Virginia Hospital Typifies Rural Health Challenges

Carilion Giles Memorial Hospital, Pearisburg, VA, is a private, non-profit CAH situated in the Appalachian Mountains near the West Virginia border. Because of the mountainous terrain, CAH criteria allow it to be 15 miles from the nearest hospital instead of the standard 35-mile requirement. Still, Carilion Giles faces the challenges of many rural hospitals especially the poor health legacy of the region.


"It was an agrarian economy for years. People went out in the fields and burned off those calories. Now, they still eat the same country cooking but are not working in the fields. So the problem with obesity and type II diabetes is rampant. That leads to co-morbidities in treating people because you are not just treating one diagnosis," explained Hospital Administrator James Tyler. "That is one of the challenges of operating a small, rural hospital because we don't have the cadre of specialists on our staff."

He noted that on any given day the average age of patients in the hospital is 82, further complicating care with co-morbidities. Up to four-fifths of inpatients are covered by Medicare; about 2% to 3% by Medicaid and about 3% to 5% are privately insured. The rest are self-pay, which often leads to bad debt for the institution.

Currently housed in a 60 year old facility, Carilion Giles is now building a brand new hospital, Carilion Giles Community Hospital, with funding from bonds and county help, along with the support of the Carilion Clinic. The new facility will be on a site nearby. "This $34 million project is helping to insulate this small community, not fully, but in part, from this economic downturn," Tyler observed.

A quick comparison: Their current facility is 60,000 square feet; the new one will be 80,000. They currently have three ICU beds; that will increase to four. They will upgrade the OR and add a special procedure room. The emergency department will go from five beds and no trauma room to nine beds plus two trauma rooms. (As is the burden on many rural hospitals where patients lack primary care and turn to the ER, tiny Carilion Giles sees 13,000 emergency room patients yearly.)

"We couldn't have built this hospital without collaborating with the town and county. The county purchased the new property, did the grading and utilities. It's a per-acre swap. When the new building is finished (targeted for 2010), we will turn [the old] building over to the county, which plans to consolidate services. They will get all 26 acres here in return for the 26 acres there and they will get to use this building."

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