Pickens County in critical condition two years after ER closed


By WVUA 23 Digital Reporter Kyle Hamrick

A mosaic placed before Pickens County Medical Center’s entrance declares the hospital’s motto: “People caring for people.”

The signs on the glass doors above, however, convey a less hopeful message: “Hospital closed.”

The Pickens County Medical Center, known in short as PCMC, closed its doors in March 2020 and left an entire county without emergency medical care.

A release issued March 2 of that year on Facebook by the Pickens County Healthcare Authority stated “the hospital’s financial condition has become unsustainable” and “closure can no longer be avoided.”

Along with a dwindling patient base, the 56-bed hospital closed because of “reduced federal funding, lower reimbursements from private payors, and high percentages of uninsured patients.”

“Health care is supposed to be a noble cause,” said David Handley, a pharmacist at Carrollton Drugs. “But the bottom line is money and financials drove that hospital out.”

Vicky McCrory, who has managed the Pickens County Ambulance Service for 12 years, said her paramedics treat cardiac arrests differently now that there is no hospital nearby.

Where once they transported those patients to PCMC for stabilization and further care, McCrory said, “now, unfortunately, we work cardiac arrests in the field for 30 minutes and go through all our protocols. If there’s no change, we call it a ‘death in the field.’ ”

Patients are not transported in such cases because paramedics cannot get them to a hospital in time for life-saving care.

Though he does not keep statistics, Pickens County Coroner Chad Harless said it does seem like he’s been getting more “deaths in the field” than residents going to the ER.

“The survivability rate is really decreased,” he said.

Pickens County is considered a medically underserved area, according to data from the Health Resources and Services Administration, a federal agency devoted to expanding and improving healthcare for individuals who are “geographically isolated, economically or medically vulnerable,”

On a scale of zero to 100, with zero indicating utter under-service and 100 indicating the least under-service, Pickens County scored 58.7, according to the same dataset.

With the nearest hospitals more than 30 miles away in Tuscaloosa and Columbus, Mississippi, residents said they’re worried about their health and that of their families and friends.

More than two years later, Pickens County residents said they want emergency care back in their county.

Bobby Boothe’s father died of complications from aortic stenosis in 1967. He was 61 years old.

Boothe, now 69, was in his 40s when his doctor diagnosed him with the hereditary heart disease. In 1999, Boothe received a mechanical heart valve along with instructions for the rest of his life.

“I still have to go every six months to have everything checked out,” Boothe said, for stress tests and echocardiograms.

He takes Coumadin, a prescription blood thinner, to maintain his health.

This regimen is complicated by transient ischemic attacks, also called TIAs. These brief episodes resemble strokes and often go away as quickly as they appear.

“You can feel your body changing,” Boothe said. “But there’s not really anything you can do about it.”

He never knows when a TIA will come, and cannot recall how many he’s endured.

But, as his wife Joan said, “We can’t even count the number of times that he’s had to use the ER.”

Though the TIAs only resemble strokes, Boothe’s preexisting conditions and medications require him to receive medical attention as soon as possible.

“You never know when it could be ‘The Big One,’ ” Joan said.

For years, PCMC was Boothe’s first point of care. Emergency room doctors there treated him in-house or stabilized him for transport to DCH Regional Medical Center in Tuscaloosa.

“When we went (to PCMC),” he said, “it was immediate care, and then the decision was made as to which direction that care needed to go.”

Six months after the hospital closed, Boothe needed it to be open.

He began passing blood Labor Day weekend, but did not seek medical attention until the Tuesday after the holiday.

He became the pastor of Carrollton United Methodist Church in July, and “several of the members talked about how pale I was” after his sermon that Sunday, he said.

“If our hospital had been open we probably would’ve gone on Labor Day,” Joan said.

On Tuesday, his primary care doctor, not wanting to wait for lab work to confirm his assessment, advised him to go to the hospital.

The Boothes drove 33 miles to Northport Medical Center.

“We registered, and then, for the next seven plus hours we sat there,” he said.

By the time they called him back to the emergency room, Joan said, her husband “was so weak and had lost so much blood he could not even stand up.”

Nurses transported him through the ER in a wheelchair. He was in critical condition.

Boothe received five bags of blood during his 30-hour stay in the Northport emergency room. He and Joan agreed he received quality care – once they got in a room. They arrived Tuesday evening and left early Thursday morning.

If PCMC were open, Boothe said, “we would’ve gotten started a whole lot sooner. Wouldn’t have had to wait in Carrollton, and if I had been transported by ambulance, I would have gotten treatment faster.”

