CUTHBERT, Ga. — Rhonda Jones Johnson received a frantic call one day last November from her cousins.

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Her aunt had collapsed on the floor. They would later learn she'd suffered a massive stroke.

Jones Johnson, who is a nurse, knelt beside her aunt and performed chest compressions on her for more than an hour waiting for help. But the ambulance — the only emergency vehicle in the county — was already responding to a gruesome car crash.

“My aunt, our aunt, died at home waiting on the ambulance,” Jones Johnson said.

In front of the closed-down Southwest Georgia Regional Medical Center in Cuthbert, a town of about 3,100 people in Southwest Georgia near the Alabama border, Jones Johnson described a brutal reality facing residents.

“If only we had a hospital open here in Randolph County,” she said, “I truly believe that her life could have been saved.”

The small rural hospital shuttered its doors in October 2020, as the coronavirus pandemic gripped the community and the state. The facility had served Cuthbert residents and its surrounding areas for more than 70 years.

Rural Georgia has seen a startling number of such emergency facilities close, leaving tens of thousands of Georgians with few to no options when a medical emergency arises. Southwest Georgia Regional marked the eighth hospital to close over the past two decades.

In communities where medical centers have closed, from Commerce in North Georgia to 250 miles down to Arlington in the southern part of the state, residents face dire situations while the state has struggled to come up with solutions.

The crush of the COVID-19 pandemic only added new challenges. When COVID suspended lucrative elective surgeries, hospitals took another blow. To survive, some have had to cut crucial services altogether.

But now, seemingly with the worst COVID case surges behind us, stranded rural Georgians and hospitals ask: Where does rural health care go from here?

‘Life below Atlanta’

Even if the ambulance in Randolph County had reached Jones Johnson’s aunt sooner, the emergency vehicle's driver faces a tough decision: drive 26 miles to the nearest hospital on the Alabama border or 45 miles to the larger hospital in Albany.

Rural residents across the state often face long drives for both emergency and primary medical care as hospitals have closed and doctors fled to larger cities.

Jones Johnson calls that a reality of “life below Atlanta.”

We need a hospital; we need some type of emergent care,” she said. “All the physicians left — we have no M.D. that lives in Randolph County. They all moved to other cities to work. So I just feel like they just left us to die.”

‘We need a hospital; we need some type of emergent care....All the physicians left — we have no M.D. that lives in Randolph County. They all moved to other cities to work. So I just feel like they just left us to die.'

rhonda Jones johnson, nurse, randolph resident

Jimmy Lewis, CEO of Hometown Health, a coalition of rural hospitals, said that rural hospitals have struggled to stay afloat and have relied on state intervention. Lawmakers this session enhanced the long-standing hospital tax credit program to increase the annual cap.

The infusion of millions of dollars in federal COVID-19 relief funds helped cover the increased costs of the pandemic, but when that money stops flowing, Georgia hospitals still face the same issues — mainly a poor payor mix and skyrocketing numbers of uninsured patients.

The loss of Southwest Georgia Regional Medical Center in Cuthbert was accelerated by the pandemic, but in the end was a victim of long-term issues, Lewis said.

But if we only lost one through the pandemic, that would fall under the category of what we call a miracle,” he said.

The loss of a community hospital not only causes a drastic change in health care access but also eliminates a major economic driver for the area. When Southwest Georgia Regional shuttered, 40 people lost their jobs, too.

Stephanie Starling, who is a health care worker in nearby Edison in Calhoun County, said that the surrounding communities are also suffering.

“Alot of people lost jobs, for one thing,” she said. “This was their livelihood. People love what they do and then it is taken away from them, like that.”

“I’m just praying that it opens back up,” Starling said.

Slashing services to survive

When Van Loskoski took on the role of CEO at Stephens County Hospital in Toccoa in the far northeastern part of the state, near the border with South Carolina, he inherited a facility on the brink of closure.

Hospital officials raised the red flag last summer that if there wasn’t more financial investment from the community, the hospital would have to close.

