When Tonopah’s hospital closed in 2015, it didn’t just leave the town without an emergency room – it left the region without one, too.

"Currently, it is kind of nice because a lot of the panic that we felt in 2015 and '16 has ebbed," said Lorinda Wichman, who is a Nye County Commissioner, "It's been relatively quiet lately."

She said some of the medical services that have been put in place since the closure like the opening of the Renown clinic and the community paramedic services have helped.

But the reality is the community does not have a full-time medical facility. It’s an uphill battle to get one as healthcare providers have been unwilling to reopen a hospital in a town where the population isn’t big enough to pay for round-the-clock care.

The recently formed Northern Nye County Hospital District is working to move that process along. It was created with an increase in property taxes in seven tax districts in the county

"Naturally, the presence of a hospital in a community or region is a stabilizing factor that is often overlooked until its gone," said Karmin Greber, a board member of the hospital district.

She said even after the panic subsided the impact of losing the hospital caught up with the community in ways many people may not realize. For example, she said it difficult to recruit new teachers when older teachers retire.

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"It's hard to get a family to come here, a teacher and their family, when there is no health care," she said.

John McCormick is the general manager of the historic Mizpah Hotel in Tonopah. He agreed that a lack of health care has hurt his efforts to hire people outside of the community.

"My experience with recruiting staff, especially if it's management people that we're trying to bring in from outside of the area, that has been a stumbling block for some of those folks," he said.

McCormick said while the owners of the hotel provide excellent health care benefits employees struggle to take advantage because the care is so far away.

"Beyond that basic health care that is provided here in town, if somebody needs to get an MRI, if somebody needs to get something beyond basic blood testing, they literally have to take a day off of work to do that," he said, "Sometimes a couple of days off of work. Sometimes they have to get a hotel room for their appointment the following day."

Greber said mining companies in the area have even established their own health clinics for their employees and their families to fill the gap. But that can be expensive and hurt a company's ability to be financially successful.

While there is no question that there is a need for more medical care in Tonopah, there is a question of whether a full-time hospital is the answer.

John Packham is the associate dean for the Office of Statewide Initiatives at the University of Nevada, Reno School of Medicine. Its mission is to improve healthcare around the state.

He said one of the problems with the Nye Regional Medical Center, which closed in 2015, and other rural health centers is there are not enough in-patients to justify a full hospital.

Another issue is what he called a "challenging patient mix." Packham pointed out that rural patients are more likely to be older, sicker and more reliant on public health assistance than more urban areas.

Packham is not entirely sure that Tonopah will ever get a fully state-certified hospital back but a variation might be more appropriate.

"I was recently in the clinic in Eureka, comparable population to the Tonopah area, and that's a great example what I consider to be medical services very appropriate to the community," he said, "They don't have a hospital but they have an outpatient clinic... that's open six days a week. They have a great little ER bay. So they're able to take ambulance calls there... they have the latest great diagnostic services with lab and radiology."

Packham said the operation in Eureka is a really good fit for that community.

Greber agreed that Tonopah may not get back what people traditionally think of as a 'hospital' but the hospital district is working towards a "medical resource" to fill the community's needs.

"Where it may not be the traditional, 25-plus-bed in-patient facility, that you see bustling in a metropolitan or even some rural areas, it will be a center for the region to come and receive the 24-hour service at the moment that they need it," she said.

Right now, the hospital district is laying the groundwork for what facilities will be needed and how the old hospital might be upgraded to meet those needs.