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A new kind of hospital is coming to rural America. To qualify, facilities must close their beds

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A new kind of hospital is coming to rural America. To qualify, facilities must close their beds

As rural hospitals continue to struggle financially, a new type of hospital is slowly taking root, especially in the Southeast.

Rural emergency hospitals receive more than $3 million in federal funding a year and higher Medicare reimbursements in exchange for closing all inpatient beds and providing 24/7 emergency care. While that makes it easier for a hospital to keep its doors open, experts say it doesn’t solve all of the challenges facing rural health care.

People might have to travel further for treatments for illnesses that require inpatient stays, like pneumonia or COVID-19. In some of the communities where hospitals have converted to the new designation, residents are confused about what kind of care they can receive. Plus, rural hospitals are hesitant to make the switch, because there’s no margin of error.

 

Unused equipment lines the hallway of the Alliance Healthcare System hospital in Holly Springs, Miss., as photographed Feb. 29, 2024. The medical facility was initially approved by the federal government as a rural emergency hospital in March 2023, requiring closing all inpatient beds and providing 24/7 emergency care. However, they have been denied the status and must now transition back to a full-service hospital. (AP Photo/Rogelio V. Solis)

 

Unused equipment lines the hallway of the Alliance Healthcare System hospital. (AP Photo/Rogelio V. Solis)

 

“It’s ironic” that the facilities that might need the most help can’t afford to take the risk, said Carrie Cochran-McClain, chief policy officer at the National Rural Health Association. She pointed to having to give up certain services and benefits, such as a federal discount program for prescription drugs.

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The government, which classifies hospitals by type, rolled out the rural emergency option in January 2023. Only 19 hospitals across the U.S. received rural emergency hospital status last year, according to the University of North Carolina’s Sheps Center for Health Services Research.

The majority are in the South, with some in the Midwest, and hospitals in Nebraska and Florida recently started to explore the option.

The designation is aimed at a very specific population, said George Pink, deputy director of the Sheps Center’s Rural Health Research Program, and that’s rural hospitals on the brink of closure with few people getting inpatient care already.

Saving rural care

That was the case for Irwin County Hospital in Ocilla, Georgia, which was the second rural emergency hospital established in the U.S.

Weeks prior to converting, the hospital received at least $1 million in credit from the county so it could make pay employees — money that county board of supervisors chairman Scott Carver doubted he’d see returned.

“We operate on a $6 million budget for the county, so to extend that kind of line of credit was dangerous on our part to some degree,” he said. “But … we felt like we had to try.”

Irwin County Hospital became a rural emergency hospital on Feb. 1, 2023. Quentin Whitwell, the hospital’s CEO, said it was an ideal candidate.

 

One of the empty beds in the Alliance Healthcare System hospital in Holly Springs, Miss., is seen on Feb. 29, 2024. The medical facility was initially approved by the federal government as a rural emergency hospital in March, 2023, requiring closing all inpatient beds and providing 24/7 emergency care. However, they have been denied the status and must now transition back to a full-service hospital. (AP Photo/Rogelio V. Solis)

 

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One of the empty beds in the Alliance Healthcare System hospital. (AP Photo/Rogelio V. Solis)

 

“We’re still finding out what some of the impacts are, given that it’s a new thing,” said Whitwell, who through his company Progressive Health Systems owns and manages six hospitals in the Southeast, most of which are rural emergency hospitals or have applied for the designation. “But the change to a rural emergency hospital has transformed this hospital.”

A combination of state programs and tax credits, plus the new designation, means the hospital has $4 million in the bank, Carver said. Simply put, the work was worth it to him.

Traci Harper, a longtime Ocilla resident, isn’t so sure. About a year ago, she rushed her son to the hospital for emergency care for spinal meningitis.

Because the new designation requires the hospital to transfer patients to larger hospitals within 24 hours, Harper’s son was sent to another in-state facility and three days later ended up getting the care he needed in a hospital in Jacksonville, Florida.

“That’s two hours away,” she said. “The whole time I could have taken him there myself, but nobody told me that.”

‘Barely surviving’

Nebraska’s first rural emergency hospital opened in February in a city called Friend.

Warren Memorial Hospital had reached a breaking point: Federal pandemic relief money had dried up. The city, which owns the hospital, had to start extending lines of credit so hospital employees could get paid. A major street repair project was even delayed, said Jared Chaffin, the hospital’s chief financial officer and one of three co-CEOs.

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“Back in the summer, we were barely surviving,” said Amy Thimm, the hospital’s vice president of clinical services and quality and co-CEO.

