James McGrath’s hospital-based practice was shut down.
James McGrath’s hospital-based practice was shut down. Photo credit: Taylor Sisk

While fondly recalling the past, Yadkin County residents ponder the future of their community hospital.

By Taylor Sisk

To anyone who’s been around Yadkinville for a while (and most folks up here have), it was “Hoots,” and forever would remain so.

Sure, the name – Hoots Memorial Hospital – was changed about five years back, but, as Yadkin County Manager Lisa Hughes sees it, when Yadkin Valley Community Hospital has been long forgotten, “this will still be Hoots.”

Rural Rx: NC Health News coverage of rural health issues. This week: Yadkin County.
Rural Rx: NC Health News coverage of rural health issues. This week: Yadkin County.

In fact though, Hughes and many of her fellow Yadkin County residents would prefer that Yadkin Valley Community Hospital, which today sits shuttered, not soon be forgotten. Rather, they’d like for it to be reopened and revitalized in the spirit of the community institution that Hoots was.

Which is not to say that the hospital was all things to all people.

LuAnn Brown, a nurse at the hospital from 1981 to 1992 and now a nursing instructor at Surry Community College, acknowledges that for as long as she can remember “lots of people have had negative views about the hospital.” Some people didn’t trust it, she said, simply because it was rural.

But it was theirs. And for Brown and many others, that amounted to something.

“You felt like everybody cared,” she said. “And they did.” She rues what she perceives as the general loss of a more personal interaction between provider and patient.

“We need to get the family feel back in the hospital,” Yadkinville Mayor Hubert Gregory said in agreement, “get the trust back with the people here.”

But Yadkin County government officials and leaders in the medical community recognize that those days have gone. Hoots Memorial is no more. A new model is needed.

Breaches of contract

Hoots Memorial Hospital opened its doors in Yadkinville on May 7, 1952, and was regarded at the time as a more or less state-of-the-art facility.

But times had changed.

LuAnn Brown, a former nurse at Hoots Memorial Hospital, awaits the return of the community hospital.
LuAnn Brown, a former nurse at Hoots Memorial Hospital, awaits the return of the community hospital. Photo credit: Taylor Sisk

HMC/CAH Consolidated Inc., a Missouri-based for-profit company, arrived in May 2010 promising to modernize the facility. The company’s advertising states: “Our corporate goal is to own and operate new, safe hospitals that are cost efficient and offer the highest quality care. We can assist communities in replacing older hospitals with new, state-of-the art facilities.”

But those plans never materialized. According to Yadkin County Attorney Edward Powell, HMC/CAH signed a contract in 2010 to renovate, but never delivered.

Then on Friday, May 22, just past 6 p.m., the hospital was shut down, with HMC/CAH walking away from a lease agreement with the county to operate it through July 31.

In a letter to the state Department of Health and Human Services informing the agency of the company’s intention to close, hospital CEO Shawn Bright cited lease renewal terms offered by the county as being “so onerous that the Hospital cannot accept them and still operate in a fiscally responsible manner.”

At the time, HMC/CAH was operating rent-free.

Times change

Yadkin County isn’t faring too badly these days.

According to the U.S. Census Bureau’s American Community Survey, 14.1 percent of families live below the poverty line; the national average is 11.3 percent and the state’s is 12.9. About 15 percent of its residents have no health insurance, right at the national average and a percentage point below the state’s.

But like so many rural communities, it’s aging.

“We have a lot of elderly citizens who don’t like to drive in I-40-type traffic, so they relied on our small hospital here for their doctors’ [appointments] and some acute care,” David Moxley, vice chair of the Yadkin County Board of Commissioners, told N.C. Health News when the hospital closed.

James McGrath’s hospital-based practice was shut down.
James McGrath’s hospital-based practice was shut down. Photo credit: Taylor Sisk

Many of those seniors were James McGrath’s patients. McGrath was the hospital’s medical director, and his practice was in the hospital – a practice that was likewise padlocked when the facility was shut down.

County Manager Hughes said most of the calls her office now receives are, “Where’s Dr. McGrath?”

McGrath practiced medicine in Yadkin County from 1983 to 1990, moved to Durham for 16 years, then returned.

