Dave Boucher

dboucher@tennessean.com



SELMER, Tenn. — Rockabilly means something to the people of Selmer.

The road that's carried the likes of Elvis Presley to and from Tupelo, Miss., passes through the heart of this small community in the southern portion of McNairy County, about 90 miles east of Memphis.

So the annual Rockabilly Highway Revival Festival and Car Show is perhaps one of the county's biggest draws, apart from lawman Buford Pusser of "Walking Tall" fame. The streets of Selmer were packed one recent June weekend to see the annual parade and festivities.

No one saw the 91-year-old man's 1987 Ford Crown Victoria driving toward the crowd until it was too late. The car blasted through a barricade before hitting and killing two people.

McNairy County Mayor Ronnie Brooks knows it could've been much worse — during a 2007 car show, six people died and 20 were injured in an accident. At that time, McNairy Regional Hospital was open and right down the road. Now it's closed.

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"Knowing that it was there does give you some comfort," said Brooks, who lives across the street from the now-closed hospital. "And I think that comfort has been disturbed since (the hospital closure) has happened.”

Tennova Healthcare, owned by Community Health Services, announced in March that the hospital would shutter its doors in May. The company cited several issues, including structural problems with the building, fewer patients and less federal funding.

A slew of other rural community hospitals in Tennessee and across the country are facing the same problems that are outweighing financial benefits for the larger companies that own the facilities. The changes affect the economy and culture of a community.

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It's affecting the state Senate race in Selmer, which is represented by state Sen. Dolores Gresham. A billboard a few blocks from the courthouse reads "Miss your hospital? Dolores didn't fight for it. Bob Shutt will." In a statement, Gresham points the finger at the Affordable Care Act. In states such as Tennessee where Medicaid eligibility has not been expanded to more income levels as part of the controversial federal health care law, rural hospitals are struggling because of a decrease in their federal reimbursement rates.

All that matters to brothers Richard and John Prindes is a hospital that's conveniently close and doesn't require a long wait. In the past, Richard Prindes, 73, who suffers from several chronic ailments, would go to McNairy Regional for any emergency or other treatment he might need. But now he needs to get a ride to Jackson from John Prindes, who lives more than 20 miles away in Savannah. On one of their recent trips to the emergency room, John said they had to wait six hours before they were seen.

"They all think it's terrible," Richard Prindes said, when asked what his friends and neighbors think about the hospital closing.

He sighed when asked if he thought any hospital would come back.

"I guess I hope it will," he said.

'Do what you can, with what you have, where you are'

The brothers were walking out of the Frix Jennings Clinic, one of several clinics that have seen an increase in patients since the hospital's closure. Nurse practitioner Pam Riley said many patients coming to them had previously used the hospital for lab tests or similar procedures. However, there are some cases they just can't handle. Riley, 35, who's lived in Selmer her whole life, said now there's no health facility in the town for delivering a baby.

Selmer and McNairy County are in the minority when it comes to rural communities losing hospitals, in that no immediate replacement or second option is open. Although at least eight rural Tennessee hospitals have closed or merged since 2013, five have been replaced by other satellite campuses of health systems or other clinics trying to fill the community's health services niche.

But that could change soon.

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Brooks, a 60-year-old former teacher who's lived in Selmer his whole life, has a framed quote from Teddy Roosevelt near his desk: "Do what you can, with what you have, where you are." As county inmates mop the courthouse floors and a technician works on an aging elevator just outside his office, Brooks says the county and city are piecing together future health care options for the community.

"We’ll have a system in place that will make the citizens feel more comfortable, but probably an inpatient care facility is probably a thing of the past. I really feel that," Brooks said.

At least three health systems are interested in having some facility in Selmer, Brooks said, noting ongoing negotiations are confidential. CHS also wants to give the building where the hospital was located back to the county; Brooks said if negotiations go well the county could have possession of the building by early August.

Acknowledging inpatient services are unlikely, he hopes any facility would offer emergency services, diagnostics, radiology, some lab work and maybe even limited outpatient services.

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'You've got to have some type of specialty'

Magnolia Regional Health Center in Corinth, Miss., is one of those facilities. The hospital's already seen the number of patients from McNairy County increase 12 percent from October to May, before the Selmer hospital closed, said Magnolia Chief Operating Officer Angela Nowlin. After the closure, she said in one recent day there were five ambulance runs to the hospital from Selmer alone.

But that presents problems, too: as a Mississippi hospital, Magnolia can't accept TennCare, the Tennessee Medicaid program. Nowlin said they've been negotiating with Tennessee officials for a year on some compromise, but nothing is imminent.

During her 13 years with the hospital, Nowlin says she's seen the struggles of McNairy Regional affect many other smaller rural hospitals as well. Even at her facility, which has 200 beds, she said it's a challenge to recruit the specialists needed to keep patient traffic up.

"I think the thing that hurts them most of all is to keep an inpatient side of the business, you've got to have some type of specialty," Nowlin said, adding she believes the traditional hospital will be replaced in these communities with smaller facilities offering some of the most-used services from a hospital.

"I think that's what you're going to see. I think you're going to see a possible ER, outpatient, diagnostic satellites."

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For Cindy Cain and many other Selmer residents, the emergency services and emergency department are key. CHS is still operating the county's Emergency Medical Services, and the county is paying for life flights. But now when the ambulance arrives at an emergency in Selmer, EMS technicians ask patients where they want to be taken.

A little more than six years ago, Cain's husband had a stroke in the middle of the night. By the time he arrived at McNairy Regional he had stopped breathing. But the doctors were able to make the right decisions to stabilize him for the helicopter ride that eventually saved his life.

"The EMS people are wonderful, but they are not doctors. He needed that emergency room doctor to make that call," Cain said.

Finding solutions

Limited health care services in rural Selmer would be welcome in light of the hospital's closure, but whatever lands in the community won't be the same. Iley Sisk, 79, says he was the second patient admitted to the hospital when it opened in 1961; he said his friend Bobby was the first, admitted after a car accident.

Sisk, who stopped his shopping for peaches on a sunny summer day to discuss the hospital, said that when the hospital opened everyone was excited that there were great doctors in the area. Now, he wishes something like the Magnolia hospital would open in Selmer.

When Joe Miller had a recent health problem, he and his wife, Sharon, decided to go to McNairy Regional instead of Jackson. They'd taken their daughter Elizabeth to Jackson before but had the same long wait times as other Selmer residents.

"I was glad it wasn't 50 miles away," said Joe Miller, 55, referring to the local emergency room.

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The Millers moved to Selmer from Arizona three years ago to grow peaches. They wanted to try something new in a new place and liked the small community feel of Selmer. The local hospital was only a few miles from the Selmer Farmers Market, where the Millers are the lone vendor on this particular day. It's proximity and size was part of its appeal: Joe Miller compared it to going to the local hardware store instead of a big box store.

But even when he used the hospital, he questioned how long it could survive.

"There were only five patients in the whole hospital when I was there," he said.

He knows people in rural communities across the country are asking the same questions. Brooks and health care officials hope they can find the right answers.

Reach Dave Boucher at 615-259-8892 and on Twitter @Dave_Boucher1.