions, crush injuries, impalement, knife or gunshot wounds, or other wounds that threaten a person’s life or limbs.

Prior to DHR Health’s designation as a Level One Trauma Center, the Rio Grande Valley was served by three Level II trauma centers – DHR Health in Edinburg, South Texas Health System in McAllen, and Valley Baptist Medical Center in Harlingen.

Anchored in southwest Edinburg on a 130-acre site, with a growing presence in neighboring McAllen, Rio Grande City, Mission, and Brownsville, DHR Health offers some of the most comprehensive medical care on the U.S. southern border, with more than 1,400 nurses and 600+ physicians providing care in 70+ specialties and sub-specialties.

Doctors Hospital at Renaissance, Ltd (“DHR”) and its general partner, RGV Med, Inc. (“RGV Med”) own and operate a 519 licensed bed general acute care hospital located at 5501 South McColl in Edinburg. The facility is one of the largest physician-owned facilities in the United States that began as an ambulatory surgery center in 1997.

“Moreover, we are working with Driscoll Children’s Hospital to establish the Valley’s first and only dedicated freestanding children’s hospital,” Gutiérrez further stated in his written testimony. “The establishment of a full-fledged children’s hospital will bring the most advanced pediatric services to our region and reduce the need for families to travel hundreds of miles to seek the care they need.”

On Friday, June 18, 2021, leaders with DHR Health and Driscoll Children’s Hospital in Corpus Christi announced their joint intention to build the eight-story Driscoll Children’s Hospital Rio Grande Valley, which will be located on the campus of DHR Health in Edinburg.

Driscoll Children’s Hospital Rio Grande Valley will provide the following services for children and juveniles (ages 0 to 17 years):

• Pediatric specialists;• Acute inpatient and outpatient surgery;• Emergency services;• Level III Neonatal Intensive Care Unit (NICU);• Pediatric Intensive Care Unit (PICU);• Rehabilitation: physical therapy, occupational therapy, speech therapy;• Radiology Imaging;• Laboratory; and• Child Life program.

Construction is expected to start later this year and be completed by late 2022.

However, deep South Texas and the Texas Legislature “still have a ways to go to ensure the entirety of our border communities have access to all the healthcare services they need,” he emphasized.

In his concluding spoken testimony to the members of the House Committee on Public Health, Gutiérrez called on the Texas Legislature to continue helping DHR Health and all other healthcare providers in promoting and expanding access to healthcare, public health, and public safety.

“All I am asking is that the Texas Legislature doesn’t forget about the Valley. Keep us in mind. We, again, on the border, have the poorest section of people,” he said. “We are growing economically, we’re getting there, and all I ask is you keep us in mind when you promote new programs, new ideas, and bring us from the bottom of the list to the top at times, and help us not only in health care issues, but in other things.”

To achieve those goals, his written testimony included the following recommendations for action by the House Committee on Public Health and eventually, the Texas Legislature and the governor.

• Significant investments to build a robust pipeline to train essential health care works, including but not limited to: nurses, respiratory therapists, sonographers, mental health care specialists, including pediatric mental health providers, and other health care professionals in short supply; and

• Adopt legislation to expand Medicaid and insure an additional 1.3 million Texans while taking advantage of an increased F-MAP as provided by the American Rescue Plan Act.

Medicaid and the Children’s Health Insurance Program (CHIP) provide health coverage for low-income children, families, seniors and people with disabilities.

https://www.hhs.texas.gov/services/health/medicaid-chip

F-MAP stands for Federal Medical Assistance Percentages, which are the percentage rates used to determine the matching funds rate allocated annually to certain medical and social service programs in the United States of America.

https://en.wikipedia.org/wiki/Federal_Medical_Assistance_Percentages

• Increase Medicaid rates for community inpatient psychiatric beds to support additional mental health capacity;

• Invest in education and economic opportunities directed at the border regions to lift people out of poverty and create opportunities for the future;

• Invest in programs to provide funding to community clinics to expand access to primary care and preventative services for the indigent;

