A technician at the Avera McKennan Hospital and University Health Center studies screens showing images with data about a patient in a remote location.
(Updated) The South Dakota prairie is a world away from the luxury hotels of New York City, where the late Leona Helmsley ruled a $5 billion real estate empire. But it is here, in the grassy plains and rugged hills of the upper Midwest, that $100 million of her fortune is driving new development.
It’s not an investment in real estate. Rather, the Helmsley Trust is building “telehealth” programs, designed to bring high-quality health care to sparsely populated areas. Much of the money is going to developing virtual trauma and intensive care units in remote locations, all linked to a state-of-the-art medical center in Sioux Falls. With the push of a red alarm button, for example, a lone nurse at a tiny 26-bed hospital, working in the dead of night, can now beam an image of herself and her patient to a screen at the Sioux Falls hub. Trauma specialists and clinical pharmacists can use the electronic portal to help the nurse make a diagnosis and prescribe the proper treatment; patients’ vitals can be monitored remotely 24/7.
Why South Dakota, where “co-op” isn’t an apartment, but a place to study crop rotation? The need is intense — in South Dakota, just 800,000 people live in the state’s 77,000 square miles. Many counties in the upper Midwest are still classified by the government as “frontier” because they are home to fewer than seven people per square mile. Fewer residents mean fewer doctors and clinics.
South Dakota also happens to be home to Walter Panzirer, 34, a former small-town cop and one of Leona Helmsley’s grandchildren. He’s a trustee of the Leona B. and Harry M. Helmsley Charitable Trust, which has two offices: one on Park Avenue and the other in a Sioux Falls office park.
“We are trying to honor Mrs. Helmsley’s longstanding tradition of charitable giving,” Panzirer told TIME. Indeed, Hemsley was a huge philanthropist — giving millions to New York hospitals, cancer and juvenile diabetes research, aid to Hurricane Katrina victims, 9/11 widows and other causes. But her generosity when she was alive was largely overshadowed by stories of her volatile and often tyrannical personality; she entranced tabloid editors as the “Queen of Mean” and was convicted of tax evasion in 1989. “Only the little people pay taxes,” she was famously quoted as saying.
Panzirer says he wanted to put Helmsley’s money where it was needed most. So the Trust enlisted the Rockefeller Philanthropy Advisors to find the need; the group’s study found that six upper Midwest states — the Dakotas, Wyoming, Nebraska, Minnesota and Iowa — had received just 1.3% of all charitable donations for health care in 2007, and some 80% of that went to the Mayo Clinic in Rochester, Minn. “I would go to Timbuktu if that’s where the need is,” says the shy, soft-spoken Panzirer, who has also worked as a firefighter and paramedic. “This is an area of great opportunity; an area of great needs. We think if [eCare] can work out here, it can work anywhere. It’s the perfect incubation area, the perfect proving ground.”
The Helmsley lore is that she would have preferred to give her fortune to dogs. When the hotelier passed away in 2007, she left $12 million to her pet Maltese, Trouble (a judge later knocked Trouble’s inheritance down to $2 million). Helmsley put the bulk of her $5 billion into the charitable trust. In a mission statement, she asked that the money be used to benefit dogs and “such other charitable activities as the Trustees shall determine.” A judge ruled that the trustees had absolute discretion over the Trust’s philanthropy, and while they have since given a dab to animal charities, such as Guide Dogs for the Blind, they’ve mostly been targeting people, not canines.
In South Dakota, the hub of eCare resides at Avera McKennan Hospital and University Health Center. Escorting a reporter through the facility, Panzirer kept nudging the tour guides to “tell her about” this gadget or another. It is a whiz-bang sight. Trauma and ICU doctors and nurses monitor multiple screens, toggling from one to the next, zooming in on this rural patient’s heart rate or that patient’s X-ray. The specialized guidance has reduced the average stay in participating remote ICU units by 25%, according to Avera, and has allowed outstate hospitals to keep their patients on site, rather than sending them to a bigger facility. That way, the smaller hospitals keep their Medicare dollars.
The ePharmacy unit that’s part of the virtual eCare suite likewise has multiple screens, where pharmacists can monitor the needs of patients at rural hospitals. In the remote locations, carts have been stocked with medicines at various doses, almost like vending machines, Panzirer says, so nurses can easily grab whatever the specialist in Sioux Falls suggests. “Sometimes we have to be the MacGyvers of medicine,” says one pharmacist, noting that she may have to coach a nurse on how to mix compounds if the prepared medicine is not in the cart.
Avera has been using eICU for its satellite hospitals since 2004 (the hospital estimates more than 700 lives have been saved), but it wasn’t until the Helmsley money started flowing in 2009 that the hospital could set up eEmergency sites throughout the state, including in Wagner, S.D., a town of just 1,500. The system worked one blazing hot day when friends rushed Michelle Standing Cloud, barely breathing after being bitten by a prairie rattlesnake, to the hospital.
The emergency team in Sioux Falls collaborated with doctors in Wagner and made the decision to give the girl Antivenin, a serum made from horse blood that can cause lethal reactions in many patients. Indeed, Standing Cloud’s lips and airways began to swell. But the Sioux Falls team was able to help their partners in Wagner stabilize her for the medical flight to the city.
Some rural doctors, like Dr. John Malm, a family doctor in Gregory (pop. 1,300), were skeptical when they first heard of eEmergency. But Malm became a believer when pheasant season opened in the fall of 2009. A young hunter rushed into Gregory’s small hospital — the shotgun being packed into the car had gone off, blasting his 26-year-old girlfriend in the chest at point blank range.
