U.S. District Court Chief Judge Linda R. Reade has ordered that the Iowa meatpacking manager found guilty on 86 counts of fraud and money laundering will remain behind bars.

Sholom M. Rubashkin, who served as the day-to-day manager at Agriprocessors in Postville and is the son of company founder A. Aaron Rubashkin, will remain in the custody of U.S. Marshals until he is sentenced on the earlier conviction. It is unknown if Rubashkin, who recently had 72 immigration-related offenses against him dismissed, will remain in a county facility or will be moved to a federal prison. An exact sentencing date has not yet been established, and, since the process requires extensive reports for judicial review, the date could be several weeks from now.

In the bail hearing on Wednesday, the Rubashkin defense team pointed to the man’s strong community and family ties in Postville as well as his record of good behavior while on release pending trial. Prosecutors, on the other hand, told the court that the fact that Rubashkin was facing a sentence of possibly several hundred years in prison that the situation had changed significantly.

In addition, the prosecution called Mike Fischels, a special agent who has long been assigned to the Agriprocessors case, to testify about an overseas telephone conversation he had with a company supervisor still wanted by the government.

Fischels testified that he spoke with co-defendant Hosam Amara on the telephone about Amara’s flight from the U.S. to Israel. Amara indicated to Fischels that [Rubashkin] told him to leave the U.S. and return to Israel in order to remove himself from the situation facing Agriprocessors.

The government also presented a copy of a check and bank documents that suggest Rubashkin provided financial assistance to Amara around the time that he fled the U.S.

The court finds that the government’s evidence for detention is compelling.
Defendant’s actions prior to and during the pendency of the instant action, when coupled with the powerful incentive to flee due to the jury’s return of the Verdicts, demonstrates that Defendant poses a flight risk. The court notes that, in the Detention Order, it previously found that Defendant posed a flight risk.

The court acknowledges the overwhelming support that Defendant’s community has provided during the trial and the instant proceeding. The court also recognizes that Defendant took great pains to comply with the terms of his pretrial release. The court agrees that Defendant has shown he is committed to his family and to his community. Nevertheless, the court finds that this evidence does not rise to the “clear and convincing” level necessary to show that he is “not likely to flee [. . .] if released under [§] 3142(b) or(c).” 18 U.S.C. § 3143(a). Accordingly, the court shall grant the Motion.

Rubashkin’s defense team has pledged to appeal the fraud and money laundering convictions. It is unknown at this time, however, if they will also appeal this detention order.

Sholom Rubashkin, who was recently found guilty of 86 charges related to money laundering and fraud in connection with the raid, was set to go back on trial Dec. 2 in Sioux Falls, S.D. on the immigration offenses.

The order for dismissal by Reade follows a request by federal prosecutors filed early Thursday morning.

According to the government’s calculation of the sentencing guidelines, due in large part to the amount of loss associated with defendant’s fraud and false statement convictions, any convictions with regard to Counts 1 through 72 would be entirely eclipsed by defendant’s recommended guideline sentence on the counts for which he has already been convicted. This is not to minimize the importance of those counts, but at least for the purposes of the advisory sentencing guideline range, any convictions on Counts 1 through 72 would have no impact upon defendant’s sentence. However, any evidence of immigration violations would be relevant conduct that the Court could consider at sentencing even without a second trial.

In the government’s estimation, now that defendant has been convicted on the most serious offenses charged in the pending indictment (in terms of potential penalties), and given that a jury has determined defendant committed crimes by making false statements about the harboring of undocumented aliens at Agriprocessors, Inc., and his knowledge of undocumented workers at Agriprocessors, Inc., dismissal without prejudice of Counts 1 through 72 and the forfeiture allegation is the most appropriate and efficient manner in which to proceed in this case. Dismissal will avoid an extended and expensive trial, conserve limited judicial and prosecutorial resources, and lessen the inconvenience to witnesses. The public interest has been substantially served because of the convictions and jury findings noted above. The government asks that such dismissal be without prejudice so criminal charges and the forfeiture allegation could be reinitiated based upon a change in circumstances or a reevaluation of present
circumstances.

According to documents filed with the court, Rubashkin’s legal team had no objection to dismissal of the charges.

Prosecutors also noted in their motion to dismiss that the current financial condition of Agriprocessors, Inc. as a company “and the fact that it is an empty shell” were justifiable reasons for not pursuing possible forfeiture charges.

