Rural health advocates start a multi-state walk to Washington, D.C., today (Monday, June1) to raise awareness of the threat of rural hospital closures. Walkers will cover 283 miles – one mile for every at-risk rural hospital.
Last year Belhaven, North Carolina, Mayor Adam O’Neal and civil rights advocate Bob Zellner didn’t have much company on their long walk from eastern North Carolina to Washington, D.C.
The pair trekked the better part of 273 miles along the backroads of North Carolina and Virginia, ending the journey in Washington, D.C.. They hoped their sojourn would attract attention to the need for changes in federal policies affecting rural hospitals.
Last year’s walk generated national attention and gave Belhaven residents hope for the future of their hospital. So this week, they plan to repeat the journey, but with reinforcements. Pedestrian advocates from 14 states will be joining the pair for the entire trip, with more joining them for part of the journey..
This year’s route will be even longer – 283 miles, one for each of the rural hospitals the men say are under threat of closure because of federal policy.
On paper, O’Neal and Zellner seem an unlikely pair. O’Neal is a Republican mayor of the small North Carolina town of Belhaven, located near the mouth of the Pungo River in the state’s Tidewater region. Zellner is a liberal civil-rights leader whose experience helping organize political walks includes the historic March on Washington in 1963.
But the two men are on the same side of the street when it comes to rural hospitals. Zellner accompanied O’Neal on most of the 273 miles last year, though he didn’t originally intend to trek that far.
“I started out the walk and I realized that part of the time [O’Neal] was going to be walking by himself,” Zellner said. “Back in the civil-rights-movement days, 50 years ago, when I worked with SNCC [Student Nonviolent Coordinating Committee], two people – James Meredith in Mississippi and William More in Alabama – went on marches by themselves and both of them were shot. One was killed and one survived. I didn’t want to see the mayor shot, so I walked all the way with him.”
O’Neal came up with the idea for last year’s march after Vidant Health, a nonprofit hospital corporation, closed Belhaven’s hospital, saying the facility didn’t generate enough revenue to remain open.
The closure left some Tidewater residents 80 miles or more from the closest critical access facility.
“We have people dying that shouldn’t be dying,” Mayor O’Neal said. “All because there’s no emergency care here anymore.”
The week after Belhaven’s hospital closed, Portia Gibbs, a 48-year-old mother of two, suffered a heart attack and died in a high school parking lot waiting for a helicopter to transport her to the closest critical-care clinic. O’Neal says that if Belhaven’s hospital had been open, Gibbs may have survived.
A month earlier, when the Belhaven hospital was still open, a minister suffered a heart attack and survived.
“They got him to the emergency room and … gave him care and brought him back,” O’Neal said. “He’s preaching in church today. If he’d had that same incident a month later, he would be dead. When you lose emergency care, people die.”
Gibbs’ death prompted Mayor O’Neal to organize the walk from Belhaven, to Washington, D.C., to speak about the importance of rural healthcare facilities in the United States. He started on July 14, 2014, and spent two weeks walking.
O’Neal says the walk was a success. “We went from a hopeless situation in our town to now, when in the next six months to a year we’ll have our hospital open again, I’m certain of that. And that walk is the reason.”
Belhaven is working on a plan to restructure and reopen the hospital. But O’Neal and Zellner are looking beyond Belhaven at the rest of rural America.
O’Neal believes a bipartisan effort is required to solve a problem that ought to transcend politics. “In our little town, Republicans, Democrats, blacks, whites, Latinos, Asians – we’re all dying from lack of emergency care when we need it. It does not discriminate.”
Last year’s walk was demanding. Each day, the two walked around 20 miles. Zellner, who was 75 during last year’s walk, says that while it was physically tough, it was rewarding, and at times even fun.
“You know what was the most amazing thing? Sometimes it was just the mayor and myself walking, way back in the backwoods down the little country roads. And poor people in old pick up trucks would come by, and they would hold a ten dollar bill out the window and give it to the mayor. And the mayor said, ‘I know those people don’t have very many ten dollars to give out.’ I get emotional when I think about it. The effect on people was electric.”
Thirty-seven rural hospitals have closed or been converted to non-emergency care between 2010 and 2014, according to the Cecil G. Sheps Center at the University of North Carolina. The 21 hospitals that closed completely were located farther from other hospitals and served a higher proportion on non-white patients.
O’Neal says that one reason so many hospitals are closing the failure of state legislatures to expand Medicaid under the Affordable Care Act (ACA). Twenty-two states, including North Carolina, have not expanded their Medicaid coverage for low-income residents using ACA funding.
“Indigent care reimbursements [for uninsured patients] within the Affordable Care Act are being lowered,” O’Neal said. “Medicaid expansion was supposed to offset those declining revenues. But when states don’t accept Medicaid expansion, there’s not any money to replace those falling revenues.”
Zellner says another reason is corporate greed. The nonprofit corporation that owns the hospital in Belhaven had ample earnings overall and a reserve fund to support the facility, Zellner said. “They’ve got plenty of money, they just wanted to make more money.”
A representative of Vidant Health said the issue is bigger than what is happening in Belhaven. “The changing landscape of health care in eastern North Carolina is part of a larger national trend due to changes in both how care is delivered and how it is financed,” wrote Christine Mackey with Vidant’s corporate communications in an email to the Daily Yonder.
She said Vidant Health has expanded the hours at a Belhaven family clinic to 24 hours a day to help fill the gap and is building a new facility that will offer around-the-clock care. But critics say these clinics do not offer adequate emergency care.
O’Neal is quick to point out that this year’s walk is not about “pointing fingers,” but rather about drawing attention to the plight of rural hospitals and the impact of their closures.
Besides affecting the availability of health care and emergency services, hospital closures affect rural economies. The 283 endangered hospitals employ 36,000 healthcare workers and contributed an estimated $10.6 billion to local economies. Communities without hospitals also have a harder time attracting new businesses and residents.
“People don’t really move to areas that don’t have hospitals,” O’Neal said. “We have a lot of people from up North that retire here because we have a lot of waterfront, and that’s starting to slow down. We have people moving away from the area because there’s no hospital.”
O’Neal has been walking for six weeks to prepare for this year’s walk. “It’s a tough walk,” he says. “You’re basically almost walking a marathon every day for 14 days.”
Zellner, who is 76 years old, says he’s in better shape than last year and hopes to walk all of the 283 miles.
After two weeks of walking, they’ll reach Washington, D.C., and along the way, they’ll have a lot of company. They anticipate 20 walkers on the road at any given time. On the morning of June 15, they’ll arrive at the Capitol, where they’ll hold a rally and speak with legislators. Their aim, says Zellner, is to “get some legislation that says no critical access hospital can be closed in a rural area without notice given and some provision provided for those people to be taken care of.”
The men hope people will take notice. Zellner believes they will.
“I think it was just the example of a very courageous white Republican mayor from a little town in North Carolina joining together with the civil rights movement… and walking with a civil rights organizer captures the imagination of the American public, and that’s why they’re coming out and supporting us in big numbers this year.”