Unyielding is a College of Missouri College of Journalism undertaking for Examine Midwest.
It’s been greater than three years for the reason that closure of Audrain Neighborhood Hospital, ending greater than a century of steady native care in Mexico, Missouri.
As soon as a cornerstone of rural well being within the area and the primary group most cancers middle within the state, the hospital shuttered in March 2022 after a sequence of administration failures underneath Noble Well being and its successor, Platinum Well being. For the hundreds who relied on it, the closure didn’t simply change the place they went for care, it modified the very rhythm of their lives.
This similar story has performed out in rural counties all through Missouri and the Midwest. Twenty-one hospitals have closed in Missouri previously 10 years, many in rural areas. Residents now should drive lengthy distances for care, or make the choice that it’s simply not value touring till the ache is just too nice or the signs too robust to disregard.
Nobody is aware of that higher than Joseph Corrado.
Corrado spent greater than 40 years working at Audrain. Now, he spends his time on the street, driving to Columbia three days per week, and to Jefferson Metropolis one other two. His 2016 Cadillac Escalade, as soon as a way of native commuting, has logged greater than 6,000 miles this yr alone.
“Effectively, I imply, as a surgeon, it’s very, very troublesome to not have a hospital,” Corrado mentioned. “I can’t, you realize, do your operation within the storage.”
Corrado used to roll away from bed and get to the working room in three minutes, usually discovering he’d beat the ambulance there.
Earlier than the closure, sufferers might see him in his Mexico workplace on Monday, and be on an working desk by Tuesday. Right this moment, every part is extra sophisticated and farther away.
However what was misplaced wasn’t simply comfort, it was belief, constructed throughout generations. Corrado mentioned most of his sufferers didn’t need to go elsewhere for care. They most well-liked seeing somebody they knew, somebody native.
After greater than 4 a long time in Mexico, he had developed a bond not simply with people, however with whole households, treating grandparents, mother and father and now their youngsters. His medical charts, he famous, are “42 years thick.”
That type of relationship made well being care private, Corrado mentioned. “I can’t go to Walmart with out my sufferers coming as much as me in aisle 5 and telling me, ‘Oh physician, have a look at my incision.’”
‘A five-minute appointment takes half a day’
Rural areas of the state have increased poverty charges and older demographics, and about one in 4 rural Missourians depend on Medicaid. With fewer sufferers utilizing non-public insurance coverage, it has turn out to be tougher for rural hospitals to offset losses.
The unemployment charge additionally has grown in lots of rural areas with hospital closures, as these cities lose a significant contributor to the native economic system.
For Elizabeth Berry, 72, and Randy Dickson, 63, not having a hospital means extra than simply not having a spot to get the care you want. It provides one other layer of problem on the subject of really attending to the closest hospital, which, for many within the Mexico space, is about 40 miles away in Columbia.
“You just about know, when you’ve got an emergency, you’re in deep trouble,” Dickson mentioned in an interview. “It’s a nasty state of affairs. And if you do get down there, it’s so crowded that you may’t get in. You may have people who find themselves being handled within the ready space.”
These struggles affect everybody within the space, however the affect is best on people who find themselves older, can’t drive or have well being points, and are on their very own.
“The one means I can get there may be in an ambulance, and I can’t afford it,” Dickson mentioned. “So if I’ve an emergency, I simply need to hope I don’t die earlier than I get there.”
Berry’s husband died after years of battling kidney failure and coronary heart points. She continues to be struggling to repay the debt that got here together with his medical payments, exacerbated by the dearth of native care.
“He needed to be airlifted a variety of instances or needed to take an ambulance due to his points, and I’m nonetheless coping with the payments which might be coming in for transportation,” Berry mentioned.
Sufferers typically dwell with accidents and diseases for lengthy stretches of time earlier than in search of medical consideration. Because of the excessive value of emergency medical transportation, some folks, when injured, await it to heal as a substitute of instantly seeing a health care provider.
This has created a layer of warning for lots of people in Mexico, figuring out “they’re solely going to a hospital whether it is ‘life or loss of life,’” Dickson mentioned, including “if we had an emergency room with some good medical doctors, that will be so significantly better.”
Angela and Steve Teeter journey weekly to Cape Girardeau for Steve to obtain radiation and chemotherapy. He was recognized in early January with Stage 3B lung most cancers, the illness having unfold to his lymph nodes. On Could 13, a spot was discovered on his mind, indicating the most cancers had unfold and resulting in a Stage 4 analysis. The Teeters might want to drive a further three and a half hours to St. Louis so he can obtain radiation therapy.
Angela walked by way of what a typical appointment appears to be like like for Steve.