Rubashkin, 50, and other senior members of the Agriprocessors management and executive team still face a state trail, currently scheduled to begin next spring, on alleged violation of child labor laws.

Currently, Rubashkin is being held by federal authorities, pending a decision in a bail hearing held Wednesday.

The study, Iowa Statewide Rural Water Well Survey Phase 2, was led by the University of Iowa Center for Health Effects of Environmental Contamination. It followed up on the results of a similar study conducted in 1988 and 1989 and concluded that many of the problems of 20 years ago remain today.

Scientists who tested samples from Iowa rural drinking water wells discovered that 48 percent had arsenic, with 8 percent containing it at a level above the Safe Drinking Water Act standard for public water supplies. Wells with high arsenic contamination (greater than or equal to 0.01 mg/L) are marked in red on the above map. The blue marks are wells that had low levels. Click the graphic to read the full study.

Investigators sampled 473 wells in 89 Iowa counties for bacteria, nutrients, metals, common use herbicides and insecticides, and herbicide degradates from May 2006 to December 2008.

Peter Weyer, the study’s lead investigator and associated director for the Center for Health Effects of Environmental Contamination, said that while nitrate and bacteria detections were expected despite efforts to address such contamination, the presence of arsenic was potentially worrisome.

“Nearly half the wells sampled had some level of arsenic, and 8 percent of those had a level that could be considered a health concern,” he noted.

One of the positive findings of the study was that the levels of the commonly used herbicide atrazine appear to be decreasing.

Of the wells tested, 43 percent had total coliform bacteria, 19 percent had enterococci and 11 percent had E. coli. In addition, 49 percent had nitrate, with 12 percent of those having levels above the U.S. Environmental Protection Agency’s standard for public water supplies.

Pesticides parent compounds were found in a small percentage of wells. A total of 8 percent had very low concentrations of atrazine, 2 percent had metolachlor and less than 1 percent of the wells had acetochlor, alachlor and trifluralin.

Herbicide degradates, or the breakdown products of the parent compound that are generally believed to be less toxic, were also found in a percentage of Iowa wells. The degradate most commonly found was metolachlor ethane sulfonic acid (ESA), which was present in 33 percent of the wells. Alachlor ESA was detected in 27 percent of the wells, while desethyl-atrazine and acetochlor ESA was present in 11 percent of the wells tested. In addition, 8 percent of the test wells had metolachlor OXA (oxanilic acid).

“If you do have a problem with your well — certainly bacteria is a problem — and if you had bacteria contamination of your well, you definitely want to boil your water,” said Weyer. “With nitrate, the research on it is kinda mixed on whether it is a problem. We have looked at things like cancer and blue baby syndrome. Some people think that the nitrate standard should be a lot higher, maybe 20 or 25. And there are others who have done research, including myself, who have found problem with nitrate at less than 10, think we ought to leave the standard alone.”

But, by and large, is the drinking water from these wells safe?

“You know, it is hard to say. I think, in general, the well-water quality in the state of Iowa really hasn’t improved that much,” Weyer said. “Compared to the study that was done in 1988 and 1989 the water quality just hasn’t improved very much with respect to nitrate and bacteria. We hadn’t looked for arsenic before, but now we are seeing that. It is really up to the individual well owner as to how they want to deal with this.”

While there was no one major indicator to determine which wells might contain contaminants, there were variables, such as well depth, that were considered by the researchers to be associated with detection. Wells under 100 feet deep had higher concentrations of nitrate and more total coliform bacteria and herbicide degradate detections than deeper wells. Wells that were constructed prior to 1991 had also had more detections. Other factors, including the construction characteristics of the wells and the presence of a liner, also were factors that could impact a well’s vulnerability to contamination.

Wells located in the northwest, southwest and south-central portions of the state were more likely to have detections of total coliform bacteria, E. coli and enterococci. In addition, wells located in the northwest and southwest regions were also more likely to have higher nitrate concentrations.

Perhaps alarmingly, the study is the state’s first systematic sampling of private wells since 1994. Although water quality in public water supplies is monitored and regulated under the Safe Drinking Water Act, private drinking water wells are not monitored under any regulatory framework. In addition, despite an estimated 450,000 Iowans using private wells for drinking water, statewide monitoring has been sporadic during the past two decades, often only following catastrophic events like the 1993 floods.