‘Our labor and delivery department has been delivering around 200 to 215 babies for the last few years, and it's just not enough to sustain the program.'

van loskoski, CEO of Stephens county hospital in toccoa

On his first day on the job, Loskoski had to make a tough call.

“I had the regrettable challenge of having to suspend our labor and delivery services,” he recalled. “Our labor and delivery department has been delivering around 200 to 215 babies for the last few years, and it's just not enough to sustain the program.”

The situation mirrored a trend being seen across the state: Often when facilities are desperate to keep their doors open, obstetric programs are the first to go.

In turn, the Northeast Georgia hospital looked to fill other patient needs, Loskosi said, such as adding a senior behavioral health unit as mental health needs have spiked to extreme levels during the pandemic.

But the crush of COVID-19 cases also depleted rural hospital staff across the state. Facing burnout and tough competition for traveling nurses, lab technicians and other specialists, hospital leaders say a majority of the time, the full bed capacity for patients isn’t available.

Lewis, with Hometown Health, said that the pandemic forced frightening choices that hospitals haven’t had to face before. Like when two needy patients show up at the door, but only one bed is open, how do they decide who gets it?

“Sometimes in deciding who gets the next bed, somebody may end up having to make a decision that costs a life,” he said.

Mercer University doctors and Harris County community leaders cut a ribbon in front of the new medical clinic in Hamilton, Georgia on April 19. Credit: Riley Bunch/GPB News

Many argue that the state’s refusal to expand Medicaid under the Affordable Care Act has put rural hospitals in the dire situation they face today. When uninsured patients show up at their door, hospitals are on the hook for the cost.

In rural communities with no primary care doctors, hospital emergency rooms become a catch-all for patients who may just need general care.

“This pandemic has shown us that the rural hospitals are clearly the safety valve in so many cases,” Lewis said. “So we've got to focus on keeping them there.”

Catching patients before emergency rooms

On a hot day in Hamilton, a large crowd gathered in front of the old Harris County Public Library.

The building was given new life as a medical clinic run by Mercer University. It’s the fifth primary care clinic opened by the school in rural communities that have no primary care doctors.

Dr. Jean Sumner, dean of the school of medicine, said the pandemic showed that communities with the highest percentages of deaths were rural communities of color with no access to a general doctor.

And state leaders aren’t unaware of the life-or-death lack of access to care, she said.

“Georgia has recognized for some time that we've got a rural health problem and they've put a lot of money into that,” Sumner said. “They've tried to come up with solutions that are sustainable, but they've not moved that needle.”

Mercer’s strategy is to bring care to residents who otherwise would face long drives for help, like that in Randolph County — where 20 miles, she said, might as well be 200.

Rural hospitals shoulder the weight of extra patients who may not need emergent care. Sumner said establishing primary care offices helps clear up clogged emergency rooms through preventative care.

‘Everybody deserves to live. Everybody deserves to have better access to health care, even if they can't afford it.'

rhonda jones johnson

“Where do you want them to go?” she lamented. “There is no place in their community and they don't want to be there, either. Who wants to go to the emergency room?”

Dr. David Kay, the new doctor in Hamilton serving patients out of the Mercer facility, knows that the work goes beyond funding and building a state-of-the-art facility. New providers also face the obstacle of building trust with residents who feel abandoned by the state’s health care system.

I was born and raised in this area,” Kay, a Columbus native, said. “I think a lot of the success of any physician in the community is being able to relate to the patients and, more importantly, the patients feel like they can relate to the physician.”

But residents in places like Cuthbert are still waiting on help. Efforts for federal grants to reopen the closed facility haven’t come through.

“Everybody deserves to live,” Jones Johnson said. “Everybody deserves to have better access to health care, even if they can't afford it.

This story comes to Stanley R. Boxer GA through a reporting partnership with GPB News, a non-profit newsroom covering the state of Georgia.

Riley Bunch is a public policy reporter at Georgia Public Broadcasting covering the intersection of government and daily life. Bunch has won awards for both her journalism and photography during her time...