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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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Remember last year’s Memorial Day travel jams? Chances are they will be much worse this year

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Remember last year’s Memorial Day travel jams? Chances are they will be much worse this year

The patience of Memorial Day weekend travelers was tested Thursday by widespread delays across the country, but there were relatively few canceled flights, raising hopes that airlines can handle bigger crowds expected Friday.

By early evening on the East Coast, more than 6,000 flights had been delayed Thursday, with the biggest backups at the three major airports in the New York City area and Dallas-Fort Worth International.

 

 

 

 

 

 

Pasha Pidlubniak waits for a domestic flight at Miami International Airport, Thursday, May 23, 2024, in Miami. A record number of Americans are expected to travel over the 2024 Memorial Day holiday. (AP Photo/Lynne Sladky)

 

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Pasha Pidlubniak waits for a domestic flight at Miami International Airport, Thursday, May 23, 2024, in Miami. A record number of Americans are expected to travel over the 2024 Memorial Day holiday. (AP Photo/Lynne Sladky)

 

The Transportation Security Administration predicted that Friday will be the busiest day for air travel over the holiday weekend, with nearly 3 million people expected to pass through airport checkpoints. It could rival the record of 2.9 million, set on the Sunday after Thanksgiving last year.

“Airports are going to be more packed than we have seen in 20 years,” said Aixa Diaz, a spokesperson for AAA.

When they aren’t waiting out flight delays, travelers are reporting sticker shock at the prices.

At Chicago’s O’Hare Airport, Larisa Latimer of New Lenox, Illinois, said her airfare was reasonable but other expenses for a getaway to New Orleans were not.

 

 

 

 

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Motorists travel along Interstate 24 near the Interstate 40 interchange Thursday, May 23, 2024, in Nashville, Tenn. A record number of Americans are expected to hit the pavement over the 2024 Memorial Day holiday. (AP Photo/George Walker IV)

 

Motorists travel along Interstate 24 near the Interstate 40 interchange Thursday, May 23, 2024, in Nashville, Tenn. A record number of Americans are expected to hit the pavement over the 2024 Memorial Day holiday. (AP Photo/George Walker IV)

 

“I just have to make the accommodation,” she said. “The rental car is up … this year, the hotel accommodations were very unusually expensive.”

Kathy Larko of Fort Meyers, Florida, used frequent-flyer miles — and some flexible scheduling — to pay for her trip to Chicago.

“I’m really conscious of looking at the cost of the entire trip. We’re staying a little farther out than we normally would” to get a lower hotel rate, she said. “We’re also flying back a day later, because we could get cheaper miles.”

More travelers will be on the road. AAA estimates that 43.8 million people will venture at least 50 miles (80 kilometers) from home between Thursday and Monday, with 38 million of them taking vehicles.

 
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Travelers wait at a TSA checkpoint at the Los Angeles International Airport, Thursday, May 23, 2024, in Los Angeles. A record number of Americans are expected to travel over the 2024 Memorial Day holiday. (AP Photo/Ryan Sun)

 

Travelers wait at a TSA checkpoint at the Los Angeles International Airport, Thursday, May 23, 2024, in Los Angeles. A record number of Americans are expected to travel over the 2024 Memorial Day holiday. (AP Photo/Ryan Sun)

 

Airport unions are using the holiday weekend to highlight their demands.

About 100 workers who clean airplane cabins and drive trash trucks at the airport in Charlotte, North Carolina, started a 24-hour strike Thursday, demanding better pay and healthcare, according to the Service Employees International Union. About 15% of flights were delayed, but it was unclear whether the strike played any role.

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A planned strike at John F. Kennedy Airport in New York was averted, however. Teamsters Local 553, which represents about 300 workers who refuel passenger and cargo jets at JFK, said that it reached a settlement with Allied Aviation Services and called off a walkout planned for Friday.

 

 

 

 

 

 

George Ridley, 4, left, rides on a suitcase as he and his father Chris Ridley make their way through the Nashville international Airport, Thursday, May 23, 2024, in Nashville, Tenn. A record number of Americans are expected to travel over the 2024 Memorial Day holiday. (AP Photo/George Walker IV)

 

George Ridley, 4, left, rides on a suitcase as he and his father Chris Ridley make their way through the Nashville international Airport, Thursday, May 23, 2024, in Nashville, Tenn. A record number of Americans are expected to travel over the 2024 Memorial Day holiday. (AP Photo/George Walker IV)

 

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“We are happy an agreement has been reached, a need for a strike averted, and we are hopeful that the deal will be ratified by our members,” said Demos Demopoulos, the secretary-treasurer of the local.

