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Hospital Closures Rattle Small Towns

RICHLAND, Georgia — For years, Sybil Ammons was the director of nursing at Stewart County’s only hospital. Now, she’s the county coroner.

Since the hospital here closed three years ago, Ammons says more than a dozen local residents were unable to get medical care quickly enough and were either harmed or died because of the delays. “We’ve had a stroke, several heart attacks,” she said, standing along Richland’s main street in this small town about 150 miles south of Atlanta. “We’ve had traumas out on the four-lane.”

Across the country, more than 50 rural hospitals have closed over the last six years, and another 283 are in fragile financial condition, according to the National Rural Health Association. With rural populations long in decline in the United States, small-town hospitals have lost customers and struggled to keep pace with the striking advancements in medical technology.

But the pace of closures has escalated in recent years, hastened by a series of budget control measures passed by Congress that reduced Medicare payments and by the Affordable Care Act, which is slowly restructuring the health care industry. The law rewards scale and connectivity — difficult goals for rural hospitals that are, by their geographic nature, low-volume and remote.

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Compounding their financial troubles, 19 states have not taken advantage of a key provision in the health law to expand their Medicaid programs. That’s left many rural hospitals with uninsured patients just as federal subsidies for taking care of the uninsured are being reduced.

It’s Hurting A Lot’

As hospitals have closed in Georgia, hundreds of people have lost their jobs, and many small towns have been left reeling.

When the Lower Oconee Community Hospital in Glenwood, two and a half hours southeast of Atlanta, abruptly laid off its workers, transferred its remaining patients and locked the front door nearly two years ago, it was yet another blow to a rural town accustomed to hardship. The hospital was the town’s largest employer and without the daily traffic from its 100 employees and families and friends of its patients, the town’s only restaurant closed, followed soon by its only bank.

“After the hospital closed, we dropped about 30 percent sales,” said D.K. Patel, owner of the local grocery store that sits on the edge of Glenwood’s town square. “All I can say is it’s been hurting a lot.”

The town’s mayor, G.M. Joiner, who has held his elected post for three decades, and whose father was mayor before him, laments the hospital’s decision to close. “It was our lifeblood,” he said. “It’s not overemphasizing or trying to be a doomsday prophet, but it’s devastating.”

Joiner has been courting suitors for the shuttered hospital, but with little success. The building sits eerily abandoned. At a nurses’ station, antiquated security cameras flicker between images of empty hallways and patient rooms with the beds still crisply made; dead cockroaches litter the floors; vials of patient blood sit in refrigerators, long ago unplugged, in the hospital laboratory.

For many residents, the disruption in medical care caused by the hospital closures has been deeply unsettling and, for some, life threatening.

It only takes one tragedy to realize how detrimental losing this facility is.

Dawn Malin

At her home in Folkston, near the Okefenokee Swamp, Pam Renshaw had to bypass her town’s closed hospital when she needed it most. After a day of yard work, Renshaw accidentally overturned her four-wheeler and spilled into a fire pit used to burn trash. Her then boyfriend, Billy Chavis, pulled Renshaw from the fire and patted down the flames on her body with his bare hands. Chavis got her into his truck and started driving down the long dirt road for help.

“And the whole time I’m driving to town, I said, ‘Where do I go? Where do I go?’”

The hospital in Folkston had closed just months before Renshaw’s accident, and Chavis scrambled to find help. He first tried the EMT office but when he didn’t find anyone, he ran to the police station and a dispatcher summoned an ambulance. Renshaw was driven to a nearby landing strip and airlifted to a hospital 100 miles away in Gainesville, Florida. Doctors finally tended to the burns, which covered 45 percent of her body, an hour and a half after the initial accident.

She spent weeks in in a medically induced coma and nearly eight months in the hospital.

Renshaw’s accident spooked this small town of 5,000 people, where dangerous, industrial jobs drive the local economy, and made clear just how vulnerable residents could be during a crisis at home or at work.

“When you have a timber industry, you’re dealing with saws, you’re dealing with heavy equipment,” said Dawn Malin, executive director of the Folkston Chamber of Commerce. “It only takes one tragedy to realize how detrimental losing this facility is.” The hospital’s closure has caused worries about workplace accidents at a local paper plant, Malin said, and hampered her group’s effort to attract new businesses.

Difficulties For Seniors

For many elderly residents of small towns, the price of the hospital closures has been steep. When the hospital closed in Glenwood, the remaining doctors moved out of the county, and residents like Joe and Sue Connell now must drive two hours round trip for medical care.

“I’m seeing about four different doctors in Dublin. This week, we’re making three trips,” said Joe Connell, 77. “Ninety percent of the miles put on our cars is going to the doctor in Dublin. It costs us, costs a bunch of money to go back and to.”

For pregnant women in rural Georgia, the hospital closures can mean dwindling access to prenatal care and longer trips when labor begins. In Waynesboro, Georgia, Dr. Frank Carter, a prenatal specialist, said after the troubled local hospital there closed its labor and delivery unit, his patients — largely poor women with little money for transportation — face an hour’s drive to deliver their babies.

“They’re going to have to be prepared and willing to travel,” Carter said. “And that’s the reality.”

It’s not overemphasizing or trying to be a doomsday prophet, but it’s devastating.

G.M. Joiner

Adjusting to that new reality is difficult for many rural residents. Hospitals are often a vital part of small-town life, said Chuck Adams, vice president of the Georgia Hospital Association.

“Towns like Glenwood have always had a hospital. When that hospital closed, then these residents immediately lost access without an opportunity to figure out what that next access model was,” said Adams. “When you have time to figure it out, I think there are models out there that could work.”

Effect On Health Unclear

But while hospital closures in rural areas can unsettle residents’ nerves and force them to travel farther distances, the effect on health outcomes remains unclear. Researchers have found that closing down a rural hospital does not increase the chance of death, and, an investigation by the Wall Street Journal found surgeries at many rural hospitals carried a greater risk of complications. Indeed, for some emergencies, patients can receive better quality care at larger hospitals that treat more cases.

“There has to be sort of a critical mass to be able to make any business viable, and especially a community hospital,” said Alan Kent, chief executive officer of Meadows Regional Medical Center, a bustling modern hospital in Vidalia, Georgia, that has taken in patients from neighboring towns like Glenwood. While rural residents need access to primary and urgent care, not every town can sustain a hospital with costly medical equipment and a roster of specialists.

“We have to be more efficient in hospitals if we are going to be sustainable, and I think that’s one of the things that you’re seeing that’s driving the consolidation in the industry,” Kent said.

But for elderly residents like the Connells, the closures have forced them to reconsider their retirement plans. Sitting on the porch of his house in Glenwood with his wife, Sue, age 75, Joe said, “I don’t know what we’re going to when she gets where she can’t drive.”

This story was reported in collaboration with PBS NewsHour producer Jason Kane.

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Health Industry Public Health Rural Health