Topekans — and especially St. Francis Health Center employees — worried and stressed for months during 2017 awaiting the fate of Topeka’s second-largest hospital.
Along with a community-wide sigh of relief when the hospital was turned over to a partnership between the University of Kansas Health System and Nashville, Tenn.-based Ardent Health came a realization of how tenuous the capital city’s health care infrastructure might be.
Randy Peterson, president and CEO of Stormont Vail Health, said the loss of a hospital wouldn’t have devastated the city, but it certainly would have been damaged for a time as Stormont worked to fill the holes. It was a scenario that had been part of Stormont’s planning for a few years.
“Quite frankly, from a strategic standpoint, we have been thinking about that for the past three, four or five years — what if,” Peterson said. “Scenario-based planning and what would be needed if they closed and how could we try to meet those needs, because we’re only here for one reason and that’s to take care of the needs of this community.”
Stormont had determined, based on the population Topeka serves, it would have been 100 beds short, he said.
“We would definitely have needed more ED (emergency department) capacity,” Peterson said.
Rep. Jim Kelly, a Republican from Independence, Kan., knows what happens in a community that loses a hospital. Mercy Hospital in Independence closed in 2015, shutting doors on the community’s only emergency department and many physician services and costing 200 employees their jobs.
The hospital’s closure, Kelly said, was unlike the closure of manufacturer Southwire Co., which closed down its Coffeyville facility and also put 200 people out of work.
“There was a ripple that developed around the plant and into Coffeyville,” he said. “They had people from both towns. It had a limited impact on the schools, and it had limited impact on the retailers or other industries.
“The ripple didn’t go out as a gigantic one. When the hospital closed, in my mind the ripple was very, very large because it touched the school. They relied on that for health care for their families. It affected other industries, because that’s where their employees got their health care and where their hospital care would be. There were several smaller counties — Elk and Chautauqua, they have very limited health care. They relied on the hospital and the physicians in Independence for their health care.
“All of the residents who would not have been impacted by an industry closing were impacted by a health care system that employed about the same number of people.”
The loss of an emergency department had a real impact, and also dealt a psychological blow. As someone who had served on the hospital board for more than 25 years, Kelly said, he was familiar with statistics showing how often people use the emergency department when they don’t need to and when an urgent care provider would be more appropriate.
Employers, too, worried about where their employees would get health care and how far they would have to travel.
Still, despite the loss of a business that was integral to residents’ feelings of stability and safety, the community two years later has rebounded in some ways, Kelly said.
Other clinics have been established, including ones founded by St. John Health System, of Bartlesville, Okla., Wilson Medical Center, of Neodesha, and Labette Health, of Parsons.
Specialists come in for day clinics from Joplin, Mo., Parsons and other areas.
The city has made adjustments. For two years before the emergency department opened — and even since then because the service can’t handle all emergencies — the ambulance service had to travel 30 to 40 minutes to take people to a Bartlesville hospital. That meant adding more paramedics and buying two ambulances.
While not necessarily a new problem — Mercy Hospital didn’t have a cardiologist on staff — emergency medical response staff needed to be more prepared to be on the road.
Continuity of care is a problem. Because so many different clinics are providing services and their electronic medical records aren’t connected, Independence residents can end up part of multiple systems, Kelly said. Some people have learned to ask for copies of their medical records.
”It’s put more on the individual,” he said. “In some instances, it won’t make any difference, and in some instances, it could make a difference.”
It has been a long road to feeling the community’s health care is once again stable.
“If St. Francis would have closed, it would have been a big impact, but it doesn’t leave Topeka without health care,” Kelly said. “You’ve still got Stormont Vail, all those clinics and everything else around. It would be bad, but it’s not like in a small town where the hospital goes and a lot of doctors go with it.
“Recruiting is still an issue that will stay to some degree, because a lot of doctors want to be where there’s a hospital that they can send their patient to or have them close at all.”
It’s been baby steps, and a big one came when an emergency department opened in July in Independence.
“We have to be thankful for Labette coming in and having the courage and the vision to put in an ER and a clinic,” Kelly said. “And they have plans already laid out on what they think their next steps would be to add care, and they have the land to do it. Nothing will be quick, but I think at least it’s headed the right direction.”
Cindy Samuelson, vice president of public relations and political fundraising for the Kansas Hospital Association, said 112 of Kansas’ 127 hospitals are classified as rural. Of those, 82 have a negative operating margin.
That doesn’t mean they are on the edge of closing their doors, Samuelson said. There can be many reasons an organization’s costs exceed revenue, and the data is a little out of date and from a single point in time. Some Kansas hospitals, such as those in oil-rich counties, have significant reserves to support their health care facilities.
Still, it is concerning.
The loss of dollars the state’s hospitals have experienced because of the lack of Medicaid expansion has been well documented. Samuelson said the industry still is hopeful going into the next session that legislation may pass.