It was like a normal Tuesday afternoon. Ramonna Matthews Polk was sitting in the living room of her Bowie house when her husband walked in during his lunch break.
“[Randy’s] life is so routine – he comes home and eats lunch, takes a 15 minute nap and goes back to work, ”Ramonna said. “During those 15 minutes, he opened the door to our room and said he was having a heart attack and had to take him to the hospital.”
Ramonna remembers telling him she was going to call 911, only to have him say, “No, I’ll be dead.”
The couple lived two blocks from a self-contained emergency room, and Randy, who was 57 at the time, was still aware enough to know that it would be faster for Ramonna to drive him instead of wait for an ambulance. She was able to get him there quickly, but she remembers that he was throwing up projectiles and turning blue during the short drive.
This Tuesday two years ago was the worst day of his life. But she remembers it like it was yesterday and fears for what might happen tomorrow as the small town is now without a local hospital or emergency room that saved Randy’s life that day.
The problem Bowie residents face has become increasingly prevalent across the country, as at least 136 rural hospitals have closed in the past decade. The Bowie Memorial Hospital closed once in 2015, was reopened in 2017, then closed again in early 2020, and was the only hospital in the city.
Bowie is one of many cities in Texas featured in an ongoing one-year survey of declining access to health care in rural areas of the state.
Texas Tech Public Media, Texas Newsroom, American Public Media Research Lab, and FRONTLINE are collaborating on the series to highlight systemic issues.
Data from the American Public Media Research Lab shows that Texas has seen the most closures in the United States – 24 hospitals have closed since 2005 in Lone Star State.
The small town of Bowie has a population of over 5,000 and holds the Guinness World Record for the largest bowie knife in the world at 20 feet long.
Bowie Memorial Hospital has faced financial hardship for years due to high rates of unpaid care, which has left the hospital with unpaid medical bills and low reimbursement from insurance companies, as well. than a decrease in the number of patients.
Former hospital administrator Lynn Heller has been called in to help keep the hospital open. When he left the hospital in 1994, the annual expenses for unpaid care were approximately $ 280,000. When he was brought back in May 2015, he was shocked to see those same expenses climb to $ 4.8 million, a 16-fold increase.
Heller left to start his own consulting firm and eventually was co-founder and president of the Texas Organization of Rural and Community Hospitals (TORCH), an organization made up of rural and community hospitals and people working in the field of health who advocate addressing systemic issues with Texas. access to health care.
“I walked in and said you must have a hospital district,” Heller said. “They had no way of keeping it open.”
Keren Carrion (KERA)
Making Bowie a tax district was the only way he would see this happen, and he knew in the mid-90s that it was bound to happen someday.
“I remember [Lynn] saying repeatedly that because Medicare was cutting funding, there would come a time when we would need to be a tax district, ”said Bert Cunningham, Bowie’s current city manager.
Naming an area as a hospital district increases property taxes for residents, which would then be an additional source of funds for the hospital located in the hospital district. Texas hospital districts use this method to help fill financial gaps that arise with uncompensated care costs or other losses, although it is not guaranteed that the amount collected by property taxes can cover all of the costs. costs associated with a hospital.
Read more: Struggle for access to healthcare in rural East Texas continues as some state hospitals face closures
“This is why we have had well over 100 of these places where these hospitals have been able to exist and continue, because they have been able to collect the local tax money,” said Kevin Reed, TORCH legal counsel who represented the hospital at that time. “In places where they can’t or the voters refuse, that makes it very difficult. “
Reed said Bowie was in a position where they couldn’t save the hospital without this tax support, and a previous attempt to raise the hospital’s taxes had already failed in 2013.
“They’ve been very, very clear throughout the campaign that they can’t keep it open unless we get the tax support,” Reed said.
The 17-cent increase would be for every $ 100 of a home’s value, so owners of a $ 100,000 home would pay $ 170 a year to support the hospital, for example. This turned out to be a dividing line for the small town.
A group that opposed the tax increase has run social media campaigns encouraging others to vote against. In a YouTube video, images of Nancy Pelosi and Barack Obama flashed across the screen, while a threatening voice claimed tax money would go into the pockets of leaders at TORCH and Heller.
At the end, the music shifted to a lighter tone as the voice said, “Vote no, and together we will rebuild Bowie to serve us …”
Heller and the hospital board tried to clarify the possible outcome for the residents.
“We said to people, ‘If you don’t vote for it, the hospital is going to close,’” Heller said. “So at the time of the vote, there was a majority that voted against. The election was defeated, and it was awful that the people of Bowie were throwing away a wonderful asset, that access to health care. “
The tax was rejected and the Bowie Memorial Hospital closed for the first time in November 2015.
Keren Carrion (KERA)
Attempts to speak with anti-tax ordinance members about this story were denied. A member who declined to speak officially said the ordinance was an unfair tax that pitted counties against each other. This person hopes that the problem can be fixed.
The hospital was purchased in 2017 by The Hashmi Group, a family-owned medical group in the Dallas-Fort Worth area. The group owned and operated two other hospitals facing financial difficulties, one in Grand Saline and the other in Grand Prairie.
In a national study from the Johns Hopkins Bloomberg School of Public Health, Texas General Hospital in Grand Prairie was among 50 hospitals that researchers said would charge more than 10 times the costs allowed by Medicare on average. The Texas General Hospital was ranked 11th nationally and the highest in Texas.
Grand Prairie Hospital closed in 2018, and Bowie Memorial Hospital closed for the second time in February 2020, just before the coronavirus pandemic, and again due to financial issues. Bowie Real Estate Holdings, which owned the hospital under Faraz Hashmi, filed for bankruptcy the following April. In May, the hospital received a loan from the Payment Protection Program, although it was closed for months.
“He won’t make it …”
In the emergency room, Ramonna’s husband narrowly survived a “widowmaker,” a type of heart attack with a very low survival rate.
His blood pressure climbed to 258/197 and due to the altitude doctors had to lower it so he could be airlifted to a cardiology specialist at Wise Health System Hospital in Decatur, in about 27 miles away. They managed to lower it, but just before take-off, medics told Ramonna that he wouldn’t be able to.
Upon arriving at Decatur, doctors quickly examined Randy and determined that surgery was necessary. However, they did not expect him to survive the operation. “He said, ‘You have an hour to get your things in order,'” Ramonna recalls.
She walked into the room where her husband was, to spend what she thought were their last moments together. “We haven’t discussed a thing or talked about it, because how do you look someone in the face and say, ‘Your doctor just said you have an hour to live?’ “
Ramonna said it was a miracle that he not only survived the flight, but also survived the operation in Decatur.
His doctor warned Randy would likely have another heart attack within 10 years of his first one – a timeline Ramonna thought of every day Bowie went without a hospital. Ramonna lives in fear of this possibility, as Randy didn’t have 30 minutes to get to the hospital at the time, and won’t have that time if it happens again.
“My husband and I have decided that if we don’t open a hospital or emergency room here, we won’t retire here,” Ramonna said. “Who wants to retire in a city where there is no medical center? “
Ramonna paused to clear her throat before adding, “It makes me cry even today thinking about it, whether this happens to him again. I pray every day that he won’t. never has another, but if it does, it won’t.
This story is part of a collaboration with The Texas Newsroom through the FRONTLINE Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.