Though residents expressed concerns at a September town hall about closing inpatient services, the importance of having emergency care outweighed other worries.

 

Alliance Healthcare System hospital Environmental Service Manager Ardency Baird checks on empty hospital beds in one of the shut-down floors of the Holly Springs, Miss., facility Feb. 29, 2024. One of the requirements to be approved as a rural emergency hospital is the closing of all inpatient beds and providing 24/7 emergency care. (AP Photo/Rogelio V. Solis)

 

Alliance Healthcare System hospital Environmental Service Manager Ardency Baird. (AP Photo/Rogelio V. Solis)

 

“We have farmers and ranchers and people who don’t have the time to drive an hour to get care, so they’ll just go without,” said Ron Te Brink, co-CEO and chief information officer. “Rural health care is so extremely important to a lot of Nebraska communities like ours.”

The first federal payment, about $270,000, arrived March 5. Chaffin projects the hospital’s revenue will be $6 million this year — more than it’s ever made.

“That’s just insane, especially for our little hospital here,” he said. “We still have Mount Everest to climb, and we still have so much work ahead of us. The designation alone is not a savior for the hospital — it’s a lifeline.”

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Rural troubles

That lifeline has proven difficult to hold onto for Alliance Healthcare System in Holly Springs, Mississippi, another one of Whitwell’s hospitals and the fourth facility in the country to convert.

Months after being approved as a rural emergency hospital in March 2023, the Centers for Medicare and Medicaid Services reneged on its decision.

Hospital CEO Dr. Kenneth Williams told The Associated Press that the government said the hospital isn’t rural because it is less than an hour away from Memphis. A CMS spokesperson said the facility was “inadvertently certified.”

The hospital has until April to transition back to full service, but many in the community of largely retirees believe the hospital has closed, Williams said. Patient volume is at a record low. If the federal payments stop coming, Williams isn’t sure the hospital will survive.

 

Alliance Healthcare System hospital CEO Dr. Kenneth Williams, said Feb. 29, 2024, that after the Holly Springs, Miss., facility was approved as a rural emergency hospital in March 2023, the Centers for Medicare and Medicaid Services later reneged on its decision saying the hospital is not rural because of its proximity to Memphis, which is less than an hour away. (AP Photo/Rogelio V. Solis)

 

Alliance Healthcare System hospital CEO Dr. Kenneth Williams. (AP Photo/Rogelio V. Solis)

 

“We might have been closed if we hadn’t (become a rural emergency hospital), so … something had to be done,” he said. “Do I regret all of the issues that for some reason we’ve incurred that the other (hospitals) have not? I don’t know.”

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Though Alliance appears to be one of few facilities that have been negatively impacted by converting to a rural emergency hospital, Pink said it’s too soon to know if the federal designation is a success.

“If my intuition is correct, it will probably work well for some communities and it may not work well for others,” he said.

Cochran-McClain said her organization is trying to work with Congress to change regulations that have been a barrier for rural facilities, like closing inpatient behavioral health beds that are already scarce.

Brock Slabach, the National Rural Health Association’s chief operations officer, told the AP that upwards of 30 facilities are interested in converting to rural emergency hospitals this year.

As Whitwell sees it: “As this program evolves, there will be more people that I think will understand the value.” ___

The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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Texas’ diversity, equity and inclusion ban has led to more than 100 job cuts at state universities

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Texas’ diversity, equity and inclusion ban has led to more than 100 job cuts at state universities

AUSTIN, Texas (AP) — A ban on diversity, equity and inclusion initiatives in higher education has led to more than 100 job cuts across university campuses in Texas, a hit echoed or anticipated in numerous other states where lawmakers are rolling out similar policies during an important election year.

Universities throughout Texas rushed to make changes after Republican Gov. Greg Abbott signed the law last year. On April 2, the president of the 52,000-student University of Texas at Austin — one of the largest college campuses in the U.S. — sent an email saying the school was shuttering the Division of Campus and Community Engagement and eliminating jobs in order to comply with the ban, which went into effect on Jan. 1.

More than 60 University of Texas at Austin staff members were terminated as a result of the law, according to the Texas Conference of the American Association of University Professors. The group said it compiled the list based on affected employees who had reached out and that the number could be greater. University officials declined to confirm the number of positions eliminated.

