The following excerpts have been taken from the article published in the Texas Observer Magazine by Christopher Collins and Sophie Novack. To read the full version of this article, please visit https://www.freestonemc.com/adyingtown/.
When a rural hospital dies, the community around it starts to follow suit. On the evening of December 28, 2014, Kourtney Bogan got an urgent call from her younger brother in Clarksville, a rural town of 3,200 bordering Oklahoma in far northeast Texas. Their mother, Gayla Bogan, who’d been fighting a respiratory infection over Christmas, was in bad shape. Kourtney jumped in her car and drove over. “When I got there, she was gasping for air, like she couldn’t breathe or something was blocking her airway,” Kourtney said. “I was panicking. She kept saying that she couldn’t breathe.”
Kourtney and her brother, Bristian, tried sitting Gayla upright in a chair, but it didn’t help. A minute later, she became “nonresponsive,” Kourtney said. She called 911. Within five minutes, an ambulance had arrived at the house, and workers loaded Gayla into the vehicle. They sped off to the nearest emergency room—a 30-minute drive to Paris Regional Medical Center in neighboring Lamar County.
Kourtney didn’t know it at the time, but Gayla, a 47-year-old who served as a church usher and worked as a nurse at a local nursing home, was having a heart attack. As the ambulance sped northwest on a thin strip of oak-lined highway, paramedics tried desperately to revive her.
The timing couldn’t have been worse.
If Gayla had gone into cardiac arrest just two weeks earlier, the travel time to the nearest hospital would have been only a few minutes. In this type of situation where transportation of patient needs to be done quicker then medical repatriation service always make sure to get the patient at its required hospital quicker. East Texas Medical Center had operated a rural hospital with an emergency room in Clarksville. But in December 2014, ETMC shuttered the Clarksville hospital along with two other facilities in surrounding Gilmer and Mount Vernon—casualties of low patient volumes, cuts to reimbursement rates from Medicaid and Medicare, and the cost of treating the uninsured. The closures rocked the small communities, upending what had been reliable sources of health care for decades.
More than 20 rural hospitals have closed in Texas since 2013, nearly double the number of closures of any other state, and about one-fifth of the total closures around the country in that time period. Many of the approximately 3 million Texans living outside the state’s major metros are left scrambling for care when emergencies crop up. Some of the approximately 160 rural Texas hospitals that have managed to keep their doors open have done so by cutting crucial services such as emergency care and maternity wards. According to health analytics group iVantage, 75 of Texas’ small-town hospitals are at risk of closure.
In East Texas, as the ambulance rushed from Clarksville to Paris, Kourtney tried to keep up, trailing the vehicle in her own car. When she arrived at the hospital, friends and other family members had already begun to crowd into a waiting area in the emergency room. Some were so worried about Gayla that they’d left work, still wearing uniforms from their jobs.
Then a few minutes later, around 10 p.m., a doctor told the crowd of 50 people packed into the waiting room that Gayla had died. She never made it to the hospital alive; her heart gave out in the ambulance, shortly before arriving in Paris.
“When the doctor came in and told us she didn’t make it, it was just a lot to take in,” Kourtney, now 29, recently told us. After the initial shock wore off, she began to wonder whether the outcome would have been different had the Clarksville hospital remained open. “I always feel like the ‘what ifs’ are in our head. Like, ‘What if we had a hospital where she could have gotten stable?’” Kourtney said. “We don’t know. But us not having a hospital close started what I feel like is a string of people not getting to the hospital fast enough.”
“You’re looking at extended transport times with a critical patient. It can be a bad outcome,” said Clifton Brown of LifeNet Emergency Medical Service, which provides ambulances in the region and transported Gayla. “If you got somebody in cardiac arrest with a 30-minute transport, that’s a long way and a long time. We’ve either got to resuscitate on the scene or they’re not getting resuscitated.”
When a hospital shuts down, everyone in the community loses—the insured and uninsured alike. The hospitals in Clarksville, Gilmer, and Mount Vernon, which closed simultaneously in December 2014, are now in various stages of disrepair. The Clarksville building is a mere skeleton; the steel support beams and concrete floors are all that remains of the three-story structure. It’s an apt symbol for the town of Clarksville, where factories and manufacturers have packed up and moved to other towns with better highway access. Even the Walmart on Highway 82 is vacant. Local public officials say it’s difficult to recruit businesses to set up shop in a town with no functional hospital. In Gilmer, an hour southeast of Clarksville, what was once a hospital is now an empty lot; the building has been ripped out, foundation and all. What was once a clinic sits vacant on the lot’s north side. Mount Vernon’s old hospital building still looks the part, save the vines creeping up the walls and underneath the window frames. Franklin County is trying to sell it as retail or office space.
When a hospital closes, doctors tend to leave too. Dr. Bacharanianda Muthappa says he was one of eight doctors in Clarksville when he arrived 40 years ago. Now, it’s basically just him. The doctor, who says he’s “over 70,” thinks often about retiring but worries about leaving people stranded. Besides Muthappa’s 8-to-5 practice, there’s a daytime urgent care clinic staffed by nurse practitioners. Another doctor in Clarksville practices only on Mondays and Tuesdays. No medical services are available on the weekends.
“Trying to recruit a physician to Red River County without a hospital is very difficult,” said Rob Riley, executive director of Clarksville Nursing Center, where Muthappa is the medical director and Kourtney now works as a nurse. “Three years or five years from now, if there’s not a hospital for physicians to anchor to or call home, will there be physician services in Red River County?”