• Invest in programs to reduce the cost of healthy food and make healthy food available to the indigent and children;

• Invest in programs to increase health and nutrition literacy to help people make better choices; and

• Use state and Local Recovery Funds from the American Rescue Plan to fund one-time investments in the State of Texas’ health care infrastructure to:

a. Respond to the COVID-19 pandemic, including mitigating ongoing and future impact;

b. Increase and develop capacity and resiliency in hospitals, community clinics, and the public health system to leverage COVID-19 innovations and be better able to respond to and address public health emergencies, infectious disease, pandemics, chronic disease, or other public health crises, and

c. Identify gaps in services; health disparities; public health and epidemic crises, needs, and response capabilities; develop better systems to share information and coordinate care; address health disparities; and increase access to care that will help improve health outcomes for all Texans.

Gutiérrez’ live Zoom discussion and his written report to the legislators was made possible by a decision in late June 2021 by Speaker of the House Dade Phelan, R-Beaumont, who issued a serious of interim assignments related to the Texas-Mexico border.

https://house.texas.gov/news/press-releases/?id=7509

The interim is the period between between regular legislative sessions.

The regular session is the period during which the Texas Legislature meets. The regular session convenes every odd-numbered year and may last no more than 140 days.

Twelve committees received a unique charge, with each of these committees also receiving a general charge to review the distribution of federal pandemic recovery funds and their potential use to respond to the border crisis in addition to their individual directives.

The Speaker of the House and the Lt. Governor issue interim charges, which are assignments for lawmakers on the committees on which they are members hear public and invited testimony, conduct research, and submit reports on issues deemed important by those two leaders.

These reports are then considered by lawmakers as they start to draft and consider legislation.

Spoken Testimony
of
Alberto H. Gutiérrez, MD
Medical Director
Hope Family Health Center
Assistant Medical Director
DHR Health Hospice

Texas House of Representatives
Committee on Pubic Health
Tuesday, October 5, 2021

Good morning, everybody. Thank you so much for the opportunity to testify.

My name is Alberto Gutiérrez. I was born and raised in Starr County here in the Valley. University of Texas at Austin graduate, medical school, medical center at Galveston, internship at Fresno County General Hospital, California.

We didn’t have medical residencies back then. Two years in the Air Force (South Carolina), and then I practiced for 30 years in Carlsbad, New Mexico.

My dad asked me to come home 23 years ago, so I have been back in the Valley for the last 23 years. I had a large practice. I turned it over to a young doctor eight years ago, and now I work for administration at Doctors Hospital at Renaissance.

I also have volunteered at the Hope Family Health Center for 21 years, Medical Director for the last 15.

I have been practicing medicine for 54 years. As of November 1998, I have treated one million patients. I’m working on my second million patients right now.

In Carlsbad (New Mexico), I was the only Hispanic (physician) in town. My name, address and phone number were in the phone book, and I did work 24/7. We did not have – back in the 70’s and 80’s – hospitalists, we didn’t have emergency room doctors. We had to manage our own patients in the emergency rooms, in the offices, in the streets.

(A hospitalist doctor focuses on patient care inside a hospital, rather than on a specific organ or medical issue, like an allergist or a cardiologist does. Hospitalist doctors are not the same as emergency doctors, though they may spend time in the emergency room.

We (Hope Family Health Center) started very small. The Hope Family Health Center was established by a nun and a priest 26 years ago when they saw how many of our poor and indigent populations here in the Valley were not getting proper medical care. They could not afford it.

Fifteen years ago (Hope Family Health Center) almost went broke. We depend on grants and donations. We’re not involved with any government entity to keep our clinic open. Donations are a big part, as are grants. Fifteen years ago, we were almost broke.

I had a talk with a man named Alonzo Cantú, and he and the administration at DHR Health started the Fishing for Hope Tournament, and that gives us some money to keep going.

