By DEANNA AMBROSE
Ozell Pouncil is a short, black man with a wide smile and snowy white hair that he combs down on his head to spread out the waves. He goes to First Missionary Baptist Church on Sundays and doesn’t use the Internet or a landline telephone.
He worked several blue-collar jobs, but his favorite was farming. Ozell farmed for eight years in Caney, 23 miles southwest of Independence, as his wife, Elizabeth worked at a nursing home. They raised four children, returning to Independence because Elizabeth was, as Ozell says, a “city girl from Albuquerque.”
Ozell had his garden, which served as a compromise, and Elizabeth had a sense of community. As they grew older, the town changed. Industries left, Washington Elementary School closed and the hospital shut down. He said as soon as he can sell his house, he will move anywhere, as long as it isn’t Independence.
“How would you like to live in a town this size, if a heart attack or something or you get a gall bladder eruption or something, you got to take them 20 miles or 45 miles or 100 miles away,” Ozell, 78, said. “You may have to get to the hospital in a hurry, you can’t wait 25, 30 or 45 minutes to get to Bartlesville, which is 45 minutes away, or go to Tulsa which is 100 miles away, or Wichita, which is 119 miles away, everywhere you go it’s a ways away. You could be dead by then.”
Ozell knows firsthand what it’s like for someone to “be dead by then.” On the evening of July 24, 2010, he and his wife Elizabeth sat at the dinner table talking about selling some of Ozell’s golf clubs. Ozell walked into the kitchen to talk with his nephew, and when he returned to the dining room, he found Elizabeth slumped over the table, unresponsive. She had suffered a stroke. He rode in the ambulance to Wichita, praying she would die peacefully and without pain. He couldn’t wish for her to come back as “a vegetable,” as he put it.
“We were married 56 years and renewed our vows twice.”
He told her if she could hang on for another 25 they could have another ceremony. That didn’t happen.
In 2010, Independence’s Mercy Hospital couldn’t provide critical care, like for a stroke, and had limited bed space. But the hospital still served other needs and provided a source of employment in the community.
Independence represents just one hospital and just one town in Kansas, but serves as a possible example for the future of other rural communities. Hospital closings only portray part of the rural health issue. Medicaid expansion and access to primary care both play a role in the overall wellbeing of Kansans and their communities. But the State Legislature and individual communities are trying to find solutions.
In addition to Mercy, 31 other hospitals in Kansas are at risk of closing too, according to the Kansas Hospital Association. This includes Sumner Regional Medical Center in Wellington. A recent 1 percent sales tax increase went into effect in 2015 to support the hospital. The future of Sumner Regional Medical Center might rely completely on the town’s residents.
Independence couldn’t save its hospital. Ozell watched as industries left town and as Mercy Hospital fell deeper into financial problems.
Independence today
Independence has a population of about 9,000 but seems smaller. On a Sunday morning, the streets are quiet: no cars, no people, no dogs, no children. Dirty storefronts that closed years ago line some sidewalks, while others still functioning keep neon open-signs hanging in the window serving as an example of what might be the beginning of the end of small-town life in Independence.
As the population has declined by more than 5 percent since 2010, other changes have come to Independence as well. In 2014, the second most common job in Independence was in health care and social assistance, which accounted for about 22 percent of employment. The highest paid employees in the community were doctors and surgeons, according to Data USA. But in October 2015, that all changed. When Mercy Hospital closed its doors, not only did 190 employees lose their jobs but the community was left without a full-service medical facility.
With the closing of Mercy, Coffeyville Regional Medical Center is the only hospital remaining in Montgomery County. It’s located 25 miles from Independence.
Since August, Mercy has functioned as Independence City Hall headquarters after an outbreak of mold in the original city hall building caused illnesses in some city employees.
Mickey Webb, the Independence city manager, said the city is leasing 10,000 square feet of the hospital to St. John’s Medical Center of Bartlesville, Oklahoma, for MRI imaging and a lab. The emergency helicopter pad remains operational but unused.
Although the helicopter pad works, Webb said, Independence does not hold emergency helicopters in the area. The procedure for moving a trauma patient from Independence to a functioning emergency room involves transporting the patient in an ambulance and stopping at pre-ordained helicopter landing areas on the way.
Labette Health will open an emergency services building in Independence sometime next summer. Labette Health media contact Kerri Beardmore said the new emergency room will feature a helicopter pad. Webb said with the opening of the emergency room, Independence could serve as a more central helicopter hub in the future.
Since 2010, 76 rural hospitals closed nationwide. That is less than 1 percent of the 5,627 registered U.S. hospitals, but 4 percent of 1,855 rural hospitals nationwide. Even with the physical buildings, though, access can remain an issue.
Medicaid expansion
Hospital administrators indicated that Medicaid expansion could have saved Mercy Hospital, whereas Kansas Lt. Gov. Jeff Colyer said expanding Medicaid would not provide much help to Kansas rural hospitals. But not all agree. In Wellington, Sumner Regional Medical Center board member Terry Deschaine said expansion would have added about $800,000 to the hospital.
Colyer leads a task force searching for a solution to the rural health care crisis outside of Medicaid expansion. The task force met with groups that work for or in rural health like the Kansas Hospital Association and National Rural Health Association.
“I think Kansans have made it pretty clear, that they’d rather have, that they don’t like big government solutions,” Colyer said.