Officials at other schools, in response to inquiries from The Associated Press, indicated that a total of 36 positions were eliminated between Texas A&M University in College Station; Texas Tech University in Lubbock; Texas State University in San Marcos; The University of Houston; Sam Houston State University in Huntsville; and Sul Ross State University in Alpine. Officials said no one was let go; people were assigned to new jobs, some resigned and vacant positions were closed.

Earlier this week, University of Texas at Dallas officials announced that approximately 20 associate jobs would be eliminated in compliance with the law. University officials declined to comment on how many of those positions are currently filled.

Texas House of Representatives Speaker Dade Phelan, a Republican, applauded the University of Texas actions in a post on the social media platform X. “It is a victory for common sense and proof that the Legislature’s actions are working,” Phelan wrote.

Texas is among five states that have recently passed legislation targeting DEI programs. At least 20 others are considering it.

Florida was the first to implement a ban, last year, with the vocal backing of then-Republican presidential candidate Gov. Ron DeSantis, who often derides DEI and similar diversity efforts as “woke” policies of the left. In response to the law, the University of Florida last month announced more than a dozen terminations.

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FILE - In this Thursday, Nov. 29, 2012, photo, ivy grows near the lettering of an entrance to the University of Texas in Austin, Texas. A ban on diversity, equity and inclusion initiatives in higher education has led to more than 100 job cuts across university campuses in Texas, a hit echoed or anticipated in numerous other states where lawmakers are rolling out similar policies during an important election year. (AP Photo/Eric Gay, File)

 

FILE – In this Thursday, Nov. 29, 2012, photo, ivy grows near the lettering of an entrance to the University of Texas in Austin, Texas. (AP Photo/Eric Gay, File)

 

Universities of Wisconsin regents reached a deal with Republican lawmakers in December to limit DEI positions at the system’s two dozen campuses in exchange for getting funds for staff raises and construction projects. The deal imposed a hiring freeze on diversity positions through 2026, and shifted more than 40 diversity-related positions to focus on “student success.”

Republican legislators who oppose DEI programs say they are discriminatory and promote left-wing ideology. Some are counting on the issue to resonate with voters during this election year. Democratic DEI supporters say the programs are necessary to ensure that institutions meet the needs of increasingly diverse student populations. Lawmakers from the party have filed about two dozen bills in 11 states that would require or promote DEI initiatives.

Texas’ anti-DEI law, which Abbott enthusiastically signed last year, prohibits training and activities conducted “in reference to race, color, ethnicity, gender identity, or sexual orientation.” Additionally, the law, also known by its legislative title, SB17, forbids staff members from making hiring decisions that are influenced by race, sex, color or ethnicity, and prohibits promoting “differential” or “preferential” treatment or “special” benefits for people based on these categories.

SB17 states that the ban doesn’t apply to academic course instruction and scholarly research. That’s why professor Aquasia Shaw was so surprised to hear last week that her supervisor was not going to renew her contract. Shaw said she was not given a reason for the termination, but considering the timing, she suspects it’s the new law.

 
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FILE - Texas Gov. Greg Abbott speaks during a news conference Friday, March 1, 2024, in Borger, Texas. Texas' ban on diversity, equity and inclusion instruction has resulted in more than 100 jobs being cut at University of Texas campuses across the state — providing a glimpse of the potential impact of such bans being implemented in other Republican-controlled states. Abbott signed a law last year prohibiting DEI initiatives in public higher education. (Elías Valverde II/The Dallas Morning News via AP, File)

 

FILE – Texas Gov. Greg Abbott speaks during a news conference Friday, March 1, 2024, in Borger, Texas. (Elías Valverde II/The Dallas Morning News via AP, File)

 

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Shaw taught courses on the intersection of sociology, sports and cultural studies in the Department of Kinesiology and Health Education at the University of Texas at Austin. Her faculty page on the university’s website states her focus as “sociology of sport and cultural studies, sport management and diversity, inclusion and social justice.” A course she taught this semester was titled Race and Sports in African American Life. But she said she had not been involved in any DEI initiatives outside of her teaching.

“I was under the impression that teaching and research was protected so … I am trying to grapple with the idea and in denial that this can’t be the reason I was targeted,” she said.

In March, Republican state Sen. Brandon Creighton, who authored SB17, sent a letter to public university boards of regents across the state, inviting them to testify in May about the changes that have been made to achieve compliance. He included a warning that renaming programs, rather than changing their intent, would not be sufficient.

Creighton’s office did not respond to an emailed request for comment.

The law’s impact was felt in Texas even before it went into effect. In anticipation, University of Texas at Austin officials last year changed the school’s Division of Diversity and Community Engagement to the Division of Campus and Community Engagement. The name change didn’t save it — it was closed this month. School officials said some of the division’s projects would be relocated, while others would be shut down. They did not provide specifics.