(On Saturday, August 28, 2021, the 15th Annual DHR Health Fishing for Hope Tournament brought more than 140 teams to Jim’s Pier on South Padre Island to compete for prizes. It is one of the largest non-profit fishing tournaments on the Texas, coast. Along with the support of many sponsors, the 15th Annual Fishing for Hope Tournament raised $300,000 for the Hope Family Health Center in McAllen.)

So we are back to full operations again. We have served more than 5,000 patients a year. These are very, very poor patients. Some walk to the clinic, some ride bikes, some have to ask for a ride, and we do the best we can taking care of these patients.

The outcome is we keep them out of doctors offices, we keep them out of emergency rooms, and we do pay for services. We have to pay for their surgeries, imaging, hospital stays, and I have to get on the phone and ask the surgeons to please give us a break because we don’t have that much money.

As most of you know, the Valley consists of four counties – Cameron, Willacy, Hidalgo and Starr. Our areas is one of the 10th poorest in the United States, has been, and will probably continue to be for a while.

Our area has 1.4 million people, 90 percent from Hispanic ancestries. We present a populous (40 percent) that lives under the poverty level. Many poor patients live in communities called colonias – substandard living, poor sanitation, plywood house, cardboard rooms – and this leads to a lot of health issues. Our uninsured rate is 30 percent, double what the rest of Texas has, and triple what the nation has.

At the Hope Family Health Center, we treat all individuals who have no (health insurance) coverage.

For years, most of these are very, very poor people.

However, in the last couple of years, I have been seeing educated people with degrees – teachers, social workers – who say they cannot afford insurance. As long as they have no coverage, we see them, take care of them, treat them like any private patient.

Our biggest health issues in the Valley are obesity, hypertension, diabetes, and of course, depression. The statistics show that our area has 28 percent diabetics. I don’t think that is completely accurate. In my practice, 40 percent were diabetics.

The only section of populous that compares to us as far as diabetes are the Pima Indians in Arizona.

https://www.legendsofamerica.com/pima-tribe/

Diabetes leads to cardiovascular disease, peripheral vascular disease, loss of eyesight, and also impacts the kidneys a lot. Diabetes has a lot of health issues with it.

At our (Hope Family Health Center) clinic, we try to prescribe generic medicines only. These are the $4 kind. Often, our patients don’t even have the $4, and we at the clinic give them $4 to buy the medication.

I often see patients at the (Hope Family Health Center) clinic who haven’t take their insulin for four or five months, with sugar (levels) in the 400 to 500. Normal sugar (level) is 100.

(Blood sugar, or glucose, is the main sugar found in blood. It comes from the food that is eaten, and is the body’s main source of energy. Blood carries glucose to all of the body’s cells to use for energy.

Diabetes is a disease in which blood sugar levels are too high. Over time, having too much glucose in blood can cause serious problems.https://medlineplus.gov/bloodsugar.html)

In summary, lack of funds, lack of medical providers, and the high percentage of indigent families in the Valley are in dire need of additional funding, more reasonable prices for medications, and they need better access to medical help.
The Valley has been Texas’ stepchild for years, and you know that. But we are catching up.

Doctors Hospital at Renaissance recently was designated a Level One Trauma Center, the only one south of San Antonio. We’ll be able to service everybody south of San Antonio.

Driscoll Children’s Hospital is going to build a 43-bed hospital adjacent to our pediatric adjoining DHR, and that is going to provide the best of pediatric care to the Valley. Our mothers don’t have to go to San Antonio or Houston to get care for their kids.

We do have a medical school now, and a residency program, and we have two nursing programs, but we need more.

What I am asking, what we need is investment in training in more health care workers, doctors and nurses. Right now at DHR Health, we have many empty beds. We cannot bring patients in because we don’t have nurses to administer health care.

Investment in education.

I don’t know the answer to poverty. Education appears to be the best way to cover that poverty.

Offer blue-collar jobs to some of these poor young males and females – carpentry, mechanics, plumbing – so they can get off the streets and maybe have a trade. That would help.

We need to expand Medicaid.

