But the number of patients still declined. Before the coronavirus pandemic, the Haskell County emergency room treated three to four patients daily. That number has dwindled to two or three patients a day in the past month.
Some days the hospital has no patients at all.
Waiting on the Promise of a Sale
By the time the Haskell County hospital entered bankruptcy in 2019, it was about $6 million in debt. It operated at a loss of more than $193,000 that year. The hospital still owes money to the employees who worked up to six weeks without pay to keep it open.
“I was so angry and I was so bitter over all of it,” Darla Barger, a former human resources manager, said in an interview with The Frontier and ProPublica. “I finally just had to let it go for my own mental health.”
The Haskell County hospital is one of 18 facilities owned or connected with EmpowerHMS, a private management company, that entered bankruptcy or closed in the past five years. Many of the hospitals experienced financial problems after insurance companies flagged ballooning laboratory costs as fraud. The U.S. Department of Justice is investigating the company, which allegedly took advantage of higher reimbursement rates designated for rural communities by billing for blood and urine tests that the hospitals did not perform.
Representatives for the now-defunct company could not be reached for comment. In court filings, the company denied wrongdoing, saying it followed federal guidelines.
Three of the former EmpowerHMS hospitals that sold at auction are still waiting for buyers to finalize the deals. Several companies received extensions after failing to come up with the money.
The company purchasing the Haskell hospital is the only one that pointed to the coronavirus as the reason for the delay.
Thomas Waldrep, the trustee overseeing the Haskell sale, said in court documents on April 8 that the buyer was waiting to secure federal stimulus money to help finance the purchase.
Waldrep said in an email that he didn’t know what type of stimulus funding the Haskell buyer was seeking.
Oklahoma hospitals this month received nearly $500 million as part of a $30 billion federal rescue package to help health care providers with the loss of revenue from the coronavirus pandemic.
This month, Waldrep said he expected the sale of the Haskell hospital to be completed by the end of the month.
But as of Tuesday, Waldrep, who would only answer questions via email, could not provide a specific date of sale. If the deal fails, Waldrep would have to find a new buyer or close the hospital and use any remaining money and assets to pay off debts.
Brent King, a bankruptcy trustee who in 2019 oversaw the successful sale of another former EmpowerHMS hospital in Hillsboro, Kansas, said it’s a challenge to find buyers even without the threat of an ongoing global pandemic.
Eight rural hospitals, previously operated by EmpowerHMS, have already closed. King says he expects more will soon suffer the same fate.
“We can only be hopeful that those hospitals can stay open but, bottom line, I suspect some of them won’t,” King said.
“I Have to Believe That We Have a Future Here”
A sale doesn’t guarantee financial stability for the Haskell County hospital, which will need an infusion of money to reopen parts of the facility and hire additional employees.
But it would provide some sense of stability for its remaining employees.
“I have to believe that we have a future here and we have to just keep moving as if it’s going to happen,” Randall said.
Barry Smith, CEO of Cohesive Healthcare Management and Consulting, which has been running the Haskell hospital during the bankruptcy, said revenue from the emergency room is not enough to sustain operations.
The temporary fix that came in October 2019 was meant only to save money and meet the minimum state and federal requirements to remain open while a sale was completed, Smith said.
If the hospital closed during the bankruptcy, it would lose its critical access status, a federal designation that qualifies remote communities like Haskell County to receive higher Medicare payments than many other facilities. The hospital could also struggle to reopen under current building code requirements.
“Every day that they don’t come in makes it harder,” Smith said.
Smith initially said that if a sale of the hospital wasn’t finalized by mid-April, financial losses would force the company to walk away. He later reversed course, saying the company understood the uncertainty caused by the coronavirus and would not place deadlines on its commitment to the hospital.
Court documents filed in March say Cohesive is owed $3.3 million for 2019, about half of which is management fees. The remaining amount owed is for other expenses paid by the company, including payroll and health benefits for employees.
“We can maintain the status quo for a while,” Smith said in a text. “Hopefully, much sooner than later, a long-term solution is found for the hospital.”
For Randall, maintaining the status quo means wrestling with the possibility of closure while juggling duties that include cleaning out the ice machine, planning for an influx of patients with Covid-19 and contending with new costs, including fixing the hospital’s leaky roof.
But Randall said she’ll keep working, as she did when the hospital stopped paying her salary and when nearly all of the staff was laid off.
“If you don’t show up for work, people are going to die,” Randall said.
This article was produced in partnership with The Frontier, which is a member of the ProPublica Local Reporting Network.