Shaw said she was the only person of color in her department. She said she saw on X that other university employees had been let go and began connecting with them. At least 10 of the other terminated faculty and staff members whom she contacted are also from minority groups, she said.

The loss of her job was a big blow to Shaw, who had already scheduled classes for this summer and fall. She said her superiors had previously told her they hoped to renew her contract.

“I am so disheartened to see that exactly what I was concerned about ended up happening anyway,” Shaw said.

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Dallas doctor convicted of tampering with IV bags linked to coworker’s death and other emergencies

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Dallas doctor convicted of tampering with IV bags linked to coworker’s death and other emergencies

DALLAS (AP) — A Dallas anesthesiologist was convicted Friday for injecting a nerve-blocking agent and other drugs into bags of intravenous fluid at a surgical center where he worked, which led to the death of a coworker and caused cardiac emergencies for several patients, federal prosecutors said.

A jury convicted Raynaldo Riviera Ortiz Jr., 60, of four counts of tampering with consumer products resulting in serious bodily injury, one count of tampering with a consumer product and five counts of intentional adulteration of a drug, prosecutors said. A sentencing date has not yet been set for Ortiz, who faces up to 190 years in prison.

“Dr. Ortiz cloaked himself in the white coat of a healer, but instead of curing pain, he inflicted it,” U.S. Attorney Leigha Simonton for the northern district of Texas said in a video statement.

Prosecutors said that evidence presented at trial showed that numerous patients at Surgicare North Dallas suffered cardiac emergencies during routine medical procedures performed by various doctors between May 2022 and August 2022. During that time, an anesthesiologist who had worked at the facility earlier that day died while treating herself for dehydration using an IV bag.

Prosecutors said Ortiz, who was arrested in September 2022, had surreptitiously placed the tainted IV bags into a warming bin at the facility and waited for them to be used in his colleagues’ surgeries.

Evidence presented at trial showed that at the time of the emergencies, Ortiz was facing disciplinary action for an alleged medical mistake made in one of his own surgeries, prosecutors said.

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Texas woman sues prosecutors who charged her with murder after she self-managed an abortion

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Texas woman sues prosecutors who charged her with murder after she self-managed an abortion

McALLEN, Texas (AP) — A Texas woman who was charged with murder over self-managing an abortion and spent two nights in jail has sued prosecutors along the U.S.-Mexico border who put the criminal case in motion before it was later dropped.

The lawsuit filed by Lizelle Gonzalez in federal court Thursday comes a month after the State Bar of Texas fined and disciplined the district attorney in rural Starr County over the case in 2022, when Gonzalez was charged with murder in “the death of an individual by self-induced abortion.”

Under the abortion restrictions in Texas and other states, women who seek abortion are exempt from criminal charges.

The lawsuit argues Gonzalez suffered harm from the arrest and subsequent media coverage. She is seeking $1 million in damages.

“The fallout from Defendants’ illegal and unconstitutional actions has forever changed the Plaintiff’s life,” the lawsuit stated.

Starr County District Attorney Gocha Ramirez said Friday that he had not yet been served the lawsuit and declined comment. Starr County Judge Eloy Vera, the county’s top elected official, also declined comment.

According to the lawsuit, Gonzalez was 19 weeks pregnant when she used misoprostol, one of two drugs used in medication abortions. Misoprostol is also used to treat stomach ulcers.

After taking the pills, Gonzalez received an obstetrical examination at the hospital emergency room and was discharged with abdominal pain. She returned with bleeding the next day and an exam found no fetal heartbeat. Doctors performed a caesarian section to deliver a stillborn baby.

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The lawsuit argues that the hospital violated the patient’s privacy rights when they reported the abortion to the district attorney’s office, which then carried out its own investigation and produced a murder charge against Gonzalez.

Cecilia Garza, an attorney for Gonzalez, said prosecutors pursued an indictment despite knowing that a woman receiving the abortion is exempted from a murder charge by state law.

Ramirez announced the charges would be dropped just days after the woman’s arrest but not before she’d spent two nights in jail and was identified by name as a murder suspect.

In February, Ramirez agreed to pay a $1,250 fine and have his license held in a probated suspension for 12 months in a settlement reached with the State Bar of Texas. He told The Associated Press at the time that he “made a mistake” and agreed to the punishment because it allows his office to keep running and him to keep prosecuting cases.

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