A wheelchair sits outside the front gates at the RAM Clinic in Wise County earlier this year. (Mason Adams/Virginia Mercury)

Lee County’s first Remote Area Medical (RAM) clinic took place in 2014, one year after the county’s community hospital closed down.

Now, even as the shuttered hospital prepares to reopen its doors as an urgent care center, RAM is gearing up to once again deliver free dental, vision and medical care to underserved and uninsured people in Lee County. 

Over the past six years, this county, home to roughly 23,500 people and with a poverty rate of 28.2 percent, well over twice the state average of 10.1 percent, has suffered from reduced access to health care.

Lee Regional closed in September 2013, with officials from then-owner Wellmont Health System citing three reasons for the move: low community use, a lack of consistent physician coverage and reimbursement cuts associated with both the Affordable Care Act and Virginia’s years-long refusal to expand Medicaid. Another community hospital in Patrick County closed in 2017.

“Lee County is an extremely poor county,” said Joe Smiddy, a pulmonologist and president of the Health Wagon, a regional free clinic. “A lot of people there are totally out of the system for a dentist or a medical doctor.”

As the hospitals have closed, RAM has stepped in to fill the health coverage gap, serving 2,073 individuals since 2014, with a value of care totaling more than $1 million. Services include not only general medical exams but dental, vision and reproductive care.

And although the annual clinic can’t replace a hospital’s emergency services or specialists, it can help patients address chronic, long-term health conditions that if left unaddressed can send them to the emergency room.

One such condition is coal workers’ pneumoconiosis, more commonly known as black lung. Southwestern Virginia is a hotspot for the illness, and the July bankruptcy of Blackjewel, which put nearly 500 Virginia coal miners out of work, could result in an uptick in cases, as many miners tend to wait until they’re laid off before seeing a doctor.

“Working miners are very concerned about their jobs, and they’re concerned about concealing any evidence of pneumoconiosis,” said Smiddy. “They often don’t want to get chest x-rays and pulmonary functions, and if they have them they don’t want the results released.”

Smiddy said that the Health Wagon has not yet seen an increase in miners applying for black lung benefits, but “it’s too short notice to have any more information yet.”

This year, as RAM’s Lee clinic prepares for the onslaught of people seeking services — about 300 to 500 are usually treated annually — changes are afoot in the county’s health care landscape.

This October, Lee Regional is expected to reopen as an urgent care center run by Ballad Health, a nonprofit health care provider formed by the consolidation of Wellmont with its primary regional competitor, Mountain States Health Alliance. Ballad, which covers about 1.2 million people in northeastern Tennessee and southwestern Virginia, plans to expand the center into a full critical access hospital with a 13-bed emergency room and 10 in-patient beds by fall 2020.

At the same time, the General Assembly’s expansion of Medicaid has increased underserved Virginians’ access to health care across the commonwealth. According to the Department of Medical Assistance Services, 1,736 people in Lee County received Medicaid under the expansion, or about seven of every 100 people in the county. 

What those developments might mean for RAM’s Lee clinic in the future aren’t clear. The organization announced this July that it would end its annual clinic in neighboring Wise County, partly because of the beefing up of local health care services and partly to serve other, smaller communities — like Lee County.

“RAM over the last two to three years has made a big push to cover more of the Appalachian region, especially southwest Virginia,” said Lee County Administrator Dane Poe. “They’re sort of blanketing the area.”

More information about RAM’s Lee County clinic can be found on its website.

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Mason Adams
A native of Clifton Forge, Mason has covered Blue Ridge and Appalachian communities since 2001. He worked for Waynesville, N.C.’s Enterprise-Mountaineer from 2001 to 2003 and The Roanoke Times from 2003 through 2012. He’s freelanced since then, with bylines in Politico Magazine, the Washington Post, the New Republic, Vice, Blue Ridge Outdoors, Scalawag, Belt Magazine and many more. He lives in Floyd County.