Drive down Back Neck Road in Cumberland County, past the lettuce, pepper, and cucumber fields, and arrive at the bright-red door of the family doctors Lori C. Talbot and Christopher T. Ballas, who offer medical services, about 10,000 visits a year, to local families and migrant farmworkers.
Serviceable and convenient, this cradle-to-grave practice in Fairfield Township, outside Bridgeton, has cared for people in this location for more than 40 years.
But now it faces an existential threat that few saw coming a few years ago: slow internet, and sometimes no internet, over aging copper phone lines.
Comcast Corp. didn't wire all the way down Back Neck Road, stopping about a mile away because of the cost of connecting so few homes and businesses to its network, the doctors say.
And Verizon Communications Inc.'s legacy copper phone lines, the area's communications lifeline for Back Neck Roaders for decades, offers DSL internet service. But it has so deteriorated that some days the doctors can't read email for many minutes or do simple online tasks such as registering deaths with the Department of Health and Senior Services.
"Looking at patients' X-rays, MRIs, or CAT scans is not even a possibility because it takes too much bandwidth," Ballas said in an examination room. "They don't load."
But the real problem for Ballas and Talbot - and the one with financial repercussions - is the federal government's giant Medicare insurance program, which has been requiring practices such as theirs to make patient records available through an online portal.
Without a high-speed connection, Ballas and Talbot can't comply with Medicare guidelines for its "Meaningful Use" program of incentives for electronic health records and may face penalties if they don't comply.
The two doctors are now part of a growing public record at the New Jersey Board of Public Utilities. Hundreds of residents, farmers, and others in 17 South Jersey towns say they are falling off the nation's communications grid as Verizon's copper wires deteriorate and the company refuses to upgrade the area to fiber transmission lines, or FiOS.
Some fear that tens of thousands of people could be left out in the cold of the high-speed data economy or forced onto higher-cost wireless services.
Verizon says that the reports of rundown copper phone lines and service problems in South Jersey have been overblown and that the firm has invested $100 million in the South Jersey copper network in the last two years.
Verizon's records show that South Jersey service is "consistently better than [the Board of Public Utilities'] minimum standards," said spokesman Ray McConville. Most areas in Philadelphia and its suburbs have the choice of Comcast Xfinity or Verizon FiOS high-speed internet.
In recent months, Verizon has been meeting with South Jersey officials, holding conference calls, and having a "good dialogue with the towns," he added.
As for the doctors' practice, McConville said: "People need to tell us when they have a problem."
That remark fired up Talbot, who said they met with Verizon officials two years ago to explain their problems but never heard back from Verizon.
This disconnect - the company says all's good, while many customers say they lack reliable service - is playing out with the petition that seeks an investigation into Verizon's copper lines in parts of South Jersey. Cumberland County and towns in Atlantic, Burlington, and Salem Counties filed the petition in November.
In subsequent months, Cumberland County employees took photos of downed and sagging lines. Through a link on the county's website, residents could report a problem to county officials.
Local officials also talked about the copper lines at public municipal meetings and published information about the fact-gathering in mailings sent with tax bills.
The petitioners thought they had to substantiate their claims after Verizon said that the rate of complaints in South Jersey was well within the acceptable range, said Theodore E. Baker, the counsel for Cumberland County who has been leading the petitioning group.
"Service obligations cannot realistically be claimed to have been met when the same customers, again and again, raise the same service issues," Baker told the Board of Public Utilities. "Verizon's 'metric' and the reality in the marketplace are markedly different."
On Aug. 4, the state agency will hold two public hearings in Estell Manor, Atlantic County, at 3:30 and 6:30 p.m. at the local elementary school, on the copper-line investigation - basically a first step in the proceeding, an agency spokesman said.
Talbot, the family doctor on Back Neck Road, will be there. For years, she and Ballas have tried to recruit a third doctor to their practice but had no luck because of the rural area. In addition, traditional family practices have fallen out of favor with new doctors, Talbot said.
Add bad internet to the list of deterrents.
It's a Catch-22. "Medicare wants us to start the portal," Ballas said. "If we don't start the portal, Medicare will reduce our reimbursements. But our infrastructure won't support a portal."
Said Talbot, "There is high-speed internet a mile up the road [Comcast], but there is no building there." As for relocating the practice, she said it seemed like a possibility.