Throughout Tennessee and the nation, rural hospitals are struggling to stay open.

Copper Basin Medical Center, a 62-year-old hospital in Ducktown, Tenn., closed in October 2017.

Ducktown residents say they now fear illness, crisis or surprise bills from out-of-state hospitals.

DUCKTOWN, Tenn. — The halls of Copper Basin Medical Center are as cold and still as a corpse.

Hospital supplies that may never be used — scrubs, gloves, catheters and oxygen masks — sit half-packed in cardboard boxes along walls of a darkened central hallway. Decades of medical records, color-coded in manila folders, wait to be transferred to somewhere else. In a reception room, where patients once gathered to see the few doctors in the region, an artificial Christmas tree has stood for more than a year because there is no one to take it down.

Doug Collins, a small-town mayor, fumbles with the keys to the operating room, eager to show off where the hospital’s most important work was done. Inside, daylight bleeds through a clouded window, illuminating a surgical chair covered in a faint layer of dust.

Most of Ducktown has ties to this hospital, the mayor says. It pained them to watch it die.

“The new governor, I hear this issue is his baby,” Collins adds, his voice thick with an Appalachian twang, as he explores the shuttered, powerless hospital on a frigid day in December. “He is supposed to do something to help. A new hospital would be great, but even just a few beds — just a standalone ER — is what we need right now.”

For 62 years, Copper Basin Medical Center, an independently owned hospital with about 25 beds, served Ducktown, Copperhill and the other old mining communities of Polk County, which is home to 17,000 people in Tennessee’s southeastern corner.

But mounting debt pushed Copper Basin to close its doors for the final time 16 months ago, becoming one of the growing number of casualties in an ongoing struggle to maintain rural hospitals throughout the state and the nation as a whole. As health care has become more expensive and health insurance lags, many rural hospitals have been unable to pay their bills, forcing them to shrink or close, creating health care deserts in poor, far-flung towns where residents are often the most vulnerable.

The crisis of hospital closures now falls to new Gov. Bill Lee, who campaigned heavily as a countryside candidate who would help and protect Tennessee’s underserved, rural areas. So far, Lee has promised money and expertise to support rural hospitals, but it remains to be seen if the governor can find a fix before more facilities shut down.

In the meantime, Ducktown remains without. In more than 20 interviews conducted in the town and the surrounding area, residents say the closure of Copper Basin Medical Center left them with a precarious choice: travel about an hour for medical attention or risk surprise bills at an out-of-state hospital. With one voice, they longed for the days when Copper Basin was still open.

“I know they were a small hospital,” said Rick Queen, 70. “But let’s say I had a heart attack and they couldn’t treat me? They’d get me out of here. In five minutes I’d be in a helicopter.”

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A long, winding drive to Chattanooga

Since Copper Basin closed, the next closest hospital is Fannin Regional Hospital about 10 miles away in Blue Ridge, Georgia. But, because Fannin is across state lines, insurance can be complicated: Fannin accepts only some TennCare coverage; only some Tennessee Obamacare coverage; and does not accept Medicare Advantage coverage from Blue Cross and Blue Shield of Tennessee, the largest insurer in the state. Many Ducktown residents simply don’t know if they are covered at Fannin or not, so they don’t go.

Instead, residents in this region have come to rely on hospitals in Cleveland and Chattanooga, which are about an hour and 90 minutes away, respectively. To reach either hospital you drive down a two-lane mountain highway along the winding Ocoee River that is susceptible to closure by car accidents and rock slides. In 2009, a rock slide closed the road for months, making the drive to Cleveland into a two-hour detour.

Nowadays, that’s a nightmare scenario of residents like Kent and Rhonda Kisselburg, grandparents who need regular visits to hospitals outside Polk County.

Kent, 47, who was a construction worker for two decades, suffers from pervasive back problems. Rhonda, 51, has a long history of poor health and needs regular blood tests to monitor her liver and kidneys. Their grandchildren, Makayla, 7, and Bentley, 5, have DICER1 syndrome, a genetic disorder that causes tumor growth and requires them to be scanned for new tumors every few months.

Copper Basin Medical Center wasn't advanced enough to treat DICER1, but workers there could detect it. Bentley’s condition was first discovered during a routine scan at the hospital three years ago. The Kisselburgs credit Copper Basin with saving their grandson’s life.

“If it wouldn’t have been for that hospital, I'd probably not have my grandson," Kent said, gesturing toward the shuttered hospital. "He grew a 17-pound tumor in six months, and he lost half a lung because he had a spot in his lung too. They caught every bit of it right up here."

