Currently, there two major hospitals in the southermost third of the city.

Texas Vista Medical Center — a 327-bed facility at 7400 Barlite Blvd. (formerly Southwest General Hospital) — has operated for nearly 40 years. It’s owned by Steward Health Care of Dallas.

LEFT: Esmeralda Salinas holds her 2-year-old daughter, Elina Arredondo, as she gets information about health care resources at a community baby shower held in October at Texas Vista Medical Center. RIGHT: Maria Hernandez opens presents with her partner, Angel Espinoza, as they finish preparations for their baby shower. The couple had been trying to have a child for several years and were excited to celebrate the arrival of their daughter. (Josie Norris)

And there’s Mission Trail Baptist Hospital in the Brooks mixed-use community on the site of the former Brooks AFB. It is one of five Baptist Health System hospitals in Bexar County owned by Dallas-based Tenet Healthcare.

People in the northern areas of the city have no shortage of state-of-the-art health care facilities nearby.

The rapidly growing Alamo Ranch area, along State Highway 151 west of Loop 1604, has attracted a flurry of hospital construction by the Christus Santa Rosa Health System, Baptist Health System and Methodist Healthcare System. The U.S. Department of Veterans Affair built a massive outpatient clinic in Westover Hills.

A little farther north on Loop 1604 between Culebra and Bandera roads, University Health, Bexar County’s public hospital system, bought land for a hospital. Nearby, a UT Health San Antonio training facility-sports clinic is being built for student-athletes at the University of Texas at San Antonio.

University Health has acquired an additional 42.5 acres of land zoned for hospital development in Selma, near the Retama Park racetrack on the far Northeast Side.

In September, George Hernandez, University Health’s president and CEO, announced plans to build a hospital on a 68-acre tract across from Texas A&M University-San Antonio’s campus on the Southwest Side.

Hernandez, who grew up on the South Side near Burbank High School, rebuffs criticism that the system took too long to buy land or build in that part of the county. He said it was waiting for the right spot to become available.

“I don’t think there’s another public health system in Texas that has as many clinics as we do,” he said.

University Health has six of its own primary care clinics on the West and South sides and one on the East Side. They also partner with CentroMed, a nonprofit that operates eight of its 25 sites on the South Side, and with CommuniCare, which has two clinics on the West Side.

“Why build bricks and mortar when you have partners like that,” Hernandez said. “You have to look at what’s the best way to get the care out quickly. Sometimes, it’s building. Sometimes, it’s partnering.”

To be sure, multiple organizations operate free and low-cost medical clinics throughout underserved areas, such as Methodist Healthcare Ministries’ two Wesley clinics. But they don’t address disparate access to higher-level care, including various specialties and emergency medicine for life-threatening conditions.

Ochoa, who has surgical privileges at the two hospitals on the South Side, said it’s not nearly enough. 

Mission Trail opened in 2011, replacing Southeast Baptist Hospital. With 110 beds, it is the smallest full-service hospital in the Baptist system. The combined 437 beds at Mission Trail and Texas Vista Medical Center pale in comparison with the more than 5,100 beds available on the North Side.

Ochoa and Negley say city leaders need to step up, perhaps by offering incentives to health care organizations to build on the South Side.

“It’s much harder for a small business to say, ‘I’m going to go down there and take the risk and maybe the business isn’t successful.’ But that’s not true for big hospital chains. They are making billions of dollars,” said Negley. “The hospitals are making profits and consciously deciding that the profits aren’t enough to reinvest in the community.”

Ochoa cited the rapid population growth on the Southeast Side and questioned why Baptist Mission Trail Hospital isn’t growing along with it.

“I think from a social responsibility standpoint, these big businesses should be accountable to the community that they are serving. If they’re too small, then they need to expand and provide the services needed,” she said.

Baptist officials did not respond to requests for comment.

Baptist operates two smaller “neighborhood” hospitals in the area, one near Port San Antonio and another on South Zarzamora near Interstate 35. But those facilities are freestanding emergency centers rather than full-service hospitals.

Unlike privately owned, for-profit ERs popping up across the city, which focus on concierge health services, Baptist’s ERs can accept Medicare patients and those covered under Tricare, a government-sponsored health insurance program for active and retired service members and their dependents.

