Taylor Mitchell, A&E Editor
On June 30, 2018, RMC Jacksonville closed down for good. Initially this was expected to have a large effect on the city, but the truth appears to be both much more counter-intuitive and positive.
The hospital was closed with Billy Grizzard, chair of the Healthcare Authority of the City of Anniston, citing that it was underutilized and high cost in a press release that announced the closure. Grizzard said, with this in mind, it was simply not responsible to keep the facility open due to high costs and it being underutilized. Immediately after the closure of the hospital, there were several concerns about response times and the ability of the city of Jacksonville to handle emergency situations without a hospital. Mayor Johnny Smith even stated that the city would look into its ability to deal with those kinds of situations.
Despite this, Jacksonville Fire Marshal Lee Batey states that there was not an impact on the fire department’s emergency services. Marshal Batey explains that the only thing to significantly change was turnaround time. The ambulance ride will be longer, and therefore more costly, but the ambulance service does not change.
The city of Jacksonville currently has one ambulance that services both Jacksonville and Piedmont, with backup provided by three ambulances operated by the Piedmont Rescue Squad. Since both the Jacksonville Fire Department and PRS cover the same area, they are able to help deal with the increased turnaround time by supporting each other. The JFD is capable of transporting patients to hospitals in Anniston and Gadsden, which Batey remarks are trauma centers of a comparable level to RMC Jacksonville. If the increased turnaround does lead to someone not being able to get in an ambulance in a short amount of time, Batey says that the JFD can still provide life-saving care.
“Our fire trucks are ASL engines and ladder trucks,” Batey explains. This means that the fire and ladder trucks are equipped with advanced life support equipment in much the same way an ambulance can. The only issue is that they are unable to transport patients in the trucks. According to Batey, this allows for JFD to provide the care people need even in situations that are not ideal and therefore mitigate those situations.
Community opinions remain mixed on the closing, but John Allen, a 74-year-old resident of Jacksonville, says the impact on the elderly community may not be as extreme as some believe. Allen explains that his wife Ginny, who died in 2016, required specialist care that RMC Jacksonville simply did not have the staff to accommodate. This lack of specialists leads to the main benefit of having the hospital being the emergency room. Yet the fact that the specialists usually required by elderly patients are not present means they likely already had a doctor at another facility.
This is backed up by some research studies that show that far less significant issues arise in areas where an alternative hospital is present. It is likely that with experiences like Allen’s, many people were in a position to handle the change in care. The lack of access to emergency care is a significant factor, but the overall health situation in Jacksonville has not been horribly impacted by RMC Jacksonville’s closing. The hospital was cited as being underutilized, but with high cost making it hard to justify its continued operations. As it happens, at the same time JSU had needed space to house its nursing program which had recently been displaced due to damage from the tornado that hit the campus on March 19th. The deal, while useful for the university, affects the community in many ways and speaks to a larger trend country wide.
The closure of rural hospitals has become somewhat of an epidemic, especially in the southern United States. Of the 83 hospitals that have closed between January 2010 and January 2018, 56 were in southern states, with the worst hit being Texas and Tennessee.
The reasons for this vary and mainly break down to economic, demographic or social issues putting pressure on hospitals. Things like changes in Medicare and Medicaid, high poverty rates, or even just having other hospitals close by, can negatively affect a hospital and lead to closure. The economic issues themselves are likely the most harmful with changes to public health programs heavily affecting payment for medical services.
To compound on this, many privately insured patients tend to go to different hospitals that may be nicer or have different specialists. This simply causes a classic money problem that is hard for some hospitals to deal with, and leads to closures.
Studies show that the effects can include things from limiting access to care for high-risk populations such as the elderly and those with low incomes. Dr. Fawad Shah of JSU, an expert in medical communication who has done several studies on access to care, explains this can have an even greater effect in rural places like Jacksonville.
“In areas like Jacksonville, you don’t have taxis, you don’t have public transportation,” he remarks on the town. Dr. Shah explains that this affects people on Medicaid or Medicare the most as they simply lack the funds to pay for care. Another issue especially affecting the elderly is the possibility of not being able to drive. He gives the example that with a hospital only five minutes away, a person will likely be able to get a ride with little issue, maybe from a neighbor or family member, but with the nearest hospital being six times further away, that becomes much harder.
In other situations, hospitals have been known to convert to a specialized facility instead of closing. This was done with RMC Jacksonville before it closed with it primarily dealing with drug detoxification and psychiatric care for the elderly. Dr. Shah believes this is to be the better option when considering what to do with a hospital.
“At least someone is benefiting,” Shah says on the situation. In many cases, this is the thought process that leads to the choice to specialize, the simple fact that there is still some money to be made and good to be done. In many cases, this also allows for the continuation of emergency care which can be vital to communities. The issue being is this specialization seems to have been unable to help the RMC Jacksonville likely due to it then being unable to help most patients.