“He’s doing chemo now, and he goes weekly for the remedies each Friday, they usually’re normally anyplace from, I’d say, on a brief day, most likely 5 hours, after which on a protracted day, most likely like seven hours,” Angela mentioned.
“As soon as we go in, we do a blood draw, then we wait, after which we see the physician, after which we wait, after which we begin the infusion. In a month and a half, we’ll (have traveled) backwards and forwards about 30 instances. It’s three hours there and again. So, you realize, a five-minute appointment takes half a day.”
With no close by hospital, his preliminary analysis was delayed. “There was lots of illness going round, you realize, flu and stuff like that. And so he went to the physician, they usually gave him antibiotics and a steroid, after which it saved on,” she mentioned.
“He saved coughing. And so he went again to the physician a month or so later, they usually did the identical factor,” she mentioned. However the coughing persevered, and she or he finally introduced him to pressing care to get an X-ray. “After which they discovered the tumor,” she mentioned, “and despatched him to the emergency room.”
By the completion of Steve’s weekly chemotherapy in June, the Teeters traveled an estimated distance of 13,400 miles.
‘Padlocks on the doorways’
In Audrain County, the hospital’s decline started quietly in early 2020, after Noble Well being acquired it. Beneath their tenure, and later that of Platinum Well being, chaos seeped into each nook of the operation. Distributors weren’t paid. Worker medical insurance was dropped, with out discover. Scores of lawsuits mounted.
“I’ll always remember the day they put the padlocks on the doorways and mentioned we’re closed,” Corrado, the surgeon, mentioned. “What do you imply we’re closed?”
Now, emergency care in Mexico usually begins with a race towards time. Sufferers are stabilized by the native ambulance district and rushed to the closest accessible emergency room, sometimes in Columbia, 40 minutes away. There they’ll face hours-long wait instances.
A possible path ahead has emerged. In October 2024, Mexico metropolis officers signed a letter of intent with Boone Well being, coming into unique talks to convey a important entry hospital again to city. The proposed three-year plan outlines a Medicare-certified facility with emergency companies and outpatient care. However for now, it’s simply that — a plan.
In the meantime, well being care advocates warn the affect of a rural hospital closure goes far past emergency care. Heidi Lucas, govt director of the Missouri Rural Well being Affiliation, mentioned the collapse of 1 service impacts all the system.
“In rural well being — actually in well being care altogether — it’s very a lot a continuum of care,” Lucas mentioned. “In the event you’re not addressing one part of it, it impacts different parts. And also you type of have to take a look at all of them to maneuver the needle in well being care entry.”
Lucas and others level to the delicate monetary state of rural hospitals. COVID-era aid funds gave many a brief cushion, however these funds have lengthy since dried up. One rural CEO advised her he was “making about $0.36 for each greenback I spend.”
Neighborhood Well being Specialist Jennifer Eldridge of the College of Missouri extension program mentioned the grant applications that when propped up rural well being initiatives are vanishing, too.
“I’m unhappy about their future,” she mentioned. “They do rely on lots of the grants … that I’m guessing might not exist anymore.”
Eldridge lately attended a public well being convention the place some scheduled presenters by no means arrived. “They’d already misplaced their jobs,” she mentioned.
For farming communities particularly, preventive care is changing into tougher and tougher to entry.
“You don’t actually get a time off until it rains,” Eldridge mentioned. “And it’s exhausting to foretell rain a month out.”
Some residents, she added, merely don’t need to go. “I’ve been sitting with my extension council they usually’ve advised me they know individuals who would reasonably keep on their farm and die than drive to town for well being care.”
For Corrado, the space isn’t just a commute, it’s a continuing reminder of what his city misplaced.
“We had a superb medical middle,” he mentioned. “We bought every kind of accolades and recognition and that’s all gone.”
Because the group waits to see if Boone Well being’s proposal will materialize, Corrado retains driving. The miles pile up. The surgical procedures proceed. And the absence of a hospital in Mexico stays a wound that hasn’t but healed.
Learn the remainder of the sequence.
Unyielding was produced by college students on the College of Missouri College of Journalism. The crew included researchers, reporters, knowledge analysts, photographers and graphic designers. The scholars, most of whom have been seniors who graduated in Could 2025, included:
Reporters: Mary McCue Bell, Alex Cox, Jonah Foster, Prajukta Ghosh, Adeleine Halsey, Ben Koelkebeck, Xander Lundblad, Lillian Metzmeier, Kyla Pehr, Seth Schwartzberg, Savvy Sleever and Mayci Wilderman.
Knowledge and graphics: Alex Cox, Yasha Mikolajczak and Mariia Novoselia
Images: Michael Baniewicz
For questions in regards to the undertaking, please contact Mark Horvit, horvitm@missouri.edu.
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