Just before 7 a.m. on a rainy August morning, L.D. Williamson is on his second cup of coffee at the Clarksville McDonald’s. Tall, with a flash of white hair, Williamson outdresses anyone else there in a lavender button-down shirt and striped purple tie. The McDonald’s is an early morning gathering spot for farmers, county officials, and city workers; other than the Sonic and Dairy Queen, Clarksville has few eateries. This has become something of a ritual for the 82-year-old county judge: Every morning for the last five years, he’s come for two cups of watery coffee, some breakfast, and an earful from local residents about the hospital.
Today, Williamson is joined by a few white-mustached men near his age in baseball caps and jean shorts. Rainwater leaks through the fast-food joint’s roof, forming small puddles on the floor near their plastic table. One of their favorite pastimes is waxing nostalgic about Old Clarksville, where gas stations stayed open all night, cars “zip zip zipped” on the highway through town, and storefronts bustled on the main square. Now things are different, they say. Motorists prefer to zip by on Interstate 30, which bypasses downtown. The square went from bustling to barren. Young people tend not to stick around after graduating from high school since few jobs are available. With no hospital, the men drive to Paris, Tyler, even Dallas to see their doctors; they worry the ambulance service, stretched thin and overwhelmed, could be the next service to fold. Before LifeNet came along, the funeral home ran the only ambulance service in town.
“This is a dying town,” said Dan Williams, a local man the others call “Dangerous Dan.” He wears a white T-shirt and dark overalls and has a nasty scrape near his eye. “If something don’t happen here in Clarksville,” Williams said of the hospital closure, “the only people that’s going to be making money here is the undertakers.”
For Williamson, the fight for a new hospital is personal. On July 22, 2015, seven months after the Clarksville hospital closed, Williamson’s wife, Margaret, walked into the living room of their home complaining of a bad headache. She’d had headaches before, but none this severe. Thinking of the cost and time it would take to wait for an ambulance, Williamson drove her the 30 miles to Paris Regional Medical Center.
Margaret and L.D. met in high school in southeast Texas and married young: Margaret was 17, L.D., 19. In 1975, they moved to Clarksville, where L.D. worked for years at an old-timey dime store that he says sold “a little bit of everything and a whole lot of nothing.” Margaret operated machinery at the Campbell’s soup factory just outside town. The couple had opposite but complementary personalities: Margaret was shy and reserved; L.D. affable and magnetic. When L.D. got into local politics a few decades ago, Margaret avoided the limelight. Still, the couple was practically inseparable during their nearly 60 years together.
As they drove to the emergency room on that July day, Margaret seemed to be holding up OK. Just after crossing the county line on the way to Paris, they made a quick stop at a gas station in Blossom for a Sprite to settle her stomach. Fifteen minutes later, they pulled up to Paris Regional Medical Center and hurried into the emergency room. Luckily, Williamson says, it was less crowded than usual, and doctors saw her quickly. Then, a troubling discovery: Physicians found bleeding caused by a ruptured brain aneurysm. Margaret was sent by helicopter to a hospital in Plano for more advanced treatment. Shortly after, she lost consciousness.
Margaret never woke up. Five days after that fateful drive to the closest hospital, Williamson and their five children decided to disconnect her from life support. She was 76.
L.D. and Margaret Williamson were married for nearly 60 years before she died in 2015.
Williamson still feels guilty for driving Margaret to Paris instead of calling an ambulance; maybe paramedics could have prevented some of the damage. But mostly he wonders whether things would have been different if the Clarksville hospital had still been open. “We’d have gotten there much quicker. The damage would have been a lot less,” he said.
It’s something on the minds of everyone in Clarksville, where residents are linked by one or two degrees of separation. With an aging population, and nursing homes and funeral homes outnumbering just about everything but churches, the fear of not making it to a hospital is top of mind. “[People] didn’t die in Clarksville; they died somewhere between here and Texarkana, here and Mount Pleasant, here and Paris,’” said James Hodgson, a Clarksville resident, over a McDonald’s breakfast. “The obituaries today for Clarksville [might as well] say, ‘died in transit, died on the road.’”
Williamson has his plan set. If he ever needs to, he’ll move to the nursing home down the street, where Kourtney Bogan works. He’ll be buried by the same funeral home as Margaret. His headstone, complete with name and birth date, is already in the ground next to hers. Meanwhile, he brings white roses to her grave at least once a week. He eats breakfast at McDonald’s—a new routine since Margaret died. And he’s doing everything he can to see a new hospital in Clarksville open in his lifetime. Margaret had said it would never happen, Williamson recalls with a smile. “We’re going to prove her wrong.”
*please visit https://www.freestonemc.com/adyingtown/ to view the full article from the Texas Observer.
In May of 2019, an election to raise the Fairfield Hospital District tax rate cap to $0.25 per $100 was approved by 86% of those who voted.
At its current tax rate of $0.215, Fairfield Hospital District remains below the average Texas Hospital District Tax rate of $0.26 (2018).
A rollback of the current tax rate would reduce Freestone Medical Center’s estimated tax revenue and jeopardize the financial stability of its hospital and clinics.
Freestone Medical Center and associated clinics employ 135, including members of this community.
A tax rollback election DOES NOT help FMC.
If you’ve signed a petition related to the hospital district tax rate and would like to have your name removed, please call 903-389-1612.
**Provided by the Fairfield Hospital District for educational purposes.
