As bulldozers and excavator tore apart Mercy Hospital in Independence, Kansas, residents watched their community change. In the weeks before, a tour of the hospital before its closure revealed photos of newborn infants and elders who were saved in the facility adorning the halls. Town residents walked through the facility and shared their memories.
Outside of being a major employer, hospitals are one of the key social services communities need in order to grow. Young couples building families rarely want to live at a great distance from a hospital, knowing that a 40-minute drive with an injured child or spouse could make a significant difference in their outcome. Even if they expect to never have to use a hospital, people want one nearby, just in case they need it at some point in their lives.
In 2015, I spent time in Independence, walking with nurses and doctors during the last day of service. Paramedics who ran ambulances and city managers alike struggled to try and figure out what should happen next.
As they shared hugs and some laughs, I asked how long many had worked at the hospital. Responses included, “I’ve been here 38 years”; “34 years”; and “21 years.” Even newcomers had time to remember the six years spent at the hospital.
“What do you do next?” I asked, wondering if many who had served their community so long had plans. The response was “Look for jobs. Still have a mortgage to pay, that’s for sure.”
It’s been three years since the closure of Independence Hospital, and the community continues to work toward recovery. In a story published in the KLC Journal, the new reality for the small Kansas community came to light:
The story of how Independence recovered after the death of its hospital is a long, contentious and chaotic one. It’s been costly, with local governments and donors investing more than $2 million and health care providers another $7 million to fill the void left by one hospital. And it’s been demanding, with volunteers logging thousands more miles transporting seniors around the region for care since the hospital closed.
It’s also a story that continues to be deeply linked to the Legislature’s ongoing debate around expanding health coverage for 150,000 low-income Kansans through Medicaid. And the continued pressures facing rural hospitals in communities across Kansas, such as Fort Scott, which recently saw its hospital announce that it was closing at the end of the year.
The result was something I was warned about in 2015, that local EMS and city services would be taxed. On the last day of the hospital in Independence, there would be six ambulance runs, mostly minor in nature, but the comfort of a local hospital meant these minor ailments and injuries could be treated quickly without a long drive.
The paramedics for city services still had work to do. By 7 PM, they had six calls in a shift, not that abnormal, said Booe. “We have ups and downs, we had more than 2000 calls last year.” By 8 PM, though, paramedics had time to come to the hospital entrance and walk through the emergency room doors one last time. The hospital was quiet tonight, with just two intakes and a last minute walk-in. They were simple illnesses, but the hospital still gave some comfort to patients who sought care. Strep throat marked what would likely be the last of the lab work, and the last patient served.
With longer runs for services (especially critical services), taxpayer burden and community risk increased significantly.
Responders who were used to running patients a few minutes across town suddenly had to take them across the county or the state line to see a medical practitioner. Even trips to the closest hospitals – Wilson Medical Center 13 miles north and Coffeyville Regional Medical Center 17 miles south – became hourlong jobs, considering the time needed for in-home assessments and starting IVs. Multiply that times 2,600 calls per year.
“If we have a fire and two EMS calls, we’re taxed,” says Shawn Wallis, Independence’s fire and EMS chief.
A single code blue requiring five EMS staff, with potentially three hours on the road to and from a large hospital, would leave Independence vulnerable. Independence EMS needed more ambulances and staff – fast.
In forums around the country, conservative Republicans have taken to bringing up “capitalist” solutions to health care. More competition is the answer, they say. For communities that lose a hospital, there is no competition: there is only proximity. For someone injured in an ambulance, there isn’t time or means to negotiate a better rate on a long drive—especailly not if you are fighting to survive.
The Kansas Hospital Association reports that many hospitals like Independence remain stressed, and the recent announcement of the closure (and then rescue, via a quick sale) of the hospital in Fort Scott, Kansas, hammers home the financial stress hospitals are under.
Just as patients cannot quickly negotiate rates on the way to a hospital, a hospital cannot quickly determine the financial viability of a patient. Even if they could, are we a society that would want that to be a priority?
I know the realities of medical emergencies first hand. As a youth, while seriously injured and unconscious as the result of an assault, I was taken to a regional hospital before being life-flighted to another hospital. The hospital didn’t have time to check my insurance. I couldn’t negotiate rates. But I trusted in a system that would protect my life in a case of great need. At the time of the hospital’s closure, Independence paramedics made it clear for me how this would impact the community:
“We have to be able to cover an emergency at peak here” contended Webb, “and if an ambulance is out on a call, it may take more time.”
How much more time? Jonathan Booe, a paramedic for the city, told me the loss of the hospital creates new logistical problems. “Getting an ambulance isn’t driving an ambulance from our loading bay to a hospital. An ambulance has to go to the scene, then load up, then take a patient to the hospital. If the patient is aware, yeah they can make the choice (as to which hospital they wish to seek service), but now we need extra training in a lot of things—so we know which hospital to take them to in case of emergencies.” Booe noted that he thought the city had been working “really hard” to help paramedics with good training and new tools, like an extra vehicle to make this possible. “Still, you look at the time. If a patient needs critical care that requires us to go to Bartlesville (Oklahoma), you’re taking an ambulance out of service for three hours, minimum. Even Coffeyville means an ambulance is out for 90 minutes or more because of the travel back and forth on top of handling patient care.”
The death of a hospital can be a body blow to a community. Property valuations stagnate. Major employers reconsider, as they want to be closer to health care.
In Proverbs 14:31, the Bible says “He who oppresses the poor taunts his Maker, But he who is gracious to the needy honors Him.” Few communities have as much need—as much immediate and desperate need—as those who are at risk of losing their lifeline to health.
This is a Creative Commons article. The original version of this article appeared here.