On December 31, most of us found ourselves ready to put 2021 behind us and anticipate what 2022 might bring. For Jennersville Hospital in West Grove, Chester County, there would be no future prospects.
At midnight on January 1, 2022, the rural hospital, which has been around for over 100 years, turned off the lights and locked its doors to patients.
To some, this may seem like an unfortunate story of “somewhere”; another rural hospital that went bankrupt, along with over 100 others since 2020. For me, this cuts short and deep – from April 2019 to March 2021, Jennersville Hospital’s emergency department was my clinical home as an emergency physician.
Jennersville Hospital was a small, 63-bed community hospital in southern Chester County near the Delaware and Maryland borders. It changed ownership in 2017 and became part of the Tower Health system. It housed Medic 94, an EMS ambulance that served an area of over 200 square miles.
Contrary to what I was used to in Philadelphia, the patient population was largely white, nearly 20% Latinos and only 5% black. But the people I treated in the ER reflected the diversity of the region in a way that demographics alone could never illustrate. From mushroom growers, to horse breeders, to farm owners, to canners, to Herr factory workers, to students at Lincoln University (the nation’s first degree-granting HBCU) , Amish families, a full range of white-collar professionals, retirees in assisted living communities, or urban transplants, generations of the area had gone to Jennersville ED for care. As the impending closing neared, my heart sank for each one of them.
The hospital was not a trauma center, had no maternity services, no pediatricians, no psychiatrists or mental health services. But the emergency department took care of everything. We treated everyone, stabilized those who needed more, and facilitated transfers to other regional hospitals that could provide higher levels of care. The cohort of ER nurses had a work ethic and experience unmatched in the entire hospital. They knew the responsibilities they bore due to their geography and no other safeguards. I had to learn a new way of thinking and operating as a clinician, away from the many services and specialties that I took for granted. I never thought I would silently pray for calm and sunny weather while stabilizing a patient with a torn aorta, knowing that a helicopter ride to a cardiothoracic or vascular surgeon was their only chance of survival.
“I had to learn a new way of thinking and operating as a clinician, away from the many services and specialties that I took for granted.
It was also a new experience to be the only female doctor of color in a hospital setting. It took time for people to recognize me as the doctor in charge and for others to understand that I am American. “Are you from Syria? a man wearing head-to-toe MAGA gear once asked me. (“No, I’m from Route 48 in Greenville,” I told him.) As they were leaving, the husband looked me in the eye and said, “You took really good care of us, Doctor.” When I gave a warm blanket to a young child who lay awake at his mother’s bedside late into the night while we assessed his injuries and treated the wounds caused by his husband’s assault, he said, ” Thank you, my aunt”.
This small community hospital had incredible camaraderie and support, especially among those of us on the front lines. When our colleagues in the cafeteria hadn’t seen anyone from the ER, they would bring us leftovers, knowing that meant we had been too busy to eat. We helped each other find and buy PPE. Ahead of the 2020 elections, ED staff helped people register to vote and encouraged them to make their voices heard through civic engagement.
Each of the more than 100 hospitals that have closed since 2020 provided a safety net for the community they served. In 2018, over 14,000 people visited Jennersville ED. Now that it is closed, ambulance dispatch times will increase, further lengthening 911 response times throughout the region. For a seniors’ residence, the time to the nearest emergency room went from 10 minutes to 40 minutes on the day Jennersville closed.
READ MORE: Brandywine and Jennersville hospitals will close, leaving thousands in Chester County without emergency care nearby
COVID-19 has brought to light and then destroyed the razor-thin margins of hospital finances, as it forced many to cancel cost-effective, elective surgeries. But long before COVID, corporate business decisions — away from hospitable communities — doomed some rural facilities. Jennersville owner Tower Health quickly expanded into the area, then had to make drastic cuts to staff, including doctors, and spending to limit the huge losses it suffered as a result of the pandemic. That’s when I too had to leave.
The story of Jennersville Hospital illustrates the complexities and far-reaching impacts of valuing “margins over missions” – or putting profits before patients. As a result of this practice, I have seen highly skilled colleagues quit hospital work. I listened to patients justifying their decisions not to seek care earlier because of the difficulties and distance of access. I felt the mighty ripples of fewer inpatient beds available all the way in my Philly ED.
Will our leaders, government agencies, medical societies and elected officials heed the lessons Jennersville Hospital offers? Do we understand that community health is not a commodity that fits easily into capital markets and financial models with zero-sum outcomes, or fodder for private equity? Until we do, the stories and voices within hospitals must continue to shine a light on the issues of the community and the providers who care for them.
Unfortunately, there will be more stories to tell. Brandywine Hospital, another Tower-owned facility in Coatesville that served more than 21,000 patients in its emergency department in 2020, is scheduled to close Jan. 31.
Priya E. Mammen is an emergency physician and public health consultant. She is chair of the section on public health and preventive medicine at the College of Physicians of Philadelphia and assistant professor of health and societies at the University of Pennsylvania. She writes a monthly column on the future of public health in the region @PEMammen