So many, many of our constituent down here need that help. They have no other recourses.

We need some programs to reduce the price of healthyfood stuffs.

We need help from the state to help some our indigents be able to buy medicines at a lower price, and I don’t know how you fix that. But many of our patients are not able to afford even the $4 (generic) medication.

Transportation – another big factor.

Many of our patients cannot afford transportation. Some walk to our (Hope Family Health Center) clinic. As I mentioned before, they ride bicycles or ask a daughter or son to leave work and bring them to the (Hope Family Health Center) clinic.

Maybe there would be some program for those who are at poverty levels, they can get some kind of ID to be able to afford transportation to health care.

That is about all I want to tell the committee.

I want to tell the committee that we are in the poorest section of this state, of the nation, and we need help for better access to care for our poor and indigent patients here in the Valley.

I would like to answer any questions the committee may have at this point.

Rep. R.D. “Bobby” Guerra
D-McAllen

Mi amigo, Doctor. How are you?

Alberto H. Gutiérrez, MD

I miss having lunch with you.

Rep. R.D. “Bobby” Guerra

Yes, sir. We need to. I find you very enlightening.

Could you explain to the committee – we must keep in mind that this committee represents the State of Texas as a whole – why are all these issues that you brought up this morning important to all Texans?

Why is it important that we focus on these issues that you have just discussed?

Alberto H. Gutiérrez, MD

Rep. Guerra, first of all, you know that not taking care of these issues leads to early death for a lot of my patients. I lose a lot of 60-year olds to diabetes and hypertension (high blood pressure), partly because of (lack of) care. It is very important that we provide more access to health care. I want a patient to live longer, I want them to enjoy life longer.

Last summer, I had a 42-year old undocumented resident – a cook – who walked two mile to the (Hope Family Health Center) clinic, and said, ‘Doctor, something is wrong with my foot.’ Took off his boot, he had gangrene of the left foot.”

(Gangrene is dead tissue caused by an infection or lack of blood flow.)

He had been working for two weeks with gangrene on his left foot. I said, “Why didn’t you go see a doctor?” (The patient replied) “I don’t have any money. I can’t afford it. I heard that you here at the (Hope Family Health Center) clinic can help me.”

This is the type of stuff that we see. And of course, he (the patient) had amputation. It is very, very sad to see this kind of things happening, and we see it often. So, it is an issue. We need more access to health care, more providers, more nurses, more education.

I don’t know how you can conquer poverty. Education probably is one of the best ways to do it. Getting these people better jobs. Educate them as far as dietary needs, nutrition, are very, very important.

I have practiced in four states. I have practiced in California, South Carolina, New Mexico, and now the Valley. I have never, ever seen the poverty we have in the Valley.

South Carolina had a large populous of people of color, but nothing compared to the Valley. We have to make it better, and you are our biggest hope, you members of this committee hopefully can help us get access to better health care, more providers, etc.

Rep. Erin Zwiener
D-Driftwood

Thank you so much for joining us, Dr. Gutiérrez.

It seems to me to be a very common refrain of your testimony was the need for more access to care, and you mentioned several factors to that: having enough providers, people’s finances, the feasibility to get to an appointment. You also mentioned Medicaid expansion. Could you tell us more about giving more people access to health care coverage through Medicaid would help improve access in the Valley, in your view.

Alberto H. Gutiérrez, MD

As I mentioned, not having funds, not having the money, keeps many, many of our poor patients from seeing anybody. They don’t want to go to the ER (hospital emergency room), they don’t want to see a doctor, or they can’t. Pride, maybe. But Medicaid would at least help a lot of the poor people access to a doctors’ care, medication, and so forth. It would really, really help.

I would have check to see how many would qualify, but I can tell you it would be thousands here in the Valley who would qualify for Medicaid.

Again, having Medicaid prevents a lot of the issues that we have. They can have routine check-ups, routine medications, maintenance medications, so it would help a lot to have another source of funding for these poor people.