Because there is so little government monitoring and over-sight of contaminants, one of the best factors to determine the health of well water was monitoring, assessment and treatment by well owners themselves. And while some may point to Iowa’s agricultural industry as a potential culprit in the issue of groundwater contamination, Weyers warns that there are many other potential culprits.

“Agriculture is one of the sources — certainly if you are looking at herbicides and pesticides, and we found some herbicide breakdown products in the well water in this study. That is certainly an agricultural source,” he said. “For things like nitrate and bacteria, not only is nitrogen fertilizer use a problem, but it is also potentially septic systems or municipal wastewater systems. So it is sort of an urban-rural mix as to the source of these contaminants.”

Researchers recommend full use of Grants-to-Counties funds for annual testing of private wells for possible contaminants as well as a consumer education initiative to provide information on the sources of bacteria, factors impacting bacterial contamination of wells, possible health impacts of consumption of such water, and available well treatment options.

Because the tested samples revealed the presence of chloride, which typically is only detected in groundwater near deep saline brine, it was also recommended that the state investigate for possible surface activities (such as de-icing compounds and fertilizer salts) that could be impacting groundwater throughout Iowa.

In the meantime, what should private well owners do?

“We suggest that if you have bacteria or high arsenic [levels] that you don’t drink that water, that you do something to treat the water to effectively remove those contaminants,” Weyer said. “It is something the well owner needs to discuss with their doctor or someone like that to determine if that water is OK for them.”

Sholom M. Rubashkin

Rubashkin, who is the 50-year-old son of Agriprocessors founder and president A. Aaron Rubashkin, was convicted of all possible money laundering and mail, wire and bank fraud charges. He was also convicted on 15 out of 20 counts of failing to provide timely pay to livestock auctions and providers.

The verdict followed nearly a month of testimony and evidence in which the government sought to paint Rubashkin as one, if not the, mastermind in a plot to defraud creditors. The defense team, in contrast, chose to portray Rubashkin as inexperienced, naive and unprepared to serve as day-to-day manager for such a large undertaking as the kosher meatpacking plant in Postville.

Following the lengthy reading of the verdict, Rubashkin was taken into federal custody, and his defense attorney, Guy Cook, pledged to appeal. Rubashkin is expected to return to eastern Iowa next week for sentencing and a possible bail hearing pending appeal. He faces a maximum sentence of more than 1,000 years in prison for the guilty verdicts.

An early December trial has been slated for an additional 72 federal immigration-related charges against Rubashkin, and he also faces a trial in state court this spring for possible child labor law violations.

All of the charges stem back to a massive May 12, 2008 immigration raid at the Postville facility. More than 300 immigrant workers detained by federal authorities pleaded guilty to criminal charges related to identity theft within days of their apprehension, and the bulk have been deported after serving brief federal prison sentences. Some immigrant workers, however, continue to live in and around Postville and are expected to be called by the prosecution in the upcoming trial.

The road between the actual raid and the federal trial in Sioux Falls, S.D., was long and has often wound its way through traditionally uncomfortable conversations for Americans regarding immigration, civil rights, religious expression and the composition and worth of charity.

The Rubashkin family, all ultra-orthodox Jews affiliated with the Hasidic Chabad Lubavitch movement, have at times suggested that the charges against them stem not from any alleged illegal activity, but from anti-Semitism. Throughout the investigation, and especially following the initial arrest and jailing of Sholom Rubashkin, many of the Jewish religious faithful, either through their own conscience or through the prodding and help of Chabad, have defended the Rubashkins from wrongdoing and stood as character witnesses for the family’s contributions.

Both inside and outside of Jewish circles, however, the Rubashkins have drawn criticism, many believing that generosity was born of ill-gotten-gains, harvested on the back of an underpaid and often mistreated immigrant workforce. Media reports, which prompted the move of the trials from Iowa to South Dakota, have given supposed victims of child labor and sexual harassment at the Postville plant a voice.

The company known as Agriprocessors fell into bankruptcy last year, and has re-emerged as AgriStar under the new ownership of SHF Industries, a venture of Canadian businessman Hershey Friedman. Heshy Rubaskin, brother to Sholom and son of Aaron, continues to work at the reborn business.

At least six former members of plant management or the human resources department have pleaded guilty in the wake of the 2008 immigration raid:

April 13, 2009 — Elizabeth Billmeyer, 48 and the former human resources manager, pleaded guilty to one count of conspiracy to harbor undocumented aliens for profit and one count of knowingly accepting false resident alien cards.

