Small Town Hospital Emergency

While Fulton Medical Center is safe-for now-after being bought by EmpowerHMS, the closure of rural hospitals is a growing problem across the country.

In an ABC 17 News special report, Alyssa Toomey dug into the issue, traveling to Ellington, MO in Reynolds County to find out how the closure of their hospital impacted the community.

“It just takes the life out of the community,” Karen White, resident and CEO of Missouri Highlands Healthcare, said. “You live with a sense of fear that you just don’t know what, if something happened, what you would do.”

Ellington is a town of fewer than 1,000 people, but it is responsible for providing health care to multiple counties. Residents received just two weeks notice before the Southeast Missouri Health Center closed its doors in 2016.

“Right off the bat, we lost 55 jobs–just went away, and the businesses in town are feeling that, ” Christy Roberts, President of the Ellington Chamber of Commerce, said. “We were just devastated, and it’s really impacted our community.”

The Southeast Missouri Health Center was owned by Southeast Health. In its three years of ownership, Southeast Health absorbed more than $17 million in operating losses. Before it closed, fewer than two beds were filled, on average, at the hospital each day.

Now, people in Ellington have to travel almost an hour to the nearest hospital. It’s been a matter of life and death.

“We had a police officer in December of last year that had a heart attack. He, no doubt, he was young, in his 50s, and [it was] deadly. He would’ve lived if we could’ve gotten him to an ER but he just simply couldn’t get there soon enough. Another 56 year old, local farmer, him too, same thing. 56 years old and he died of a heart attack,” Roberts said. “I can come up with five or six people right off the top of my head that easily would have lived if we would’ve had service here.

The lack of a hospital in Ellington isn’t just affecting healthcare, it’s also affecting the economy.

“Some of the restaurants have said anywhere between a 20 to 25 percent reduction in their lunch crowd. That hurts,” Roberts said.

A dentist recently turned down a position in Ellington and one of their only doctors left. White said her clinic has had to absorb a lot of the care–not only in Reynolds County but in nearby Carter County that’s more than 40 miles away.

“We are it when it comes to providing healthcare,” White said. “That’s a lot to put on an organization. Immediately, we had 2,000 to 2,500 extra patients.”

The county does have three ambulances but they are no longer stationed in Ellington, meaning they could be dozens of miles away from someone’s call for help.

“From that point they’re having to go maybe a 45-minute to maybe a 60-minute drive to get somebody to an emergency center,” Roberts said, adding that the overall health of their community has gone down.

The problem is not unique to Reynolds County. The closure of rural hospitals is a growing problem across the nation.

From 2005 to 2016, three rural hospitals shuttered their doors in Missouri, according to the NC Rural Health Research Program. During that same time frame, seven rural hospitals closed in North Carolina.

There are a number of factors that play into the closures. One of the big reasons is a high number of uninsured patients. Medicaid and low patient volumes are also issues. More than 50 percent of closures happened in states that did not expand Medicaid. In March, the Missouri House voted against a proposal by Columbia Rep. Kep Kendrick that would’ve expanded Medicaid eligibility.

The problem is also reaching Mid-Missouri. In September, Fulton Medical Center nearly closed its doors before it was bought by EmpowerHMS.

Officials said it was losing roughly $200,000 a month–that’s about $2.4 million in just one year.

The potential closure would’ve forced some Callaway County residents to drive 30 minutes to the nearest hospital. That’s not an option in the case of something like a heart attack.

“They have to be treated immediately, and getting them to a facility closer to here in Fulton could be the difference between life and death,” Bruce Hackmann, economic development director for the Callaway Chamber of Commerce said.

Outside of emergency care, Hackmann said the presence of a hospital has an affect on everything, just as Ellington has experienced first hand.

“If you don’t have a hospital you go from being like a first-class community, down maybe to a second-class community,” Hackmann said. “People don’t understand, [but] when I fill out requests for proposals for projects and everything, it always asks, ‘do you have a hospital?'”

Under its new ownership, Fulton Medical Center is by no means out of the woods. Leaders said the key to not going the path to closure again is figuring out what the hospital can do well and what it simply cannot support.

“Low patient volumes come from not having enough diversity in your programs,” Isabel Schmedemann, CEO of Fulton Medical Center, said.

“You’ve got to pare down what you do, you can’t be the Amazon–you can’t be everything for everybody,” Hackmann added.

Leaders in Callaway County said it’s going to take effort to get people in the door. They said there’s a stigma surrounding the hospital that they need to help break.

“There’s people in this community that are well-respected and they’re gonna have to be some of the first ones through the front door,” Gary Jungerann, Callaway County presiding commissioner said. “Until they see us doing it, it’s going to be tough to get them to walk back in I think.”

In terms of a solution, experts said an expansion of Medicaid would certainly help. White said she is also pushing for freestanding ERs.

“Missouri is one of the states that does allow a freestanding ER. It has to be associated with a hospital. They are approving some hospitals and ERs with just a few beds, three to eight bed hospitals, but you still have to have all of that infrastructure in place to make that happen,” White said.

In the meantime, towns like Ellington are struggling. The hospital building is currently tied up in bankruptcy. In March, it will be two years since anyone has used the hospital building.

“We’re waiting for this to be over with and at that time we’ll see where we can go and what we can do as a community,” Roberts said. “I really do think that we’ll pull together.”

While there’s still hope for Ellington, other towns across the country haven’t been so lucky as their economies dry up.

“They only survive if they can monetarily make a living, and if they can’t they go away. That’s where your small towns dissolve and dry up over time. We don’t want that for Ellington, and we don’t think that will happen,” Roberts said.

“It is very much life and death to not have these services here,” White said, adding, “We’re resilient people.”