Rep. Erin Zwiener

Thank you, Dr.Gutiérrez. I know that Texas Medicaid reimbursement rates (to health care providers) are relatively low compared to other states, but do you think more patients having another way to pay for care would help recruit and retain more health care providers in the Valley?

Alberto H. Gutiérrez, MD

We try at DHR Health and other hospitals to recruit young doctors to come to town. They come, they look at it, they look at the demographics, and either they – and a lot of times their wives – don’t want to live in the Valley. It has been a trial trying to get them to come to the Valley.

I think this is a beautiful place. I love the Valley, and I have lived in beautiful states, but I love my Valley. But it is very difficult to get health care workers to come to the Valley.

Anything the state could do to help us, some kind of incentives, and we try. But we do need more health care providers. We need more than 700 doctors in the Valley. We are still very underserved. We are still looking for more providers. And yes, it would help.

Rep. Erin Zwiener

Thank you Dr. Gutiérrez. We as a Legislature are also looking right now on how to spend $15.8 billion of American Rescue Plan funds. Is there anything you want to ask us to keep in mind regarding access to health care in the Valley while we’re spending those funds?

Alberto H. Gutiérrez, MD

All I am asking is that the Texas Legislature is don’t forget about the Valley. Keep us in mind. We, again, on the border, have the poorest section of people. We are growing economically, we’re getting there, and all I ask is you keep us in mind when you promote new programs, new ideas, and bring us from the bottom of the list to the top at times, and help us not only in health care issues, but in other things.

At this point, we do need more access, more health care providers, more funding.

Written Testimony
of
Alberto H. Gutiérrez, MD

Texas House of Representatives
Committee on Pubic Health
Tuesday, October 5, 2021

Chair Klick, Vice Chair Guerra, and Members of the Committee, thank you for the opportunity to testify. Access to health care along the Texas-Mexico border is an issue of vital importance and I thank the Committee for holding this hearing.

My name is Dr. Alberto Gutiérrez and I have been practicing family medicine for the last 52 years, with a focus on serving the indigent and most vulnerable in the community. In my lifetime, I have treated over one million patients and am still practicing to this day.

For the past 15 years, I have had the honor of serving as the Medical Director for the Hope Family Health Center, a non-profit charitable clinic that provides free integrated medical and behavioral services to low-income and indigent residents of the Rio Grande Valley. During my tenure, I have overseen the clinic’s growth from a small clinic on the verge of closing its doors to one that has strong community partnerships and has 5,000+ patient encounters a year.

https://www.hopefamilyhealthcenter.org

I also serve as Assistant Medical Director for DHR Health Hospice, providing compassionate care to patients in their final days.

Situated on the U.S.-Mexico southern border, the Rio Grande Valley encompasses the four southern-most counties in Texas including Cameron, Hidalgo, Starr, and Willacy. According to the latest U.S. Census, the Rio Grande Valley has a population of approximately 1.4 million, however due to COVID-19 there was significant undercount, and it is believed that the actual population is somewhere between 1.5 million and 1.8 million.

Approximately 90 percent of Valley residents are Hispanic.

Although a vibrant and fast-growing community, the Rio Grande Valley is one of the most economically disadvantaged regions of the country. The four counties in the Valley regularly rank in the top ten most impoverished counties of the nation and 40 percent of all families in the region live below the federal poverty rate, which is twice the rate for the State of Texas as a whole.

Median family income ranges from $27,000 to $34,500 (about 50 percent of the Texas and U.S. median).

Unemployment ranges from 12 recent to 17 percent.

Additionally, approximately 240,000 residents in the Rio Grande Valley live in informal settlements (colloquially referred to as “colonias”) in unincorporated county areas with little or no infrastructure, substandard housing, and minimal or no access to essential services such as public utilities, health care, electricity, water, and fire and police protection.

Lack of healthcare access for a large proportion of the Rio Grande Valley’s population is rooted in extreme levels of economic and health disparities and compounded by unprecedented epidemics of chronic disease (including diabetes and depression), fueled in part by high levels of adult and childhood obesity.”

