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What happens when the only hospital in a county closes? Fairfield is about to find out

Fairfield County residents say they know what it is like to get kicked in the teeth — again and again.

In just the past two years, they have seen two major utilities walk away from a $9 billion project to build two new nuclear reactors at the V.C. Summer Nuclear Station in Jenkinsville, putting about 5,000 construction workers out of work — some from Fairfield.

Then in August, TV-maker Element Electronics said it will close its Winnsboro plant, costing more than 100 jobs — most, if not all, held by Fairfield residents — as a result of President Donald Trump’s recently imposed tariffs.

But the slow death of the county’s Fairfield Memorial Hospital has been one of the most painful closings to watch, some say.

“Those are always the worst,” said Fairfield County Council Chairman Billy Smith, whose friends have worked at the hospital and family members have been born there. “It weighs on you heavily.”

Fairfield Memorial will close later this year, leaving only a stand-alone satellite emergency room that will open in its place about a mile away.

The closing is part of a national trend of rural hospitals shutting their doors, leaving some of the country’s poorest residents to find health care elsewhere — the result of dwindling rural county populations and, in some cases, states rejecting federal Medicaid dollars.

Anticipating the hospital’s impending death, Fairfield officials have tried to preemptively act to head off a potential health care crisis in their rural county of less than 23,000 residents.

Leaders have beefed up the county’s ambulance system and given paramedics higher wages, comparable to nearby Richland and Lexington counties. They are working to buy buildings on Fairfield Memorial’s property, leasing them back to physicians already working there.

County officials also are working to better market their public transit system. That system now takes about 14,000 Fairfield residents a year — many on Medicare, the federal health care program for older Americans, or Medicaid, the joint federal-state health care program for the poor or disabled — to doctors’ appointments in the Midlands, even Charleston.

“If we couldn’t save the hospital, we were going to do everything to save health care,” said County Administrator Jason Taylor.

Part of a larger problem

Fairfield’s situation is not unique in South Carolina.

Three other rural S.C. hospitals have closed since 2010 in Bamberg, Barnwell and Marlboro counties.

In Bamberg, the county’s more than 14,300 residents lost their full-service hospital in 2012. They also lost 350 jobs, when Bamberg’s hospital merged with Barnwell’s hospital, which itself closed in 2016.

“Those were good-paying jobs,” said Bruce Watson, the city of Bamberg’s clerk-treasurer. “A lot of people had to move to look for jobs somewhere else.”

Today, the closest hospital for Bamberg’s residents is the Regional Medical Center in Orangeburg — a 30-minute ambulance ride away.

That drive could be shortened in January, when an emergency department opens in Denmark.

“The whole idea is if you get in a bad wreck, get bit by a copperhead or have a heart attack, now it will only take seven to 10 minutes to get all your emergency treatment,” said state Rep. Justin Bamberg, D-Bamberg. “It could save a life.”

In other areas of South Carolina, the trend has been for smaller hospitals to be swallowed up by larger ones, consolidating services into regional systems.

In 2015, Marlboro Park Hospital in Bennettsville was shuttered, as McLeod Health consolidated patients and services at Chesterfield General Hospital in Cheraw 20 minutes away.

That same year, the Wallace Thomson Hospital in Union was acquired by Spartanburg Regional Healthcare System when the Union Hospital District went bankrupt. The Spartanburg-based hospital committed to building a new medical center in Union, but ground has yet to be broken for that facility. Meanwhile, the Union hospital has continued to operate.

“It’s increasingly harder for smaller hospitals to make ends meet, so you see a lot of them partnering with larger hospitals,” said Graham Adams, head of the S.C. Office of Rural Health, a not-for-profit that works with the state to serve rural communities.

In 2014, state lawmakers created a $40 million hospital transformation fund to assist with those changes. The fund makes up to $4 million per project in one-time money available if a nonrural hospital makes at least a 10-year commitment to serving a rural area.

Columbia’s Providence Health, for instance, received $3.8 million to assist with the creation of the stand-alone emergency department in Fairfield that will open when Fairfield Memorial closes, according to the S.C. Department of Health and Human Services.

Health care economist Lynn Bailey of Columbia says rural hospitals were hurt by South Carolina’s decision not to expand Medicaid as part of the federal Affordable Care Act, a move that would have provided health care coverage for the mostly poorer residents the rural hospitals serve.

But Bailey notes that hospitals, like other businesses, need customers to stay open. Each of the four counties that have seen their hospitals close has less than 30,000 residents.

“That’s not a paying customer base,” Bailey said. “You’ve got to have between 30,000 and 50,000 people, and 25 percent of them need to have good commercial insurance. You can’t survive on Medicare and Medicaid alone.”

Hospital officials recognize the problem.

