Above: Shan Wilson was scheduled for prostate surgery at the Rockdale Hospital when the facility abruptly closed.
Shan Wilson’s surgery will have to wait.
The 64-year-old retired Marine was scheduled to have his prostate removed in early January at the only hospital in Rockdale, a town of 5,600 between Round Rock and College Station. Wilson had it all planned out: He’d drive his motorized wheelchair the four blocks from his home in west Rockdale to the hospital for the operation that day. Then, he’d take it easy at home for a week or so, finally putting an end to months of painful, recurring urinary tract infections. The surgery had been scheduled for months.
Then, last week, Wilson was hit with a bombshell: Rockdale Hospital abruptly shut down, taking with it his primary care physician, urologist and surgeon. Wilson said he was shocked by the closure, partly because he received no notice from the hospital. Instead, Wilson said, he heard about the situation by “word of mouth” at the Rockdale Senior Center, where he eats lunch most days, plays bingo and does crafts.
“I thought, ‘Who’s running the Mickey Mouse railroad?’” Wilson said over a plate of barbeque on Friday. “You can’t even tell the patients the hospital is closing? People depend on the hospital. How can you do this to people?” Wilson would later discover that Little River Healthcare, the hospital’s parent company, also closed three satellite clinics in the county and another hospital in Cameron, the county seat 18 miles away. The closures leave a gaping hole in health care access for Milam County residents; the five facilities together averaged about 3,000 visits a month, providing a wide range of services, said John Weed, the hospital’s former medical director. “We’ve had health care jerked out from underneath us,” he said.
The mood inside the senior center was tense last Friday. Most everybody complained about how the closures were sprung on them; many fretted over whether they could find a new doctor in Round Rock, Temple or College Station. And even if the Rockdale seniors can secure a new, out-of-town physician, how will they get to the doctor’s office? Virtually none of them drive; the only public transportation costs $5.50 per 50-mile trip. It’s an expense that can add up quickly for people on a fixed income who need to visit the hospital multiple times a week. The distance could also be a death sentence for someone in the midst of a medical crisis — the county’s sole emergency room was housed at Rockdale Hospital.
Rosa Braun, 64, credits the Rockdale hospital with saving her life when she had a stroke in 2016. Braun was working as a home health nurse in Rockdale when she lost all feeling on the left side of her body. Because she doesn’t have health insurance, she called her son to drive her to the hospital. Hospital staff successfully triaged her until Braun could be transferred to Baylor Scott & White in Temple, where she recovered. “If we hadn’t had a hospital, I would have died,” she said. “Now that this hospital has closed, we have no doctors, we have nothing. It’s not right. It’s not fair.” Braun is still a stroke risk; she has two untreated aneurysms in her right leg. “If they bust, I’ll be gone,” she said.
Bobbie Hairston, 81, said she’s managed to find a doctor in Round Rock, but hasn’t yet worked out the logistics of how to get to the appointments 50 miles away. “I guess I could hitchhike. Or I could find me a donkey and a sled,” Hairston said. “At 81 years old, it’d be pretty hard to walk to Round Rock, now wouldn’t it?” At a nearby plastic folding table in the senior center, a woman in a wheelchair sobbed about losing her doctor; a staff member wheeled her outside to calm down.
Though the shuttering of the Milam County facilities came as a surprise to many community members, the Rockdale-based Little River Healthcare had been in financial trouble since this summer. The 600-employee company operated medical facilities in Georgetown, Round Rock, Waco and Temple, in addition to its Rockdale and Cameron locations. In July, it filed for Chapter 11 bankruptcy, citing debts of more than $50 million. In late November, it sought to liquidate its holdings, which include the Milam County facilities as well as a network of other health care facilities across Central Texas. Little River didn’t return repeated Observer inquiries for this story. A representative at one of the company’s facilities hung up when I asked for an interview on Tuesday.
Modern Healthcare, a trade publication, haslinked the Little River closures to the company’s practice of overcharging insurers for lab tests to bolster its bottom line. Insurers, claiming that they were fleeced by the hospital group, are trying to recoup the money they overpaid, piling on debt to the company. The publication also found spikes in lab charges at Stamford Memorial Hospital, 40 miles north of Abilene, which closed in July and reopened as an outpatient clinic. The loss of the facility cost the region an emergency room and 54 jobs.
Rockdale, Cameron and Stamford are just the latest victims in a recent string of rural hospital closures in Texas — casualties of low patient volumes, stingy Medicaid and Medicare reimbursement rates, and the burden of operating in Texas, which has more uninsured people than any other state. Others have been forced to cut crucial services — Lamesa’s hospital, for instance, recently opted to stop delivering babies. Approximately 20 rural hospitals in Texas have been shuttered since 2013. Seventy-five more are at risk of closing down.
The burden of caring for the state’s uninsured rural population could be eased if Texas chose to expand Medicaid under the Affordable Care Act, a choice rejected by governors Rick Perry and Greg Abbott. In lieu of expanding Medicaid, some rural hospitals have raised funds through bond elections and levied property taxes to stay in the black: In Clifton, for example, voters narrowly passed a measure in November to create a hospital district that will eventually assess a tax. Rockdale’s hospital district stopped levying a tax years ago.
Many rural Texans — and the officials they elect — are philosophically opposed to the idea of government funding for health care. That’s certainly true in Milam County. County Judge Dave Barkemeyer, who describes himself as a conservative Republican, said he thinks the free market should solely determine the placement of hospitals. If the market in Rockdale isn’t large enough to support a hospital, so be it: “The hospitals can operate in larger, populated areas, and the people in rural areas have to go to the larger, populated areas where they are,” he said. But what about people who lack the means to travel to Round Rock or Temple, like the folks at the senior center? “Then they’ll have to go to a rest home in a larger area,” Barkemeyer said. “Sorry, but I’m a conservative guy who understands economics.”
The free market has been rough on Milam County in recent years. In 2016, aluminum smelter Alcoa put its 32,000 acres up for sale and retired its state coal mining permit amid a downturn in the coal industry. Last year, Luminant announced the closure of its coal-fired power plant in Milam County — the 325 lost jobs represented nearly one-tenth of all private-sector jobs in the county. With the hospital’s shuttering, the county has hemorrhaged roughly 200 good-paying jobs, said Weed, the former hospital medical director who also chairs the local economic development group. He doesn’t buy the argument that rural health care is best left to the whims of private industry.
“It’s not working for anybody, quite frankly,” he said. “Everybody worries about socialized medicine, but capitalized medicine is controlling us more than anything.” Weed said he anticipates universal health care in the United States in the next 10 years. Until then, though, he’s working to resurrect at least some of the services that have been lost in Milam County. A hospital group is “very interested” in reopening the downtown satellite clinic, Weed said; he expects to broker a deal in the next two months. He predicts some services, such as lab testing and outpatient services, may return to the hospital in 2019 once bankruptcy proceedings have concluded.
A lot of people in Milam County are counting on Weed to bring back some modicum of their health care services. That includes Weed’s 9-year-old grandson, who, after being picked up from church one day last week, asked about the situation.