March 19, 2009 — Penny Ann Hanson, 41 and a former human resources employee, pleaded guilty to conspiracy to make false statements on immigration documents.

Dec. 10, 2008 — Karina Pilar Freund, 29 and a former human resources employee, pleaded guilty to one misdemeanor count of aiding and abetting a pattern or practice of hiring undocumented aliens.

Oct. 29, 2008 — Laura Althouse, 38 and a former human resources employee, pleaded guilty to one count of conspiracy to harbor undocumented aliens and one count of aggravated identity theft.

Aug. 27, 2008 — Martin De La Rosa-Loera, 43 and a former plant supervisor, pleaded guilty to one count of aiding and abetting the harboring of undocumented aliens.

Aug. 20, 2008 — Juan Carlos Guerrero-Espinoza, 35 and a former plant supervisor, pleaded guilty to one count of conspiracy to hire illegal aliens and one count of aiding and abetting the hiring of illegal aliens.

Former plant operations manager Brent Beebe, 51, will soon be tried on immigration-related charges in federal court. Two additional plant managers — Hosam Amara and Zeev Levi — also face criminal charges, but have yet to be apprehended by authorities.

“[This report] really highlights that the need for health reform that isn’t limited to people who are working outside their home — that it is a big issue for those who are self-employed and for people across the country,” said Andrew Cannon, a research associate with IPP and author of the study. “It’s not just an urban issue. It’s not just a rural issue. It’s an issue that touches Americans from all walks of life. Health reform needs to address the needs of all populations, including America’s rural population.”

Nearly 20 percent of America’s uninsured live in rural areas, according to the study, and are more likely than residents of urban areas to purchase their insurance on non-group, private markets where they typically pay higher costs.

The latest white paper from The Iowa Policy Project highlights the disparities facing rural Americans in need of health care insurance. Click graphic to view full PDF.

“The situation really is not sustainable barring some sort of reform,” Cannon said. “What we’ve seen over the past 10 to 20 years is that medical inflation, and health insurance inflation in particular, far out-stripping wage inflation. So, health insurance costs are going up 7 to 8 percent each year for this population while their wages are increasing 3 percent, if that. This is especially true in a recession like we are going through now, where people’s wages are stagnant or decreasing and yet their health insurance cost is increasing by 7 or 8 percent. That just puts this on an unsustainable trajectory.”

As The Iowa Independent has outlined as a part of  its rural health care series, residents in these geographic areas often have lower incomes and higher poverty rates, but seldom meet income and asset guidelines necessary to receive assistance through existing public health insurance options like Medicaid and the Children’s Health Insurance Program. The study estimates that 1.2 million rural residents in Iowa “need increased access to affordable, quality health insurance.”

The white paper also provide the first-hand account of a Grinnell farming family that is attempting to navigate health insurance in the current system.

“It’s irksome that I’m a healthy person and I can’t get decent health insurance,” Suzanne Castello is quoted as saying in the narrative.

Castello, who had hoped to be able to purchase non-group, private insurance once she left outside employment and began to run the family farm with her husband, soon learned that the process would not be as easy as she thought. When the couple learned that they were expecting a child, the pregnancy was added to a list of pre-existing condition exclusions for which no insurer wanted to help pay.

“We were hemorrhaging money, but we didn’t qualify for Medicaid,” Castello said. “It really rankles me that we’re seeing something as fundamental as childbirth as kind of like, ‘Would you like dessert with that meal?’ There’s a double-standard between group policies and individual policies, which cover most farmers.”

Nationally, Castello is far from alone. Researchers have taken a keen interest in rural women who, despite a desire to work full-time on the family farm, have accepted off-farm employment solely for health care insurance. The phenomenon is known as “third shift,” due to often sleep-deprived realities held by the women who attempt to juggle work, family and farm duties.

“I have looked at some of the research on the third shift and that is a growing issue for a lot of rural families,” Cannon said. “As far as numbers go, I’m not sure and I wouldn’t want to peg a number. What we do know is that while 8 or 9 percent of the population in the U.S. gets insurance on the non-group, private market, in rural areas in Iowa it is a much higher rate — up to 37 percent in some parts of rural Iowa.”

It is very difficult overall to provide an accurate picture of what’s happening in rural Iowa in terms of health care insurance. While there is very good data available to provide a national picture, no such data exists on the local or state-level. That’s why, Cannon says, white papers like this are important.

