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At the beginning of 2020, things were looking good at Ferry County Memorial Hospital in northeast Washington. 

The hospital was in the black, just a few short years after being millions in the red. A late starting flu season was concerning, but still manageable. And the organization was working to purchase and run the town of Republic’s 116-year-old pharmacy, Republic Drug Store. 

The drug store, owned by Rob and Patty Slagle, was started by Rob’s grandfather. The business opened in 1898, when Republic (pop. 1,100) was still a gold mining town. The business has been in the Slagle’s family ever since. 

But as Rob and Patty grew older – he’s 64, she’s 59 – and their son found happiness as a pharmacist elsewhere, the thought of selling the place and retiring grew. 

“After 39 years of being in the pharmacy business, I was a little burned out,” Rob Slagle said. “I love the interactions with patients and knowing our customers by name, but I was just tired of dealing with the health care entities and insurance companies and (pharmacy benefits managers).” 

Aaron Edwards, Ferry Memorial’s CEO, lives next door to Slagle. He knew what could happen to the townspeople if no one bought the pharmacy. 

“A pharmacy is what this community needs,” Edwards said. “The next closest option is a pharmacy 40 or 45 miles away or there’s the Rite Aid that’s 60 or 65 miles away.” 

Indeed, Mayor Elbert Koontz said it was critical for the community to have both entities, the hospital and the pharmacy for the safety of the county’s residents.

“Without the pharmacy, there’s no hospital. With the hospital, there’s no pharmacy,” Koontz said. “They’re both so important to our area. Moving here, you kind of get used to the idea that the EMTs are going to be there in two minutes. It’s critical to have the hospital here.”

Republic is located in the middle of the Monashee Mountains about 30 miles south of the Canadian border. Surrounded by mountains and lakes, the town is home to snowbirds who leave their winter residences in Arizona and California to enjoy “air you can’t see and water you can’t taste,” as former Republic city council member Fred Bremmer put it. Republic is the county seat of Ferry, which has about 7,600 residents. 

For a while, in 2016 and 2017, the hospital struggled, at one point being $5 or $6 million in debt, the men said. The hospital was at risk of closing its doors for good. 

But through some re-arranging and re-prioritizing, Edwards and his team were able to pull the hospital back into the black. Programs had to be cut back. A clinic in an outlying area of the county was closed, while some out-sourced services were brought in house. Tough decisions had to be made, but ultimately Edwards and his team worked to improve the hospital’s bottom line, Slagle said. 

And then Covid-19 hit. 

Or rather, it hasn’t hit, so far. 

After years of work to ensure Ferry Memorial was solvent, the hospital all but shut down while it simultaneously prepared for an onslaught of Covid-19 patients. Closures to elective surgery and physical therapy meant money stopped flowing in. An increase in demand for personal protective equipment and changes in how the hospital was structured meant an increase in money going out. The hospital was losing money and furloughing employees.

The change in the financial picture meant the pharmacy deal was put on hold. The hospital hired a pharmacist to help Rob and Patty out, but further efforts were stalled as the hospital struggled to get a grip on its finances. 

In-person visits changed to telehealth visits, slashing the charge from $100 or more to closer to $50 per visit. Elective surgeries stopped, further reducing the hospital’s revenue. People stopped coming into the emergency room and the clinic for services, dealing another blow to the hospital’s income. 

In the meantime, the hospital got ready for Covid-19 patients. They installed dividers between the hospital and the long-term care facility adjoining it and established hand sanitizing stations outside every room. The late starting flu season meant the hospital didn’t have adequate face masks and other personal protective equipment, something it struggled to find, as it competed with other healthcare providers across the country. 

“You know, they’ll talk to you, but then when they find out how small you are, you never get a call back,” Edwards said at the time. 

Except the Covid patients never came. At least, not yet, Edwards said. Ferry County had one reported infection nearly three months ago and none since, according to USA Facts. The snowbirds came back from Arizona and California and no one got sick. The preparations the county made, the three men said, were thankfully for naught. 

In the past month though, the hospital, with the help of federal aid money, has begun to pull itself out of the red. 

When money came in from the Paycheck Protection Program,Congress’ second economic stimulus package, the hospital was able to apply for that money after a change in the language of the bill allowed community-owned hospitals to qualify. The $375,000 they received paid for about 10 days of operating expenses, Edwards said. 

More money from the Coronavirus Aid, Relief and Economic Stimulus (CARES) Act, Congress’ third economic stimulus package, helped provide another two months of revenue, Edwards said. 

It was enough to bring back all of its furloughed employees. 

And bringing back those furloughed employees was important. At about 100 full-time equivalent employees, the hospital employs the equivalent of 10 percent of the city of Republic.  

“We used to have a gold mine right here, but it closed down. And we used to have a sawmill, and it closed down. Both of those (employed) about 80 or 90 people apiece,” Koontz said. “Our unemployment rate was about 16 percent, even before Covid, so the hospital is very important. It’s our largest employer.” 

Now, however, with Covid-19 missing the community for the present, the hospital and the community brace for new changes. 

The long-term care facility will remain closed off to the rest of the hospital. Hand sanitizing stations and personal protective equipment will remain. Patients who can’t do telehealth visits because of broadband limitations will be able to come to the hospital parking lot – a visit that earns more revenue for the hospital because the patients are on hospital property. 

And the community will turn to its tourist business. Those from the cities hours away from Republic will come to the small town for its mountain beauty: to fish for a week, to hike the mountains, or to enjoy the fresh air and small town charm. 

Edwards just hopes they don’t bring Covid-19 with them. 

In the meantime, Rob and Patty Slagle will put off their retirement dreams for a while. 

“When we saw what was happening, we said ‘Let’s put this on hold for a little while,’ ” Rob said. “If it’s not something we can finalize by the end of the year, we’ll just have to wait a little longer. I don’t see Covid out of the national dialogue for the next year or two. It’s affected us, but then again, it’s affected every sector of the country, Republic included.”