Iron County is one of the state’s least healthy counties, according to the Missouri Health Atlas.

So when Iron County Medical Center in Pilot Knob, about 85 miles southwest of St. Louis, filed for bankruptcy protection last year, there was great concern.

“We’re all people around here have. It’s a very impoverished area,” said Joshua Gilmore, the CEO of the hospital.

Gilmore met with creditors, Medicare and Medicaid officials, and created a plan to return to solvency in five years.

Everyone was on board, except the U.S. Department of Agriculture, which had given Iron County Medical Center a rural development loan, and is still owed $7 million.

The USDA went to court opposing the hospital’s plan, insisting that it be repaid before any other creditor. The plan was to defer those payments for five years.

The USDA directed questions on the matter to the Department of Justice, which did not respond to requests for comment.

Gilmore said he was baffled by the USDA’s position.

“Logic would say they would come to the table and be excited that we’re generating sustainability so we can keep our doors open and take care of the impoverished people of this region,” Gilmore said.

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Gilmore said if it has to pay back the USDA first, the hospital will likely close.

“If we keep the doors open for the long term, everybody wins. The patients win. This region wins. We’re able to provide services to people that otherwise would not be able to receive the services,” Gilmore said. “Plus, you can’t get money from a hospital that is closed.”

A judge has ordered the USDA and the medical center to continue negotiations. The matter is scheduled to return to court in August.

If the center closes, it would be the sixth rural hospital in Missouri to shut down in the past 10 years.

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