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BY KEITH ROYSDON

The Daily Yonder

Jamestown, Tennessee, was struggling to withstand decades of loss of jobs and population when fate dealt the city of fewer than 2,000 people what could have been a fatal blow: the 2019 closing of its hospital.

In the four years since the Jamestown Regional Medical Center closed, people in the county seat of Fentress County depended on a handful of doctors’ offices or, if they needed trauma care or an emergency department, traveled to a hospital more than a half-hour away.

But local officials worked with their state counterparts and the University of Tennessee Medical Center and in July 2023, a freestanding emergency department and clinic was set to open, following a June open house.

It’s a victory in a time when rural and small-town medicine is increasingly hard to find across the United States: For financial reasons, particularly in states like Tennessee that did not expand Medicaid, a wave of rural hospitals has closed: 195 since 2005, according to the University of North Carolina’s Cecil Sheps Center for Health Services Research. Rural Tennessee is losing more hospitals than anywhere else in the country, 100 Days in Appalachia reported in 2021.

While Jamestown’s free-standing emergency department will be a literal lifesaver for those seriously ill or injured, one Fentress County official – while delighted the emergency department is opening – despaired over the idea of bringing a full-fledged hospital back to the Eastern Tennessee community.

“Rural hospitals are going to be a thing of the past,” Fentress County Executive Jimmy Johnson said in an interview for this article. “We tried to buy our hospital on seven different occasions and we always got turned down.”

Johnson is among those who believe the new free-standing emergency department could be a model for rural communities that have lost their hospitals.

Rural hospitals throughout the United States have struggled, and their towns have struggled along with them.

Rennova Health, which operated hospitals in Jamestown, Jellico and Oneida in East Tennessee but closed the Jamestown and Jellico hospitals, cited large amounts of debt – $49 million in 2020 – routinely had trouble making payroll and let hospital supplies dwindle down to “dangerous levels,” according to a 2020 report from WBIR-TV . Rennova faced $4.4 million in Internal Revenue Service liens. In 2021, two years after the company’s Jamestown hospital closed, the facility in Jellico was shut down.

Fentress County can’t afford a lack of convenient and expedient health care: The city on the Cumberland Plateau – which marks its 200th anniversary as the county seat in 2023 – has a median household income of $12,136.

Even after four years, the exterior of the former Jamestown Regional Medical Center looks neglected but not yet falling down in disrepair. The parking lot is empty and neglected, however, and signs posted in the doorways tell the tale. One notes that the hospital was closed as of June 13, 2019, while another is, if possible, even more grim: “NOTICE: During this time, all prescription medication has been removed from this building. NOTICE NOTICE.”

Just a few blocks down Jamestown’s Central Avenue, local, state and federal officials gathered on June 27 to cut the ribbon on the new University of Tennessee Medical Center Jamestown Emergency Department.

The facility, estimated by Johnson as a $7-8 million project, including renovation of an existing building, features 9,500 square feet devoted to healthcare, including a six-bed emergency department, X-ray and CT scan facilities, laboratories for bloodwork and a medical clinic that will act as a doctor office.

Johnson said most of the funding for the center came from UT Medical Center, with “maybe a million or two” in federal funding, although Johnson. A UT Medical Center spokesperson did not answer questions for this article about funding or operations, although Johnson said the center will have “between 25 and 30 on staff.”

A 2021 filing to the state from UT Medical Center said the estimated $5.5 million project cost would come from cash reserves.

UT Medical Center did say in a July 19 press release that the Jamestown facility marked its first off-campus emergency department.

While Jamestown was without a hospital, local officials agonized over the possibility of serious injuries or a catastrophic accident.

“When it comes to emergency care, minutes matter,” Jacob Rosenbaum, executive director of the Fentress County Chamber of Commerce, said in an interview for this article. “When you are 30 minutes away from the closest place you can go and be triaged, or five minutes away, that matters.”

In July 2020, the University of Tennessee Medical Center signed a letter of intent to open the freestanding emergency department in Jamestown.

“The effort began pretty much immediately after the hospital closed,” Rosenbaum said. “We were reeling for a couple of months there.”

The Jamestown emergency department will not only provide some workload relief for the few physicians in Fentress County, who have been filling in for people who need a hospital for four years, but provide much quicker care, Johnson said.

“Until this, you’ve had to travel 36 miles to the Cumberland Medical Center (in Crossville) or 45 miles to the Cookeville Regional Medical Center.”

“People have been going to Livingston or Crossville via ambulance or, in more extreme cases, by helicopter,” Rosenbaum said.

The very remoteness of rural hospitals and emergency departments is a concern nationally. The Rural Health Information Hub noted, “Access to EMS is critical for rural residents, but providing pre-hospital services in rural areas can be challenging. Responding to a mass casualty incident, such as a crash involving a bus, can deplete EMS resources from several jurisdictions.”

In rural areas, emergency medical responders must not only cover long distances to get to a trauma center but “navigate rough terrain when responding to a call or transporting a patient to the hospital. Adverse weather conditions, when combined with longer distances and geographical obstacles, can significantly affect response or transport times.”

Rosenbaum said that aside from just securing funding, the new emergency department had to attain requirements like a certificate of need from the state.

During the Jamestown open house, which featured comments from officials who helped facilitate the new emergency department, several repeatedly cited the possibility that the project could be a model for other small communities.

Johnson – who was honored during the ribbon-cutting – said in an interview that he believed the creation of the Jamestown facility could show other towns the way forward.

“This will help rural medicine in the whole state of Tennessee,” Johnson said. “We’ve had calls from people (from other communities) wanting to come take a look.

“I wish we still had this hospital, but this is the next best step if you don’t have a hospital.”