Joan said her husband “was a very sick man,” and a seven-hour wait “is a long time when you’re in critical condition.”  Even now, “his numbers [are not] what they need to be.”

Boothe does not know what could reopen the hospital, or at least reopen the emergency room, “but we need to try to do it.”

“It just seems such a shame for that facility to be sitting there and at least not have something going on,” he said.

McCrory, the manager of the Pickens County Ambulance Service, entered her profession over 30 years ago in response to a nationwide shortage of emergency medical service workers.

“I think it’s probably worse now than it was then,” she said.

Born and raised in Pickens County, McCrory relied on PCMC when it was open. Her two children and granddaughter were born there.

The hospital was also a critical stabilizing spot for patients attended by her paramedics who might not make it to a facility in Tuscaloosa or Columbus, Mississippi.

The combined effect of the hospital closing and the COVID-19 pandemic spread the non-profit’s two ambulances thin across Pickens County.

Total response times have increased, along with “deaths in the field” and times waiting to relieve patients to doctors in emergency rooms.

Pickens County Ambulance Service came under management by NorthStar EMS in 1993. Operations Director Edgar Calloway said paramedics now wait roughly six hours a day turning patients over to emergency room care, compared to three hours a day in 2019.

“It costs roughly $100 per hour to do what we do,” Calloway said, and that time waiting at emergency rooms costs the Pickens County Ambulance Service around $139,000 per year.

Since PCMC closed, Calloway said, Pickens County Ambulance Service has lost $700,000 in revenue.

“We lost about a third of our revenue with an unchanged fixed cost,” he said. “At some point, something’s gotta give.”

Mary Price has lived in Pickens County for all of her 84 years. She was born there, finished high school there, formed lightbulbs for Westinghouse there and started a family there.

The only time she ever went outside of the place she calls home to see a doctor was to give birth to her last child in Tuscaloosa in 1970. Since it opened in 1979, PCMC cared for her and her family when they needed it.

“We knew the people, we knew most of the doctors,” she said, “It was just a convenience, and sometimes a lifesaver.”

Price lives with atrial fibrillation (AFIB), a condition where her heart beats at an irregular rhythm and can cause strokes or heart attacks if left unattended.

The last time she felt her heart race, she could not drive to her go-to hospital of more than 40 years.

Instead, she drove to DCH Regional Medical Center in Tuscaloosa early one morning in January, more than 30 miles away from home, and arrived at the emergency room around 9.

She waited in the emergency room for eight hours before doctors sent her home.

“Sometimes I go into AFIB and by the time I get to Tuscaloosa, I’m OK,” she said. “But I’ve still got to sit in that emergency room and wait for hours.”

Her granddaughter, Anna Adams, worked in physical therapy for PCMC. Now a home health care worker, she said she worries for her grandmother and others who have to seek the care they need outside the county.

“It’s been hard on her because she has had to get someone to take her to Tuscaloosa for every health care need unless it can be treated at (University Medical Center). But they’re only open during business hours.”

The University Medical Center opened a clinic in a wing behind PCMC in August 2021 to offer primary care and some specialty services to Pickens County residents. But people needing emergency attention must still venture outside the county to receive care when minutes matter.

“Having a hospital here to stabilize them until they could get somewhere where there was a doctor available for them or treatment available, it could mean life or death,” Adams said.

At Baptist Memorial Hospital – Golden Triangle across state lines in Columbus, Mississippi, Megan Pratt said she can see the effect of PCMC’s closure.

The marketing director’s office is next to the hospital’s emergency room entrance.

“When I’m walking out, I can see the ambulances, and I am seeing more Pickens County ambulances here” than before, she said.

Hospital Administrator Paul Cade said the regional hospital’s emergency room saw an increase in patients from Pickens County, from 1,659 in 2020 to 1,911 in 2021.

Pratt lives in Carrollton a few miles away from PCMC.

“I had my appendix taken out there,” she said. “I was in a really bad situation. My surgeon told me I would have died if my appendix had ruptured. It was a really good little hospital, and they had some good folks working there.”

DCH Regional Medical Center in Tuscaloosa could not determine any change in the number of patients from Pickens County before and after PCMC closed from their records.

When she thinks about her parents living by themselves in Carrollton without a hospital to care for them when they need emergency care, Christy Payne wonders, “What if?”

“Thirty minutes” to the nearest hospital, she said, “is a substantial amount of time when you only have seconds.”