___

Associated Press video journalist Melissa Perez Winder in Chicago and Associated Press radio reporter Shelley Adler in Washington contributed to this report.

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Texas health department appoints anti-abortion OB-GYN to maternal mortality committee

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Texas health department appoints anti-abortion OB-GYN to maternal mortality committee

AUSTIN, Texas (AP) — Texas’ health department has appointed an outspoken anti-abortion OB-GYN to a committee that reviews pregnancy-related deaths as doctors have been warning that the state’s restrictive abortion ban puts women’s lives at risk.

Dr. Ingrid Skop was among the new appointees to the Texas Maternal Morality and Morbidity Review Committee announced last week by the Texas Department of State Health Services. Her term starts June 1.

The committee, which compiles data on pregnancy-related deaths, makes recommendations to the Legislature on best practices and policy changes and is expected to assess the impact of abortion laws on maternal mortality.

Skop, who has worked as an OB-GYN for over three decades, is vice president and director of medical affairs for the Charlotte Lozier Institute, an anti-abortion research group. Skop will be the committee’s rural representative.

Skop, who has worked in San Antonio for most of her career, told the Houston Chronicle that she has “often cared for women traveling long distances from rural Texas maternity deserts, including women suffering complications from abortions.”

Texas has one of the most restrictive abortion bans in the U.S., and doctors have sought clarity on the state’s medical exemption, which allows an abortion to save a woman’s life or prevent the impairment of a major bodily function. Doctors have said the exemption is too vague, making it difficult to offer life-saving care for fear of repercussions. A doctor convicted of providing an illegal abortion in Texas can face up to 99 years in prison and a $100,000 fine and lose their medical license.

Skop has said medical associations are not giving doctors the proper guidance on the matter. She has also shared more controversial views, saying during a congressional hearing in 2021 that rape or incest victims as young as 9 or 10 could carry pregnancies to term.

Texas’ abortion ban has no exemption for cases of rape or incest.

The American College of Obstetricians and Gynecologists, which says abortion is “inherently tied to maternal health,” said in a statement that members of the Texas committee should be “unbiased, free of conflicts of interest and focused on the appropriate standards of care.” The organization noted that bias against abortion has already led to “compromised” analyses, citing a research articles co-authored by Skop and others affiliated with the Charlotte Lozier Institute.

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Earlier this year a medical journal retracted studies supported by the Charlotte Lozier Institute claiming to show harms of the abortion pill mifepristone, citing conflicts of interests by the authors and flaws in their research. Two of the studies were cited in a pivotal Texas court ruling that has threatened access to the drug.

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Uvalde shooting families sue Texas police over botched response

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Uvalde shooting families sue Texas police over botched response

AUSTIN, Texas (AP) — The families of 19 of the victims in the Uvalde elementary school shooting in Texas on Wednesday filed a $500 million federal lawsuit against nearly 100 state police officers who were part of the botched law enforcement response to one of the deadliest school shootings in U.S. history.

The families said they also agreed to a $2 million settlement with the city, under which city leaders promised higher standards and better training for local police.

The lawsuit and settlement announcement in Uvalde came two days before the two-year anniversary of the massacre. Nineteen fourth-graders and two teachers were killed on May 24, 2022, when a teenage gunman burst into their classroom at Robb Elementary School and began shooting.

The lawsuit, seeking at least $500 million in damages, is the latest of several seeking accountability for the law enforcement response. More than 370 federal, state and local officers converged on the scene, but they waited more than 70 minutes before confronting the shooter.

It is the first lawsuit to be filed after a 600-page Justice Department report was released in January that catalogued “cascading failures” in training, communication, leadership and technology problems that day.

The lawsuit notes that state troopers did not follow their active shooter training or confront the shooter, even as the students and teachers inside were following their own lockdown protocols of turning off lights, locking doors and staying silent.

“The protocols trap teachers and students inside, leaving them fully reliant on law enforcement to respond quickly and effectively,” the families and their attorneys said in a statement.

