JUDY WOODRUFF: But, first, rural communities around the country have experienced a wave of hospital closures in the last five years, with hundreds more on shaky financial footing.
For many small towns, it all adds up to hard times that may soon get harder.
Sarah Varney has our report from Georgia. The story was produced in collaboration with our partner Kaiser Health News.
SYBIL AMMONS, Stewart County Coroner: It’s just sad. And the hospital, oh, my goodness.
SARAH VARNEY: Sybil Ammons is a fixture in the town of Lumpkin, Georgia, population 1,500. For years, she was the director of nursing at the county’s only hospital in nearby Richland. Now she’s the county coroner.
SYBIL AMMONS: Our people built this hospital, our ancestors. The hospital, when I ride by there, it just breaks my heart, because my mama worked over there before I did. My sister was born over there.
It’s just so sad, so sad.
SARAH VARNEY: The hospital closed in 2013. Since then, Ammons can count off the local residents she thinks have been harmed or died because they couldn’t reach medical care quickly enough.
SYBIL AMMONS: We have had a stroke, several heart attacks, several cardiac problems. We have had traumas out on the four-lane. I would say at least 10 to 15 people have had bad outcomes from the hospital closing.
SARAH VARNEY: Two hundred miles away, in Folkston, Georgia, 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 overturned her four-wheeler, spilling into a fire pit used to burn trash.
Her then-boyfriend, Billy Chavis, pulled her from the fire and patted down the flames on her body with his bare hands.
PAM RENSHAW, Burn Victim: Whenever I got in the truck, my whole — everything right here just fell in my lap. And I just pulled it back up, and I’m like, oh, my gosh. It’s bad, isn’t it?
BILL CHAVIS: And I said, yes, we got to get you to a doctor. And I seriously thought we was going to lose her. And the whole time, I’m driving to town with the palms of my hands, where I burnt my hands. I said, ‘Where do I go? Where do I go?’
SARAH VARNEY: The hospital had closed just months before Renshaw’s accident, leaving Chavis scrambling. He first tried the EMT office. When he didn’t find anyone, he ran to the police station and a dispatcher summoned an ambulance.
Renshaw was airlifted to a hospital in Gainesville, Florida, 100 miles away. It was an hour-and-a-half before doctors tended to her.
PAM RENSHAW: It burnt like 45 percent of my body, the whole arm, all the way across my stomach, and down the left leg to my knee.
SARAH VARNEY: Renshaw was in a medically-induced coma for three months and spent nearly eight months in the hospital. Her body remains terribly scarred.
Dangerous industrial jobs drive the economy in Folkston, and Renshaw’s accident spooked this small town of 5,000. Local leaders are still trying to reopen the hospital.
More than 50 rural hospitals across the country have closed since 2010, and hundreds more are in fragile financial condition. It’s a trend hastened by declining revenues and a restructuring of the health care industry that rewards scale and connectivity — difficult goals for hospitals that are small and remote. As rural hospitals have closed here in Georgia, hundreds of people have lost their jobs. And many small towns have been left reeling.
In Glenwood, Georgia, the hospital has been abandoned for more than a year. Inside, antiquated security cameras flicker between images of empty hallways and still-made beds. In the hospital laboratory, it’s as if the workers simply got up one day and left. Unplugged refrigerators still hold vials of blood.
There are signs of decay outside, too. After the hospital closed, the bank and the town’s only restaurant quickly followed suit. Next may be the nursing home.
YOLANDA JEFFERSON, Glenwood Healthcare, LLC: We have a 50-bed facility, and we have 35 residents. That’s a threat to us. That’s very detrimental. If we go any lower, we might have to close. We can’t — because we can’t meet our financial standards. We can’t meet the financial obligations.
SARAH VARNEY: The hospital was the town’s largest employer, and the loss of more than 100 jobs was yet another blow to a rural community accustomed to hardship.
G.M. JOINER, Mayor of Glenwood: This through the years has been a hair salon, styling-type shop, tanning beds and that kind of stuff. And, of course, it’s vacant now.
SARAH VARNEY: G.M. Joiner has been Glenwood’s mayor for three decades. His father was the mayor before him. Joiner says without the traffic from hospital workers and visitors, local businesses are barely hanging on. The owner of the local grocery store, D.K. Patel, says sales have plummeted.
D.K. PATEL, Owner, Red & White Quality Foods: Yes. After the hospital closed, we dropped about 30 percent in sales. It’s been hurting a lot. All I can say is: it’s been hurting a lot.
G.M. JOINER: Obviously, it was our lifeblood, mainstay. It’s not overemphasizing or trying to be a doomsday prophet, but it’s devastating. It’s devastating.
SARAH VARNEY: Across the country, rural hospitals have struggled to adapt to a steady decline in rural populations and to a new reality. A series of budget control measures passed by Congress cut Medicare payments. Further, 19 states have not expanded Medicaid under the Affordable Care Act, also known as Obamacare.
That’s left many rural hospitals with unpaid bills just as federal subsidies for the uninsured are scheduled to taper off. For many patients in these small towns, the price has been steep. Sue and Joe Connell of Glenwood, age 75 and 77, now must drive two hours round-trip to their doctors’ appointments. There are no physicians practicing anywhere in their county.
Joe Connell has a blood disorder and other medical problems that keep him and his wife on the road almost daily.
JOE CONNELL, Glenwood Resident: I’m seeing about four different doctors in Dublin. And some trips, like this week, we’re making three trips to Dublin; 90 percent of the miles put on our cars is going to the doctor in Dublin. It costs us. It costs a bunch of money.
SARAH VARNEY: The pace of the closures has only escalated in recent years, and the National Rural Health Association says more than 280 hospitals with 700,000 patient visits are at risk of shutting down.
Chuck Adams travels the state meeting local health care leaders. He’s the executive vice president of the Georgia Hospital Association.
CHUCK ADAMS, Vice President, 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. When you have time to figure it out, I think there are some models out there that could work.
SARAH VARNEY: While the closures have disrupted emergency care, reduced options for pregnant women and drained doctors from some rural communities, researchers have found, on average, that closing down a rural hospital doesn’t increase the chances of death.
Indeed, a separate investigation by The Wall Street Journal found surgeries at many rural hospitals carried a greater risk of complications. And for some emergencies, patients can receive better quality care at larger hospitals that treat more cases.
Alan Kent is CEO of Meadows Regional Medical Center, a bustling, modern hospital in Vidalia, Georgia, that has taken in patients from neighboring towns like Glenwood.
He says that 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.
ALAN KENT, CEO, Meadows Regional Medical Center: There has to be sort of a critical mass to be able to make any business viable, and especially a community hospital.
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.
SARAH VARNEY: Back in Glenwood, Joe and Sue Connell sit on their front porch watching the traffic leave town. They worry that someday soon, they, too, may need to leave for good.
JOE CONNELL: I got where I can’t drive. And I don’t know what we’re going to do when she gets where she can’t drive.
SARAH VARNEY: For the “PBS NewsHour” and Kaiser Health News, I’m Sarah Varney in Glenwood, Georgia.
JUDY WOODRUFF: In the coming days, we will look at a hospital in rural Texas that turned similar challenges into opportunity, and, in the process, became one of the top hospitals in the nation.