RICHLAND, Georgia 鈥� For years, Sybil Ammons was the director of nursing at Stewart County鈥檚 only hospital. Now, she鈥檚 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. 鈥淲e鈥檝e had a stroke, several heart attacks,鈥� she said, standing along Richland鈥檚 main street in this small town about 150 miles south of Atlanta. 鈥淲e鈥檝e had traumas out on the four-lane.鈥�
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 鈥� difficult goals for rural hospitals that are, by their geographic nature, low-volume and remote.
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Compounding their financial troubles, have not taken advantage of a key provision in the health law to expand their Medicaid programs. That鈥檚 left many rural hospitals with uninsured patients just as federal subsidies for taking care of the uninsured are being reduced.
鈥�It鈥檚 Hurting A Lot鈥�
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鈥檚 largest employer and without the daily traffic from its 100 employees and families and friends of its patients, the town鈥檚 only restaurant closed, followed soon by its only bank.
鈥淎fter the hospital closed, we dropped about 30 percent sales,鈥� said D.K. Patel, owner of the local grocery store that sits on the edge of Glenwood鈥檚 town square. 鈥淎ll I can say is it鈥檚 been hurting a lot.鈥�
The town鈥檚 mayor, G.M. Joiner, who has held his elected post for three decades, and whose father was mayor before him, laments the hospital鈥檚 decision to close. 鈥淚t was our lifeblood,鈥� he said. 鈥淚t鈥檚 not overemphasizing or trying to be a doomsday prophet, but it鈥檚 devastating.鈥�
Joiner has been courting suitors for the shuttered hospital, but with little success. The building sits eerily abandoned. At a nurses鈥� 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.
At her home in Folkston, near the Okefenokee Swamp, Pam Renshaw had to bypass her town鈥檚 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.
鈥淎nd the whole time I鈥檓 driving to town, I said, 鈥榃here do I go? Where do I go?鈥欌��
The hospital in Folkston had closed just months before Renshaw鈥檚 accident, and Chavis scrambled to find help. He first tried the EMT office but when he didn鈥檛 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聽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鈥檚 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.
鈥淲hen you have a timber industry, you鈥檙e dealing with saws, you鈥檙e dealing with heavy equipment,鈥� said Dawn Malin, executive director of the Folkston Chamber of Commerce. 鈥淚t only takes one tragedy to realize how detrimental losing this facility is.鈥� The hospital鈥檚 closure has caused worries about workplace accidents at a local paper plant, Malin said, and hampered her group鈥檚 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.
鈥淚鈥檓 seeing about four different doctors in Dublin. This week, we鈥檙e making three trips,鈥� said Joe Connell, 77. 鈥淣inety 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.鈥�
For pregnant women in rural Georgia, the hospital closures can mean dwindling access to prenatal care and . In Waynesboro, Georgia, Dr. Frank Carter, a prenatal specialist, said after the troubled local hospital there closed its labor and delivery unit, his patients 鈥� largely poor women with little money for transportation 鈥� face an hour鈥檚 drive to deliver their babies.
鈥淭hey鈥檙e going to have to be prepared and willing to travel,鈥� Carter said. 鈥淎nd that鈥檚 the reality.鈥�
It鈥檚 not overemphasizing or trying to be a doomsday prophet, but it鈥檚 devastating.
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.
鈥淭owns 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,鈥� said Adams. 鈥淲hen you have time to figure it out, I think there are models out there that could work.鈥�
Effect On Health Unclear
But while hospital closures in rural areas can unsettle residents鈥� nerves and force them to travel farther distances, the effect on health outcomes remains unclear. Researchers have found that closing down a rural hospital , 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 that treat more cases.
鈥淭here has to be sort of a critical mass to be able to make any business viable, and especially a community hospital,鈥� 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.
鈥淲e have to be more efficient in hospitals if we are going to be sustainable, and I think that鈥檚 one of the things that you鈥檙e seeing that鈥檚 driving the consolidation in the industry,鈥� 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, 鈥淚 don鈥檛 know what we鈥檙e going to when she gets where she can鈥檛 drive.鈥�
This story was reported in collaboration with PBS NewsHour producer Jason Kane.