Surgical nurse Karen Kilian thought she would work her entire career in one place, St. Mark’s Medical Center in the small city of La Grange, Texas.

That changed when the hospital abruptly stopped in-patient services and laid off over 40% of the staff last month. Kilian was one of 64 employees let go in the city of about 4,400 residents. La Grange is located roughly halfway between Austin and Houston. 

The sudden appearance of so many healthcare workers on the job market was difficult.

“We’re a small community,” Kilian said in an interview with the Daily Yonder. “There’s not that many jobs in healthcare here.”

Kilian has a new job, but it’s in Austin, a 1.5-hour drive away.

“I’ve worked at St. Mark’s my entire career,” she said in an interview with the Daily Yonder. “I was looking forward to… ending my career here. Now I’m starting over in a new position.”

St. Mark’s Medical Center is the fourth rural hospital in Texas to convert to a new designation called Rural Emergency Hospital (REH). The federal program provides economic incentives to rural hospitals that focus on emergency services while ceasing most other functions such as inpatient care and surgery. 

Residents said the hospital’s switch  will have big repercussions on both healthcare and the county’s long-term economic health. Hospital officials said the REH designation saved the healthcare center from complete closure.

Roxanne Cotter, the vice president of the La Grange Chamber of Commerce, said in an interview with the Daily Yonder that area businesses – from nursing homes to employment services – hoped to help those who lost their jobs and held job fairs for the displaced workers.

“But La Grange has just under 5,000 people,” Cotter said. “… There are only so many community resources for those in the healthcare field.”

Kilian said she feared the hospital’s closure as a full-service facility would prevent people from moving to the area in the future.

“I feel like people once said they wanted to move to La Grange for the schools, the hospital, the businesses… I feel like they’re not going to move here anymore,” she said. “This is going to deter people from moving into our community.”

John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals (TORCH) said in an interview with the Daily Yonder that hospitals are often one of the largest employers in rural communities. Losing a rural hospital can have devastating effects.

“It’s not a community killer, but it is damaging,” he said. “The primary thing is that a rural hospital is the foundation to economic development in a rural community. It’s not just those jobs that are lost. It’s the economy that those jobs support. The hospital is an economic driver in rural communities.”

Without a hospital, rural counties and communities struggle to bring in new businesses because they lack the facilities to care for the companies’ employees.

St. Mark’s is the fourth rural hospital in Texas to switch to the Rural Emergency Hospital designation, Henderson said. St. Mark’s, with 65 beds, is the largest hospital in the state to take on the new designation.

St. Mark’s has struggled for years, officials said. In 2019, a tax increase to fund the hospital was put to voters but failed. The next year, Dudley Piland, chair of the hospital’s board of directors said in a statement, Covid-19 funding from the federal government and negotiations with its lenders saved it.

But it wasn’t enough, Piland said.

“For the decade that I have served on the St. Mark’s board, we have struggled to make ends meet, including considering bankruptcy more than once,” Piland said. “The new REH designation is the first significant change to federal hospital designations in over 25 years… Without this new federal program, St. Mark’s would be forced to close the doors in the first quarter of 2023, an outcome no one wanted for the staff, their families of the community.”

Switching to the new designation was the only option, Mark Kimball, St. Mark’s president and CEO, said in a press release. Kimball did not return email and phone requests for comment. 

Without inpatient capabilities though, the hospital will be forced to stabilize emergency room patients and then transport them elsewhere for further treatment, officials said.

That need for more transportation may cost taxpayers in Fayette County more money, said Josh Vandever, director of Fayette County’s EMS services. He estimates the switch to REH will cost his department more than $1 million in added labor, gas, and wear on ambulances.

His department is seeing an increase in the amount of time EMTs and paramedics are spending transporting patients to other hospitals, Vandever said in an interview with the Daily Yonder. Prior to the hospital switching to an REH, the average turnaround time for a call was about an hour and 20 minutes, he said. Now, call times are running between an hour and 40 minutes to two hours and 15 minutes.

Vandever said additional costs will likely be paid for through cost cutting measures and county reserves. It’s too early to tell what the new reality of St. Mark’s as an REH will mean for the EMS budget next year, he said.

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