Tennessee lost at least 10 rural hospitals

Ducktown is far from the only Tennessee town to feel the sting of a dead hospital.

Across Tennessee, at least nine rural hospitals have closed their doors since 2012, according to media reports and records kept by the Tennessee Hospital Association. A 10th facility, Cumberland River Hospital, is scheduled to close in March. Others have eliminated all inpatient services, becoming husks of their former selves.

Many closures are clustered in the midwestern counties surrounding Jackson, which lost three hospitals — Gibson General, Humboldt General and Haywood Park Community Hospital — all in 2014.

In hopes of stopping this hemorrhaging, Tennessee lawmakers last summer passed the Tennessee Rural Hospital Transformation Act, which sets aside $3 million to hire consultants to help rural hospitals become more financially viable.

The selection process has taken months, but officials expect to ink a deal with the chosen consultants, Navigant Consulting, as soon as next week, said Jennifer McEachern, a state government spokeswoman.

Lee has called the law a “solid framework” for helping rural communities keep their hospitals.

“In building on this framework, Gov. Lee plans to convene hospital CEOs and experts from across the health care industry to develop best practices and recommendations for rural health care delivery,” governor's spokeswoman Laine Arnold said in a written statement. “We will ensure there are dedicated resources in place to support the successful implementation of the Tennessee Rural Hospital Transformation Act in its first year.”

Democrats, unsurprisingly, push a different approach, insisting that Medicaid expansion would bring more health coverage to rural areas, therefore generating more revenue for struggling hospitals. Democratic gubernatorial candidate Karl Dean made expansion the central issue of his campaign last year, but expansion did not resonate with voters even in the counties where hospitals were in jeopardy. With the lone exception of Haywood County, Lee resoundingly defeated Dean in rural regions that had lost hospitals.

Regardless, some advocates continue to argue that expansion is the best hope for saving the rural hospitals that are left. Among them is Jill Holland, the mayor of McKenzie, Tennessee, a town of 5,000 that closed its hospital in September, deeply wounding the local economy.

Holland insists that expansion would have saved McKenzie Regional Hospital.

“We appreciate consultants and advice, but at the end of the day, our hospitals are like other businesses,” Holland said during a January protest on the steps of the legislature. “There is no substitute for the revenue they need to meet their expenses. We need the state to not just give us advice but help us tap any revenues that are available.”

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Copper Basin: Built by dads and granddads

Although rural hospitals are closing throughout Tennessee, few communities had the same relationship to their hospitals as Ducktown.

Ducktown and the surrounding towns, known collectively as the Copper Basin, were founded as mining towns shortly before the Civil War. Mining thrived into the second half of the 20th century, eventually spawning a secondary industry of manufacturing sulfuric acid. Eventually, industry in the Copper Basin grew to the point that it demanded a hospital, so miners donated from their paychecks to fund construction, creating a hospital that the region built for itself.

Copper Basin Medical Center opened on Aug. 28, 1955, with 20 employees, including nine doctors and a dentist.

“It wasn’t just that some doctor decided to open a hospital. The town did,” said Ken Rush, longtime director of the Ducktown Basin Museum. “It was truly theirs.”

Eventually the hospital outlasted the industry it was built to support. The last Copper Basin mine closed in 1987, and acid manufacturing shrunk until it ended in 2008, leaving the medical center as the largest private employer in Polk County.

But the county’s close ties to Copper Basin Medical Center also contributed to the hospital’s downfall, said Collins, the Ducktown mayor, who is also a former member of the hospital’s board. In the waning years at Copper Basin, hospital leadership rebuffed an offer to sell the facility to Erlanger Health Systems, a Chattanooga-based hospital chain that thought it could turn the facility around.

The choice was clear — sell or close — but the board wasn’t willing to let go, Collins said.

“I didn’t want to sell it at first, but then I came to realize that we couldn’t do it anymore,” Collins said. “But we had some of the older blood who decided there was no way we were going to sell.”

Ultimately, Copper Basin shut down in October 2017, still owing about $100,000 to its employees. Residents launched a GoFundMe page to raise funds but collected only about $5,700. The town also planned to auction off hospital supplies, but the event was canceled for legal reasons.

The closure was a personal blow to residents like Dawna Standridge, 77, who has lived her entire life in Ducktown. Her father and uncle, both miners, contributed to the construction of the hospital. All three of her children were born there. One of her daughters later became the director of nursing.

For decades, Standridge said, Copper Basin Medical Center was a dependable, comforting pillar in her small-town corner of Tennessee. Now it’s not. If she had a medical emergency tomorrow, she said, she is not entirely sure where she would go.

“We need our hospital,” Standridge said. “We really do.”

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Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.

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