Barnwell — Police Chief Reuben Black found out that Southern Palmetto Hospital was shutting down in January just like most people in this small town did — on Facebook.
“It closed at noon the next day,” he said. “It’s extremely hard to lose a hospital that’s been here since 1950-whatever. The people of this community depended on it.”
Three years after Gov. Nikki Haley’s administration began bolstering rural hospitals with millions more dollars, three of them, including Southern Palmetto, have closed in 10 months.
Marlboro Park Hospital in Bennettsville shut down in May. Williamsburg County Hospital was forced to close in October due to building damage caused by rain. And, after 60 years in Barnwell County, staff at Southern Palmetto Hospital treated patients for the final time in January.
“It scared me,” said Amber Cornett, who works at Common Grounds coffee shop in town. “I have two young children. If something happens to them, what am I supposed to do? ... They could die in transit to another hospital.”
These closures and the problems they present aren’t unique to South Carolina. The North Carolina Rural Health Research Program reports 71 rural hospitals have closed across the country since 2010 as patients move to bigger cities or seek treatment outside small towns at larger medical centers. The smartest health care minds haven’t figured out how to keep these facilities open or even agreed if some rural communities justify full-fledged hospitals.
One of Haley’s solutions — a $40 million hospital “Transformation Fund” — will expire this summer. S.C. Medicaid Director Christian Soura said he will not ask the Legislature to renew the program, which was meant to encourage larger hospitals to forge partnerships with the smaller, struggling facilities. To date, only $8 million of the $40 million has been spent.
“I suspect right now we won’t get all the way to $40 (million),” Soura said.
The Legislature also has approved for several years a multi-million dollar program that allows Soura’s agency to reimburse rural hospitals for almost all the uncompensated care that they give away for free to uninsured patients. But that financial cushion hasn’t ensured the rural hospitals’ survival either — a problem made clear by three back-to-back closures.
“Those three happened to hit in this particular time frame, but it’s part of a larger trend we’ve seen across the country,” Soura said. “Certainly we’re concerned about it.”
Part of the problem in Barnwell, he pointed out, was that patients there weren’t using Southern Palmetto even before the hospital closed.
“They were voting with their feet,” he said. “They couldn’t get people who lived there to go there.”
Approximately 95 percent of Barnwell patients covered by private health insurance plans passed over the local hospital, he said, for out-of-town care.
“It’s really hard to make the math work at that point.”
Haley’s office directed all questions for this article to Soura’s agency.
Meanwhile, Graham Adams, executive director of the S.C. Office of Rural Health, is worried that more rural hospitals will close.
“There are still some hospitals that are very concerned about their ongoing viability,” Adams said.
Approximately 60 hospitals operate in South Carolina. Roughly one-third of them are designated rural by the state Medicaid agency.
“I think that the state needs to continue to work with smaller rural communities to figure out how to best meet the needs at the local level and to do everything we can to prevent the hospital from closing,” Adams said. “But if it does close, that’s where the state can be helpful.”
Conservative state leaders, including Haley, have pushed back against the federal Affordable Care Act, most notably by declining billions of federal dollars that could have been used to expand eligibility for the low-income Medicaid program in the Palmetto State.
Most adults without dependent children do not qualify for Medicaid in this state, even if they fall below the poverty line.
Medicaid expansion would extend health insurance coverage to an estimated 224,000 South Carolinians.
“If that gets some traction, it would solve a lot of our state’s problems,” Adams said.
Even though Williamsburg County Hospital in Kingstree closed due to water damage, the facility laid off a “large portion” of its staff this month. The decision was “extremely difficult, but necessary because of a lack of insurance funds,” an announcement on the hospital’s website explained.
Williamsburg County Hospital hopes to open a “temporary modular hospital” soon. For now, only a mobile emergency room exists on site.
Connie Dozier, who owns a bakery next door to the hospital, said an ER alone isn’t sufficient.
“I really honestly feel that we need a full medical building — not just the emergency room,” Dozier said. “We have so many elderly people in the area who may not be able to travel to other locations to get medical attention.”
But patient care isn’t the only casualty in Kingstree. Dozier’s bakery business has suffered, too, since the hospital closed.
Hospital employees used to call in lunch orders or stop by in the afternoon for a slice of cake.
“We have definitely seen a decline in that since they have closed,” she said. “We hope it will come back.”
In Barnwell, the Bradford pear trees are blooming outside Southern Palmetto Hospital and the American flag still flies on the pole out front, but no one there expects the facility to reopen. The People-Sentinel in Barnwell reported earlier this month that a health clinic will consider opening an urgent care center in town.
“That would be awesome,” said Cornett, who works at the coffee shop in Barnwell.
Otherwise, she said she would drive her children an hour each way to Aiken for medical care, if necessary.
Rural hospitals not only provide emergency health care to residents in small towns. They also employ a lot of people.
When Bamberg County Hospital closed in 2012, the county changed, said Bakari Sellers, an attorney and former state lawmaker.
“We lost so many jobs,” he said. “We’re not talking about people who are making $7.50 an hour. We’re talking about skilled labor.”
Those professionals leave a county when a rural hospital closes, he said.
“I don’t think people completely understand. ... If you have a heart attack now (in Bamberg), you die,” he said. “These hospitals are the lifeblood of many of these small communities.”
Black said his county has changed since the hospital closed, too.
The police chief must now pay his officers overtime because it takes them longer to drive to hospitals in Allendale or Aiken to interview crime victims.
Primary care patients have felt the impact, too, he said.
“One of the things that most people don’t know — I didn’t even know — when the hospital left, the hospital had the only X-ray machine in Barnwell,” he said. Local doctors in town would send patients to the hospital for routine X-rays. That’s impossible now.
“That’s a huge loss,” Black said. “Now they’ve got to send you to Aiken, Allendale, Orangeburg, somewhere else.”
Black said that residents in big cities must have a hard time imagining the inconvenience of a two-hour round trip for a simple X-ray.
“Charleston is like Greenville — there’s a hospital on every corner it seems,” he said. “They don’t get it.”
Reach Lauren Sausser at 843-937-5598.