Photo: South Dakota Department of Tourism

Celebrating National Rural Health Day with Walter Panzirer

This year on National Rural Health Day, we join people from across the country to celebrate major achievements in rural health and look forward to the exciting advancements yet to come. We sat down with Trustee Walter Panzirer to explore why rural America is so close to his heart and to talk about what Helmsley’s Rural Healthcare Program has in store to continue improving access to quality care in the least populated areas of our country.

Tell us about the origins and purpose of Helmsley’s Rural Healthcare Program.

WP: The Helmsley Charitable Trust began with the death of my grandmother, Leona Helmsley, 10 years ago. We looked through the history of her giving patterns and realized the majority of her charitable giving was in support of medical improvements and medical research. I presented the idea of supporting rural health to Helmsley’s Board of Trustees as a way to honor her giving patterns and her legacy. We then completed a study of healthcare funding across America and found that rural areas were underserved by private foundations. In particular, the study found that the states of Minnesota, Iowa, South Dakota, North Dakota, Montana, Wyoming, and Nebraska received only 3.5% of all private philanthropic funding and, of that amount, 80% went to Minnesota, primarily to the Mayo Clinic. In the last decade, Helmsley’s Rural Healthcare Program has provided over $320 million in funding for rural healthcare initiatives. 

Rural healthcare is an issue close to your heart. Why is it so important to you personally?

WP: I grew up in Central California in a semi-agricultural area. I put myself through school in the Bay area, worked as a paramedic and firefighter for the Forest Service and moved to South Dakota in 1998. Once in South Dakota, I continued my education at Black Hills State University while working for the City of Sturgis as a police officer. I then transferred to a position with law enforcement in Mitchell, SD, and even ran for sheriff in Davison County. I was studying to become a pastor and had just two courses left to complete when my grandmother died. It was a complete surprise to discover that she had named me as a Trustee. It changed the focus of my life.

My life and work experiences have helped form my core values. Living in rural America, I’ve witnessed extreme poverty, people who have been harmed and let down by the criminal justice system, and people who have suffered from a lack of healthcare. Those experiences have made me recognize the small-town struggle of access to quality healthcare, including the challenges of attracting and retaining physicians, and providing advanced treatment technologies. And it’s made me a firm believer that no matter where you choose to live – urban center or rural town – you should have the same access to quality healthcare. 

What is Helmsley doing to make improvements in rural healthcare?

WP: The Rural Healthcare Program has improved healthcare in the Upper Midwest in several ways. 

First, access to specialty medicine. One of our largest initiatives is a telemedicine program that provides hundreds of small hospitals with access to around-the-clock specialty coverage in the areas of pharmacy, emergency care, and ICU care. Helmsley did this by partnering with Avera to expand its comprehensive telemedicine program, eCare. Helmsley continues to provide funding for rural hospitals to implement ePharmacy and eEmergency. ePharmacy provides 24/7 pharmacist coverage. Many people are harmed by medication dosing errors and adverse interactions between medications that could be avoided through first-dose review. However, for a hospital to provide 24-hour pharmacist coverage, they must have up to five full-time pharmacists on staff. In many small towns, it’s difficult to recruit, retain, and afford even one pharmacist, let alone five. eEmergency helps rural hospitals by providing instant virtual access to an emergency physician in their emergency departments. Instant access is important when you consider many rural hospitals are staffed by a nurse at night and a provider may take up to 30 minutes to arrive once a patient presents. If a patient is having a heart attack, this could be the difference between life and death. The virtual physician can work with the nursing staff to order tests and help to determine if something serious is happening. When a doctor is onsite, the eEmergency staff can provide any needed support. This saves time and money, and reduces the likelihood of ill-effects and even mortality – a win-win for everyone. These programs give patients access to specialty care in their communities, allowing patients to be cared for in their hometown hospitals near family and friends. 

