After A Rural Hospital Closes, Delays In Emergency Care Cost Patients Dearly

When Mercy Hospital Fort Scott in Kansas closed at the end of 2018, hospital president Reta Baker had been “absolutely terrified” about the possibility of not having emergency care for a community where she had raised her children and grandchildren and served as chair of the local Chamber of Commerce. Now, just a week after the emergency room’s closure, her fears were being tested.

Nationwide, more than 110 rural hospitals have closed since 2010, and in each instance a community struggles to survive in its own way. In Fort Scott, home to 7,800, the loss of its 132-year-old hospital opened by nuns in the 19th century has wrought profound social, emotional and medical consequences. Kaiser Health News and NPR are following Fort Scott for a year to explore deeper national questions about whether small communities need a traditional hospital at all. If not, what would take its place?

Delays in emergency care present some of the thorniest dilemmas for nurses, physicians and emergency workers. Minutes can make the difference between life and death — and seconds can be crucial when it comes to surviving a heart attack, a stroke, an anaphylactic allergic reaction or a complicated birth.

Though air ambulances can transport patients quickly, the dispatch system is not coordinated in many states and regions across the country. And many air ambulance companies do not participate in insurance networks, which leads to bills of tens of thousands of dollars.

Knowing that emergency care was crucial, the hospital’s owner, St. Louis-based Mercy, agreed to keep Fort Scott’s emergency doors open an extra month past the hospital’s Dec. 31 closure, to give Baker time to find a temporary operator. A last-minute deal was struck with a hospital about 30 miles away, but the ER still needed to be remodeled and the new operator had to meet regulatory requirements. So, it closed for 18 days — a period that proved perilous.

During that time, Fort Scott’s publicly funded ambulances responded to more than 80 calls for service and drove more than 1,300 miles for patients to get care in other communities.

Across America, rural patients spend “statistically significant” more time in an ambulance than urban patients after a hospital closes, said Alison Davis, a professor at the University of Kentucky’s department of agricultural economics. Even local law enforcement feel extra pressure when an ER closes down, said Bourbon County Sheriff Bill Martin. Suspects who overdose or suffer split lips and black eyes after a fight need medical attention before getting locked up — that often forces officers to escort them to another community for emergency treatment.