By Peggy O'HareOctober 27, 2014 | Updated: October 27, 2014 11:17pmThe counties in the Eagle Ford Sh...

1. 'Serious deficiency' in shale's health providers
By Peggy O'Hare
October 27, 2014 | Updated: October 27, 2014 11:17pm
The counties in the Eagle Ford Shale oil and gas play struggle with a "serious deficiency" in the
number of health care providers and a shortage of ambulance services, according to a study being
released this week.
An increase in vehicle wrecks and workplace injuries -- along with other health and social factors --
have only exacerbated the need.
The assessment, a two-year effort by researchers at the University of Texas at San Antonio's
Institute for Economic Development and paid for by Methodist Healthcare Ministries, found an 18-
county area -- a big swath of the shale region -- is seeing a "sharp increase" in the need for
emergency care, women's health services, pediatric care and specialty health services.
"In a lot of these cases, we're talking about traditionally some of the poorest counties in the state, if
not the country," said Thomas Tunstall, research director of the UTSA institute. "So health care-related
issues are not new to these areas. But all of the activity associated with the Eagle Ford Shale
made the need for a study even more compelling."
The findings, detailed in a 96-page document titled South Texas Community Medical Needs
Assessment, take a close look at the medical needs and health infrastructure in an area spanning
nearly 24,000 square miles, including Gonzales, DeWitt, Karnes, Wilson, Atascosa, Live Oak,
McMullen, Frio, La Salle, Zavala and Dimmit counties. It also examined counties on the periphery of
the shale play, such as Bexar, Bee, Edwards, Kinney, Uvalde, Maverick and Webb.
Public officials will discuss the findings at an all-day forum at the UTSA Downtown Campus on
Friday.
The 18 counties collectively had an estimated population of more than 2.2 million in 2010, but that
number is projected to reach 3 million to 4 million by 2050, according to the report.
Yet some of the rural areas still have limited health care resources. Six of the counties have no
hospitals in their jurisdictions. Some counties have low numbers of clinics, while one -- McMullen --
has no clinics or doctors at all. Bexar County has the only family planning services among all of the
counties, researchers found.
"In some areas, the only medical personnel are nurses associated with schools, retirement homes or
jails," the study states. "In addition, locales that are served by a single physician who is either
recently retired or near retirement struggle to recruit replacements.
"Despite the existence of public policy and government-sponsored programs, such as
Medicare/Medicaid and affordable insurance, if there is no doctor, there is no care," the study
concludes.

2. Add to this a part-time workforce of nearly 360,000 people that is mostly uninsured, and it's
apparent why emergency rooms at some rural hospitals are feeling the effects. Some counties, the
report said, exhaust their annual funding for indigent health care in just weeks. One hospital
administrator, who was not identified in the report, said its funds for uncompensated care are
normally gone by the end of January and that its costs for such care have doubled from $1 million to
$2 million monthly.
"All of this activity in the Eagle Ford has put a lot of pressure on the existing health care facilities,
which were really already lacking," Tunstall said.
Emergency medical services also have been strained. "The need for first responders was probably
the most apparent," Tunstall said.
"In a lot of cases, the first responders in some of these counties were volunteer. ... Obviously, you
can only tap volunteers so much," he said, noting some volunteer EMS squads began hiring paid
personnel to keep up with demand.
One Methodist Healthcare Ministries official said Monday that she was not surprised by any of the
researchers' findings.
"Disparity in health care is not new to South Texas," said Rebecca Brune, the nonprofit's vice
president of strategic planning and growth.
The study found that the biggest increases in traffic accidents occurred in McMullen, Karnes and La
Salle counties, based on data from 2009 through 2011. McMullen County saw the most dramatic
change, with a fivefold increase in wrecks during that period.
McMullen County also experienced the biggest increase in workplace injuries among the 18 counties
from 2010 to 2011, jumping nearly 400 percent, the report shows. McMullen County has the Olmos
and Wilcox formations, which researchers said makes the county a key area for the shale's
development.
McMullen County also had the fewest health care professionals among the 18 counties, researchers
found, while Live Oak County experienced a decline in the number of primary care physicians and
licensed occupational therapists. Zavala County saw its number of EMS workers decline.
The report suggests that rural areas of the shale region might be better served by telemedicine -- a
technology that allows patients in remote areas to consult with physicians through a live video link
after health care professionals have recorded the patients' vital signs and other necessary
information. Other options include public-private partnerships and incentives for health care
providers, the study said.
Cellphone coverage in the rural areas is critical for the development of new health care facilities, the
study noted.
Because the Eagle Ford Shale's production is projected to last 20 to 30 years, the report suggests
that officials would be "shortsighted" to do nothing because of assumptions that such growth will
eventually slow.
Methodist Healthcare Ministries, which helps fund medical care and other health needs for low-income
and uninsured people in South Texas, hopes the study will prompt conversation about the

3. gaps in health services and how to plan for the future, Brune said.
"There's been a tremendous amount of conversation around water and transportation, the
environment, air quality. And I think health care is just as critical," Brune said. "And I think it's all of
those integrated to really create sustainable solutions."
pohare@express-news.net
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