Cancer care is another Rural Healthcare Program initiative. Helmsley has provided funding for new linear accelerators at hospitals in six states, as well as other funding to improve access to cancer care services across the Upper Midwest. I’m a firm believer that cancer care should be given close to home. I can’t imagine having to drive two to three hours to receive a chemotherapy or radiation treatment. So, where we can make the case for improving or establishing cancer care services, we will. If we can bring care closer to home, we can improve and extend people’s lives.

Our cardiac care initiative is working to improve systems of care. Cardiac problems kill thousands of Americans every year. It’s the number three killer of rural Americans. The Rural Healthcare Program funded the implementation of Mission: Lifeline, which included providing 12-lead EKGs in a majority of ambulances across seven states, allowing first responders to identify the deadliest heart attacks. Helmsley has also provided funding for LUCAS™ Chest Compression Systems to be placed in a majority of rural ambulances and hospitals in the seven states. These machines provide mechanical, computerized CPR to the correct depth and number of compressions. They can do this for long periods of time while a patient is transferred to a hospital or at a hospital, so those caring for the patient can have free hands to administer other life-saving interventions.

Recently, the first responders and hospital staff in Buffalo, WY, completed a training exercise using Mission: Lifeline protocols. Less than a week later they encountered the same scenario in real life. They had made errors in the training scenario, but when the real deal happened, they did it correctly and the patient lived. It gives me goosebumps to know that we helped to save a life because they knew what to do.

One last initiative I want to highlight centers on our support for the healthcare workforce. One program, Simulation In Motion, is a mobile training program that brings life-like mannequins and proper equipment to communities. The vast majority of first responders in our seven states are volunteers, and so much is required of them, including annual training. It can be difficult for these volunteers to leave work, take time from their families, and drive hundreds of miles to attend training. Simulation In Motion brings hands-on, high-quality training to them. The first responders practice working together with the local hospital staff in real-life situations. The realistic training ensures better outcomes when an emergency arises and saves money for the ambulance service and hospital staff who can avoid the time and expense of travel. Another program Helmsley has been working with Billings Clinic on is a rural residency internal medicine program. It has been historically difficult to attract and retain physicians in rural areas. The program at Billings Clinic gives residents an opportunity to experience the challenges and rewards of a rural practice. The program offers eight rural internal medicine residency spots. So far, we are seeing many of these physicians choosing to stay in our seven-state region.

Tell us about a new project you are most excited about and the impact it will have in the affected communities.

WP: It’s difficult to single out one because all of Helmsley’s initiatives are having an impact on rural communities. We are attempting to provide rural Americans with a continuum of care that assists patients every step of the way. Depending on if your family is affected by cancer or your community needs a doctor, one initiative may be more important than another to you.

But, if I had to pick one that is near and dear to my heart, it is the new cancer center being built in Pierre, SD. Over the years, so many people could have benefited from comprehensive cancer services in the area. I know a great many people who have been affected by cancer and didn’t survive, so this is personal to me.

The Rural Healthcare Program covers seven states. What should people in those states expect to see from the program in the next few years?

WP: We have so much in store. We’re currently answering the most obvious challenges, including cardiac care, cancer care, emergency training, and equipment. And these programs are not going away. Next on the horizon is behavioral health. A few years back, Helmsley partnered with Oregon Health and Science University to look at behavioral health in South Dakota, as many states have similar concerns. The study showed there are huge pockets of the state that lack behavioral healthcare and assistance. That, coupled with my experience and knowledge from working with police departments, increased our interest in behavioral healthcare improvements.

In rural America, behavioral health issues carry such a stigma, but so many people have issues and unfortunately, this can be a burden to emergency rooms and rural hospitals. There is a gap where people are not getting the care they need. We are working to help train providers to identify behavioral health issues and deal with them at a local level. In the next few years, we plan to address behavioral health needs and improve access to services in rural areas. Our goal is to integrate behavioral health into the health system with family or pediatric visits. Behavioral health should not be a stigma – it’s a health disorder which requires a course of treatment. Helmsley is working to better address behavioral health needs and to better understand what might come next. No one size fits all; this is a tricky issue.