“With stroke, we have a very short time window when we’re able to treat people,” said Dr. Marilyn McKasson , telestroke medical director for Intermountain Healthcare.
She talks to patients in the emergency rooms of small Utah towns, helping to diagnose a stroke and beginning treatment before the patient is transferred to a larger hospital that is equipped to help dissolve the clot, restore blood flow and give them the best chance for recovery.
"During a stroke, a person loses 32 thousand brain cells a second, and so the faster we can treat a person with a stroke, the better that they’re going to do over the long term," she said.
"Especially in these rural areas with one provider covering an entire emergency department, it’s impossible to be an expert in everything. And with stroke management, it’s pretty high-stakes. Our treatment can sometimes have dangerous complications and so it can be a tough decision to make.
“They can page us, they tell us about the patient, and then we get on camera and evaluate the patient using video and audio, so we can see them, and they can see us, and it’s almost like we’re in the room with the patient and their family,” McKasson said.
So, specialist support for small-town medicine is expanding. Intermountain Healthcare is not the only provider backing up emergency rooms in Utah. But for Mike and Mary Kava in Castle Dale, living in a small town in south-central Utah still meant they were limited, not because of technology, but because of distances and insurance.
“He was getting ready to go to bed about 10 o’clock, 10:30, and he started throwing up," Mary said. "And we’re thinking, ‘Oh. Flu.’”
It wasn’t flu. It was a stroke, and Mike and Mary lived more than two hours from Provo, the city with the nearest hospital that could treat him.
“I said, ‘Maybe you’re dehydrated,'" Mary said. "We’ll go up to the emergency room. So we went up to Price. And the doctor waves, ‘Come here,’ and he says, I’ve called for a helicopter. They gave him some medicine and then a storm came in and lightning. So we couldn’t go on the helicopter. So we go up Highway 6 and they took him to the hospital in Provo and got him stabilized there.”
Mike’s journey began with a face-to-face diagnosis. In Utah Valley hospital, his treatment continued. So did the next stage: working through insurance and benefits issues.
"But they didn’t cover Utah Valley Hospital," Mary said. "The ambulance had to take him there because that was closer. So while I was on the phone with the insurance company, about ‘how can I get this approved or how can we get him moved, or what,’ this doctor, this neurosurgeon was standing there. He said, ‘May I see your phone?’ And he took my phone and he said who he was, and he said, 'There are two places in the state of Utah with neurology specialists, and you have to cover it.' And they did. They did.”
Mike stayed in Provo at first. Then he went to Salt Lake City for rehabilitation. They spent a month away from home, and that was expensive.
“That first month, though, was pretty scary,” Mary said. “We called our kids and said, we might have to sell our house and move in with you. Luckily we had some retirement he could cash out. I think of people who don’t.”
"We found out the hard way, you have to make sure your employer considers stroke an illness," Mike said. "I had over a year of sick leave coming, and they told me I couldn’t use it because stroke isn’t a sickness."
The stroke eventually forced Mike to leave his job. They both lost their insurance with his employer. Today Mike’s care is provided through the Veteran’s Administration. Mary changed insurance providers twice, first going on an exchange and then on Medicare. She was driving long distances, even when there wasn’t an emergency—not because of doctors, but because of insurance.
“If you needed lab work for quite a while you couldn’t go to Castle Dale," Mary said. "You had to go to Provo. They got some of that worked out, but it’s still an issue. You’re limited, what insurance you can have. If I live in Salt Lake, I have a couple different choices I can make. Down here, that’s it.”
Mike is recovering. He is also receiving some telehealth services through the Veteran’s administration, which allows him to talk to a dietician, a diabetes specialist and his primary care physician—after he makes the half hour drive to the clinic in Price. That’s still a lot less travel time if he needs to see a specialist.
Additional resource: The Disability Law Center advises patients who have trouble accessing health care.
Music credit: "Rotisserie Graveyard" by Dr. Turtle.