We all gathered around the nursing station in preparation for the last celebration of a patient discharging from the inpatient rehabilitation unit. There were many more employees than usual lining the hallway, not surprising as the census had dwindled down from a high of twenty-six patients several weeks previously, to thirteen on the day I arrived to take over their care, to just one patient.
Everyone had a lot of down time as the patient census decreased, including myself. Each day as patients discharged, the celebrations became more and more bittersweet, and the anxiety of the staff increased. There were no new patient admissions to fill up the increasingly empty beds, no more nursing shifts to fill, and no more traveling physician assignments scheduled. The Encompass rehabilitation unit was closing, forced to as the 15 hospital HSHS system had unexpectedly and suddenly decided to close two of their hospitals, Sacred Heart Hospital in Eau Claire, Wisconsin where I was working, and St. Joseph’s Hospital nearby in Chippewa Falls, Wisconsin.
The patient was wheeled down the hallway by one of her daughters, a cart filled with her belongings in plastic bags trailing behind, a smile on her face in anticipation of finally going home. One of the staff handed her the gold celebration bell, which she rang loudly as all the employees cheered and clapped, one nurse with shaking pom poms in her hands, many with tears in their eyes, including myself. The cheers were so loud they could be heard several floors below. I had only been working at this rehabilitation unit for about a month, and I could not stop myself from feeling a heaviness in my heart, for the employees, for the patients, and for the community of Eau Claire, Wisconsin. I imagined the collective tears being shed were five percent joy at the patient’s successful rehabilitation and 95 percent grief over all the loss to come. Loss of employment, loss of financial stability, loss of autonomy, loss of control, loss of access to healthcare, and loss of the ability to attend to family obligations.
During the week prior to the last patient discharge, I heard many staff anxiously talking about the hard decisions they had to make in the upcoming weeks and months. Whether they could move to another city or state, with or without their family—their children, their spouse, and their aging parents. How they would pay their bills after their severance package ran out, or the guaranteed 60 days of pay—as determined by the federal WARN act—met their financial obligations. I could see in real time all the stages of grief. There was denial—this can’t be happening! There was anger—how dare they close this hospital! People are going to die! There was bargaining—maybe someone could come in and buy the hospital so it could stay open longer! There was depression—tears, hugs, and supportive pep talks. Very slowly, as the human resource department scheduled one-on-ones with each employee, as leadership scheduled workshops to answer questions, as employees attended job fairs, resume building and interview skill workshops, acceptance of the definitive closure of the hospital slowly seeped into employees’ consciousness. This was really happening.
This is not the first, or the last, hospital to shut down in the United States, not only leaving many unemployed, but more importantly, leaving so many patients at risk of not getting the medical care they need. According to Becker’s Hospital Review, a third of the 107 closures of rural hospitals since 2005 have occurred since 2020, a result of the financial losses associated with the COVID-19 pandemic, rising medical costs, and staffing shortages. This hospital in Eau Claire had suffered the same fate, though I’m not sure it would really qualify as rural, with a metropolitan catchment area of 173,000. Regardless of whether it was a community or a rural hospital, the doors would shut forever on April 21, 2024, and signs indicating this were pasted on all the hospital doors.
To make matters worse, not only were two local hospitals closing, but many urgent care centers, x-ray centers, laboratory services, and outpatient clinics as well—places where patients receive their primary care, psychiatric and behavioral care, orthopedic care, pediatric care, cardiac rehabilitation care, substance abuse care, spine care, allergy and asthma care, ear/nose/throat and audiology care, concussion care, podiatry and foot care, kidney care, infectious disease care, occupational health care, cancer care, acupuncture, personal and wellness coaching, and physical/occupational/speech therapies. Almost twenty clinics provide all these types of care for the residents in the Eau Claire metropolitan area and every single one of them was closing. All that care that will no longer be provided. Where will patients go? How many will suffer while waiting to get care? How many will in fact die?
In an effort to help the community, Mayo clinic will be trying to fill the gap of the hospital closure, a daunting task as they were already very busy even prior to now. The question is, will it be enough? And when did providing basic care disappear from the mission statement of every hospital in the United States? Yes, I know that medicine is a business, relying upon supply/demand, profit/expenses, balance sheets and income statements. But what about the patients? What about first do no harm? the oath I took as a physician, and one you would think would be the foundation of healthcare in this country. How many people will have to suffer before we change how health care is delivered? I don’t have the answers, but I know, as all the employees and patients affected by these hospital closures do, when something isn’t right.