About two years ago, a rural, mountainous Virginia county lost its only hospital, and local officials have now all but given up trying to bring it back.
Community leaders in Patrick County said in recent interviews that reopening the hospital has proven financially unworkable, in large part because of the deteriorating building's $5 million price tag.
"There's a lot of despair, to be frank with you, about the fact that the hospital closed. There's a lot of despair about healthcare in general," said Michael Farley, executive director of a coalition that provides healthcare to mainly low-income patients in an area that includes Patrick County.
Local officials said they have moved on to looking for other ways to improve healthcare services in the rural, aging county where state figures show the population is expected to continue declining.
"At this point in time there is no active discussion around reopening the hospital. … That's not to say it could never reopen. But the sun, the stars and the moon would have to align pretty closely to get it reopened," said Bill Clark, vice chair of the Patrick County Economic Development Authority.
While rural hospitals across America are stressed, the closure of this particular 25-bed hospital in September 2017 caught community members off guard. The hospital's owner, Mississippi-based Pioneer Health Services, had filed for bankruptcy a year earlier but had been negotiating with another buyer who planned to take over the facility.
That deal fell apart at the last minute.
More than 100 people lost their jobs when the hospital in Stuart closed. In addition to that direct hit, the shutdown has also made it difficult to lure new residents or new businesses to the area, said Bryce Simmons, the county's economic development director.
It has also meant longer trips for rescue squads, which sometimes must take patients across the state line to North Carolina. Calls to 911 sometimes get response times of up to an hour, Simmons said.
Lawmakers passed bipartisan emergency legislation aimed at paving the way for the hospital to reopen by extending an important license. Democratic Gov. Ralph Northam, a pediatric neurologist who campaigned as a pragmatic problem solver, wrangled some members of his own party to revive the bill—the first he would sign—after it became part of a bitter partisan dispute over Medicaid expansion.
Multiple factors including complex licensing issues have hampered efforts to reopen the facility, but the biggest issue, officials involved in the efforts say, was the expected cost.
The building is now owned by the not-for-profit Virginia Community Capital, which has it listed for sale with an asking price of $5 million.
Many in the community think that price is too high for a 1960s-era building, the contents of which were recently sold at auction. The building has also deteriorated since it closed and deferred maintenance problems there now "run the gamut," Clark said.
But Edward Chin, senior credit officer at Virginia Community Capital, said the organization has an appraisal that supports the asking price.
"I think at this point we just want to find someone who's interested. It's been sitting on our books for a long time," Chin said.
The Pioneer hospital was the second rural hospital in Virginia to close since 2013, according to the N.C. Rural Health Research Program at the University of North Carolina at Chapel Hill, where researchers have been closely tracking closures. The first Virginia closure, a hospital in Pennington Gap, left Lee County, Virginia's westernmost, without a hospital .
Nationwide, 155 rural hospitals have closed since January 2005, according to the research program's latest figures. Experts say a variety of factors are driving the closures, including the fact that the hospitals are generally located in areas with declining populations of people more likely than their urban counterparts to be older, more sick, uninsured and living in poverty.
Nancy Bell, the Virginia Health Department's population health manager for the district that includes Patrick County, leads a team of community leaders studying the hospital issue and healthcare access more broadly.
"We're not pursuing any solutions that involve rebuilding or reopening the hospital," Bell said.
Instead, the group recently secured a grant from the Appalachian Regional Commission to hire an expert who can advise the county about other solutions.
Some of the ideas under consideration include adding medical personnel at fire and rescue stations or expanding the use of telemedicine, she said.
Since the hospital closed, a local doctor who ran the only family medical practice in the county has opened a new urgent-care center, helping fill the service gap. And the county has started a paid EMS service to supplement the volunteer squads previously in place.
Republican State Sen. Bill Stanley sponsored the bill that aimed to help keep the hospital open. He said that while so far "the mountain has been too high," he hasn't totally given up hope.
"Nothing's over till it's over," he said. "For me, it's not over because the need is great."