CUTHBERT, Georgia – Lacandie Gipson gasped for breath.
The 33-year-old woman with multiple illnesses found herself short of breath waiting for an ambulance. It was there about 20 minutes after the 911 call.
Cuthbert’s home where Gipson lived was less than a mile from the Southwest Georgia Regional Medical Center, but the ambulance couldn’t get them to the single-story brick hospital because it had closed three months earlier, in October 2020.
Instead, rescue workers loaded Gipson into the ambulance and drove her more than 25 miles to the hospital in Eufaula, Alabama, where she was pronounced dead.
“They said it was a heart attack,” said Keila Davis, who lived with her husband at Gipson. “If the hospital had still been open, it could have saved her.”
Cuthbert Hospital was one of 19 rural hospitals in the US to close in 2020. This is the largest number of such facilities closed in a single year since the Cecil G. Sheps Center for Health Services Research at the University of North Carolina began tracking the data in 2005.
Eight rural hospitals in Georgia have closed in the past 10 years; only Texas and Tennessee had more closings. The center’s data shows that 86 of the 129 hospitals that closed during that time were located in Texas and the southeast.
Health experts and recent studies say Medicaid’s expansion will help keep hospitals afloat as the number of low-income adults with health insurance increases. None of the eight states with the most rural hospital closings since 2014, when the Medicaid expansion was first implemented through the Affordable Care Act, had chosen to expand the insurance program until early 2021. In several of these states, including Georgia, Republican leaders have stated that such a move would be too costly.
Georgia’s inaction on the Medicaid expansion “probably hurt us more than anyone,” said Cuthbert’s Mayor Steve Whatley, a Republican who lost his re-election in November in the city of around 3,400 people.
Hospital closure may be more felt in some communities than others. The one in Cuthbert, Whatley said, “is incredibly powerful.” Having no emergency room nearby means any ambulance response will be offline for two to three hours, said Whatley, who is also chairman of the Randolph County Hospital Authority.
Clifford Hanks, 78, of Cuthbert recently had to drive to Eufaula’s emergency room when his back pain was severe. “The ambulance is too slow and unavailable,” said Hanks while sitting in a store in Cuthbert Square. The journey, he said, was bumpy.
Several factors contributed to hospital closings across the country, according to the Sheps Center. Troubled rural hospitals treat large numbers of uninsured patients and people with chronic illnesses, said George Pink, a senior research fellow at the center. “They have high levels of free care,” Pink said, and there aren’t enough patients with private health insurance that reimburses hospitals at higher rates than Medicaid and Medicare.
In rural areas too, the population tends to be older, which would lead to increased care costs.
Pink also said doctor recruiting is difficult in rural counties, many of which have shrinking populations. And many of the closed hospitals have had infrastructure problems as funds for the maintenance of buildings and equipment have declined.
“These hospitals have been losing money for years,” said Pink.
Researchers at the University of Washington found that rural hospital closings resulted in increased inpatient mortality in the area, while urban closings had no measurable impact. Some of the reasons they cited included longer travel time for hospital treatment and the fact that some medical providers leave communities when hospitals are closed.
Federal Covid aid funding has dampened the rate of hospital closures this year, according to Brock Slabach, chief operations officer at the National Rural Health Association. Still, the group estimates that 453 rural hospitals, or around a quarter of all hospitals, are at risk of closure.
“We could close eight to ten rural hospitals in Georgia in the next few years,” said Jimmy Lewis, CEO of HomeTown Health, a Georgia rural hospital association. “They’ll run out of money.”
According to the Sheps Center’s North Carolina Rural Health Research Program, nationwide rural hospitals serving communities with large black populations are more likely to be in financial distress than rural hospitals as a whole. And the program’s research shows that among financially troubled rural hospitals, those serving areas with larger black and / or Hispanic populations are more likely to close. (Hispanics can be of any race or combination of races.)
The closure of Cuthbert Hospital has hit the region’s black population hard.
More than 60% of Randolph County’s residents are black, and the surrounding counties, whose residents previously traveled to Cuthbert for hospital care, have a black population of 47% or more.
In the region, Black Americans, especially the elderly with diabetes and high blood pressure, are very concerned about the hospital closure, Charisse Jackson, a health care worker at CareConnect told the hospital.
The community is hoping for some medical care, if not a full resuscitation of the hospital. The Hospital Authority, locally based Andrew College and a Mississippi management company are working together on a US Department of Agriculture grant offer of US $ 1 million and US $ 10 million. The vision is to have a stand-alone emergency room with a handful of beds. The hospital authority, Whatley said, has “a few million dollars” to support the funding if it is approved. “Fifteen million dollars would do it,” Whatley said.
U.S. Senator Jon Ossoff (D-Ga.) Has been interested in the health care vacuum in Randolph County, helping identify private and public opportunities to restore more medical services to the area. “The challenges that people face in Randolph County are similar to those of rural health care,” Ossoff said.
In downtown Cuthbert, the history of the Southwest Georgia Regional Medical Center unfolds in a mural on the walls of the old Randolph County Courthouse, now home to the Randolph County Chamber of Commerce.
The family of local pharmacist Carl Patterson founded the hospital as Patterson Hospital in 1916. After the facility closed, Patterson said Randolph County did not have a full-time doctor.
Funding the hospital has always been difficult. It took $ 10 million in upgrades, and operations that were a lucrative service at some facilities weren’t performed there.
“Our hospital wasn’t the best, but it was a means of keeping you stable. It has helped a lot of people,” said Brenda Clark, who was born in the hospital and now works at a Cuthbert wellness center across from the closed facility. Elderly care-dependent people “cannot get into their cars and drive to Eufaula or Albany,” she said.
The hospital closure was “devastating” for businesses, said Rebecca White, executive director of the county Chamber of Commerce. About 25% of Randolph County’s residents were already below the poverty line.
“This hospital has been, without a doubt, a lifesaver in my opinion,” said Dr. AS Ghiathi, a family doctor who worked at the Southwest Georgia Regional Medical Center for more than 20 years. Ghiathi, 64, still lives in Randolph County but works primarily at a Mercer Medicine clinic in nearby Fort Gaines, Clay County. This county does not have a hospital either.
The closure of the Randolph County hospital was “like a death,” he said. “People mourned this loss. We wanted to pass this hospital on to the next generation.”
Some Randolph County residents say the loss of the hospital was a contributing factor in medical tragedies such as Lacandie Gipson’s death and could cause others.
Jeanette Love, 67, who lived in the town of Shellman, Randolph County, died while waiting for an ambulance, her sister Susie Jackson said. It was named because love had a hard time breathing.
The Randolph County ambulance was tied up, Jackson said, so someone had to be sent from another county to pick up Love, who had chronic obstructive pulmonary disease and diabetes. The delay became even longer when the ambulance drove to the wrong address.
“It took an hour and a half or more,” said Jackson.
“It’s about 15 to 20 minutes from Cuthbert,” said Jackson, who drove from her Shellman home to Love’s house that July day to help her. “I had a car. I could have taken her to the hospital. Maybe she would have been saved.”
Instead, while the sisters waited, Jackson said, “Love sat with me, put her head on my shoulder and died.”
Regarding the medical situation in Randolph County, Jackson said, “We’re better than that.”