By Kristi L. Nelson
The Knoxville News-Sentinel
ONEIDA, Tenn. — Car after car slowed to a crawl late this week to see the hand-lettered banner that blocked the emergency- room entrance to Scott County’s only hospital.
“HOSPITAL-ER CLOSED,” read the block letters on the back side of a vinyl banner touting Mercy Health Partners, which last operated the 25-bed acute-care hospital in Oneida. A smaller sign directed visitors to a still-operational phone next to the outside door, with a direct line to 911.
The county-owned hospital closed at midnight Thursday, after county officials turned down a 60-day lease extension with Health Management Associates, the company that acquired Mercy last October and operates its Knoxville-area facilities under the name Tennova. Hospital employees joined hands in the parking lot for a prayer and vigil before leaving the brick building, built in 1955. On Thursday and Friday, the only movement at the hospital was that of wrapping up business. Some employees stayed behind in case former patients came by for medical records. A TeleServe station that lets doctors communicate with rural patients remotely was moved a few streets over to Ridgeview’s psychiatric outpatient facility. The hospital’s signs were shrouded in tarps.
People driving by “just want to see it for themselves,” said Jim Reed, director of Scott County Emergency Medical Services, which has its office and ambulance fleet behind the hospital. “It’s a big change” for the community. For his 34 full-time paramedics, the change will be minimal. Even when the hospital was open, more critical patients were taken to LaFollette Medical Center, Jamestown Regional Medical Center or one of the Knoxville hospitals. A patient having a heart attack might be stabilized at the Scott County Hospital but would have to be taken on to Knoxville — an extra 10 minutes by speeding ambulance, Reed said - because no closer hospital has a heart catheterization lab.
Now, those patients, and others, will be stabilized on the ambulance ride, Reed said. He has increased staff to compensate for even more out-of-county runs.
But, being in a remote area, “we’ve always been a very aggressive EMS, as far as our protocols” for treating patients on the ambulance, Reed said.
“We have learned over the years that helicopters don’t fly all the time. ... If we’d been lackluster in our training, I might be worried. But I feel very comfortable that our paramedics can handle” treating patients during the longer transport times.
Scott County, where the median household income is $28,728 and nearly a quarter of the population lives below the federal poverty level, has the highest unemployment rate in the state. The rate, at 17 percent, has risen over the past few years, and so have the number of people who lost their insurance and/ or their ability to pay for medical care, said Dr. Larry Wolfe, a primary-care physician at Mountain Peoples Health Council’s Huntsville clinic. The federal government has designated Scott County as having a shortage of primary-care providers.
That translated into more people using the hospital emergency department for primary care or “urgent” - but not emergent - care, said Wolfe. He expects them to be channeled back into the primary-care clinics in great numbers. Mountain Peoples operates five clinics in the area, with three physicians and four nurse practitioners among them. Wolfe, who’s practiced in Scott County for 20 years, already frequently sees patients who have chronic health problems with serious long-term effects: diabetes, hypertension, congestive heart failure. At least 70 percent either have no insurance or are on the rolls of TennCare, the state’s Medicaid program. An influx of more patients will strain the system further.
Moreover, the primary- care clinics “are not equipped” to treat patients who are “truly urgently ill,” Wolfe said. Yet Scott County has no urgent-care clinic; the two closest are in Somerset, Ky., a little more than an hour away, and in Oak Ridge, about an hour and 25 minutes from Oneida. Round-trip cost for gas would be about $60 — beyond the reach of some residents.
It would be a hardship for Natasha Phillips, who’s been on unpaid maternity leave, if she had a gallbladder attack like the one that landed her at Scott County Hospital a few years ago.
But what really worries her is the possibility of one of her three children - ages 6, 3 and 1 month, all born at Scott County Hospital - needing emergency care. When the oldest was 2, Phillips said, she was hit by a car and taken to Scott County’s emergency room. She’s fine now.
“But if the hospital hadn’t been here, I don’t know what would have happened,” Phillips said. “It can happen in two seconds. I can’t imagine traveling an hour away.”
Phillips, who returns to work June 1, also worries about her clients at the residential/day center program for handicapped people, where she works. Many are older or have multiple medical problems. “They’re so apt to have things happen,” such as accidents, falls or aspirating food or liquid, she said. “Anything could happen. ... I can’t imagine how this is going to affect their lives.”
Joann Crowley has been through that several times with her 33-year-old son, who has Down syndrome and cerebral palsy and has aspirated liquid into his lungs more than once.
“He coded on me twice,” Crowley said. “If it hadn’t been for Scott County Hospital, he’d have died.”
Crowley herself was hospitalized there for a week last year with pneumonia.
“I don’t know what people are going to do” without the hospital, she said.
Like many Scott County residents, she blames the county, which has been seeking a company to run the hospital since the 2010 agreement to terminate the lease with Mercy.
“The county cannot run the county and the hospital,” Crowley said.
“The commissioners want to run it, and that’s not their business,” Wolfe said, adding that the county should sell the hospital to a company that operates hospitals and “leave them alone and let them run it like a hospital should be run.”
After failing to find a partner to operate the hospital, city and county officials said earlier this month that the only way to keep the hospital open was to increase the county’s property tax by 37 cents, or 16.7 percent.
But residents cried foul.
“They raised our land taxes already and said that was for the hospital,” said lifelong Scott County resident Betty Lou Slaven. Slaven remembers taking her granddaughter Baileigh, now 11, to the hospital when she was 3, after she badly burned her arm pulling a bowl of macaroni and cheese out of a microwave oven. Her younger granddaughter, Shelby, was just treated there for a badly abscessed tooth.
“It’s bad when a hospital shuts down,” Slaven said.
Besides 24-hour acute emergency care and some surgeries, the hospital, which employed some 240 people, had an intensive care unit, an obstetrics unit and a cardiology practice. It provided some diagnostic imaging, women’s health and rehabilitation services. It also handled a number of workers’ compensation injuries in a region where many of the jobs were in manufacturing. An adjacent professional building housed surgeons’ offices; those moved last month to LaFollette Medical Center.
Dr. Tom Kim called on local physicians to take action to help fill the gaps in care the hospital’s closing will leave. Kim, who operates the Free Medical Clinic of America in South Knoxville that provides free care for the “working poor,” opened a clinic in Oneida in August. He currently practices there Wednesdays but says he may increase hours if necessary and needs other physicians to volunteer to go to the clinic as well.
This past Wednesday “was so sad,” Kim said. “Everyone was crying,” both patients and his staff.
“We bailed out General Motors,” he said. “Is automobiles more important than human health? ... Now we have an opportunity to help your neighbors. Get your butt over there and help those people.”
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