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WEDOWEE, Ala. (AP) — An ambulance carrying a person with stroke symptoms backs up the emergency room on summer morning at Wedowee Hospital.
The tiny, red brick hospital is the closest hospital for about 45 miles in this rural stretch of east Alabama. "We have had people who would not have survived if we hadn't been here," said emergency room physician Dr. Jose Oblena.
The hospital could also be the next hospital to be shuttered as rural hospitals struggle to survive. Eight rural Alabama hospitals have closed over the last 15 years, according to the Alabama Hospital Association. Nationwide, 54 rural hospitals have closed since 2010, according to the North Carolina Rural Health Research Program.
"This hospital has struggled for years," said Wedowee Hospital Administrator Mike Alexander.
A network of rural hospitals was set up across the country more than 60 years ago as a way to make sure people had access to medical care. However, low Medicare and Medicaid reimbursements rates, plus caring for large numbers of poor and uninsured patients, are now financially squeezing to death those same hospitals, said Danne Howard, Senior Vice President of the Alabama Hospital Association.
"It's not just one thing. It's a perfect storm," Howard said.
Voters in Randolph County will go to the polls Tuesday on a one-cent sales tax to keep the hospital afloat. The money would support a bond issue to construct a new hospital. Tanner Health Systems, which runs the hospital, hopes the new facility will attract patients who, in non-emergency situations, drive by in favor of flashier, larger hospitals. Alexander said the hospital will be closed if the referendum fails.
Proponents of the tax referendum said it will keep a medical anchor in the community, while opponents said it is time to look at other options.
Randolph County is a county of about 22,000 people and is typical of the communities served by rural hospitals. Wedowee has a stop sign instead of a stoplight at the main downtown intersection. About one in four people live in poverty, although the lake is also dotted with $300,000-plus houses as retirees and others move to the area.
The 34-bed hospital is 60-years old. Window air-conditioning units cool a few areas of the hospitals. Hallways aren't wide enough to meet modern requirements for gurneys. Chipped wood here, and a cracked window pane there, show the age and financial struggles.
But the hospital's walk-in, tiny waiting room is jammed on the one day of the week the hospital performs outpatient surgery. The emergency room takes in a steady stream of patients, ranging from suspected strokes to people who got fish hooks lodged in their skin at the lake.
Elba General Hospital closed in 2013. Two clinics are available for care during the day, said Mayor Mickey L. Murdock. Murdoch said the closure has tangential effects on the community, including the loss of jobs and making the town less appealing to potential new residents and new businesses.
"I think it causes an uneasiness among people. I think it causes a loss of people moving in," he said.
State Health Officer Don Williamson said a study for a group working on Medicaid changes in Alabama said there were about 13 Alabama hospitals "teetering on the brink financially" — which it did not name— but that could likely close without impacting access to care because of proximity to other hospitals.
"That's a nice thing to say, but here's the problem. In that community, in Wedowee, if that hospital closes, what does it do the community?"
Medical staff will leave the community and there is not a place for the most critically injured patients to get care quickly or a nearby place for people without transportation, Williamson said.
He said there needs to be some way to preserve health infrastructure in rural communities, but so far there have been no easy answers.
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