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Reviving the heart of a rural community

A week before Thanksgiving in 2017, the owners of Lakeland Community Hospital in Haleyville, Ala., called a special meeting with all department heads. Judging by the mood in the room, Megan Welborn, director of imaging services, could tell the news was not going to be good.

In the hours that followed, the owners announced that the hospital would close Dec. 31.

“Tears just started rolling down my face. I was just in shock,” Welborn says. “The first thing you think about . . . my family, my job . . . what are we going to do? What’s the community going to do? It was just a shock.”

Welborn had two small children to care for at home—a one-year-old and a three-year-old. Just recently, another three-year old was flown into the Haleyville emergency room. Without the ER and helipad, that child probably would not have made it. Thinking of her own child at home, Welborn asked herself, “Do I want to live in a town that doesn’t have a hospital?”

When assistant lab manager Whitney Fowler’s manager called to notify her that the hospital was closing, Fowler first experienced a moment of disbelief, followed by the painful reality of the situation. In a little over a month, she and her brother would no longer have jobs, and her grandparents would no longer have easy access to care.

“It was like a bad dream. A bad shock,” Fowler says. She wondered what the community would do without a hospital.

But Fowler’s grandparents were confident and steadfast in their belief that the hospital would not close. The historical “home of 911,” Haleyville could not be without a hospital.

There is historical precedence for the indomitable spirit of this community. It is a vein that runs through the entire town of Haleyville and the surrounding county. During the Civil War, in opposition to the Confederate States of America, Winston County “seceded” from Alabama to form the Free State, or Republic of Winston. If the town’s ancestors could standup to state secession, they could fight to keep their hospital open.

Patient care and economic development
The immaculately clean and well-kept 50-year old facility stands as the sole hospital in Winston County. The next closest emergency room is anywhere from 45 minutes to an hour away by ambulance—a long drive for someone in need of critical care.

Whether they’re seeking preventive procedures like a mammogram or care for critical emergencies, patients living in rural areas should not have to suffer because of where they live. Additionally, the Haleyville hospital employs close to ten percent of the town’s working population and plays a critical role in fostering growth and attracting new business.

“Our community had to have medical care . . . we needed the emergency room, that was the most critical thing,” says Haleyville Mayor Ken Sunseri. “Secondary economic development . . . you can’t recruit an industry or a business if you can’t provide health care.”

Not only would attracting new business become a challenge, but without a nearby hospital, companies currently employing residents would see an increase in workers’ compensation rates. The loss of a major employer would also put a huge dent in municipal funding previously gained through Alabama’s employment tax.

Formation of the Haleyville Healthcare Authority
When calls from shocked and concerned citizens began to pour into his office, Mayor Sunseri was quick to take action. After reaching out to officials from neighboring towns and receiving advice from rural health advocates, the city council concluded they would need to form a health care authority. However, they still needed to find the money and organize the purchase in less than a month.

Once it was decided the city would purchase Lakeland, ownership agreed to keep the hospital open for another 30 days. But the decision was not an immediate remedy. The hospital had assumed a large amount of debt over the years, and some vendors had not been paid in nearly nine months.

In a city council meeting attended by more than 120 people, including state senators, legislators, and federal officials, a solution was born. With amazing buy-in from the citizens of Haleyville, it was decided that a one-percent sales tax increase would go towards financing the hospital and sustaining its growth.

Ensuring profits and long-term viability would take two and a half years and close to $5 million. To accomplish this, they would need help from investors and an experienced hospital management entity that could guide the business end of recovery.

At this critical time, Bappa Mukherji and the Java Medical Group launched into action.

An investment in rural health care
When Mukherji first toured the Lakeland facility, he noticed a bulletin board decorated for the holidays that included a note: “To Santa: All we want for Christmas is to save Lakeland. Love, Third Floor Nurses.” This small symbol of dedication was enough to inspire Mukherji and his business partner to fully commit.