The high poverty rate, high uninsured rate, and physician shortages faced in the Rio Grande Valley create significant obstacles to accessing healthcare which in turn results in many patients seeking care while in crisis at hospital emergency departments with advanced manifestations of disease.

Consequently, the overall cost of treatment increases as does the demand and need for inpatient acute beds.

Poverty presents significant challenges to accessing preventative and primary health care services to manage chronic disease in various ways. The high-cost of health insurance translates into high uninsured rates. The uninsured rate hovers between 23 percent and 33 percent for the Rio Grande Valley, which is a little less than double the rate for Texas and approximately triple the national uninsured rate.

The COVID-19 pandemic has substantially increased the uninsured rate.

At the Hope Family Health Center clinic, we are starting to see a worrying trend of educated individuals such as teachers, social workers and the like seeking care at our clinic because they simply cannot afford health insurance.

Additionally, many simply go without medical care or medicines required to manage their chronic disease because of a lack of transportation, or they cannot afford the out-of-pocket costs for medical services, prescription medications, and co-pays and deductibles associated with having insurance.

It is estimated that nearly half the patients diagnosed with diabetes are not on appropriate medications.

Combining that with the fact that 43 percent of adults that are suspected of having diabetes yet are undiagnosed shows that only about 30 percent of those with diabetes in the community are under adequate treatment.

The Rio Grande Valley also faces substantial shortages of health professionals in many areas such as primary care, family medicine, general medicine, mental health, specialized pediatric care, community health and public health.

All four counties of the Rio Grande Valley have long classified as both Medically Underserved Areas as well as Health Professional Shortage Areas by the Health Resources Service Administration.

In terms of the number of physicians, the Rio Grande Valley ranks 42 percent less than the Texas average. It is estimated the Rio Grande Valley has a shortage of 700+ physicians through 2022, including primary care and specialties based on an analysis commissioned by the University Of Texas Rio Grande Valley School Of Medicine

In regards to nursing, the Rio Grande Valley is facing severe nursing shortages amid unprecedented demand caused by the COVID-19 pandemic. Prior to the pandemic, the Rio Grande Valley faced a nursing shortage, ranking 37 percent and 50 percent with respect to registered nurses and Nurse Practitioners respectively as compared to the Texas average.

Due to the effects of the COVID-19 pandemic, the Rio Grande Valley has lost many nurses to national staffing agencies or fatigue/burnout. I cannot quantify exactly the number of nurses needed in the Rio Grande Valley, but as an example I can illustrate just one hospital’s needs. DHR Health is a major health system in the Rio Grande Valley and operates 519 licensed beds.

As of the time of this testimony, DHR Health alone had 300 clinical positions open, with approximately 120 being nursing. Nurses are the backbone of the healthcare industry and nursing shortages will only exacerbate already significant access to healthcare issues along the border region.

Additionally, and importantly, the region has 40 percent of the rate of mental health professionals as compared to the Texas average, which itself ranks one of the lowest states in ratios of psychiatrist to population.

With the COVID-19 pandemic taking a heavy toll on the mental health of all of us, the need for mental health professionals has only increased.

Finally, I would like to discuss the connection between healthcare access and health and nutrition literacy, and access to affordable and healthy food options.

Health is not all about medical care, but about prevention and making the right choices. Due to a lack of education regarding nutrition or simply a lack of affordable healthy food options, and food insecurity, there is a pandemic of chronic disease linked to obesity.

The lack of affordable healthy food options is a significant concern – approximately 30% of children in the Rio Grande Valley are food insecure, and most often the cheapest food available can be categorized as junk food.

The prevalence of obesity and diabetes is an overwhelming determinant of health conditions in the region, including cardiovascular disease, chronic liver disease and liver cancer, peripheral artery disease leading to amputations, bone disease in older people, renal failure resulting in dialysis, retinopathy, and depression.

Obesity alone is a significant health risk factor, and results in increased hospital admissions consistently correlated with a higher Body Mass Index.

