Closed Hospitals Leave Rural Patients ‘Stranded’ as Coronavirus Spreads

Map of where the nearest hospital is more than 30 minutes away.

Many red states chose to NOT expand Medicaid under the Affordable Care Act and one consequence has been the closure of many rural hospitals, leaving many rural residents with no nearby hospital.  In a medical emergency, having a hospital nearby is literally a matter of life and death - something I learned years ago when one of my children was stricken with bacterial meningitis.  We lived at the time about 5 minutes from a large hospital with a trauma center ER.  We had a positive result and full recovery.  Had the hospital been 30 minutes or more away, things would have been horrifically different. Now, with the Covid-19 pandemic still raging - cases are still rising in Virginia and many other states - many rural residents are finding a serious lack of hospital access.  The irony, of course is that many of these same areas support Republicans (usually because of GOP calls to racism and religious extremism) whose policies have exacerbated the lack of local hospitals. Talk about voting against one's own best interests! A piece in the New York Times looks at the predicament rural Americans are facing.  Here are highlights: 

Michael Nuzum had spent weeks fighting coronavirus-like symptoms — a wracking cough, terrible chills, an exhausting fever — before collapsing at his home in rural West Virginia.

Mr. Nuzum, a 54-year-old animal control worker, was already in cardiac arrest when the emergency workers arrived on April 3. That left them with a difficult decision: Should they transport their patient to the nearest hospital, 30 minutes away?

“There’s only so much one paramedic can do in the back of an ambulance,” said Michael Angelucci, who leads the Marion County rescue squad that cared for Mr. Nuzum. The two-person team that responded decided it couldn’t risk the long ride and instead tried to revive the patient at the scene. But the workers couldn’t save him.

Two weeks earlier, the options would have been different. Fairmont Regional Medical Center, just five minutes from Mr. Nuzum’s home, would still have been open. Mr. Angelucci, who is also a state representative, can’t help wondering if the hospital and its emergency room could have given the man a fighting chance.  “It’s incredibly frustrating that this entire community is stranded without a hospital,” he said.

Fairmont was one of three hospitals that have shut down in this corner of rural West Virginia and Ohio since September. They delivered hundreds of babies each year, treated car crash and gunshot victims, repaired hearts and knees and offered addiction treatment and psychiatric care.

They had been acquired by a for-profit company, Alecto Healthcare Services, beginning in 2014. Employees expected the new ownership to put the institutions on solid footing after years of financial struggle. Instead, decisions made by Alecto wound up undercutting patient care and undermining the hospitals’ finances, according to more than two dozen interviews with doctors, nurses, other staff members, government officials and patients, as well as a review of court records.

Finally, one after another, the three hospitals ceased operating. At the request of the governor, the West Virginia attorney general’s office is investigating the company’s decision to close them. The shutdowns . . . . have forced the region to fight a coronavirus outbreak with 530 fewer licensed hospital beds than it had a year ago. Across the United States, hospitals serving rural areas have spent decades trying to provide medical care and produce enough revenue to stay open. They have closed in increasing numbers in recent years as local populations have declined. About 170 rural hospitals have shut down since 2005. [F]or-profit hospitals are more likely to close than the others, one recent federal study showed. It found that for-profit facilities accounted for 11 percent of rural hospitals but 36 percent of closures among the group. Within the past year, rural hospitals have closed in Pennsylvania and Tennessee after selling to for-profit chains. Ms. Horwitz’s research found that for-profit rural hospitals were less likely to offer needed but unprofitable medical services, such as hospice and inpatient psychiatric care.

“The goal of the for-profit is to make money,” Ms. Horwitz said. “That doesn’t mean they’ll do anything to make a buck, but they have a different goal from nonprofits.”

Alecto’s hospitals generally serve low-income communities, with most patients covered by Medicare or Medicaid. In Marion County, for example, the population once served by Fairmont has higher-than-average smoking and obesity rates. The state also had the country’s highest rate of drug overdose deaths in 2018. West Virginia University’s health system, about 12 miles from Fairmont, plans to reopen part of the Fairmont hospital but will not be able to do so until late May.

For now, the three communities face a stretch of months where hospital beds could be scarce in the midst of a global pandemic. Jennifer Henderson Hayes, who was the chief pharmacist at East Ohio, now works at the remaining hospital in Wheeling.

She has already seen greater strain on the emergency room there. “You see people, potentially sick with Covid-19, waiting for eight or 12 hours just to be seen.”

For profit hospitals are a problem in my opinion.  Years ago when I worked for a law firm that represented a non-profit hospital system, administrators regularly complained that the for profit Humana hospital 20 minutes away would send uninsured patients by taxi to the non-profit hospital rather than treat them.