Payne grew up in Carrollton and moved to Mississippi when she graduated high school. She’s earned two bachelor’s degrees at Mississippi State University, one in forestry and another in accounting.

She married and started a family in Philadelphia, Mississippi, where she has lived and worked for the past 25 years.

“My family used (PCMC) on and off throughout the two decades or so I was there,” Payne said.

She recalled the time in 2005 when her father suffered a heart attack while working in town. He was 57 years old.

His coworkers drove him to PCMC, where doctors stabilized him before transporting him by ambulance to Tuscaloosa.

“My dad survived his heart attack,” she said. “Because he had life-saving emergency care five minutes from him, not 30 minutes from him. And if he had not had it we don’t know what else might have happened.”

Her parents still live in Carrollton. Both have chronic health conditions, and that makes her anxious.

“Nobody in their age bracket has a hospital to rely on in those emergency situations,” she said.

Back in July, her dad felt dizzy, and her mom drove him to DCH Regional Medical Center in Tuscaloosa because all of the local doctors had already closed their offices for the day.

“He didn’t know where he was, who my mom was,” Payne said. Doctors diagnosed him with dehydration and administered treatment.

Her father received the care he needed, but she cannot help but wonder, “What if it had been a stroke? There was nothing closer.”

When PCMC was open, her mother received treatment for anaphylaxis. Payne said her mother was lucky that PCMC was there.

“She might not have been as lucky if she had to ride 30 minutes for that,” Payne said.

Payne is grateful for the care her parents received at hospitals outside of Pickens County, but, “it’s just the fact that it’s so far, and the fact that you sometimes don’t have much time to get there.”

“You do what you have to do,” she said, “but we need it to be here in Pickens County.”

Glenn Davis and Travis Parker are Nationally Registered Paramedics who teach in the University of Alabama’s College of Community Health Sciences’ Emergency Medical Services Program. There is more than half a century’s worth of emergency care experience between the two of them.

Davis became the regional director for Alabama Emergency Medical Services Region Four (West) in 1993, and has held that office since.

He said a typical EMS call in a rural area should take about 16 minutes for paramedics to fulfill, from the point of dispatching an ambulance to taking the patient to “the appropriate hospital” for further treatment.

That’s what happened before PCMC closed, he said, noting that rural hospitals like it served 90% of all EMS calls.

With PCMC closed, however, patients are now transported to hospitals beyond their community, which lengthens and belabors paramedic response times and adds strain to patients and their support groups, Davis said.

Parker, who started his career with Tuscaloosa Fire Rescue and has 40 years of EMS experience, said ambulance runs for paramedics and patients in Pickens County now take about three hours to complete.

“You’ve got an hour transport time to the hospital, an hour wait (to relieve the patient to hospital personnel), and an hour back into Pickens County,” he said.

Both agreed the closure strains not only those who need emergency care but the emergency personnel attending to those people. They said expanding Medicaid and Medicare would allow more funds for hospitals and EMS services, along with a recent development called community paramedicine.

“Basically,” Davis said, “the paramedics would be doing the things that home health is not able to do now and fill in the gaps not being provided in rural areas.”

Those who meet Alabama’s new licensure and certification requirements – “a whole new curriculum that present paramedics would go through that would allow them to go into peoples’ homes” – would be able to assist individuals with chronic conditions manage their symptoms, Davis said.

This new program, which the legislature approved in a bill last year, “would reduce the number of calls on the EMS profession so that they would be available to respond to those true emergencies,” he said.

Solutions to the problem of emergency care in Pickens County vary. Some say expanding Medicaid and Medicare would help, while others propose subsidizing emergency services. All require local, state and federal governments to take action.

“EMS is like a third public service that has got to be supported by taxpayers,” Edgar Calloway said. “At some point, the state government and local county government are going to have to get involved and find tax-supported solutions to provide the level of service they deem necessary.”

Travis Parker said he believes expanding Medicare and Medicaid would allow more funds and reimbursements for rural hospitals and EMS services. David Handley agreed that Medicaid reimbursements could have helped keep the hospital open.

Paul Cade said Pickens County could turn the hospital into a critical access hospital, or open a free-standing emergency room like some communities in Tennessee have done. Either way, Pickens County would have to seek approval and help from the state legislature.

Speaking for Pickens County Ambulance Service, Vicky McCrory said, “It bothers me personally that someone has to wait for an ambulance an hour sometimes that’s really sick. We’ve had people pass away waiting for us to get there when we’re responding from Tuscaloosa or outside the county. It would be nice if we had a local hospital.”

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