“Life was interesting” in his first tenure at the hospital, he said over lunch last week at the Yadkin Dairy Freeze.

He’d developed an interest in obstetric care. The hospital was part of the Wake Forest Baptist Health system at the time, and system administrators encouraged the contribution he could make in a state that, at the time, had the second-worst infant mortality rate in the country. (Though that rate has improved somewhat, disparities between rural and urban communities persist.)

McGrath zeroed in on prenatal care, and, he said, was told by the Wake Forest administrators that, “Anything you folks out there in the hinterland can do will help.”

“Nine months later,” he said, “the baby’s fine and the mama’s fine. And you think, ‘Maybe we did something.’ Because this was a person who right from the get-go was a setup for a bad outcome.”

‘Sweet spot’

McGrath delivered babies right up until he left for Durham. But by the time he returned, the practice of medicine had changed. Specialty practices were no longer a part of the hospital landscape.

Mark Holmes
Health economist Mark Holmes. Photo courtesy of the UNC Gillings School of Global Public Health

Experts say that in order to survive, rural hospitals must respond to changing times, and providing needed specialty services might be one of the few means of survival.

In a May interview with N.C. Health News, UNC-CH health economist Mark Holmes said rural officials should “figure out what makes most sense for their community and tailor to that.”

Find the “sweet spot,” Homes urged.

“Maybe you find one or two specialties that aren’t otherwise available, and use those to help support your emergency facility.”

Hughes agrees.

“We need to make sure that we’re providing services that people want to receive in Yadkin County,” she said, “that they don’t want to go to Elkin or Winston[-Salem] to receive.”

She said county officials would welcome the passage of a Congressional bill sponsored by U.S. Sen. Chuck Grassley (R-Iowa). The bill calls for critical access hospitals, like Yadkin Valley Community Hospital, to have the option to be redesignated as “rural emergency hospitals,” allowing them to continue to provide emergency medical services without maintaining inpatient beds.

“That would be a tremendous benefit to us,” Hughes said. “It would offer us, without the expense of the inpatient beds, to be able to have an emergency room,” to have a few beds available for short-term needs and observation, transporting to nearby hospitals the more critical cases. And to provide a select few specialty services.

‘It was gone’

“My heart aches for Yadkin County residents as we await word on the outcome of our small community hospital,” LuAnn Brown wrote in a letter to the county’s attorneys.

County Manager Lisa Hughes inside the abandoned hospital.
County Manager Lisa Hughes inside the abandoned hospital. Photo credit: Taylor Sisk

“The hospital and the physician offices are truly a lifeline for many residents,” she wrote, describing elderly residents who felt “safe and secure” with the hospital. “Now, that security is gone and many long-term patients will suffer.”

Hughes said the county is consulting with a couple of firms to determine how best to move forward: examining the best options from a financial perspective, and learning of service models that might best match the community’s needs and the facility.

McGrath would like to see a hospital system “look at this facility and see how it could dovetail with their larger strategic needs.”

And maybe, in so doing, reestablish some of that Hoots-like “family feel” that Mayor Gregory spoke of, in a more tightly focused environment.

As for his practice, McGrath intends to be “up and running here, hopefully within a few weeks,” back in the hospital. But he acknowledges the facility needs renovations. “The physical layout that traditional practices have just doesn’t fit anymore.”

He said, for example, that a “central area for support staff with the examining rooms configured like a clock face” would be ideal.

But, McGrath said, he can’t realistically expect the county to foot the bill for that; they’ll need some outside resources.

UNC’s Mark Holmes said it’s not uncommon for rural communities to “think of their hospital as metropolitan areas think of their professional sports team: This is what puts us on the map; this is a big part of our identity.

“And then you lose that.”

But Cari Harold, an EMT employed by the county to be at the abandoned hospital lest someone come by in need of the ER, said the loss of the hospital is more basic: “A lot of citizens will tell you it was a comfort having this hospital here. Whether they used it or not, it was a comfort.”

“And then, all at once,” Brown said, “it was gone. And we need it.”

[box style=”2″]This story was made possible by a grant from the Winston-Salem Foundation to examine issues in rural health in North Carolina. [/box]

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