By Amanda Seitz and Allen G. Breed | Associated Press

WILLIAMSTON, N.C. — Weeds have punctured through the vacant parking lot of Martin General Hospital’s emergency room. A makeshift blue tarp covering the hospital’s sign is worn down from flapping in the wind. The hospital doors are locked, many in this county of 22,000 fear permanently.

Some residents worry the hospital’s sudden closure last August could cost them their life.

“I know we all have to die, but it seems like since the hospital closed, there’s a lot more people dying,” Linda Gibson, a lifelong resident of Williamston, North Carolina, said on a recent afternoon while preparing snacks for children in a nearby elementary school kitchen.

More than 100 hospitals have downsized services or closed altogether over the past decade in rural communities like Williamston, where people openly wonder if they’d survive the 25-minute ambulance ride to the nearest hospital if they were in a serious car crash.

When Quorum Health shut down Martin County’s 43-bed hospital, citing “financial challenges related to declining population and utilization trends,” residents here didn’t just lose a sense of security. They lost trust, too, in the leaders they elected to make their town a better place to live.

People like 73-year-old Bobby Woolard say they don’t believe any politicians – from the local county commissioners to the presidential candidates who will pass through this swing state with big campaign promises in the coming months – care enough to help them fix the problem.

“If you’re critically ill, there’s no help for you here,” Woolard said on a sunny April afternoon while trimming his neighbor’s hedges. “Nobody seems to care. You got a building sitting there empty and nobody seems to care.”

Trouble for Biden’s health care campaign?

The sentiment in this sharply polarized and segregated eastern North Carolina county could hint at trouble for President Joe Biden, who has made health care a key part of his reelection campaign against Republican rival Donald Trump.

His TV campaign ads hone in on Trump’s promises to diminish the Affordable Care Act. On social media, Biden regularly reminds followers of the law he signed that caps the cost of insulin. And in North Carolina, the campaign is narrowly focused on promoting Democrats’ successful efforts to expand Medicaid, which will extend nearly free government health insurance to thousands of people and reduce the indigent population for hospitals.

Biden and Trump are fiercely competing for the state, which also features the most prominent governor’s race of the year. Martin County, where Williamston is located, voted for Trump in 2020.

“Health care is on the ballot this year, and voters will remember that when they reject Donald Trump in November,” said Dory MacMillan, the Biden campaign’s North Carolina communications director.

But Biden’s achievements might not be enough for crucial voters living in towns like this one in North Carolina, where people have a hard time just getting emergency care when they need it.

Nationally, emergency room wait times have ballooned, with the average emergency room visit taking nearly three hours last year, according to the Centers for Medicare and Medicaid Services. Health care systems are also grappling with a health care worker shortage that worsened after burned-out employees emerged from the pandemic.

Those problems are particularly pronounced in rural communities, where more than 68 hospitals have closed in the last decade. The closures slowed down during the COVID-19 pandemic, when the federal government doled out billions of dollars in extra funds to hospitals. But with that money spent, hospital closures might tick up again, said George Pink, the deputy director of the University of North Carolina’s Sheps Center’s Rural Health Research Program.

Often, it’s emergency room care that residents miss the most, Pink said.

“If you’re having a heart attack, if you’re having a stroke, if you’re giving birth, all those are the kinds of life events where you need access to emergency care quickly and properly,” Pink said. “Those communities that have lost their rural hospitals, they don’t have that.”

A system ‘at risk’

Months before Williamston’s hospital closed, an outside consultant sent a dire warning about emergency care in the county.

The county’s volunteer first responder system was ineffective and long response times that stretched past 15 minutes in some areas were putting “lives at risk,” the consultant told the county’s commissioners last April.

The system was “in desperate need for vision, direction, guidance, command and control, and additional financial support,” the consultant advised the county, according to meeting minutes.

Since Martin General Hospital shut down, things have only gotten worse.

Longer drives to hospitals outside of the county mean ambulances and their crews are tied up for hours sometimes on a run, said Capt. Kenny Warren of the Williamston Fire and Rescue.

“A call that used to take us 20 to 30 minutes is now taking an hour to two hours, depending on where we’ve got to transport to,” Warren said. He added that the agency is staffed with emergency medical technicians, but not paramedics who are trained to provide more advanced care to patients in emergencies.

Warren, however, said he doesn’t think anyone has died as a result.

“Most of the outcomes probably would have been the same anyway,” he said.

In December, first responders arrived on a Williamston street within three minutes of receiving 911 calls that several shots had been fired and a young man might be dead.

They tried unsuccessfully to get a medical helicopter to transport the 21-year-old gunshot victim. The closest option was a six-bed hospital, a 21-minute ambulance ride away. All told, it would take 34 minutes from the time of the 911 call to get him there, according to police dispatch logs. He was transferred from that hospital to a higher-level trauma center where he died a few days later.

The scene of the shooting was just four minutes away from Martin General Hospital’s site.

‘Do you really care?’

More than a dozen Williamston residents interviewed for this story blamed the Martin County Board of Commissioners for failing to prevent the troubled hospital from closing.

Last month, Williamston resident Verna Perry told commissioners that her sister made a 25-minute drive to the closest hospital only to find out she would not be able to get the treatment she needed there.

“Do you really care, commissioners?” Perry asked. “If you cared, you would do something to get us a hospital here.”

Kaitlyn Paxton was seeking treatment for her asthma at Martin General Hospital’s emergency room the day it shut down. She watched staff wheel out patients on stretchers to transfer them to other hospitals.

Since then, she’s had a hard time finding primary care doctors and specialists to replace the ones who left once the hospital closed.

“As far as everyday doctors and appointments, from my personal experience it has been a nightmare trying to find someone,” she said.

She’s used the federally qualified health center, called Agape Health, which is one of a few facilities in the county still offering primary care. More than a thousand of these health centers operate across the U.S. They receive federal government funds and take patients on a sliding pay scale, regardless of their insurance status or ability to pay.

Agape Health added Saturday hours because of an influx of new patients after Martin General closed, said clinic CEO Dr. Michael McDuffie. Last month, Agape reopened one of the orthopedic clinics that shut down along with the hospital.

McDuffie wants to reopen Martin General next, even if just as a stand-alone emergency room.

“It could mean life or death,” McDuffie said. “They need an emergency department here so that it could at least stabilize them.”

The county, which still owns the hospital and land, is consulting with state officials and federal Health and Human Services agency representatives to determine whether the facility can reopen as a Rural Emergency Hospital, said interim County Manager Ben Eisner. Gov. Roy Cooper helped to usher in a new state law that allows North Carolina’s rural hospitals to make the transition.

The Rural Emergency Hospital program was developed by Congress, signed into law by Trump and finetuned by the Biden administration. The designation allows rural hospitals to unlock millions of federal dollars and beef up Medicare payments if they stay open to provide 24/7 emergency care.

“The simple question we’re trying to answer is how do we go from closed to open in a way that makes sense for the citizens of Martin County,” Eisner said.

If successful, Martin County would be the first hospital in the country to reopen its doors after closing with the new federal designation.

“It’s a top priority for us, we live it every day as a community,” Paxton said of getting the hospital reopened. It’ll be top of mind for her when she votes in the presidential election this fall.

Even still, she said: “I do not think it is a top priority for any of them at all – president, senators – any of them.”