Many people have spotted the symptoms in the more than three years since River Valley Hospital closed its doors - extended drives, long waits and a lack of a community identity.

A migration of professionals out of state,

funnels money across those same borders.

The diagnosis? Lawrence Countians want a hospital to call its own once again. Countless questions about the need for and feasibility of a new hospital in Lawrence County have continued to surface:

Does the community need a local hospital? Where does the population go now? What services are needed? Would you use a new hospital?

With the questions mounting, local leaders have spent the past few months seeking some of these answers by taking the community's pulse on the issue.

In June, 16,673 questionnaires were mailed to

western Lawrence County residents asking them about their health care needs and if they would support the development of a hospital in the Ironton area.

"I think the overall results reinforced what we had suspected - that there is a general feeling that there is a need and a desire to have a hospital," said Ralph Kline, executive director of development for the Ironton-Lawrence County Community Action Organization. "Emergency services was one of the biggest needs that were reported."

Ultimately, the fate of any facility will be in the hands of the community and its willingness to use it.

Crunching the numbers

The Lawrence County Commissioners, Ironton Mayor John Elam

representatives with Southeast Ohio Emergency Medical Services, the Lawrence Economic Development Corporation and the CAO partnered to initiate the study earlier this year. Art Wicinski, a Cleveland-based independent consultant, is heading up a team of professionals who are conducting the feasibility study.

Based on the draft results, community leaders feel the survey has "real credibility."

The 21-question survey was returned by 3,677 households, or 22 percent. Study representatives feel that this is slightly above average for mail surveys and "is indicative of the level of the concern among community residents regarding health services and health care access in the area," according the draft summary report.

The focus of the survey was on the western part of the county. Approximately 62 percent, 2,275, of respondents live in the Ironton zip code. The rest were as follows: South Point 724, Pedro 220, Kitts Hill 219, Franklin Furnace 156. The remaining 83 were in the surrounding communities.

A total of 87 percent of responding households had used a hospital in the past two years for a variety of reasons. Outpatient testing made up 74 percent of households saying they had used hospital services. Emergency room care represented 66 percent. Outpatient and inpatient surgery combined for 69 percent of households responding.

Getting right to the heart of the matter, the survey asked how important it is for Lawrence County to have a hospital.

A total of 3,578 households answered the question. Approximately 82 percent of the responses were that it is very important. Another 7 percent said it was fairly important, while 5 percent were unsure. Slightly more than 5 percent of the respondents said it was fairly unimportant or not at all important.

So, if there was a hospital in Ironton, how likely is it that the people would use it for outpatient care?

With 3,587 responses, 65.5 percent said they would be very likely to use it, with another 7 percent fairly likely. A total of 16 percent said they were unsure. Only 11 percent said they were fairly or very unlikely to use it.

What about for outpatient diagnostic services?

More than 70 percent of respondents said they were likely or very likely to use such services. Ten percent said they were unsure. Only 9 percent said they were fairly unlikely or very unlikely to use the services.

Even if the community buys into the concept, everyone agrees that it may be equally as important for area physicians to support it as well.

What about physicians?

"Doctors put patients in hospitals. If the doctors buy into it, it will be successful," said Dr. Bill Dingus, executive director of the Lawrence Economic Development Corporation and the county's chamber of commerce.

"It has to be a combination of community and medical leadership. It can only succeed with a unified effort."

The researchers conducted several focus groups with individuals and groups of physicians. The compiled results of these will be available later this month, but the overall feeling was that there was interest in the concept.

"Many doctors saw a problem with the amount of time people wait for service. I thought the physicians were generally open to being supportive, but they will have to see if it is something they are comfortable with," CAO Executive Director D.R. Gossett said.

"Physicians hospitalize where they feel comfortable that patients will get the best care. What we hope is that if the project takes off, our physicians and other community physicians would have input and be supportive of this because they have helped influence the direction."

What type of hospital?

One of the primary options being considered remains a critical-access hospital.

This type of facility could provide urgent care, 24-hour inpatient services with typical stays of two to three days in a 25-bed facility. Much of the specifics would be based on what the community and physicians feel this area needs.

"Our initial goal is not to try to be everything to everyone," Gossett said. "We are trying to find a niche that would provide services needed in Lawrence County."

Kline agrees that it is about addressing a void that the community perceives.

"It is not a competition with any other agency," Kline said. "We are just trying to provide services that the community feels is needed."

But would it be able to be successful?

"I personally believe that western Lawrence County could support a community hospital with the right leadership," Dingus said. "I think the committee looking at it and studying it are very cautious. However, I tend to believe we will see a tremendous community buy-in if the project is viewed as viable."

Where from here?

The survey was one component of the phase 1 study that was primarily looking to determine if a hospital would be feasible.

The next steps will be to determine the revenue and usage levels that could be expected, the type of facility that could be supported and then to determine from where funding could come.

These aspects of the initial phase could be completed by early fall, Gossett said. Depending on the results of these studies, then the committee could look to move forward with more advanced stages.

"We hope that in the next few months we will get some solid figures so we can quantify what the potential revenue for this would be, based on the usage," Gossett said. "A lot of data is already out there. (The analysts) know enough and we know enough to pull out revenue projections."

Phase 2 would be developing a marketing and business plan. Phase 3 would be actually implementing it and bringing a hospital back to Lawrence County.

"Economically, a hospital is very strategic. You are speaking of high-quality jobs with linkage to doctor's offices, health institutions and so many other spin-off services," Dingus said. "A functioning and profitable hospital would be very important to the Ironton area's economics."

News editor Michael Caldwell can be reached at 532-1445 ext. 24 or by e-mail at mike.caldwell@irontontribune.com