The door to the emergency room at the Ellwood City Medical Center is locked.
A sign states that the hospital is temporarily closed “until further notice. Please proceed to the next closest hospitals.” Those facilities, located in New Castle, Butler and Brighton Township, are all roughly 30 to 40 minutes away.
In 2017, Ellwood City's non-profit medical center was purchased by Americore Health Solutions, a for-profit company based in Florida. Americore’s website describes it as “a new healthcare company focused on saving and revitalizing rural communities through the acquisitions and management of rural hospitals across the United State.”
Americore is currently falling short of this mission in Ellwood City.
A broken CT scanner in late November 2019 prompted the Pennsylvania Department of Health to close the medical center’s emergency room and bar it from admitting new patients.
“[Americore] is debating leasing new equipment versus repairing the current [CT] machine. It would be more cost effective to go with a new machine but would surmount to a much longer period of time and would also necessitate the use of a temporary mobile unit,” wrote Ellwood Medical Center CEO Beverly Annarumo in an email to WESA in early December.
Annarumo, who has since resigned, said that Americore hoped to reopen the hospital in January.
The company missed payroll for Ellwood City hospital workers the week the scanner went down, as well as for the next payroll period, two weeks after. The Monday after employees weren't paid for the second time, the vast majority of the medical center’s staff were laid off.
Then right before the new year, Americore filed for bankruptcy.
No one in Ellwood City seems to know if or when the hospital will reopen, and Americore hasn't responded to media requests.
This situation has confused some of Dr. Beth Magnifico’s patients, whose primary care practice rents office space from the hospital in an adjacent building.
“I think that the community thought that [our] doors were truly padlocked,” said Magnifico. “We had to say, ‘Oh no. Doors are open. We’re here Monday through Friday.'”
Magnifico’s practice is part of Primary Health Network, a group of Pennsylvania health centers that receive federal funding for providing care to medically underserved communities. Though Magnifico’s office is open, the hospital’s closing presents challenges.
“I’m missing those X-ray services, MRI services, CT services that were at my fingertips for my patients,” she said.
It had been widely known around town that the hospital was in poor financial shape, even prior to its purchase by Americore Health. Despite this, many Ellwood City residents said the facility’s closing was a shock.
“No matter where you look it’s affecting everybody,” said florist Patti Kuhn, who runs “Posies by Patti” in downtown Ellwood City. “They have to get new doctors. They have to go outside the area. You need transportation.”
While arranging a bouquet of daisies and hydrangeas, Kuhn said that Ellwood City having its own hospital made the borough special.
“In a community of big hospitals, we were one of the few little ones left, but that seems to be what’s happening these days,” she said.
In 2019, 19 rural hospitals closed. This is the most in at least 15 years, according to data collected by the Cecil G. Sheps Center for Health Services Research at the Univeristy of North Carolina at Chapel Hill.
Populations across rural America are declining. As a result, small-town hospitals treat fewer patients and generate less revenue. Ellwood City sits on the border of Lawrence and Beaver counties, where populations have been dwindling for more than half a century.
Additionally, since many rural hospitals were built, medicine has transformed to where out-patient treatment is more common.
Many rural hospitals that remain open reduce medical services, with patients traveling to larger facilities for more complex care. This was true for the Ellwood City Medical Center, which closed its maternity ward in 2013.
While these cuts are not welcome, one resource that communities are especially loath to part with is an emergency department.
“That concerns me a lot,” said Ellwood City fire chief Rick Myers.
The fire department attends every 911 emergency in the borough. Myers said that last year there were nearly 600 calls. Now that the hospital is closed, this puts a strain on local first responders.
“Somebody may now call 911 for something they may not have before because they could have just drove right up the street,” he said.
When the fire department attends a medical call, they provide immediate care. But they aren’t licensed to transport people to the hospital, instead patients wait until an ambulance arrives. Now that EMS have to drive people out of town, the wait might be hours.
“Especially for somebody who needs a higher level of care immediately, that’s a big difference,” said Myers.
Last year, Pennsylvania began a program that attempts to stabilize the finances of rural hospitals through fixed revenue payments.
Ellwood City’s hospital was not part of this initiative. Then-CEO Annarumo told the Ellwood City Ledger that facility's ER did not meet the program's threshold for meaningful use. The Pennsylvania Department of Health, however, told WESA that the medical center was eligible.