CUTHBERT, Ga. — Rhonda Jones Johnson got a frantic call one day last November from her cousins.
Her aunt had collapsed on the floor. They would later learn that she had suffered a severe stroke.
Jones Johnson, who is a nurse, knelt next to her aunt and performed chest compressions on her for more than an hour while waiting for help. But the ambulance – the only emergency vehicle in the county – was already responding to a horrific car accident.
“My aunt, our aunt, died at home waiting for the ambulance,” Jones Johnson said.
Outside the closed Southwest Georgia Regional Medical Center in Cuthbert, a town of about 3,100 in southwest Georgia near the Alabama border, Jones Johnson described a stark reality to faced by residents.
“If only we had opened a hospital here in Randolph County,” she said, “I truly believe his life could have been saved..”
The small rural hospital closed in October 2020 as the coronavirus pandemic gripped the community and the state. The facility had served the residents of Cuthbert and surrounding areas for over 70 years.
Rural Georgia has seen a staggering number of these emergency facilities close, leaving tens of thousands of Georgians with little to no options in the event of a medical emergency. Southwest Georgia Regional marked the eighth hospital to close in the past two decades.
In communities where medical centers have closed, from Commerce in North Georgia 250 miles away to Arlington in the southern part of the state, residents face dire situations as the state struggles to find solutions.
The crushing of the COVID-19 pandemic has only added new challenges. When COVID suspended lucrative elective surgeries, hospitals took another hit. To survive, some have had to completely cut crucial services.
But now, seemingly with the worst of COVID cases behind us, Georgians and stuck rural hospitals are asking: Where does rural health care go from here?
“Life Under Atlanta”
Even though the Randolph County ambulance had reached Jones Johnson’s aunt earlier, the driver of the emergency vehicle is faced with a difficult decision: drive 26 miles to the nearest hospital at the border of the State. ‘Alabama or 45 miles to the largest hospital in Albany.
The state’s rural residents often face long commutes for emergency and primary medical care as hospitals have closed and doctors have fled to major cities.
Jones Johnson calls it a reality of “life below Atlanta.”
“We need a hospital; we need some kind of emergency care,” she said. “All the doctors are gone – we don’t have any doctors who live in Randolph County. They all moved to other cities to work. So I just feel like they just let us die.
Jimmy Lewis, CEO of Hometown Health, a coalition of rural hospitals, said rural hospitals were struggling to stay afloat and were relying on state intervention. Lawmakers this session enhanced the longstanding hospital tax credit program to increase the annual cap.
The injection of millions of dollars into federal COVID-19 relief funds has helped cover the rising costs of the pandemic, but when that money stops flowing, Georgia hospitals still face the same problems — primarily a poor mix of payers and a skyrocketing number of uninsured patients.
The loss of the Southwest Georgia Regional Medical Center in Cuthbert was hastened by the pandemic, but ultimately fell victim to long-term issues, Lewis said.
“But if we only lost one during the pandemic, it would fall into the category of what we call a miracle,” he said.
The loss of a community hospital not only brings about a dramatic change in access to health care, but also eliminates a major economic driver for the region. When Southwest Georgia Regional closed, 40 people also lost their jobs.
Stephanie Starling, who is a healthcare worker in Edison, Calhoun County, said surrounding communities were also suffering.
“A lot of people have lost their jobs, on the one hand,” she said. “It was their livelihood. People love what they do and then it’s taken away from them, like that.
“I’m just praying it reopens,” Starling said.
Cut services to survive
When Van Loskoski assumed the role of CEO of Stephens County Hospital in Toccoa, in the far northeast of the state, near the border with South Carolina, he inherited a facility on about to close.
Hospital officials reported last summer that unless there was more financial investment from the community, the hospital would have to close.
On his first day on the job, Loskoski had to make a tough decision.
“I had the unfortunate challenge of having to suspend our labor and delivery services,” he recalls. “Our labor and delivery department has delivered about 200 to 215 babies in recent years, and that’s just not enough to sustain the program..”
The situation mirrored a trend seen across the state: Often, when facilities are desperate to keep their doors open, midwifery programs are the first to go.
In turn, the Northeast Georgia Hospital has sought to meet other patient needs, Loskosi said, such as adding a senior behavioral health unit, as mental health needs have increased. reached extreme levels during the pandemic.
But the crush of COVID-19 cases has also drained staff at rural hospitals across the state. Faced with burnout and stiff competition for traveling nurses, lab technicians and other specialists, hospital leaders say that most of the time the full bed capacity for patients is not available.
Lewis of Hometown Health said the pandemic has forced some frightening choices that hospitals haven’t had to face before. Like when two needy patients show up at the door, but only one bed is free, how do they decide who gets it?
“Sometimes in deciding who gets the next bed, someone can end up having to make a decision that costs a life,” he said.
Many argue that the state’s refusal to expand Medicaid under the Affordable Care Act put rural hospitals in the dire straits they face today. When uninsured patients show up at their doorstep, hospitals are responsible for the cost.
In rural communities lacking primary care physicians, hospital emergency rooms become a catch-all for patients who may only need general care.
“This pandemic has shown us that rural hospitals are clearly the safety valve in many cases,” Lewis said. “So we have to focus on keeping them there.”
Catch patients before emergencies
On a hot day in Hamilton, a large crowd gathered outside the old Harris County Public Library.
The building was given new life as a medical clinic run by Mercer University. This is the fifth primary care clinic opened by the school in rural communities that do not have primary care physicians.
Dr Jean Sumner, dean of the medical school, said the pandemic showed the communities with the highest death percentages were rural communities of color without access to a GP.
And heads of state are not ignoring the lack of access to life-saving or life-threatening care, she said.
“Georgia has recognized for some time that we have a rural health problem and they’ve invested a lot of money in that,” Sumner said. “They tried to find lasting solutions, but they didn’t move that needle..”
Mercer’s strategy is to bring care to residents who would otherwise face long journeys to get help, like the one in Randolph County — where 20 miles, she said, might as well be 200.
Rural hospitals bear the brunt of additional patients who may not need emergency care. Sumner said establishing primary care offices helps clear clogged emergency rooms through preventative care.
“Where do you want them to go?” she lamented. “There is no place in their community and they don’t want to be there either. Who wants to go to the emergency room?
Dr. David Kay, Hamilton’s newest physician serving patients at the Mercer Facility, knows the work goes beyond funding and building a state-of-the-art facility. New providers also face the hurdle of building trust with residents who feel let down by the state healthcare system.
“I was born and raised in this area,” said Columbus native Kay. “I think a big part of any doctor’s success in the community is being able to relate to patients, and more importantly, patients feel like they can relate to the doctor.”
But people in places like Cuthbert are still waiting for help. Efforts to secure federal grants to reopen the closed facility were unsuccessful.
“Everyone deserves to live,” Jones Johnson said. “Everyone deserves better access to healthcare, even if they can’t afford it.”
This story comes to The Current GA through a reporting partnership with GPB News, a nonprofit newsroom covering the state of Georgia.