SMITHVILLE, Mo.-Residents say a big-city health system betrayed their small Missouri town when it closed most acute-care and emergency services at the local hospital.
But executives at Saint Luke's Health System in Kansas City, Mo., say they made a sound-and inevitable-business decision because eliminating excess hospital capacity is key to cutting overall healthcare costs.
There's the rub. So often in hospital consolidation it's "damned if you do, damned if you don't."
The controversy centers around the Smithville campus of Saint Luke's Northland Hospital, once a 92-bed full-service hospital serving 3,000 residents of the lake community and thousands of tourists.
Saint Luke's Northland operates a second 55-bed campus, Barry Road, 12 miles away in Kansas City.
Saint Luke's Northland is part of Saint Luke's Health System. The system's flagship hospital is 498-bed Saint Luke's Hospital in Kansas City.
Last month, the system closed most of the services at the Smithville campus and transferred them to the newer Barry Road campus.
The system left Smithville with skilled-nursing, rehabilitation, psychiatric and home health programs.
Now some residents are vowing to travel to competitors, rather than seek care from any of Saint Luke's hospital sites. In fact, local politicians are trying to figure out if Smithville can take control of the hospital, although they admit they're not optimistic.
"The community looked on this hospital as its own," said David "Scoop" Peery, editor and publisher of the Smithville Lake Democrat-Herald, a weekly newspaper with a circulation of 2,400. "As the Barry Road hospital census grew, this one declined. A lot of people think that was planned."
The Democrat-Herald slogan-"The Only Newspaper That Gives a Darn About Smithville"-is, perhaps, testimony to the pride and self-reliance of the town. In 1938, residents pitched in $11,000 to build a small hospital, later named Spelman Memorial after a local physician.
Competitors sprang up in the Kansas City region's northern counties, where the population is swelling. In 1989, Spelman and Saint Luke's, through a joint venture, opened the Barry Road site, partly to fight off rivals.
Three years later, Spelman formally became part of Saint Luke's system, and the Smithville and Barry Road sites became two campuses under the Saint Luke's Northland name. A separate board oversees the two-campus Northland hospital.
Changes in medical care, leading to less use of hospitals, hurt the Smithville campus, despite the system's best efforts to support it, said Paul Shy, chairman of the Northland board of directors. Shy declined to be interviewed but agreed to respond in writing to MODERN HEALTHCARE's questions.
On an average day, the Smithville facility treated about 12 acute-care inpatients and eight emergency-room patients, said John Miller, Northland's marketing director. Executives forecast a $3.2 million loss at the campus this year without changes. After consolidation, the Northland campuses will earn $2 million on operating revenues of $60 million, Miller said.
Residents say Saint Luke's broke its promises to them. The system was supposed to make the Smithville campus stronger. If it had to close a facility, they ask, why not Barry Road?
"It's a devastating blow to the community," said Mary Lee Chiles, executive director of the Smithville Area Chamber of Commerce. "Besides losing our hospital, we're going to lose our doctors. Why would they stay?
"This town is irate," Chiles said. "They weren't dealt with up front. They weren't told the hospital was in trouble. Saint Luke's has a bad name."
Community resentment is particularly strong because Saint Luke's plans a $10.9 million expansion and renovation at the Barry Road site. It won state approval in January.
A state representative on the Missouri Health Facilities Review Committee said he'll be less cooperative the next time Saint Luke's seeks certificate-of-need approval.
"They didn't mention plans to basically close all hospital services at Smithville and move them to Barry Road," said Gary Witt, a Democrat representing an area just west of Smithville. "My constituents go to the hospital, work at the hospital, and it looks like I helped close it. The way they did it is what has most upset me."
Saint Luke's announced its consolidation in February and held a series of public meetings to explain. Officials say no communications plan could have prevented a public outcry.
The system had to solve the Smithville facility's financial problems, regardless if it expands the Barry Road campus, Miller said. And the community had a say in the matter, since the 11-member Northland board-which made the decision-includes three Smithville residents, he said.
"We appreciate and recognize the emotions of the local community, but it comes down to a business decision," Miller said. "We don't expect people to like this."