“I don’t think it is something that most people are aware of — particularly with the rate of uninsured,” he said. “That’s because the current surveys … don’t get large enough sample within individual states for us to really get any good information. So, we know what the picture looks like nationally, but it is a little bit harder to get to it on a state level, which I think makes awareness of the issue much more difficult for people.”

When asked if how many people residing in his district were uninsured, King responded that the people of the 5th district “want freedom.”

An August 2009 study by the Economic Research Service Division of the U.S. Department of Agriculture documented that roughly 13 percent of all individuals living in the Midwest had no current health care insurance. The study also noted that although there were no statistical disparities between rural and urban in coverage or levels of health expenditures, rural residents earn less than residents of urban areas and, therefore, often spend larger portions of their income on health care.

Among all farm-operator households, according to the study, 14 percent of all members did not have health insurance during 2007, and that lack of insurance coverage was higher (20 percent for non-elderly and 6 percent for elderly populations) for members of households in which farming was the primary occupation of the operator.

More of Stark’s series can be found on his website.

“Understanding the swine genome will lead to health advancements in the swine population and accelerate the development of vaccinations for pigs,” said Roger Beachy, director of the National Institute of Food and Agriculture. “This new insight into the genetic makeup of the swine population can help reduce disease and enable medical advancements in both pigs and humans.”

A Duroc pig, similar to the sow above, was selected by researchers to have its genome sequenced. It is expected that the advance will be of benefit to both pork producers and humans. (Photo: Wikipedia)

NIFA, previously the Cooperative State Research, Education, and Extension Service, provided the $10 million in funding in 2006 to the University of Illinois at Urbana-Champaign. The total cost was about $24.3 million, with additional support from U.S. Department of Agriculture’s Agricultural Research Service and various American, Asian and European funders.

University teams selected a red-haired Duroc pig from a farm at the university to use for the sequencing project. Duroc is one of the older breeds of American domesticated pigs, and considered to typically be a more aggressive breed, that is a basis for many mixed-breed commercial hogs. The Duroc now will be among the growing list of domesticated animals that have had their genomes sequenced.

In addition to the USDA funding, funding and technical support were provided by the Iowa Pork Producers Association, Iowa State University and several other national and international organizations.

Researchers will announce the achievement today at a conference at the Wellcome Trust Sanger Institute, located Hinxton, England, where most of the sequencing was performed.

Dr. Temple Grandin, a woman considered to be a national authority on humane livestock slaughtering who also spoke about practices at the Agriprocessors plant in Postville, reviewed the undercover footage from Bushway Packing, Inc. in Grand Isle, Vermont that was obtained during August and September. She and one of her doctoral students at Colorado State University pronounced that “the conditions and acts shown in the videos that we received were not as severe as those shown in the Westland-Hallmark investigation in 20087-2008; however, the handling practices and attention to insensibility in this plant are unacceptable and must improve.”

Video footage shows veal calves, some with their umbilical cords still attached and yet unable to walk, being kicked, slapped, and repeatedly shocked with electric prods.

“The deplorable scenes recorded in the video … are unequivocally unacceptable,” said Tom Vilsack, U.S. Secretary of Agriculture. “The callous behavior and attitudes displayed in the video clearly appear to be violations of USDA’s humane handling regulations.”

Vilsack indicated that the USDA Food Safety and Inspection Service (FSIS) has launched an investigation into the allegations against the business, and took immediate action.

“The Department fully supports the investigation of all those involved in these alleged violations of the Humane Methods of Slaughter Act,” he added. “To this end, I have also called on our Inspector General to conduct a criminal investigation into the events in the video.

“FSIS has a rigorous program to train inspection personnel in verifying humane handling and slaughter at establishments. When an FSIS employee observes behaviors that are not in compliance with [regulations], they are obligated to take immediate action. The behavior of FSIS and establishment personnel witnessed in this video is inexcusable.”

Michael Markarian, operating officer for the Humane Society of the United States, praised Vilsack for his “decisive action to address the problems at this slaughter plant and for taking animal welfare concerns seriously.”

Vermont Secretary of Agriculture Roger Allbee said the alleged animal welfare practices are “disturbing.”  He was also quick to note that such practices are “not representative of the industry as a whole in Vermont and such actions will not be tolerated in our state.”