Some doctors say “micro-hospitals” can drive up costs for consumers who aren’t aware that urgent care facilities provide many of the same services at much lower rates.

Lives and limbs

A grim way to measure health disparities is by life expectancy.

The average number of years a person may live varies by up to 18 years across San Antonio, depending on what neighborhood you live in. Life expectancy is strongly influenced by so-called social determinants of health, such as access to healthy food, recreation, living wages and medical care.

For example, it’s harder for someone living in a neighborhood with a high crime rate, few street lights and no sidewalks to get adequate exercise and remain fit. It’s harder still if the person works multiple jobs, or if they can’t afford a health club membership — or if they can but have no way to get to its gym.

In contrast, it’s easier for a person who lives near a park or walking trail and who works 40 hours a week at decent pay to stay active and avoid chronic health conditions.

Residents in census tracts on the South Side can expect to live into their early 70s on average, according to data from the Centers for Disease Control and Prevention. For people in certain census tracts on the North Side, life expectancy is 84 to 88 years on average.

The average life expectancy for all of Texas is 78.6.

Another chilling measure of health disparities is loss of limbs to diabetes. The most recent data available, from 2015, shows that ZIP codes on the South, West and East sides had the state’s highest rates of hospital admissions for amputations of lower extremities.

Such amputations are often a last-ditch effort by a surgeon to save a patient’s life after an infection or uncontrolled diabetes blocked blood vessels.

“It’s completely preventable,” Ochoa said. “There’s so many stages that it’s preventable and controllable.”

As a vascular surgeon, Ochoa treats patients’ veins and arteries and tries to make sure they are clear enough so that oxygenated blood can flow to every part of the body.

On the West Side at the Texas Diabetes Institute, there’s another surgeon working to save lives among the disenfranchised.

Dr. Thomas Zgonis is a podiatry specialist whose work is protecting infected toes and legs from amputation. When surgery is necessary to save a patient’s life, he helps them recover and regain mobility.

Zgonis is eyeing University Health’s recent land acquisition on the Southwest Side as a future site for a new clinic that could focus on prevention and help patients avoid amputation.

Diabetes is a true epidemic, he said, especially in parts of the West and South sides, where up to a quarter of the adult population shares this diagnosis.

Salvador Martinez, a 63-year-old West Side resident, was on his way to a job interview when he tripped on an uneven sidewalk. He fractured his shinbone and contracted a severe infection. A month later, doctors surgically removed his left leg below the knee.

“It was a freak accident. I didn’t even know I was diabetic,” he said. “I’ll be honest. Those first couple of weeks” after losing the leg “I went through some dark moments in my life.”

After the surgery, he waited three years for a prosthetic limb because of the cost and problems with insurance.

In March 2021, Martinez contracted another infection, and Zgonis had to remove part of his remaining foot.

But during a checkup last fall, Martinez said he was thankful to be able to stand again and hoped to be well enough to go watch his favorite national team, Mexico, play in the World Cup someday.

Another patient, Ray Anthony Alcaraz, knew that he had diabetes but didn’t realize how much it mattered where he went to get medical care.

The day after Thanksgiving in 2020, he ended up in a local hospital with an ulcer on the bottom of his foot. One doctor told him he would lose both legs, but he remembers another doctor fought to save one of them.

“When I was getting discharged, she told me, ‘I don’t want to see you here at this hospital. Where you need to go is University (Hospital), but don’t tell them I told you that,’” he said.

Later, he was able to get on CareLink, a financial assistance program through University Health, and made an appointment at the Texas Diabetes Institute.

Zgonis was able to do another surgery so that his remaining leg would heal properly. It worked.

Because he is uninsured and now can’t work, Alcaraz waited over a year for a prosthetic leg to help him walk again.

County Judge Nelson Wolff said residents outside the city limits were left behind during the COVID-19 pandemic.

County Manager David Smith’s presentation on the need for a county health division cited the first article in this series, which showed that COVID-19 death rates were up to 16 times higher in parts of the South Side compared with parts of the North Side.

At least 5,320 Bexar County residents have died because of COVID-19. Many of them were at greater risk because they suffered from conditions that can be prevented or controlled, such as diabetes and obesity.

“We’re trying to help people before they get really sick,” Wolff said. “They might not have lost their lives had they not had one of those underlying conditions.”