The Rio Grande Valley suffers from high-rate of diabetes, obesity and associated health issues:

• 82 percent of the population are obese or overweight.

• 27.6 percent of adults have diabetes, among whom 35.5 percent remain inadequately treated or untreated.

• 32 percent of the population is pre-diabetic.

• High rates of cardiovascular disease and increased findings of risk factors for heart disease or Diabetes present in 56 percent of hospital cardiovascular disease admissions and 54 percent of sepsis; and

• High prevalence of chronic liver disease, peripheral artery disease; and chronic kidney disease, and retinopathy.

People with diabetes visit physician offices and emergency rooms more frequently and are more likely to be admitted to the hospital. In fact, people with diabetes are 2.6 times more likely to be hospitalized than a person without diabetes, and 30 percent of persons with diabetes were hospitalized two or more times in the past year.

Summary

In summary, Lack of healthcare access for a large proportion of the Rio Grande Valley’s population is rooted in extreme levels of economic and health disparities and compounded by unprecedented epidemics of chronic disease (including diabetes and depression), fueled in part by high levels of adult and childhood obesity.”

The high poverty level, the extremely high cost of insurance and prescription drugs, the lack of regular transportation options, a shortage of healthcare professionals, and a deficit in health and nutrition literacy combined with a lack of affordable healthy food options has lead to high chronic disease and less access to healthcare for our region.

Recommendations

While I have laid out some serious healthcare access challenges we face on the border, not all is bad.

We have been making significant strides over the past several years in closing the gap. We want to ensure that all of our residents have access to the healthcare services they need. To that end, DHR Health has and is investing millions of dollars in becoming the largest teaching hospital in the Valley, training 130 residents and fellows in 12 Graduate Medical Education programs in partnership with the University of Texas Rio Grande Valley.

DHR Health also was recently designated the Valley’s first and only Level I Comprehensive Trauma facility.

Moreover, we are working with Driscoll Children’s Hospital to establish the Valley’s first and only dedicated freestanding children’s hospital. The establishment of a full-fledged children’s hospital will bring the most advanced pediatric services to our region and reduce the need for families to travel hundreds of miles to seek the care they need.

However, we still have a ways to go to ensure the entirety of our border communities have access to all the healthcare services they need.

In order to making more meaningful progress to close the gap, we recommend the following:

1. Significant investments to build a robust pipeline to train essential health care works, including but not limited to: nurses, respiratory therapists, sonographers, mental health care specialists, including pediatric mental health providers, and other health care professionals in short supply;

2. Increase Medicaid rates for community inpatient psychiatric beds to support additional mental health capacity;

3. Invest in education and economic opportunities directed at the border regions to lift people out of poverty and create opportunities for the future;

4. Adopt legislation to expand Medicaid and insure an additional 1.3M Texans while taking advantage of an increased F-MAP as provided by the American Rescue Plan Act;

5. Invest in programs to provide funding to community clinics to expand access to primary care and preventative services for the indigent;

6. Invest in programs to reduce the cost of healthy food and make healthy food available to the indigent and children;

7. Invest in programs to increase health and nutrition literacy to help people make better choices; and

8. Use State and Local Recovery Funds from the American Rescue Plan to fund one-time investments in the State of Texas’ health care infrastructure to:

a. Respond to the COVID-19 pandemic, including mitigating ongoing and future impact;

b. Increase and develop capacity and resiliency in hospitals, community clinics, and the public health system to leverage COVID-19 innovations and be better able to respond to and address public health emergencies, infectious disease, pandemics, chronic disease, or other public health crises, and

c. Identify gaps in services; health disparities; public health and epidemic crises, needs, and response capabilities; develop better systems to share information and coordinate care; address health disparities; and increase access to care that will help improve health outcomes for all Texans.

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For more on this and other Texas legislative news stories which affect the Rio Grande Valley metropolitan region, please log on to Titans of the Texas Legislature (TitansoftheTexasLegislature.com).

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