The calves shipped to the facility were primarily being prepared for slaughter for veal. Calves, especially male calves within the dairy industry, are often sold to veal manufacturers. Many such calves are confined to maintain low muscle growth and tenderness of the meat they provide.  Although Iowa has not passed laws to phase out the use of veal crate confinement systems, the states of Arizona, California, Colorado, Maine and Michigan have passed such laws. Even so, those states still allow transport and slaughter of calves at any age.

Readers should be aware that the video posted below, provided by the Humane Society of the United States, contains graphic images:

“While Kansas and North Carolina have a few little rivalries going on, [Hagan and I] have had a great time working together on health care issues, and particularly for rural citizens in this country because both of us come from states with a significant rural population,” Sebelius said.

The conference call with reporters was held in conjunction with the release of a new report by Sebelius’ office. The report, titled “More Choices, Better Coverage: Health Insurance Reform and Rural America,” documents many of the challenges faced by the estimated 15 million rural residents who seek health care insurance in the current system.

“A lot of rural Americans are self-employed or work for small businesses, including family farms,” Sebelius said. “A lot of them have to buy insurance on the individual market where they don’t have many choices and they have extremely high prices and rules that don’t protect consumers. Even when they do secure insurance, many folks in rural America then have difficulty finding a doctor. Two-thirds of the under-served community in America are in rural areas.”

According to Sebelius and Hagan, reform would begin to solve many of the access and insurance problems currently faced by rural residents.

“North Carolina does have a very large sector [of population] in rural areas,” said Hagan, who serves on the U.S. Senate Health, Education, Labor and Pensions Committee that is led by U.S. Sen. Tom Harkin of Iowa. “I think one of the critical aspects of the health care reform effort in Congress right now is that it is going to improve the quality, accessibility and affordability in our rural area.”

Forty percent of self-employed workers living in rural areas are uninsured, compared to 32 percent of self-employed workers living in urban areas, Hagan noted.

“[In North Carolina], 65 percent of of the uninsured population who are full-time workers, work for small businesses — compared to about 46 percent in urban areas,” she said. “And whereas there are nine doctors for every 10,000 North Carolinians in the larger cities, there are only about six-and-a-half for every 10,000 in rural areas. People in rural North Carolina are four times as likely to live in a county with lower access to health care professionals.”

Residents who live in these rural areas, according to the report, not only have more difficulty affording and accessing care, but typically have higher rates of poverty and chronic disease such as diabetes and heart disease. Because many of these same residents work for small businesses, or work part-time or seasonal jobs, it is much less likely that they will have private, employer-sponsored health care benefits. Nationally, a third of all rural residents work for small businesses, yet less than half have health insurance — a figure expected to climb as more small business owners drop health insurance coverage in order to keep their businesses afloat.

Farmers and agricultural workers are especially challenged in today’s insurance market. A multi-state survey of farm and ranch operators found that, while 90 percent of farmers have insurance coverage, one-third purchased it directly through an insurance agent (compared to a national average of 8 percent). The other two-third likely have a spouse that is forced to work off-farm so that the family can be provided with consistent health insurance coverage through an employer.

Sebelius and Hagan also acknowledged that simply providing rural Americans a way to pay for health care doesn’t always translate into access to health care. There were only 55 primary care physicians per 100,000 residents in rural areas in 2005, compared with 72 per 100,000 in urban areas. In the nation’s most isolated and small rural areas, that figure drops to 36 per 100,000. Hagan asserted that although the earlier stimulus had already addressed an expansion of the federal program for loan repayment of medical professionals who agree to practice in under-served areas, the current reform measure provides an extensive and necessary boost to further those efforts.

“There will be scholarships and loan-repayment programs for primary care providers who actually practice in these under-served areas,” she said. “The National Health Service Corps will provide grants and scholarships and loan-repayment programs to providers that’s going to include nurses, nurse practitioners, physician assistants, dentists and mental health providers who actually work in these under-served areas.

“The idea is to increase this dramatically from where it is right now, to be sure that we can get people who hopefully have lived in rural areas to actually go to these medical schools and into these medical professions and then return to their homes, or to agree to living in a rural area for a period of time.”

The current proposals would also provide payment bonuses to primary care providers practicing in under-served areas. Those who have studied ‘doctor drain’ acknowledge that the problem focuses on getting doctors and other health care professionals to begin a practice in an under-served.

