Good morning, everybody. Chairman Klick, Vice Chair Guerra, members of the committee, thank you so much for giving me the opportunity to testify.

My name is Alberto ‘Beto’ Gutiérrez. A real Beto.I was born and raised in Starr County here in the (Rio Grande) Valley. University of Texas at Austin graduate, medical school, medical center at Galveston, internship at Fresno County General Hospital, California.I am so old, we didn’t have medical residencies back then. One year and then into practice. Two years in the Air Force (South Carolina), and then I practiced for 30 years in Carlsbad, New Mexico.

My Dad asked me to come home 23 years ago, so I have been back in the Valley for the last 23 years.

It is going to be a tough act following Dr. Villarreal. She was so good at what she said and what she did. I am going to echo some of what she already proposed to you.

I had a large practice. I turned it over to a young doctor eight years ago, and now I work for administration at Doctors Hospital at Renaissance.

I also have volunteered at the Hope Family Health Center for 21 years; medical director for the last 15.

I have been practicing medicine now for 54 years. I am not president of anything but I have treated, as of November 1998, one million patients. I’m working on my second million patients right now.

In Carlsbad (New Mexico), I was the only Hispanic (physician) in town. My name, address and phone number were in the phone book, and I did work 24/7. We did not have – back in the 70’s and 80’s – hospitalists, we didn’t have ER doctors. We had to manage our own patients in the emergency rooms, in the offices, in the streets.

I have volunteered, again, at the Hope clinic for the last 21 years, as I mentioned. We currently… we started very, very, small. The Hope clinic was established by a nun and a priest 26 years ago when they saw how many of our poor and indigent populations here in the Valley were not getting proper medical care. They could not afford it.

Fifteen years ago we almost went broke. We depend on grants and donations. We’re not involved with any government entity to keep our clinic open. Donations are a big part, as are grants. Fifteen years ago, we were almost broke. I had a talk with a man named Alonzo Cantú, and he and the administration at DHR started the Fishing for Hope Tournament, and that gives us some money to keep going.So we are back to full operations again.

We service now more than 5,000 patients a year. And again, these are very, very poor patients. Some walk to the clinic, some ride bikes, some have to ask for a ride, and we do the best we can taking care of these patients.

The outcome is we keep them out of doctors offices, we keep them out of emergency rooms, and we do pay for services. We have to pay for their surgeries, imaging, hospital stays, and I have to get on the phone and, not beg but ask the surgeons to please give us a break because we don’t have that much money.

As most of you know, the Valley consists of four counties – Cameron, Willacy, Hidalgo and Starr. Our area is one of the tenth poorest in the United States, has been and will probably continue to be for a while.

Our area has 1.5 million people living in that area, 90 percent of Hispanic ancestry. Forty percent of our populous live under the poverty level. And again, I am going to echo a lot of what Dr. Villarreal said, as far as poverty in the Valley (is concerned). Many of our poor patients live in communities called colonias – substandard living, poor sanitation, plywood houses, cardboard rooms – and this leads to a lot of health issues. Our uninsured rate, that we reckon, stands at 30 percent, double what the rest of Texas has, and triple what the nation has.

At the Hope clinic, we treat all individuals who have no coverage.And for years, most of these are very, very poor people.However, in the last couple of years, I have been seeing educated people with degrees – teachers, social workers – who say they cannot afford insurance. As long as they have no coverage, we see them, and take care of them, and I treat them like I would any private patient.

Our biggest health issues in the Valley, as Dr. Villarreal mentioned already, are obesity, hypertension, diabetes, and, of course, depression. The stats show that our area is 28 percent diabetic. I don’t think that is completely accurate. In my practice, 40 percent were diabetics.

The only section of populous that compares to us as far as diabetes are the Pima Indians in Arizona.

Diabetes, as you guys know, leads to cardiovascular disease, peripheral vascular disease, loss of eyesight, and also impacts the kidneys a lot. Diabetes has a lot of health issues with it.

At our clinic, we try to prescribe generic medicines only. These are the $4 kind. Often, our patients don’t even have the $4, and we at the clinic give them the $4 to buy the medication.

I often see patients at the clinic who haven’t take their insulin for two or three months, with sugar (levels) in the 400 to 500. Normal sugar (level) is 100.

In summary, and I am going to make this short, lack of funds, lack of medical providers, and the high percentage of indigent families in the Valley are in dire need of additional funding, more reasonable prices for medications, and, as Dr. Villarreal mentioned already, they need better access to medical help.

The Valley has been Texas’ stepchild for years, and you all know that. But we are catching up.Doctors Hospital at Renaissance recently was designated a Level One Trauma Center, the only one south of San Antonio. We’ll be able to service everybody south of San Antonio. We also have, currently, Driscoll Hospital, pediatric. (It) is going to build a 23-bed hospital adjacent to our pediatric, adjoining DHR. And that is going to provide the best of pediatric care to the Valley. Our mothers don’t have to go to San Antonio or Houston to get care for their kids.

We do have a medical school now, and a residency program, and we have two nursing programs, but we need more.

So, in summary, what I am asking, or what we need, is investment in training in more health care workers, doctors and nurses. Right now at DHR, we have many empty beds. We cannot bring patients in because we don’t have nurses to administer health care.Investment in education.

You know, I don’t know the answer to poverty. Education appears to be the best way to cover that poverty.Offer blue-collar jobs to some of these poor young males and females – carpentry, mechanics, plumbing – so they can get off the streets and maybe have a trade. That would help.

We need to expand Medicaid.So many, many of our constituents down here need that help. They have no other recourses.

We need some programs to reduce the price of healthyfood stuffs.

We need help from the state to help some our indigents be able to buy medicines at a lower price, and I don’t know how you fix that. But, again, many of our poorer patients are not able to afford even the $4 medication.

Transportation – another big factor.Many of our patients cannot afford transportation. Some walk to our clinic. As I mentioned before, they ride bicycles or ask a daughter or son to leave work and bring them to the clinic.

Maybe there could be some program for those that are in poverty levels can have some kind of ID and be able to afford transportation to health care workers.

And that about is about all I can tell the committee.That we are in the poorest section of this state, of the nation, and we need help for better access to care for our poor and indigent patients here in the Valley.

I would like to answer any questions the committee may have at this point.

Editor’s Note: The above testimony was given by Dr. Alberto H. Gutiérrez, MD, (pictured above) at a recent hearing of the Texas House Committee on Public Heath. The “Chairman Klick” Gutiérrez referred to is state Rep. Stephanie Klick, chair of the House Committee on Public Health. The “Vice Chair Guerra” is state Rep. R.D. ‘Bobby’ Guerra, vice chair of the House Committee on Public Health. The “Dr. Villarreal” Gutiérrez referred to is Dr. Linda Villarreal, MD, president of the Texas Medical Association.

Editor’s Note: The Rio Grande Guardian will feature the testimony of Dr. Linda Villarreal, MD, in an upcoming edition.

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