For the better part of a century, Glenn Medical center dealt with all kinds of injuries, ailments and emergencies in the far northern reaches of California\u2019s Sacramento valley \u2013 heart attacks, car collisions and even plane crashes.<\/p>\n
The only hospital in this agricultural county, not far from the rice fields and almond orchards, many of the area\u2019s 28,000 residents have a story about how the hospital saved them, or a loved one, said Lauren Still, the medical center\u2019s chief administrative officer.<\/p>\n
But at 7pm on 30 September the hospital closed after 75 years.<\/p>\n
Glenn Medical center could not keep its doors open after the federal government moved this year to eliminate its critical access designation, a special status for hospitals that helps ensure access to emergency health care in rural communities, officials said.<\/p>\n
The Centers for Medicare & Medicaid Services (CMS) determined that the hospital no longer met the distance requirement for the designation \u2013 critical access facilities must be more than 35 miles from the nearest hospital.<\/p>\n
The decision means that tens of thousands of people will have to travel more than 30 miles for emergency medical care, driving on sometimes winding country roads, behind the tractors and heavy equipment used in area agriculture or, if they\u2019re lucky, in one of the county\u2019s two ambulances.<\/p>\n
\u201cIt\u2019s a tragedy that you\u2019re gonna leave 30,000 people without readily access to an emergency room,\u201d said Rick Thomas, the vice-mayor of Willows, the Glenn county city where the hospital is located.<\/p>\n
Rural hospitals across the US are under threat. Nearly 200 rural hospitals have closed since 2005,<\/a> and one-third, more than 700 hospitals, are at risk<\/a> of shutting their doors. Such hospitals serve smaller populations, meaning there are fewer dollars coming in, and often lose money providing patient services because of the greater costs associated with providing care in rural communities and insurance reimbursement rates that do not cover costs, according to the Center for Healthcare Quality and Payment Reform.<\/a><\/p>\n An almond orchard in Glenn county in 2008. Photograph: Kathy Coatney\/Design Pics\/Getty Images\/Design Pics RF<\/p>\n Meanwhile, experts warn the budget signed by Donald Trump, with its massive cuts to Medicare and Medicaid, over the summer will have devastating effects on rural hospitals, which rely more on federal funding from the US\u2019s largest public health insurance programs.<\/p>\n Glenn county is now trying to fill the gap with expanded fire department services, and studying how it can improve emergency services delivery while the community grapples with a difficult new reality.<\/p>\n The Centers for Medicare & Medicaid Services did not respond to a request for comment.<\/p>\n Located more than an hour from the state capitol in Sacramento, Glenn Medical center opened in 1950 in Willows, a city that Thomas, who previously served on the hospital board, described as a classic American small town in a heavily agricultural region.<\/p>\n \u201cWe\u2019re the folks that grow and produce the food that everybody eats,\u201d said Still, the hospital administrator. \u201cBeing right on I-5, we get a lot of travelers that come through. And despite not having an active labor and delivery unit, we\u2019ve had two or three [births] here in the last year.\u201d<\/p>\n The center used to be far larger, with a full geriatric wing, an obstetrics and gynecology department and a psychiatric hospital. Over the years, with changes in funding models, it gradually shrank and nearly closed more than once. But in 2001 it received the critical access designation from CMS, granting Glenn Medical center greater reimbursements from Medicare and allowances for certain staffing requirements.<\/p>\n That enabled the hospital to remain open. While the facility had its challenges, owing to the age of the infrastructure and difficulty bringing staff to the area, it served some 8,000 people a year with about 225 staff, Still said.<\/p>\n Capped at 25 beds as a critical access hospital, its capabilities were limited compared with more advanced facilities in Sacramento or Chico, but it was a lifeline for patients, the majority of whom are on Medicare or Medicaid, said Still and local officials.<\/p>\n \u201cI\u2019ve always said if you\u2019re bleeding, broken and stroking, you need that hospital there to take care of you,\u201d Thomas said.<\/p>\n Many of the center\u2019s patient population doesn\u2019t have gas money or transportation to get to larger hospitals, Still said.<\/p>\n \u201cWe\u2019re the front door to our entire healthcare system,\u201d Still said. \u201cIf you show up on our front door and you\u2019re having a real serious situation, we can ship you out to UC Davis in 30 minutes. You can\u2019t drive that.<\/p>\n \u201cWe take pride in the folks that we keep alive and we bring back from the dead, and it happens more often than you\u2019d like to believe,\u201d she added, pointing to a man who recently came into the ER with a core body temperature of 89F. \u201cWe brought him back. He wouldn\u2019t have survived the ambulance ride.\u201d<\/p>\n The hospital sees a large portion of patients with chronic illness, including diabetes, COPD, asthma, as well as cancer \u2013 Glenn county has some of the highest lung and colorectal cancer rates in the state. Funding was always a challenge, which was why the critical access status, and the regulatory relief it provided, was so crucial, Still said.<\/p>\n Earlier this year, Still learned CMS was pulling the hospital\u2019s critical access certification because the federal agency had erroneously determined that Glenn county was no longer rural, she said. Still believed it was a mistake that the agency would correct. But CMS then told the hospital it had found that Glenn Medical center was ineligible for the designation because it was too close to the nearest hospital, according to Still.<\/p>\n Doug LaMalfa, the area\u2019s congressman, said in a statement that CMS began calculating the distance between hospitals with a different route that uses a \u201crural cut-through\u201d, decreasing the distance between Glenn Medical center and the nearest hospital from 35.7 miles to 32.5, putting the facility out of compliance.<\/p>\n Hospital and county officials argued that ambulances and residents typically take a different route, that spans more than 35 miles, to avoid the winter flooding that is common in this area, to no avail.<\/p>\n \u201cI am deeply frustrated about this decision, as the hospital has maintained its CAH status since 2001, and no new roads have been built, nor have the hospitals picked up and moved three miles closer during this time frame,\u201d LaMalfa said in his statement.<\/p>\n CMS moved to revoke the critical access status in April. Hospital leadership and local officials advocated for months to preserve the certification, including a trip to Washington, and residents sent nearly 2,000 letters. But CMS said it had determined that the hospital never should have received the designation in the first place. The agency denied requests for reconsideration late this summer, LaMalfa said in his statement, meaning Glenn Medical center would lose reimbursement rates associated with the status in spring 2026.<\/p>\n \u201cWe\u2019re hung out on a technicality,\u201d Thomas said.<\/p>\n Still said she pointed out to CMS that some 500 critical access hospitals across the US don\u2019t meet the distance requirement, and that the agency suggested it planned to decertify all of them. Such a move would have enormous ripple effects, said Lisa Pruitt, a professor and rural law expert at the UC Davis School of Law.<\/p>\n \u201cThe funding for lots of hospitals is pretty fragile, but with rural hospitals, it\u2019s kind of like a house of cards in that all these different funding streams that are not local,\u201d Pruitt said. \u201cIf you\u2019ve already got a fragile house of cards, then you take away one of the cards, it means that the facility is lost.\u201d<\/p>\n LaMalfa said that he had urged CMS and its administrator, Dr Mehmet Oz, to reconsider without success.<\/p>\n Glenn county in 2011. Photograph: Barbara Rich\/Getty Images<\/p>\n \u201cThis is not how government is supposed to operate \u2013 it\u2019s unfair and just plain wrong,\u201d LaMalfa said. \u201cI refuse to believe CMS\u2019s hands are tied, and I will do everything in my power to fix this situation for Glenn county.\u201d<\/p>\n