But, a survey from the Kansas Hospital Association indicates 62 percent of Kansans support Medicaid expansion in some form. In addition, 171,000 Kansans would qualify for expanded Medicaid, according to the Center on Budget and Policy Priorities. In a 2014 study conducted by the Urban Institute, the 10-year financial losses of not expanding Medicaid are $5.3 billion from direct expansion and $2.6 billion from hospital reimbursements.
Colyer also linked health care to overall economics of rural communities.
“One thing that the task force is recognizing is that health care has a big economic impact in these communities, and how do we best preserve it or expand it, not just with the services, but with the economic part.”
Health as a profession is related to rural economies. Colyer said on problem facing rural communities is retaining health care professionals. He said training doctors in a rural area during their residencies is a key factor to retaining those professionals in rural communities. He said he’d like to focus on ways to increase opportunities for training in rural areas. He expects the task force report to be available to legislators in January.
University of Kansas Associate Professor Dr. Mugur Geana is the Director of the Center for Excellence in Health Communication to Underserved Populations, and has conducted research in coordination with the Kansas Department of Health and Environment. He’s identified access to health care in rural communities as a primary issue.
“When I’m talking about availability of resources, I’m not only talking about having a hospital or a clinic, I’m talking about having doctors, having different specialties available, nurses, and so on and so forth, having transportation means to go to the hospital.”
Geana also said oftentimes communities have plentiful health resources, but still face problems.
“Because access means more than just having a building with doctors in it. It means affordability, you know, it means ease of access in terms of transportation, in terms of language barriers.”
When affordability enters the mix, Medicaid expansion and the lack of it in Kansas become a talking point. Geana said health is often a for-profit industry and even highlighted the importance of competitiveness to the development of health care.
Jeff King, R-Independence and vice president of the state Senate, was against Medicaid expansion until Mercy Hospital closed. Although he is not seeking re-election, King now agrees that Medicaid expansion, done correctly, could benefit Kansans and rural hospitals. He said when the federal government allowed Indiana to create its own form of expansion that he changed his mind on the issue.
The Healthy Indiana Plan provides insurance to adults 19-64 based on income levels and family size. The plan differs from traditional Medicaid expansion in that those insured pay copays for care and prescription. Each month they deposit an amount based on income into a POWER account, a type of health savings account, which the state uses for $2,500 of initial expenses.
King said the money problems and provider problems can’t be separated.
“I’m an attorney; I’m not going to move my family where there are no clients,” he said. “It’s the same for a doctor that it is for a lawyer.”
Primary care
Primary care is another important aspect of rural health that contributes to further declines of health services accessibility. Jason Wesco, Vice President of Community Health Center of South East Kansas, which is a federal nonprofit corporation, said the issues at this point become the corporate influence and cost of health care for residents of Independence, which lacked what he termed good city planning for the hospital.
The Community Health clinic in Independence exemplifies a possible way to cut costs because of the nature of its integrated services. It is located in Four County Mental Health Center, and while serving behavior health issues, also takes on general health issues.
Kansas Secretary of Health and Environment Susan Mosier said integrated care is a hopeful solution to cutting costs while ensuring quality of services, as well as allowing patients to access more services they need in one place. She also said technology she called “telehealth” could cut costs to residents and provide them with additional services.
One example of telehealth at work would be a doctor or nurse practitioner engaging in “telementoring,” which means a licensed professional would assist them via video conferencing or some other form of communication to help train them in behavioral health issues that may arise outside of their immediate experience.
As of now, Community Health Center of Independence has increased its open hours from three days a week to five days a week since the closing of Mercy Hospital in 2015, though Wesco noted other factors could have played into the expanded hours.
He also said 35 percent of the patients the Independence clinic sees are uninsured, and that 90 percent can be described as low-income. Wesco said many of the uninsured would qualify for Medicaid if it were expanded. But access to health insurance isn’t the only problem for rural Kansans.
Without insurance or health care providers, poorer residents suffer from lack of access and extended wait times as clinics close in communities that lack access to health care, Wesco said. He also said eventually that lack of access will probably extend to the middle-income population as well.
The same Medicaid expansion that might have kept Mercy Hospital open, would also provide low-income Kansans with the safety of some form of health insurance in terms of both emergency and primary care. Quality primary care can often reduce the need to go to a hospital anyway, Wesco said.
The Wellington solution
In Wellington, Kansas, another local hospital has faced its share of financial problems. In 2015, 64 percent of residents voted yes to a 1 percent sales tax increase to support Sumner Regional Medical Center. The total sales tax rate now sits at 9 percent, according to the Kansas Department of Revenue.
Terry Deschaine, a board member of Sumner Regional Medical Center, said it’s not uncommon for towns to raise sales taxes in order to keep hospitals afloat.
“It’s not a solution to save hospitals. It’s a solution to help hospitals survive,” he said.
Sales taxes can only go so high, he said, before they start adding up, especially on major purchases, which create a burden for everybody.
He also said Sumner is now working to recruit more physicians since three have either retired or relocated. Although the hospital faced significant financial problems for two years, Deschaine said through good management and recruitment he thinks the hospital will succeed.
He also said that the future for Kansans and Kansas hospitals probably will include Medicaid expansion, because Kansas will see a shift in policy and new faces in legislature after the election.
In the meantime, Ozell Pouncil isn’t going to wait. He’s willing to leave behind a community he has known his entire life to find a place with proper health availability.
“You could always depend on (Mercy Hospital) being there,” he said. “Back when I was a kid, there was always a place to go for safety.”
Deanna Ambrose is a University of Kansas senior from Frankfort, Kansas, majoring in journalism.