“How many people have to die?”: What does a closed rural hospital tell us about US healthcare


Cindy Anderson worked for 39 years in the only hospital in Kennette, a small town in the countryside, southeast of Missouri.

Starting as an on-call manager, Anderson saw the Twin Rivers Regional Health Center, which after a heart attack or accident pulled thousands of people back from the brink.

Then in February 2018 the hospital was for her own family. Anderson’s husband Ray, known around the city as Butch, woke up at 4 am when he couldn’t breathe properly before he fell unconscious. Within minutes, an ambulance brought him to the emergency room and to the hole that saved his life.

So Anderson, like almost everyone else in Kennette, was worried when a few weeks later the owners of Twin Rivers suddenly announced its closure.

Once one of the largest commercial hospital operators in the US, community health systems reported that the facility was “consolidated” with the new health center, recently built an hour drive north.

The Twin Rivers Regional Health Center sits empty on December 21 in Kennette, Missouri. Photo: Brandon Dill / The Guardian

In deciding to close Twin Rivers, the company executives made a calculation. Near one hospital and patients will be forced to use the other. Costs are falling, profits are rising.

Kennett’s Council convened a public meeting on “the crisis for our city”. Hospital staff led fierce criticism of the kennel and accused the greed of society and financial shenanigans. Doctors asked why the profitable hospital was closed.

When Anderson arrived, she described how Twin Rivers saved Butch’s life weeks ago. “It won’t happen if this hospital disappears,” she said at the meeting. “I’ll tell you that if this hospital is gone, many lives will be lost.”

Anderson should have been shown a tragic right.

“How many people must die?”

People with a long-standing struggle for Kennett, one of a set of small midwestern towns with a fading memory of prosperity and a main street to support life, accepted one factory closure after another as part of the natural order of modern America.

The electric motor manufacturer went first. Then the trailer factory, and most recently the hose manufacturer, who robbed Kennett of hundreds of relatively well-paid jobs that supported many other jobs in one of the poorest parts of the country.

There are still jobs in fast-food outlets that line the main road to the city, but they do not pay nearly as well as those that have been lost. The low-cost Aldi supermarket in Kennette closes at the end of the year because people have less money to spend in a city of about 10,000, where one in four people lives below the poverty line.

Lucille Jenkins, left, smiles in April Swinney in the Dunklin County Cab on December 21 in Kennette, Missouri. Photo: Brandon Dill / The Guardian

Each closure multiplied the sense of decline, which was supported by the understanding that it was difficult for an isolated rural city to compete. The announcement that the only hospital in the vast Dunklin County was closed was welcomed as a terminal diagnosis.

At the council meeting officials spoke of “shock and pain”.

Cindy Anderson’s warning came from one hospital worker after another.

“Patients with a heart attack will not make it,” said Tonia Swink, a nurse at a hospital that has worked in the healthcare industry for 38 years. “Stroke victims will not do this or will be severely affected”.

The door was well screwed on June 12, 2018, less than six weeks after the staff informed that the hospital where some had worked for decades had been completed. The ‘Emergency Room’ sign and other evidence that the building was once removed by the hospital immediately. Among the few remaining clues are the spaces in a lush parking lot labeled “Only for doctors”.

The empty Twin Rivers Regional Health Center is visible because Gaetanna and Chad McCarthy are seeking donations to pay for cancer treatment for Margie Wilson in Kennette, Missouri. Photo: Brandon Dill / The Guardian

In a move that enraged many at Kennette, the kennel did not sell Twin Rivers for sale. Doctors believed the company did not want a commercial rival to reopen it and suck the company out of the new Poplar Bluff Hospital, 50 kilometers away. Instead, the company cut off the power supply and let the building rot.

One night in October, Cindy Anderson was awakened in the middle of the night by Butch, who tried to breathe and called 911. The ambulance arrived in about 10 minutes. The rescuers worked on Butch for another 20 minutes and then decided to take him to a small base hospital without emergency, 20 miles away in Hayti. It was almost an hour since Butch finally saw his doctor that his wife had called the ambulance.

I think people who die in ambulances could be saved.

Cindy Anderson

Anderson does not know if the doctors at Hayti have ever had a chance to save their husband, but within a quarter of an hour after arriving at the hospital, they heard them stop trying to revive. A few minutes later, her doctor told her that Butch was dead. He was 71 years old.

“I think they just ran out of time.” I think if there was a hospital, they would have saved him. It’s not the only one, ”Anderson said. “How many people must die? I think people who die in ambulances could be saved. “

“Polluted population is now without medical care”

Dave Jain, who worked as an intern at Twin Rivers for 29 years and now runs his own Kennette clinic, asks the same question.

“We probably have three to five more deaths per month without having a hospital here,” he said. “I had a 35-year-old patient who started having chest pain. He needed to get to the emergency room, but he died on his way to the hospital. There are several deaths due to the absence of emergency services, mostly from heart attacks and accidents. There is nowhere to stabilize them. If they have a heart attack, they die before they reach the hospital. In addition, infant mortality has increased since the hospital was closed. “

Dr Dave Jain introduces a photo during his practice on December 23 in Kennette, Missouri. Photo: Brandon Dill / The Guardian

Dunklin County already has one of the highest neonatal mortality rates in Missouri. Andrew Beach, one of the few pediatrician who left in Kennett, said the region, with approximately 70,000 people, is now without a obstetrician.

