Tucked away in the back of Van Zandt Regional Hospital, a small East Texas hospital, is a quaint makeshift bedroom that is reminiscent of a nun’s quarters.
A desk lamp illuminates the extra-long twin-sized hospital bed — with the white sheets neatly pulled tight over the mattress. Hats are strewn about the large wooden vanity in the room, and a Bible is placed beside the window, with pages fanning out from its daily use.
These are the temporary living quarters for the hospital’s Chief Executive Officer, Randy Lindauer. The unassuming, Indiana-native has worked his way across the country, resuscitating rural hospitals in Kansas, Florida, West Virginia and Indiana -- all of which are still up and running. Van Zandt Regional Hospital in Grand Saline, TX is his most recent project.
Lindauer has spent the last few months renovating Van Zandt Regional Hospital in Grand Saline, preparing it to reopen after it closed in 2019 — leaving about 56,000 residents without access to basic or emergency healthcare.
His day typically starts at 4 a.m. and often doesn’t wrap up until about 10 p.m. -- though sometimes Lindauer goes days without a full night’s rest. There’s too much work to get done.
“I’m here 24/7 because you never know when a pipe is going to break and, when you’re here always, you want a place to lay your head,” Lindauer said.
Grand Saline is located about an hour from Tyler, TX. It’s known for its national treasure: The Morton Salt Company, and their Salt Palace — a structure made completely of salt — is at the center of the town. Residents estimate that there could be a 10,000-year supply of salt in the famous salt mine beneath the structure.
A few blocks away from the Salt Palace is the Van Zandt Regional Hospital — a medical center with deep roots in the community that stem back to the 1920s. Most recently, however, the hospital’s status has been shaky, much like most rural hospitals in the state, and has struggled to stay open since 2012 after a string of management changes.
Texans in rural communities are facing an ongoing crisis as hospitals and medical facilities shutter. An analysis by the American Public Media Research Lab data shows that since 2005, 24 rural hospitals have closed in the state, which is the highest number of closures in the country. Separately the Lab also found that with the closure of the Hospital in Salinas, Van Zandt became one of the 85 Texas counties without a hospital.”
In August 2019, one of the physician assistants for Van Zandt Regional Hospital stated in a post on the hospital’s Facebook page that it would be closing as a result of Medicare cutbacks and low reimbursements from insurance companies. The post also stated that the hospital would be closed within 48 hours.
In the fall of 2020, Dr. Gary Martin, CEO of Innate Medical Solutions, a medical provider group in the Dallas-Fort Worth area, finalized an agreement to purchase the hospital from the previous owner for an undisclosed amount. He brought Lindauer in to help reopen it.
Lindauer arrived shortly after and immediately got to work.
“It looked like something in the movies before I got here — it was horrific,” Lindauer recalled. “The brick was all discolored. It had whiteboards that were rotten and chipped. The trees were horrible and out of control. The sign they had was rotting.”
It took more than a week to get everything landscaped--a chore Lindauer rolled up his own sleeves to complete. For many members of the community, the sight of the hospital CEO landscaping was a lasting first impression and has gone a long way in regaining trust.
Part of Lindauer’s secret to flipping rural hospitals is abiding by a strict budget. For him, that means wearing as many hats as he can--from maintenance man to executive. Sometimes though, the team couldn’t avoid paying high costs to clean up the mess left behind by the previous owners.
“We emptied eight 30-yard dumpsters worth of junk, shredded 18,431 pounds of outdated medical records, that cost about $8,000,” Lindauer said.
Reconnecting the community to quality care
The 50-bed hospital is preparing to reopen and adding more than just emergency services — residents can be seen in their medical complex for dental, in-patient services, a full laboratory, respiratory therapy, and ophthalmology.
Fruitvale resident Carl Evans explained that once the hospital closed, his wife had to go to Tyler for her doctor’s appointments, which was a hassle for them to manage since Tyler is about 50 miles away from Fruitvale. When the hospital in Grand Saline was open, they were just five miles away from care.
His wife died in 2019, but Evans feels relieved that he can get treated for Bell’s Palsy or any other need he may have once the hospital is open again.
“It’s just knowing it’s there,” explained Evans. “I’m 81, you never know what could happen. It’s a comfort knowing I don’t have to go to Tyler and be passed around a bit. It’s a blessing that they can possibly stay here.”
Both Martin and Lindauer’s goals are to bring hospitals back into rural communities, something that they have accomplished both separately and now, as a team.
Martin has worked in rural health clinics and facilities throughout Texas, though this is his first time working in a full-service hospital. His work through Innate Solutions has led to him opening a surgery center in Ennis, a pain practice in Waxahachie and Corsicana, and an imaging center and pain practice in Plano and Carrollton, among other facilities in East Texas.
“I was born in a hospital like this in West Texas,” recalled Martin, a Hobbs, New Mexico native. “My mother worked in a hospital like this, my aunts worked in hospitals like this, all their lives. And these are the hospitals becoming extinct.”
However, there are still challenges ahead in Grand Saline. The biggest at the moment is that, despite having the building ready, they are still waiting for the state to come out to the property and inspect, so their licensing is on hold, leaving the facility closed for now and their staff temporarily furloughed.
The setback has cost Martin, who is funding the whole project through his personal finances, cash flow and his retirement fund. Much of the money that was meant for operating costs instead went to paying the staff. Once patients can be seen in their Ambulatory Surgery Center in Ennis, Martin said that should be able to help with finances.
“We don’t have a lot of money, we’re doing it on a shoestring,” said Martin. “It’s way over budget, and we’re underfunded.”
The challenges that may lie ahead can happen for both the hospital in Grand Saline and any other area that may have a previously-closed facility reopen.
“It’s very challenging to reopen a hospital, there’s been very few successful reopenings,” said Don McBeath with the Texas Organization of Rural and Community Hospitals (TORCH). “The problem is, when a hospital closes, people develop relationships with different doctors, different hospitals. And, there’s an inherent distrust that the hospital might not make it again.”
In regards to the Van Zandt Regional Hospital reopening, McBeath said “We certainly wish them luck, we’ll be watching and cheering for them as this evolves.”
Martin’s plan for the hospital in Grand Saline is to keep it on a budget that doesn’t price-gouge patients but still lets them put the money back into the hospital. Paired with accepting patients with Medicare, Martin is confident the outcome will be different than from the previous owners.
“They didn’t have their Medicare Cost Reports done so they didn’t get any of that money, which is the main money you would have to have to make this work,” Martin said. “We’re going to have all our ducks in a row on Medicare, run [the budget] very lean, so I think that’s how we make it work.”
Lindauer will keep living in the hospital for another month, but he did find time for a visit from his wife and daughters from Indiana. He estimates that he’ll be working as the CEO in Grand Saline for at least another five years to ensure it’s sustainable, then he hopes to retire after 51 years in healthcare.
In the meantime, the team is already looking for where they can help next, and he’s hoping that some of his actions, like joining city boards, show the community that they are committed to staying.
“I’m hoping that all rural healthcare facilities, not only in Texas but across the U.S., realize what a blessing it is to have a rural hospital in their community,” said Lindauer, “and maybe the county will step up and hopefully do something about keeping healthcare in their community.”
— Kaysie Ellingson of Texas Tech Public Media contributed reporting.
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