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In California, rural communities are hit hard by hospital closures

Topics in Health: Lessons From The Field

In California, rural communities are hit hard by hospital closures

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In the past several years, across the nation, hospitals serving small rural communities have shuttered their doors at a disquieting rate — since 2010, essentially one per month. And in California’s Central Valley and in the vast empty spaces north of Sacramento stretching to the Oregon border, more than a dozen hospitals have closed since the early 2000s, adding to the region’s economic woes, for when a hospital closes, it takes jobs with it. Some communities never recover, in part because with no nearby hospital, businesses are hesitant to locate in the area.

For rural residents, the concerns are more immediate when their local hospital closes: How far is it to the nearest emergency room? What if I have a serious illness and need frequent treatment over many months? These are but some of the repercussions of a rural hospital closing.

I write about the American West for the nonprofit Rural Community Assistance Corporation, covering rural poverty and economies, the environment, and tribal issues. Increasingly, the focus here is health care and how rural residents access it. In learning of the hospital closures, I was curious to know how rural communities were responding.

At the same time — and as a cancer survivor — I wondered about how rural residents with the disease received treatments if their local hospital closed. Cancer treatment tends to be lengthy, frequent and debilitating, making travel to medical facilities an added burden. In reading more about the general topic of rural health care, I learned, too, that telemedicine was making great strides in responding to the national hospital closure crisis, but that it also has limitations.

My Center for Health Journalism fellowship work therefore would focus on these three aspects of rural healthcare: hospital closures and what they mean for California’s rural residents; how rural cancer patients get the treatment they need; and what role telemedicine can play in it all.

I started my research with an ongoing survey started in 2010 by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. It illustrates rural hospital closures across the nation; as of October 2016, the number is 76, among them five in California (with one, in Lone Pine, having reopened in 2015). Going back even further, to 2006, I found that an additional five of California’s rural hospitals had closed, and that experts have warned of hundreds more around the country vulnerable to closure. Midway through my reporting, in April, Colusa Regional Medical Center, north of Sacramento, announced it would close.

“It is almost like the town has given up on any hopes of ever having something in this community to attract more families to locate here,” Kathy Ebner, a nurse who runs a small clinic in Dos Palos, which lost its hospital in 2006, told me. The median home income price here is just about $100,000 and unemployment hovers at about 15 percent. “It is as destitute as you can imagine.”

In March 2016, I visited Kingsburg and Corcoran in California’s Central Valley, both of which lost their hospitals in 2010 and 2013, respectively. I wanted to see how each had fared in the aftermath. Some months earlier, I had interviewed Cristina Miller, an economist at the USDA’s Economic Research Service who studies rural economies and health care. She had explained to me that hospitals create a large demand for labor and offer local jobs, both for high- and low-skilled workers, from the obvious, like nursing, to janitorial services and maintenance.

“An employee buys a house in the area,” she said, “brings their family with them and demands public goods. Their kids will go to school there, they’ll buy gas and food there, money circulates. The idea is that there is spillover.” I had also read in a 2006 study, “The Effect of Rural Hospital Closures on Community Economic Health” in the journal Health Services Research, that a rural hospital’s closure “decreases the economic well-being of the community and likely places the local economy in a downward cycle that may be very difficult to recover from.”

Kingsburg, which was settled by Swedish immigrants in the 1870s, is today a Scandinavian Mayberry, with beautifully tended gardens on its main street intersections and hand-painted coats of arms alongside half-timbered building facades. But in interviewing the city manager and fire chief, I learned more about the hospital and how it affected the city. When Kingsburg Medical Center closed and in its place a mental health clinic opened across from an elementary school, residents protested, claiming it posed a risk to the children. They also now had to travel further in medical emergencies. One resident told me about a harrowing drive one November night for 13 miles in the Central Valley’s notoriously dense fog to the nearest emergency room.

In Corcoran, about 30 miles south of Kingsburg and home to two prisons, the city manager told me the town had lost out on two businesses looking to relocate to the town. They reneged once they learned there was no nearby hospital. While visiting, too, I saw the abandoned Corcoran District Hospital; bolted glass doors shielded a dusty reception area, an eerie and disheartening site.

I learned, at the same time, that telemedicine was helping fill in the gaps in places like Redway, population 1,200, in Northern California. There, clinical nurse manager Sarah Foster told me that the ability to have a doctor remotely consult patients on hepatitis C, diabetes, thyroid abnormalities and rheumatoid arthritis was a boon for this rural community, and patients had quickly adjusted to this modern kind of medical care.

“These are chronic, long-term diseases, and we were overwhelmed and overworked caring for these patients,” Foster said. “We have no specialty services around here.” The clinic, she added, plans to expand telemedicine services to their psychiatric patients.

Yet I learned, too, that rural areas still lack the required Internet connectivity to support telemedicine. Critics also argue that telemedicine does nothing to enrich a local economy in the way that a hospital does, providing jobs and a platform for other community goods, such as schools and property values.

Meanwhile, I contacted several Northern California cancer support groups and learned of the added burden patients have if they live in a rural area. One group organizer told me, “If we were to have a patient who was maybe 45 to 90 minutes east or west of us (in Red Bluff), it was often a problem for them to have one more thing to do following a radiation or chemotherapy treatment. You're exhausted.”

Perhaps more significantly, I learned that rural Northern California has no pediatric oncology services, and no plans to change this because, as I was told by the California Hospital Association, the business model for such medical care doesn’t support it, and because childhood cancer is relatively rare. Parents of children with cancer living in Northern California must travel to Sacramento and San Francisco for treatments that can last up to a year and, in some instances, insurers do not cover travel costs.

Just like the highways and dusty country roads that link Corcoran to Kingsburg to Sonora to Colusa and Dos Palos, all of which have lost their hospitals in the past decade, each is bound by the disappearance of a trusted establishment. Older residents in each town can recall births and deaths there, the fraternity of nurses and doctors, the security, and even pride.

“It is almost like the town has given up on any hopes of ever having something in this community to attract more families to locate here,” Kathy Ebner, a nurse who runs a small clinic in Dos Palos, which lost its hospital in 2006, told me. The median home income price here is just about $100,000 and unemployment hovers at about 15 percent. “It is as destitute as you can imagine.”

And yet she remains.

“I have had many offers over the years to relocate, but I just can’t walk away,” Ebner told me. “The residents, the staff, they become part of your family. We have all at some point helped each other to raise children or bury a loved one. You just don’t walk away from that.”

[Photo by neil o via Flickr.]



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