“One of the things that we’ve found around the country is that once a person begins a practice, such as a practice in a rural area, [he/she] tends to voluntarily stay,” Sebelius said. “So it really hasn’t been necessarily the challenge of keeping folks there, it has been the challenge of getting them there and getting them back.”

Both women also expressed their optimism that the confirmation of Dr. Regina Benjamin as U.S. surgeon general would be forth-coming, as well as their belief that her personal experience will be a positive influence for young medical students to take advantage of incentive programs to not only serve in rural areas, but to build practices that add to the fabric of those communities.

For the past several months, The Iowa Independent has documented the health costs associated with provider shortages in rural areas. Without sufficient providers, some rural residents are forced to travel significant distances for general health, mental health, dentistry and pharmaceutical services.

According to a 2007 study by the National Center for Rural Health Works at Oklahoma State University, one full-time primary care physician generates, on average, approximately $1.5 million in revenue, $900,000 in payroll and creates 23 jobs. The relatively large impact is created through clinic employment, inpatient services, outpatient activities and the multiplier effect of these contributions, and it does not include potential benefits to local pharmacies.

The study also documents another important factor: If primary health care services are not available in a rural town, residents will often travel to the nearest urban centers to meet their needs. Because such urban centers often provide expanded shopping and specialty service opportunities, the traveling patients will often make other purchases out of town that may have otherwise made locally.

In many ways, a general practitioner’s economic contributions are as important to a community as his/her medical contributions.

The National Center for Rural Health Works estimates that a rural community with a shortage as low as one-half of one full-time physician stands to loose $236,565 from clinic visits and $451,169 net revenue at a local hospital for in-patient and out-patient activity. When those figures are adjusted for indirect multipliers — for example, services purchased by the physician, the clinic and employees — the total impact of the shortage was 13.8 jobs and $533,493 in income.

Despite all the evidence, few rural areas currently target medical professionals as a part of their routine economic development efforts.

“Some of our larger communities struggle to attract health care providers to those communities, and I know that it gets very competitive as far as what they need to do in order to draw physicians, physician assistants, nurse practitioners, primary care providers and the whole gamut of health care providers,” said Tom Newton, director of the Iowa Department of Public Health. “It is gets very competitive to draw those individuals to your community. But when you look at the rural communities, the people (i.e., providers) just not willing to go out there and work.

“Somehow we need to re-invigorate those communities and show the benefits that they have and what they can offer to providers who are willing to go out there and work.”

It is typically only when a primary care physician leaves a community or retires that residents and local leaders understand the impact of that business on the local economy. And, unfortunately, creating a medical practice from scratch instead of transitioning from one physician to another is a much more formidable task.

There are, however, promising approaches rural communities could take to reduce the decline of medical professionals, but none is in widespread use.

Some rural communities are taking a “grow your own” approach, whereby community groups attempt to identify young adults — even as young as middle school or junior high students — who might have an interest in attending medical school. Through scholarships and other incentives, they pay for a student’s medical training in exchange for a promise to return to the community and practice medicine there.

Although most rural communities have been slow to adopt this approach, it is gaining momentum as smaller communities are faced with aging medical providers and few prospects to fill those potential voids in service. According to Newton, such approaches to provider shortages have been “the most effective” in bringing providers into rural areas.

“It is much easier for a young person to go back into a rural community if that’s where they grew up, and if that is where they raised, because they understand the benefits of living in those rural communities” he said.

Another, somewhat more popular method of training physicians and other health care providers for service in smaller communities is the implementation of rural residency programs. Not only do programs such as the Smoky Hill Family Medicine Residency Program in Kansas and the Durant Family Medicine Residency Program in Oklahoma prepare physicians for work in smaller communities and rural areas, but they also provide a boost to local communities where they operate.

“I think we also need to do a better job of selling what we have in Iowa. We don’t do that. We make a lot out of the fact that we don’t have oceans and we don’t have mountains, and everyone is under the assumption that is what attracts young people today. Well, to some degree it does. But, eventually those young people get married, have kids and have other priorities that begin to take precedent in their lives,” Newton said. “If they understand that there are safe communities, that have good schools, that have short commutes — ones in which there is a sense of community and they know their neighbors, and their patients and they can have a real relationship with them — there are aspects of that which are very appealing to people.”

As the recession takes its toll and small town populations continue to age, health care providers will become an increasingly important part of rural economic development. Doctors are an important component of the rural economy, improving conditions far beyond the walls of an examination room.