“It’s really difficult to continue to run a hospital when you have rural flight and opportunities leaving rural areas,” said Schipp Ames with the S.C. Hospital Association. “Under-served, rural areas tend to have less access to health care and to be less healthy.”

Falling into disrepair

Three days a week, Fairfield County’s Bertha Goins accompanies her husband to Columbia. There, he gets treatment for multiple ailments that small Fairfield Memorial, lacking specialized care, cannot treat.

As she and her husband grow older, the trek is not always easy, said Goins, Fairfield County Council’s vice chairwoman. “That back and forth can get a bit weary.”

But that is reality for many of Fairfield’s residents, who require specialized care or, in some cases, can’t find a doctor in the county who takes their insurance.

“Fairfield County is one of the most poverty-stricken counties in the state,” Smith said. “A lot of people here just don’t have the resources to pay for their medical care.”

One in four Fairfield residents live in poverty, one of the highest poverty rates in a poor state. Many do not have the means to drive themselves to a doctor.

Since the late 1980s, Fairfield County has offered its own public transit service, partially funded by the state, that takes county residents to doctors in Columbia and sometimes even Charleston.

“We’ve got people who couldn’t get medical care if that service wasn’t there,” Smith said. “We’re looking at ways to expand it. It’s just been a huge thing for them.”

Specialized medical services have dwindled as Fairfield Memorial has failed, even with the county giving it more than $1 million a year.

“Even in a subsidized situation, they (Fairfield Memorial) were still losing money,” said Taylor, the county administrator.

Increasingly, Fairfield County residents who need hospital care go elsewhere.

Four to five years ago, at least 70 percent of Fairfield patients transported by the county’s emergency medical service went to Fairfield Memorial, said EMS director Mike Tanner. Only about 20 percent do now, he said.

In December, Providence Health is expected to open its 18,000-square-foot emergency room in Fairfield. The county will help subsidize that operation, paying $1 million a year for a 10-year period, Taylor said.

The hope is that some of the fewer than 100 employees now at Fairfield Memorial will be able to get jobs at the new emergency center.

But “the new facility will only employ around 45 to 50 (people),” Smith said. “There’s going to be a net loss.”

The county also is in the process of buying Fairfield Memorial’s adjoining buildings — a $1.6 million cost. Officials hope the hospital sells quickly, maybe becoming a nursing home or rehab-like facility.

But Adams with the state Office of Rural Health worries that stand-alone emergency departments will face the same problems as hospital emergency rooms — overrun by residents with nonemergency needs and nowhere else to go.

“A free-standing ED (department) holds promise,” he said. “But it’s not going to meet all the needs of a local hospital either.”

Bailey, the economist, also is skeptical.

“That’s not where you go for diabetes treatment or to get your blood pressure checked,” she said. “It’s not a community health center.”

Still, some say the loss of a local hospital doesn’t have to be life-altering.

“I grew up in Batesburg-Leesville, and we didn’t have a hospital,” said Watson, the Bamberg city administrator. “People get used to it being down the street, but for me it was always 30 minutes away.

“I would tell communities that, with the updates in telemedicine, they don’t have to be concerned.”

‘It’s been an institution’

The issuing of failing rural hospitals is not limited to South Carolina.

Nationwide, 87 rural hospitals have closed since 2010, according to the Sheps Center for Health Services Research at the University of North Carolina.

Independent emergency rooms are being used to fill some of the gaps. But gaps remain.

Bamberg, the state legislator, knows firsthand how important having fast access to life-saving services can be.

When the lawmaker’s cousin was in a car wreck in Bamberg County, he died before he could reach the closest hospital.

“If the weather’s bad and the helicopter can’t get you out, you have to hold on for 45 minutes in the back of the ambulance,” he said. “The paramedic might have to do CPR for 45 minutes to an hour before they get to an emergency facility.”

The lack of emergency facilities also can hurt an area’s ability to attract new business.

“What employer wants to come when they know if they have an accident, their employee dies?” Bamberg asked.

The closing of a local hospital also often marks the end of an era in a rural county.

While Fairfield is adding an emergency department and improving its transport service, County Councilman Smith said it is painful to watch Fairfield Memorial’s inevitable demise.

“It’s been an institution around the county that we’re now losing.”

Maayan Schechter: 803-771-8657, @MaayanSchechter; Bristow Marchant: 803-771-8405, @BristowatHome

Rural S.C. hospitals closing

Over the past six years, four S.C. hospitals in small, rural counties have closed their doors:

Bamberg County’s hospital in 2012, in a county of 14,381

Marlboro County’s hospital in 2015, in a county of 26,825

Barnwell County’s hospital in 2016, in a county of 21,345

Fairfield County’s hospital in 2018, in a county of 22,607

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