ADEL, Ga. – For years, the hospital in this small, south Georgia city was in grave financial trouble.
Like other rural American hospitals, Cook Medical Center was saddled with an outdated building, trouble recruiting doctors and a patient population short on health insurance.
In 2017, hospital officials shut down the emergency room, and the 60-bed hospital itself was next, local officials say, unless the city and county could cover some of the cost of a new building.
"I think we were weeks away from our hospital going away forever,” said Jerry Connell, former president and CEO of the Adel-Cook County Chamber of Commerce.
Adel and Cook County did approve public financing, and a new, $52 million hospital opened its doors in October. Southwell Medical has far fewer patient beds than the old hospital and at least for now, lacks an ER.
Some community leaders see the streamlined facility as a model for other rural communities struggling to save their hospitals. More than 120 rural hospitals in the U.S. have closed since 2010 — seven of them in Georgia —, and last year, nearly 200 were thought to be at high risk of financial distress, according to researchers at the University of North Carolina’s Sheps Center.
But key factors in Adel and Cook County's outcome show it may be difficult to replicate in other rural communities. And even in Adel, where support for the new hospital is strong, many people are concerned about not having an emergency room.
“You never know what the next minute brings,” said Tammie Bobo, 47, as she tidied up her downtown thrift store on a recent morning. "I worry that extra five minutes of not having the ER could cost me my life, my family’s life.”
The emergency room was a major financial drain on the old hospital, yet it treated few true medical emergencies, said Chris Dorman, president and CEO of Southwell, the nonprofit corporation that runs the new hospital in Adel about three hours south of Atlanta. Cook Medical spent millions of dollars on doctors and services to run the ER 24 hours a day, and many patients couldn't pay.
About a quarter of Cook County's 17,000 residents live in poverty, and nearly one in five lacks health insurance, according to U.S. Census estimates. Cotton and vegetable production dominate the local economy.
"Folks come in for whatever their needs may be, and we can’t say, ‘We can’t treat you if you don’t pay your bills,’” Dorman said.
Hospital officials plan to build a new ER in Adel, but don't have a timeline for the project, Dorman said. Southwell has an emergency room at its other hospital in Tifton about 25 miles north of Adel.
The focus at Southwell Medical is not on filling hospital beds, but preventing illness and drawing patients for services that can generate revenue such as same-day surgeries and CT scans. The sleek design includes pendant lights, a piano in the lobby and colorful photos of the region on the walls.
“We told area citizens that smaller rural communities can’t support a traditional hospital any longer,” Jimmy Allen, chairman of Southwell's board, said at a ribbon cutting ceremony for the new facility.
But other small communities may find it a challenge even to build a more efficient, refocused hospital like this one. Adel has economic advantages, including its location on a major interstate and a Walmart that generates significant tax revenue. A boutique candle shop and other new businesses have opened downtown, and crews in late January were completing construction of a town home and apartment complex nearby.
The city and county were able to commit a total of $9 million to the project without raising taxes.
Southwell, additionally, is a relatively big health care provider with roughly two dozen physician practices in addition to its other hospital. It had strong financial reserves and put up the rest of the money for the project with the help of a federal loan, according to Allen.
Adel Mayor Buddy Duke said he had concerns about investing public funds, but losing the hospital would have been catastrophic.
“We have seen that in other towns. Literally, they just end up being a ghost town.”
A similar infusion of public funding was not an option when Stewart-Webster Hospital closed in 2013 in Richland, Georgia, 30 miles (48 kilometers) south of Columbus, Mayor Adolph McLendon said during a recent phone interview.
“We’re real small, and we just don’t have that much of a tax base,” he said. The closure put several restaurants and a grocery store out of business, he said.
"When the hospital closed, you done everything but kicking the dirt over.”
Cook Medical's hospital executives, some of whom grew up in the area, discussed their financial struggles with city and county officials more than a year before deciding to close the emergency room, said Lisa Collins, executive director of the county's Economic Development Commission.
When it appeared public officials might balk at funding a new hospital, hundreds of residents signed a petition supporting the project even without an emergency room, Connell said.
"It is a very, very strong emotional tie that people have with the medical facility," said Howard McClain, a judge who sits on the county's economic development commission.
For Stephanie Maine, 51, Cook Medical was where she learned in 2018 that she had breast cancer, and where her doctor prayed with her before her biopsy. She still recalls the comfort of that prayer.
“I had this warm feeling everywhere," she said. "I was very thankful for that.”