In the next two weeks they created a plan to keep the hospital open. Along with the sales tax increase, the plan required an expansion of services, compromises with vendors and surrounding area hospitals, and – most importantly – a huge commitment from the staff.

In an unprecedented display of comradery, every hospital who had extended a job offer to Lakeland employees agreed to hold those offers for 30-days, with no extra incentives.

MEDHOST pitched in by offering to take over Lakeland’s central business office functions and create a process for fiscal recovery that included a payment plan for outstanding bills.

A hospital family and a holiday wish
Lakeland employs many individuals who have called Haleyville home their entire lives. A few employees left the hospital, but many were committed to stay.

“I wasn’t going to look for another job,” Welborn says. “This is my home . . . Any department could have made the decision not to stay and it would have been devastating for the hospital. I am proud of all the people who put in the effort.”

Welborn’s imaging department got whittled down to three people. Each of them worked long days, often spending two to three nights a week at the hospital away from their families. For two months, their team made personal sacrifices to ensure their patients received the care they needed.

Gerita Rye was nine years old when the hospital was built. Now the hospital’s director of safety, marketing, and physician recruitment, she can’t recall a time when the hospital wasn’t there—for her it had always been an essential part of their community.

“You need good schools and a hospital to bring in an economy . . . without the hospital it would have been devastating to our town,” Rye says.

Thanks to the unyielding efforts of hospital staff, the community, and rural health advocates like Java Medical Group, MEDHOST, and other area hospitals, the 30-day extension turned into three months. Two weeks before Christmas, it became clear the hospital would survive.

The Road to recovery: Lakeland today
Lakeland COO Ashley Pool is a figurative bridge between the small Alabama community and the new management in Nashville. With a background in nursing from Vanderbilt University, she provides a unique outsider-turned-in perspective.

“Just in speaking with the people here, it’s really obvious that failure is just not an option for them,” says Pool. “The word is not even part of their vocabulary.”

In cooperation with Java Medical Group, Pool is working on adding new services to Lakeland. She is also working alongside other departments to bring on specialists and institute new processes designed to build more efficiency into the hospital and elevate patient care.

Pool refers to this three-month battle as a “textbook example” of what it takes to save a rural hospital—a lesson that should be taught in health care management courses and shared with rural hospitals nationwide.

Almost a year later, Lakeland is still making progress towards recovery. Mukherji notes the hospital is still in the early stages of its business management plan, but with the right people and the right services, everything should fall into place.

“This wouldn’t have happened without some tremendous leadership . . . it came from the mayor, it came from the city council, it came from the people that work in this facility,” Mukherji says.

Challenges facing rural health
This story is not unique to Lakeland. Hospitals in rural communities across the country are struggling to keep pace with changes in health care. Constantly evolving legislation and shifting payment models are among rural health’s top challenges. While many of the innovations spurring health care forward come from rural hospitals, those same facilities are closing at outstanding rates.

Along with policy and payments, the National Rural Health Association states that the battle for rural health in America has much to do with the social determinants of health. For the 60 million-plus people who call rural America home, easy access to care often does not exist, and their environments may do little to support healthy lifestyles.

Aged travel infrastructures and workforce shortages are difficult to remedy without a wealth of capital. Social barriers that may include increased mortality rates, rampant opioid abuse, and a high percentage of uninsured patients put even more stress on rural hospitals.

Even more critical, rural hospitals represent essential community centers that not only strive to keep populations healthy but also act as structures for economic support.

NRHA calls the hospital the “beating heart” of a rural community. Without hospitals, many of the small towns dotting the American landscape may fade away.

What does it take to revive the beating heart of a rural community and save it from its own 911 emergency? As Haleyville shows, it takes empowered people from different walks of life working together – from health care industry leaders and government officials to the third-floor nursing team –people who understand that access to quality health care has incredible value for those living in remote areas.

Watch our video and listen to our podcast to join the conversation.

NRHA commissioned the above piece from MEDHOST, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog

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