“We were carrying babies in parking lots.” We hardly got women in the operating room to give birth. We breastfed at Piggott Hospital (half an hour in Arkansas) where there are no facilities for OB (Obstetrics) and it’s basically a drop and boom, you get the baby. Of course this is not ideal, ”he said. “A truly oppressed population, poor dirt, is no longer left without medical care or has limited medical care.”

Julie Helfer, a nurse at the Labor Department, who gave birth to her three children at Kennett’s Hospital, is now working for the County Health Office’s program for mothers and low-income children.

“Many of our moms have to travel long distances to schedule routine meetings, such as ultrasound,” she said. “But for many of our mothers, transportation is a huge problem. They have no vehicle or a way to get back and forth to appoint their doctor in hospitals. If they go to work, they cross their fingers and hope to do it. “

Dunklin County had the second highest number of children in Missouri who died before their first birthday after the neighboring Pemiscote. The mortality rate is partially double the country average due to the high number of premature births, especially among African American women in an 80% white county.

Jemere Brock, 13, (left) and Tank Borders, 13, play basketball at Kennette. Photo: Brandon Dill / The Guardian

Toll in life since the closure of the hospital has not yet been calculated. Data for the past year is still collected, so doctors do not yet know the full impact, but among doctors, nurses and those working with new mothers at Kennett, it is not yet known that the number of deaths has risen.

In an effort to mitigate the effects of the loss of the Twin Rivers, doctors have teamed up to open the Urgent Care clinic, but it lacks equipment to deal with trauma and other emergencies and is not open 24 hours.

“It was overwhelming,” said Dr. Tim McPherson, who has been practicing in Kennette after 35 years of hospital work, even as a medical secretary when he closed. “Trying to make these patients truly ill and in need of emergency services becomes difficult because we get them to the office and try to figure out where to send them and how they get there.

“People have died as a result.”

“It breaks my heart when they give money to people.”

Kennett is not alone in losing medical care. Since 2005, more than 160 rural hospitals and clinics have been closed in the US, mostly under financial pressure. Hundreds of others are at risk, including 14 in Missouri, which are considered necessary for the communities they serve.

But Twin Rivers did not fall because they were losing money. Terry Berry, chairman of the board, told the Guardian that the hospital was profitable until it was closed. Dr. Jain and other doctors who worked at Twin Rivers reported having reached around $ 5 million in 2017. Anderson said it the same way.

Julie Helfer presents a portrait at the Dunklin County Health Center in Kennette. Photo: Brandon Dill / The Guardian

“I know it was profitable because I was working at a sales office at one point. I know they made money from it. It breaks my heart when they give money to people. I know they have to make money … but they made money, ”she said.

The kennel said it closed the Twin Rivers because medical innovations reduced the demand for overnight stays. The company said that 95% of people treated in the hospital were outpatients who would be better served by “more resources” in the newer Poplar Bluff hospital. He argued that consolidation is “the most sustainable plan for the future”, suggesting that Twin Rivers is not financially viable because of declining revenues. However, the chief executive said at Wall Street conference that CHS is emerging from markets that did not have the potential to grow significantly.

This hospital was closed mostly by the greed of society.

Dave Jain

The doctors working in the hospital reported that the number of overnight stays has dropped in part because the CHS has sharply increased its prices to benefit more from the publicly funded Medicaid program for low-income Americans. This drove people with private insurance who need emergency operations.

Chancellor Wayne, a chiropractor who was elected mayor of Kennett earlier this year, said Twin Rivers charged an MRI fee of $ 5,000 and therefore sent patients to Arkansas Hospital for $ 800. Wayne accused the Kennel of closing Kennett’s Hospital “of greed”.

A dog standing in front of a house in Kennette, Missouri. Photo: Brandon Dill / The Guardian

The CHS did not respond to requests for comments.

With the gradual decline in private business, the number of specialists employed in the hospital decreased. Even so, it remained profitable.

“This hospital was closed mostly by the greed of society,” Dr. Jain. “This hospital made money and the Poplar Bluff hospital owned by the same company was not. At Poplar Bluff, however, they built a brand new hospital that they could not close, and they thought that if they closed the Kennett hospital, they would all be inundated. “

People have been betrayed here.

Cindy Anderson

The kennel finally left the hospital at auction with a reserve dollar this month. But since it has been closed for over a year, regulations would require millions of dollars to renovate to reopen as a medical facility. Doctors in the city see the delay as a cynical step that discourages another company from taking over.

However, if the CHS counted on patients coming from the Kennett flood to Poplar Bluff, it was wrong. Some people in Kennette who need routine hospital care did not want to make a 120-mile round trip on a difficult road that flooded in winter.

Instead, they opted for an equally long but much easier journey to facilities in neighboring Arkansas and Tennessee.

Anderson said others are boycotting the kennel.

“What they didn’t prepare for was that people would be so angry with them that they wouldn’t go to Poplar Bluff,” she said. “I have been blown away that this company will simply leave all these people and will not have the possibility of medical treatment in an emergency. People have been betrayed here. “