On July 14, a middle-aged mayor left his tiny town of Belhaven, North Carolina (population 1,780), and set off on an ambitious two-week trek. He was armed with little more than a broad-brimmed hat, sunglasses and a walking stick in hand. His shirt was emblazoned with "Save Our Hospital," and that slogan explains why this is no casual stroll northward.
Adam O'Neal, 45, a lifelong resident of Belhaven, is on a crusade to save his town's only hospital, where he was born—but which opened decades before his birth. On July 28, he aims to finish his 273-mile walk to Washington, D.C., where he hopes to get federal lawmakers and Justice Department officials to help reopen the facility on the Pungo River waterfront that was shuttered July 1.
"We've walked over 80 [miles], and we're north of Murfreesboro, North Carolina, headed toward Yale, Virginia,” O'Neal told Healthcare Dive on the morning of July 18. He said he felt fortunate that he hadn't gotten blisters yet, jokingly referring to himself as a "finely tuned athlete." But, he added, "My mother's even got blisters driving the car."
'A healthcare desert'
The story of Pungo Hospital's closing in Belhaven, Beaufort County, is long, complicated, controversial and, ultimately, highly emotional. It's a story that illustrates the struggles of rural healthcare delivery across the U.S., and what a critical access hospital (CAH) means to its community.
According to O'Neal, the hospital's recent shutdown means that some Belhaven residents now must travel up to 84 miles to get emergency care. He said others are perhaps in more dire straits: Not only is there no hospital in neighboring Hyde County, but there isn't even a doctor.
"I have personally taken my youngest son to the [Pungo Hospital] emergency room not breathing, and I am horrified to think I might have had to take him another half hour [to a farther-off hospital while he was] struggling to breathe," O'Neal said. "He was OK once the ER doctor got a-hold of him."
Belhaven's hospital was serving about 20,000 people in an area of high poverty where many lack health insurance—in a state where the GOP-controlled state legislature and Republican Gov. Pat McCrory declined to expand Medicaid under the Affordable Care Act.
The mayor himself is a Republican, but he is upset that North Carolina won't expand Medicaid at a time when more rural hospitals have been forced to close in the past year than in the previous 15 years. "I think that's totally wrong," he said. The ACA "is the law of the land now," he said. "I'm not a big fan of it...but Medicaid expansion is part of it"—and needed to offset rising indigent care.
Entering the Great State of Virginia!!! pic.twitter.com/wlxt10IIRq— Adam O'Neal (@MayorONeal) July 18, 2014
A shift to outpatient care
Pungo District Hospital opened in Belhaven in 1947. The 49-bed hospital became a Medicare-designated CAH in a town with three physicians, a dentist and three pharmacies: where the median average household income is less than $17,000, and more than one-third of residents are officially living below the federal poverty level. It also was the town's largest employer with 129 employees.
Times got tougher, and O'Neal said Vidant Health, a network of hospitals along North Carolina's eastern shore, bought Pungo hospital in 2011 with the promise of strengthening and maintaining it. He said he first learned of Vidant's plans to close the hospital instead from a TV station seeking comment.
Vidant did not return requests for comment. In recent months, the company has tried to explain what it described as the economic realities forcing the hospital's shutdown and a shift to outpatient care.
O'Neal disputes that. Despite a federally-mediated agreement April 1 that kept the hospital open another 90 days, Vidant didn't cooperate during the three months in transferring hospital ownership to the town, he said. For example, he said, under the agreement Vidant was supposed to transfer all tangible hospital assets to the town; but Vidant insisted that cash-on-hand, accounts receivable, and an electronic health records software set-up funded with a $1.2-million federal grant weren't included.
O'Neal asserted that Vidant's aim all along was to shut Belhaven's CAH, forcing people to go to Vidant Beaufort Hospital 30 miles away.
Part II now live. We look into Pungo hospital's town-sponsored business plan to become profitable, and why Vidant chose to close a CAH that wasn't their worst-performing hospital.
Want to read more? You might enjoy this story about the cheap and efficient delivery of rural healthcare at a CAH in the mountains of Tennessee.