Terry England, the powerful chairman of Georgia’s House Appropriations Committee, was sitting in his church Sunday morning when he started getting the texts. Tornadoes had just ripped through South Georgia. And victims were headed to an emergency room — one whose closure was announced that same week.
Then relief: A document flashed in England’s memory saying the ER still had 37 days before shutting down.
“Thankfully,” England thought. “Because they’re about to get real busy.”
The Cook County tornado killed seven in one trailer park. Fifteen of the tornado's other victims went to the Cook Medical Center.
That emergency room in the small country town of Adel is just the latest victim to be claimed by Georgia’s rural hospital crisis. England has been deep in the fray, heading a task force aimed at stabilizing the hospitals. Cook Medical Center underscores his dilemma: Statewide, there is a clash between what communities need and what hospital systems can afford.
A profusion of uninsured or underinsured patients, poverty, and sluggish (even declining) population growth have hit rural hospitals particularly hard. That’s in an era when the cost of delivering care is steadily increasing.
» RELATED: A map of rural hospital services in Georgia
» RELATED: The emergency at Georgia’s rural hospitals
According to the hospital’s parent company, Cook Medical was losing about $2.6 million annually, mostly through the emergency room.
Jimmy Lewis, a business consultant with rural Georgia hospitals, said a hospital might luck out with a big charitable backer. “Other than that,” Lewis said, “this is business. Health care is about taking care of patients and people. But at the end of the day, no money, no mission.”
When the Cook County ER closes, the next ER will be nearly 30 miles away. Tift Regional Health System, which owns the Cook hospital, announced the closure on Jan. 19 and said a local clinic will offer extended hours for minor ailments. But for emergencies, they said, call 9-1-1.
The Legislature is concerned not only because of rural health care needs, but also because hospitals tend to be financial anchors in such communities. They employ a lot of skilled people, and they also attract employers that want to locate in an area where they can make sure their employees have somewhere to get care.
Local residents are distressed.
“What happens if there’s an emergency?” said Billie Summers, who lives just outside the Cook County line. Summers spoke to an Atlanta Journal-Constitution reporter in the aftermath of the storm, outside a packed volunteer center where residents were providing hot meals and donated supplies to victims.
Recommendations out of the task force so far include more communication and collaboration between an area’s medical facilities, so a hospital may act as a “hub” while smaller care providers can be “spokes” that work with them to funnel patients to the most efficient place for care the fastest.
Another initiative is to identify high-frequency patients and work with them to address some of the reasons for their visits before they rise to that level, necessitating expensive care.
The state Legislature has also established a tax incentive for charitable donations to hospitals, and hopes to increase it this year.
Still, there seems to be little in play that would clearly restore the state’s failing hospitals to a strong footing.
» RELATED: Failing rural hospitals turn to taxpayers
“Turning the ship on a dime, I don’t know that that can happen,” England said. “This is something that happened over a period of 50, 60 years to get us in a condition we find ourselves in today.”
Tift Regional Health System cited among the factors that led to the closing the number of uninsured patients that Cook serves.
“Approximately 22.7 percent of Cook County’s population is uninsured, which led Cook County residents to seek minor medical care in the most expensive care setting — the emergency room,” Chris Dorman, the Tift system’s president and chief operating officer, said in the statement. He also cited reductions in the amount of money that providers are reimbursed for providing services.
England said the Legislature has twice acted to raise reimbursements but still recognizes it’s a problem.
As to expanding Medicaid to insure more people as envisioned under the federal health law, however, that has become a political football. Georgia Democrats on Thursday announced again that expansion was part of their legislative agenda. Republicans in the state have rejected it for years.
England said it’s not that simple. He said that other states that have expanded Medicaid, such as Kentucky, have run into unintended consequences.
Emergency rooms are usually the most expensive part of a hospital to operate. However, take away the emergency room and you take away the gateway for a lot of admissions that fund the rest of the hospital, Lewis said. One such ER closure in Ellijay was followed not long after by the closure of the entire hospital.
» RELATED: Rural hospitals may not make it
On a recent afternoon, a handful of patients trickled in to the emergency room behind the main facility of Cook Medical Center, a one-story building surrounded by a cluster of medical offices.
It serves a population with plenty in need. Census data show about one in four of the county’s 17,000 or so people live beneath the poverty line. The median household income for its residents is about $35,000.
Lee Joiner Jr., who owns the Whatchadilly Smoothie & Juice Shop in downtown Adel, said shuttering the ER sends a disastrous message to the local economy.
“People in our community need emergency services and the tornado proved that,” he said. “What if this happens again and we don’t have an ER? We need to fully take care of people here in this community. Lives could be at stake.”
That’s the same worry for Dana WhiteEagle, who lives in Adel and works at a local retailer. She fears what shuttering the emergency room could mean for residents and the county’s meager workforce.
“I am definitely, definitely concerned,” she said. “Especially if I have an emergency.”
» RELATED: Even in Trump country, rural hospitals brace for damage
County leaders are trying to convince Tift Regional Medical Center to reconsider. Chase Daughtrey, a local probate judge who chairs the local hospital’s board of trustees, said he’s asking Tift leaders to “take another look” after Sunday’s devastation.
“Health care is a complicated beast. The Tift leadership has done a great job informing the community stakeholders, but after the storm they need more community buy-in,” said Daughtrey. “I don’t know if they’ll reconsider, but we’re going to ask them to consider it more by the human aspect than the numbers aspect.”
For now, many of the county’s most prominent residents have a fingers-crossed mentality.
“Tift Medical Center is an incredible operation, and they wouldn’t make the decision without doing the research. I trust them and the decision they’re going to make,” said Eric Gordon, pastor at Adel First Assembly. “Maybe the storm will affect their decision, but only time will tell.”
GEORGIA’S RURAL HOSPITAL CRISIS
Between 2001 and 2015 in Georgia, of 69 rural hospitals:
» 8 rural hospitals closed
» 21 suffered budget shortfalls at least five years in a row
» Just 7 made a profit each year
