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ASHLAND — When Greenup County and the surrounding area lost past industries, the blow was devastating, but when the region lost its third industry in a five-year span — a hospital, during a time of pandemic — community members had to act fast.

Two years after the Russell CSX railroad closure and five years after the shutdown of AK Steel, Our Lady of Bellefonte Hospital (OLBH) officially shut its doors April 30, about four months after the board announced on Jan. 21 that the closure would happen in September.

The closing came 50 days after the World Health Organization declared the coronavirus to be a pandemic in the United States.

As COVID-19 cases begin to climb for the second time, residents such as Rob Hayes, former OLBH medical director, fear they may really start seeing the effects of this loss.

The hospital was the No. 1 employer for Greenup County residents. Its end meant a loss of more than 1,000 careers in the nearly 1,200-staffed, not-for-profit facility.

OLBH was one of the two hospitals serving the Boyd, Greenup and Carter county area, reducing hospital accessibility to 465 beds for nearly 100,000 residents.

Lisa Huff, 56, never thought this would happen in her lifetime when she was roaming the hospital hallways with her uncle at age 6 or accepting a job there as a physician recruiter 36 years later.

“I was born where I worked. My two grandmothers and my grandfather (received care) there; two of my brothers passed away there. I remember being a child and having to wait in the lobby while my mom did her appointments,” Huff said. “I grew up in the hospital.”

Huff’s experience was common of those in the area who knew OLBH as a health care staple for over 60 years. The hospital offered support to the community, from free food delivery services to specialized pediatric care.

When employees got the news, Huff said it was a bombshell to staff. Management had told employees just months before that the hospital was doing well financially, with plans to possibly buy out a competing facility.

“I found out 10 minutes before the world did. We were completely blindsided. This was the job I thought I was going to retire from,” Huff said. “I hadn’t updated my resume in 14 years.”

Belinda McCune, 37, is a longtime resident of Greenup County and former OLBH lab tech. She worked at the hospital for 13 years until its closing and, like Huff, said the loss was a shock that left a gap in the community.

“It makes longer wait areas in the other health care facilities. Now I’m working with King’s Daughters (Medical Center in Ashland), and the number of patients has really skyrocketed,” McCune said.

McCune, Huff and over 1,000 others’ last days were cut short when Bon Secours Mercy Health, the Cincinnati-based parent company of OLBH, fast-tracked the layoff process.

Physicians were let go without severance, according to Huff, halting the opportunity to continue appointments.

The growing financial burden to keep the building open without crucial staff meant the hospital’s original closing date, sometime in September, would be moved up to late April — in the thick of the COVID-19 pandemic.

Hayes, the former medical director of the hospital, was one of the many employees forced to relocate to a new hospital following the closure. Now Hayes works for St. Mary’s Medical Center in Huntington, one of the closest remaining providers in the Tri-State.

“I was one of the lucky ones,” Hayes said. “I was pretty blessed to come up with basically the same job I was doing.”

A lot of the responsibility fell on the individual employees to find new jobs, according to Hayes, who said job fairs offered by hospitals and health care facilities in neighboring states were the only forms of assistance provided to those laid off.

Our Lady of Bellefonte Hospital told employees in late January they would be let go. The job fairs took place the next month.

Kimberly Duty, a longtime patient of OLBH, said many of her doctors are struggling to find placements, leaving those who received long-term care in a difficult position.

“I hoped I could follow my doctors, but they didn’t even know where they would be, if they would stay or have to leave — it’s like we’re all in limbo,” Duty said.

Duty, who receives frequent care for chronic obstructive pulmonary disease (COPD), is still transitioning to new health care, despite beginning the process in February.

“When I found out they were closing, I was devastated and scared. I called my physician’s assistant and said, ‘This is so wrong. Tell me this isn’t true,’” Duty said.

Losing industry by the year

Although Ashland was once a hub for the manufacturing industry, residents today have grown accustomed to losing jobs.

AK Steel’s Ashland Works, a steel production plant that employed 633 residents, closed in 2015. After that, the Russell branch of CSX railroad corporation closed in 2018, furloughing over 100 residents employed by the company.

But no one was ready to lose a critical need like health care, said Hayes, the former medical director.

“Russell’s tax revenue will be utterly destroyed by this, unfortunately. How that affects the school system, and the city, and the county at large has yet to be seen,” Hayes said.

In a community with 25% of residents living below the poverty line, the constant cycle of loss could mean irreparable harm without a strategic economic approach from all sides, according to economic policy expert Geoff Marietta.

Marietta runs a nonprofit organization, Invest 606, that aims to reinvigorate the Appalachian economy by bridging the gap between rural and urban entrepreneurs.

“Just imagine how many of those people who work at the hospital are regular customers at things like boutiques. It’s not just that the hospital is closing and those jobs are going — a lot of the income that those people spent in the community is going, too,” Marietta said. “That’s when you’ll really see the full effect of something like this.”

Marietta’s organization gathers a yearly group of entrepreneurs who live in Eastern Kentucky, giving them the opportunity to receive grants and zero-interest loans to kick-start their businesses.

He said efforts like this are part of the solution for prosperity in rural towns hit by large economic losses when for-profit companies pull out.

But a lack of access to funding or enticing real estate options hurt rural areas when trying to execute investment programs in small towns like Ashland. A time when the economy is thriving still seems far off on the horizon for Marietta.