The Sioux Falls doctors could not help save the hunter’s girlfriend, but their presence in the ER by video reassured Malm that he had in fact done everything he could.
“It’s a pretty cold, lonely place to be,” Malm told TIME. “One minute a young person is healthy and alive, and the next you have to tell the family you’ve done everything you can, but their daughter or son is dead. … I had these young, well-trained savvy doctors (helping from Sioux Falls). I felt way less isolated. I knew there had been no stone unturned.”
It was the first time he had slept through the night after losing a patient, Malm said.
Panzirer notes proudly that one of the goals of eCare is to provide enough support for doctors such as Malm, so that good caregivers might be convinced to come to rural areas. While America’s cities average 150 doctors to every 100,000 residents, the doctor-to-patient ratio dwindles to 52 physicians per 100,000 residents in rural areas, the Trust said.
For years, hospitals, the military and even prisons have used “telehealth” programs, monitoring patients from afar or videoconferencing in on a surgery to improve quality and access; the Helmsley-funded initiative is considered more sweeping, because dozens of hospitals from six different states, with different owners, are monitoring patient data in real time to provide computer alerts when things go bad.
“They are bringing innovation to scale in a way that could not happen without philanthropy dollars,” said Jim O’Sullivan, director at Rockefeller Philanthropy Advisors, which helped the Helmsley Trust find the need. “This is the kind of revolution ATMs were to banking. … This is an incredibly alluring way to bend the curve of health care inflation and get people better care at the same time.”
After a couple of years worth of data are in, O’Sullivan predicted, other regions will follow the Helmsley-backed model and link up competing or far-flung hospitals. “Patients are going to expect their doctors to work together,” he said.
Panzirer lives near Sioux Falls and owns and operates a hunting lodge north of Pierre, where he spends a lot of time with his wife and five kids. But his philanthropic role is now a full-time job. He’s up to his elbows in the details of the $108 million that the Helmsley Trust has granted so far to projects in the Upper Midwest — of which eCare is but one.
Three million dollars went to the Abbott House, a home for troubled girls in Mitchell, and $8 million to the Good Samaritan Society for a program that puts sensors in the homes of elderly people. The sensors track movements at all hours, reporting how often a homebound senior takes a shower or wakes up in the middle of the night. Compare $750 a month for the sensors to $80,000 a year for a nursing home, “and you see the savings,” said Panzirer. “And it lets people stay in their own homes.”
Helmsley money has also purchased digital mammography equipment for isolated corners of the Dakotas — the goal is to make sure that a high-quality scan is no farther than an hour by car from every woman. Another initiative will equip every ambulance in the Dakotas — where ranchers and Native Americans have some of the deadliest heart attack rates in the nation — with a 12-lead electrocardiograph machine. Those ECGs let first responders know whether a patient is having the most lethal of attacks, so they can administer clot-busting medicine or dispatch a medical helicopter to get the patient to a hospital that can perform an angioplasty.
Dr. Elliott Antman, a cardiologist at Harvard Medical School, says the Helmsley grant serves as a potential game-changer. When first responders know what they’re doing, it helps reduce the all-important “door-to-balloon time” — that is, the time it takes from the moment a heart patient rolls through the ER bay before the completion of an angioplasty or stent to open up the heart valve and lessen damage to the heart muscle.
“Time is muscle,” said Antman. The national median door-to-balloon time was 96 minutes in 2005; last year it was down to 64 minutes. The more ambulance services are equipped with life-saving tools such as those purchased by the Helmsley grant, Antman says, the more lives will be saved. “Foxhole by foxhole, we can get there,” Antman said.
Whether it’s a heart attack or a gunshot wound, the red buttons, likewise, are adding precious moments. According to Panzirer, ongoing reviews of eEmergency facilities show that when a patient arrives in a rural ER in the middle of the night and no doctor is on site, a trauma specialist in Sioux Falls can be on the case 12 minutes faster than the local physician, who has to be rousted out of bed. “Twelve minutes can save a life,” he says, adding, “there’s no reason why a rural person shouldn’t get the same care as someone in a big city.” The Trust estimates as much as $2.3 million has been saved in unnecessary transfers since it started expanding into more ER sites two years ago.
Panzirer’s passionate conversation with TIME about rural health care took place in a blandly understated conference room. He is as demure and self-effacing as his famous grandmother was self-promoting. Where she starred in the advertising campaigns for Helmsley hotels, he will hardly let himself be caught in the frame at ribbon-cutting ceremonies. Most folks in the Dakotas have never heard of Panzirer and have no idea that a trustee of one of the world’s wealthiest charitable trusts is in their midst.
He is the type of person who neglects to mention that the antique partner desk of his multibillionaire step-grandfather, Harry Helmsley, Leona’s late husband of 25 years, is in his office. Walter uses the desk daily, tending to the charitable work made possible by the shrewd man who started out as a $12-a-week errand boy and ended up a mogul. (Harry Helmsley once told a reporter that the biggest accomplishment of his life was marrying Leona.)
Panzirer seems puzzled when asked about the desk. No, he doesn’t know if it’s oak or walnut. “They were renovating the office in New York, putting furniture in storage,” he explains. “I took it to be thrifty.”
Correction [2:50 p.m.]: Due to an editing error, the original version of this story misstated that a judge deemed Helmsley mentally unfit when she executed her will, and granted $10 million originally bequeathed to Trouble to two of Helmsley’s grandchildren. In fact, Helmsley was deemed fit and the money went to her charitable trust.
Karen Ball is a former AP national reporter who now occasionally contributes to TIME.com from Kansas City.