The Doctor is Out: Texas Community Worries About Future Without Local Healthcare
It felt like a normal Tuesday afternoon. Ramonna Matthews Polk was sitting in the living room of her Bowie home when her husband walked in on his lunch break.
“[Randy’s] life is so routine - he comes home and eats lunch, takes a 15-minute power nap and goes back to work,” Ramonna said. “During that 15 minutes, he opened our bedroom door and said he was having a heart attack, and to get him to the hospital.”
Ramonna recalls telling him she was going to call 911, only for him to say “No, I’ll be dead.”
The couple lived two blocks away from a freestanding emergency room, and Randy, who was 57 at the time, was still aware enough to know it would be faster for Ramonna to drive him instead of waiting for an ambulance. She was able to get him there quickly, but she recalls that he was projectile vomiting and turning blue during the short drive.
That Tuesday two years ago was the worst day of her life. But she remembers it like it was yesterday, and fears for what might come tomorrow as the small town is now without a local hospital or the emergency room that saved Randy’s life that day.
The problem the residents of Bowie face is one that has become more prevalent around the country as at least 136 rural hospitals have closed in the last decade. Bowie Memorial Hospital closed once in 2015, was reopened in 2017, then closed again in early 2020, and was the only hospital in town.
Bowie is one of several Texas towns being featured as part of an ongoing, year-long investigation into the declining access to healthcare in rural parts of the state.
Texas Tech Public Media, the Texas Newsroom, American Public Media Research Lab and the PBS series FRONTLINE are collaborating on the series to bring the systemic problems to light.
Data from American Public Media Research Lab show that Texas has seen the most closures in the U.S. — 24 hospitals have closed since 2005 in the Lone Star state.
The small town of Bowie has a slowly-declining population of just over 5,000 people and holds the Guinness World Record for the world’s largest bowie knife at 20 feet long -- It’s also been on a rollercoaster when it comes to healthcare access.
Bowie Memorial Hospital faced financial hardships for years through high rates of uncompensated care, which left the hospital dealing with unpaid medical bills and low reimbursement from insurance companies, as well as a decline in patients.
Former hospital administrator Lynn Heller was brought in to help keep the hospital open. When he left the hospital in 1994, the annual expenses for uncompensated care was about $280,000. When he was brought back in May 2015, he was shocked to see those same expenses ballooned to $4.8 million — a 16-fold increase.
Heller left to start his own consulting firm and eventually was a co-founder and chairman of the Texas Organization of Rural and Community Hospitals (TORCH), an organization made up of rural and community hospitals and individuals in healthcare advocating to address systemic problems with Texas healthcare access.
“I came in and said you’ll have to have a hospital district,” said Heller. “There was no way they can keep it open.”
Making Bowie a tax district was the only way he could see that happening, and he knew back in the mid-1990s that it would have to happen one day.
“I remember [Lynn] saying several times that because Medicare was reducing funding, there would be a point in time where we would need to be a tax district,” said Bert Cunningham, the current Bowie City Manager.
Naming an area a hospital district raises property taxes for residents that would then be an extra source of funds for the hospital in that area. Hospital districts around Texas use this method to help fill the financial gaps that occur with the costs of uncompensated care or other losses, though it is not guaranteed that the amount gathered by property taxes can cover all the costs associated with a hospital.
“That’s why we’ve had well over 100 of those places where those hospitals were able to exist and continue on, because they’ve been able to raise that local tax money” explained Kevin Reed, legal counsel for TORCH who represented the hospital at that time. “In places where they can’t or voters turn it down, it makes it very difficult.”
Reed said Bowie was in a position where they couldn’t save the hospital without that tax support, and a previous attempt to increase taxes for the hospital had already failed in 2013.
“They were 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 per $100 in home value, so owners of a $100,000 home would pay $170 a year to support the hospital, for example. That proved to be a dividing line for the small town.
A group that opposed the tax increase led social media campaigns encouraging others to vote against it. In one YouTube video, images of Nancy Pelosi and Barack Obama flashed on the screen, while an ominous voice made claims alleging that the tax money would all go into the pockets of TORCH executives and Heller.
At the end, the music shifted to a lighter tone as the voice said, “Vote no, and together we’ll reconstruct Bowie to serve us.”
Heller and the hospital board tried to make the possible outcome clear for the residents.
“We told people, ‘If you don’t vote for it, the hospital is going to close,’” said Heller. “So when it came time for the vote, there was a majority that voted against it. The election was defeated, and it was awful that the people in Bowie would throw away a wonderful asset, that access to healthcare.”
The tax was voted down, and Bowie Memorial Hospital closed for the first time in November 2015.
Attempts to speak with members of the anti-tax ordinance for this story were declined. One member who declined to speak on the record said the ordinance was an unfair tax that pitted the county against each other. This person hopes the issue could be laid to rest.
The hospital was purchased in 2017 by the Hashmi Group, a family medical group in the Dallas-Fort Worth area. The group owned and operated two other hospitals that faced financial upsets -- one in Grand Saline and another in Grand Prairie.
In a nationwide study by Johns Hopkins Bloomberg School of Public Health, Texas General Hospital in Grand Prairie was among the 50 hospitals that researchers found would charge an average of more than 10 times the Medicare-allowed costs. Texas General Hospital was ranked 11 nationwide and the highest in Texas.
The Grand Prairie hospital closed in 2018, and Bowie Memorial Hospital closed for the second time in February 2020, right before the coronavirus pandemic, and again due to financial problems. Bowie Real Estate Holdings, which owned the hospital under Faraz Hashmi, filed for bankruptcy the following April. In May, the hospital received a Payment Protection Program loan, despite being closed for months.
“He won’t make it…”
At the emergency room, Ramonna’s husband narrowly survived a “widowmaker”— a type of heart attack that has a very low survival rate.
His blood pressure rose to 258/197, and because of the altitude, doctors had to get it lowered so he could be flown to a cardiac specialist at the Wise Health System hospital in Decatur — about 27 miles away. They were successful with lowering it, but just before take-off, doctors told Ramonna he wouldn’t make it.
Upon arrival in Decatur, doctors quickly examined Randy and determined surgery was necessary. However, they didn’t expect him to survive the operation. “He said, ‘You have one hour to get your affairs in order,’” Ramonna recalled.
She went into the room where her husband was, to spend what she thought could be their last moments together. “We didn’t discuss one thing about it or talk about it, because how do you look someone in the face and tell them ‘Your doctor just said you have one hour to live?’”
Ramonna said it’s a miracle that he not only survived the flight, but that he also survived the surgery in Decatur.
His doctor warned that Randy will likely have another heart attack within 10 years of his first — a timeline that Ramonna has thought about each day Bowie goes without a hospital. Ramonna lives in fear about that possibility, because Randy didn’t have 30 minutes to get to the hospital then, 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 an ER here, then we won’t retire here,” said Ramonna. “Who wants to retire in a town where there’s no medical facility?”
Ramonna paused to clear her throat before adding, “It makes me cry today still thinking about it, about if that happens again to him. I pray every day he never has another one, but if he does, he won’t make it.”
Correction on Aug. 12: An earlier version of this report said that 85 counties in Texas do not have hospitals. In fact, there are 84 counties with no hospitals.
This story is part of a collaboration with FRONTLINE, the PBS series, through its Local Journalism Initiative, which is funded by the John S. and James L. Knight Foundation and the Corporation for Public Broadcasting.
The APM Research Lab is collaborating with the Texas Newsroom as a part of our coverage of rural health care issues. For a deeper dive into the data see https://www.apmresearchlab.org/rural-hospital-closures