Terrified students inside the classroom called 911 as agonized parents begged officers — some of whom could hear shots being fired while they stood in a hallway — to go in. A tactical team of officers eventually went into the classroom and killed the shooter.

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“Law enforcement’s inaction that day was a complete and absolute betrayal of these families and the sons, daughters and mothers they lost,” said Erin Rogiers, one of the attorneys for the families. “TXDPS had the resources, training and firepower to respond appropriately, and they ignored all of it and failed on every level. These families have not only the right but also the responsibility to demand justice.”

A criminal investigation into the police response by Uvalde District Attorney Christina Mitchell’s office is ongoing. A grand jury was summoned this year, and some law enforcement officials have already been called to testify.

 

 

 

 

 

 

 

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A resident arrives for a news conference with families of the victims of the Uvalde elementary school shooting, Wednesday, May 22, 2024, in Uvalde, Texas. The families of 19 of the victims announced a lawsuit against nearly 100 state police officers who were part of the botched law enforcement response. The families say they also agreed a $2 million settlement with the city, under which city leaders promised higher standards and better training for local police. (AP Photo/Eric Gay)

 

A resident arrives for a news conference with families of the victims of the Uvalde elementary school shooting, May 22, 2024, in Uvalde, Texas. (AP Photo/Eric Gay)

 

The latest lawsuit against 92 Texas Department of Public Safety officials and troopers also names the Uvalde School District, former Robb Elementary Principal Mandy Gutierrez and former Uvalde schools police Chief Peter Arredondo as defendants. The state police response was second only to U.S. Border Patrol, which had nearly 150 agents respond.

The list of DPS officials named as defendants includes two troopers who were fired, another who left the agency and several more whom the agency said it investigated. The highest ranking DPS official among the defendants is South Texas Regional Director Victor Escalon.

The Texas DPS told The Associated Press that the agency would not comment on pending litigation.

The plaintiffs are the families of 17 children killed and two more who were wounded. A separate lawsuit filed by different plaintiffs in December 2022 against local and state police, the city, and other school and law enforcement, seeks at least $27 billion and class-action status for survivors. And at least two other lawsuits have been filed against Georgia-based gun manufacturer Daniel Defense, which made the AR-style rifle used by the gunman.

The families said the settlement with the city was capped at $2 million because they didn’t want to bankrupt the city where they still live. The settlement will be paid from the city’s insurance coverage.

“The last thing they want to do was inflict financial hardship on their friend and neighbors in this community. Their friends and neighbors didn’t let them down,” Josh Koskoff, one of the attorneys for the families, said during a news conference in Uvalde on Wednesday.

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The city of Uvalde released a statement saying the settlement would bring “healing and restoration” to the community.

“We will forever be grateful to the victims’ families for working with us over the past year to cultivate an environment of community-wide healing that honors the lives and memories of those we tragically lost. May 24th is our community’s greatest tragedy,” the city said.

But Javier Cazares, the father of slain 9-year-old Jackie Cazares, noted that the announcement — which was made in the same Uvalde Civic Center where the families gathered to be told their children were dead or wounded — was sparsely attended.

“On the way over here, I saw the sticker, which I see everywhere, ‘Uvalde Strong.’ If that was the case, this room should be filled, and then some. Show your support. It’s been an unbearable two years. … No amount of money is worth the lives of our children. Justice and accountability has always been my main concern.”

Under the settlement, the city agreed to a new “fitness for duty” standard and enhanced training for Uvalde police officers. It also establishes May 24 as an annual day of remembrance, a permanent memorial in the city plaza, and support for mental health services for the families and the greater Uvalde area.

The police response to the mass shooting has been criticized and scrutinized by state and federal authorities. A 600-page Justice Department report in January catalogued “cascading failures” in training, communication, leadership and technology problems that day,

Another report commissioned by the city also noted rippling missteps by law enforcement but defended the actions of local police, which sparked anger from victims’ families.

“For two long years, we have languished in pain and without any accountability from the law enforcement agencies and officers who allowed our families to be destroyed that day,” Veronica Luevanos, whose daughter Jailah and nephew Jayce were killed, said Wednesday. “This settlement reflects a first good faith effort, particularly by the City of Uvalde, to begin rebuilding trust in the systems that failed to protect us.”

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