RIO GRANDE CITY, Texas — Dr. Jake Margo Jr. stood in the triage room at Starr County Memorial Hospital explaining why a person with persistent fever who could be treated with over-the-counter medication didn't need to be admitted to the emergency room.

"We're going to take care of the sickest patients first," Margo, a family medicine physician, said.

It's not like there was space on that June afternoon anyway. A small monitor on the wall pulsed with the vitals of current patients, who filled the ER. An ambulance idled outside in the South Texas heat with a patient waiting for a bed to open up.

"Everybody shows up here," Margo said. "When you're overwhelmed and you're overrun, there's only so much you can do."

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Starr County, a largely rural, Hispanic com

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