“It has to be easier to start a business in Eastern Kentucky before we’re really going to start to see things turn around. That starts with making sure small-business owners and entrepreneurs have opportunities to network with each other,” Marietta said.

The loss of small hospitals is taking place across the nation. By May, 15 hospitals had closed since January in the U.S., according to Ayla Ellison, the managing editor of Becker’s health care.

In an article she wrote for Becker’s Hospital Review, a publication for health care issues, Ellison cites patient volumes and COVID-19 financial blows as reasons for the mass closings.

Our Lady of Bellefonte Hospital is No. 1 of the 15 hospitals Ellison examined.

COVID-19 concerns

Although there are other health care options in the Tri-State, the loss of Our Lady of Bellefonte Hospital meant the disappearance of an emergency response provider and pneumonia care facility for Boyd and Greenup counties.

It also meant residents of those counties would join the 66 other Kentucky counties with a single accessible hospital, according to information gathered by the Rural Health Information Hub.

Kentucky ranks in the top 10 of states most at risk of hospital closures, according to a February 2019 analysis by Navigant Consulting Inc.

This is due to the state’s large percentage of rural hospitals, which have a higher chance of closure due to lower population and patient demand, according to Navigant.

In a time of pandemic, OLBH’s closure expanded the access gap for those in the rural community. With longer travel times in case of emergency and 214 fewer beds in the face of a new and highly contagious illness, leaders in the health care community feared the worst.

Rocky Adkins, senior adviser to Kentucky’s Democratic Gov. Andy Beshear, said earlier in the year that the hospital’s closing was a “bomb” for the community.

In a news conference March 30, Beshear called on the center to remain open despite set closing dates, citing the necessity of the facility should there be a need in relation to a rise in COVID-19 cases.

As of Friday, Boyd County had 73 reported cases and Greenup County had 33.

Regardless of the pandemic, the closure of the hospital is sounding alarms for all emergency cases, according to Hayes, the former OLBH medical director.

“Particularly for emergency care, our emergency department saw an enormous number of (emergency) cases for the size that we were, and it would be difficult, I think, for any one system to absorb all of those emergency room visits,” Hayes said.

The future of Ashland health care

For Greenup and Boyd counties, the loss of Our Lady of Bellefonte Hospital means a monopolized health care system in the area.

While residents have the option to go across the river to Ohio or West Virginia to receive health care, for those who want to stay in Kentucky, or those with insurance-related restrictions, there is only one dominant health care provider they can use: King’s Daughters Medical Center (KDMC).

This was a concern for some regional FTC employees conducting oversight, according to Hayes.

When the FTC senses a monopoly could be forming, it intercedes the process by filing complaints to block the merger of head-to-head health care providers, according to Betsy Lordan, the FTC’s public information officer for mergers and competition.

“That was a fairly heated discussion. … Some felt Bon Secours Mercy Health was choking out the competition for the other competing health care facility; others felt that having more than one health care option was what made our area so great,” Hayes said.

Despite this, Lordan said the FTC did not file a complaint.

Losing a hospital that offered a diverse number of practices affects residents like Teresa Smith, 60, who is the caregiver for her 89-year-old mother.

“My mother’s doctors were all at OLBH. Now her family physician is at one hospital and her cardiologist at another,” Smith said. “That security is gone, and with her advanced age and worsening health, it’s the worst possible time for such changes.”

Duty said the sudden closure also slowed the transition for many in need of immediate care due to the long file transfer times of patient information from OLBH to other health care facilities.

“The information is not transitioning over as quickly as I need,” Duty said. “I’ve had to get into it a time or two with the doctors because they don’t have access to it themselves.”

Jenifer Cantrell, the property manager for the Bellefonte Centre, an independently owned building that housed OLBH practices, said the building will stay and she hopes to incorporate more options with facilities run by providers in the Tri-State.

Those include King’s Daughters Medical Center, Southern Ohio Medical Center of Portsmouth, Ohio, and Cabell Huntington Hospital.

As of now, Cantrell said pediatric, podiatry and pulmonology practices run by KDMC have transitioned their care to the former OLBH facilities, along with one family practice provided by Southern Ohio Medical Center.

Though the facilities and programs are gone, former employees and longtime patients share the nearly 70 years worth of memories in community groups.

One Facebook group, called Our Lady of Bellefonte Memory Lane, was organized by Shelly Gibson to bring residents together to grieve, laugh and reminisce on their time at the hospital.

“We lost something special, and everybody that I know is in different stages of that grieving process,” Gibson said. “A lot of people stayed angry longer, some cried more, and others accepted it faster.”

Cheryl Bailey, a 22-year employee of OLBH, is also a member of the group and comes there to deal with her frustration.

“I still get upset when I drive by OLBH and see the emptiness of everything. We should not have closed; we were needed in this community,” Bailey said. “We were busy most every day.”

Kathy Fairchild, another member, said the sudden loss of her job felt like a divorce. After 41 years of working as a nurse, Fairchild said leaving felt like the “death of an era.”

As residents once again adjust to their new normal after substantial loss, group members like Fairchild remember Our Lady of Bellefonte was more than a hospital; for many, it was home.

“I watched a doctor go to the pharmacy and get a patient’s medicine because he didn’t have any money. It was just what they did,” said Huff, a longtime staff member of OLBH. “If anyone needed anything, we jumped in and we did it.”

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