AUSTIN — Come August, the southeast Texas city of Trinity will not only lose 60 jobs, but also the local hospital where its employees worked, leaving residents with a 20-mile trip to the nearest hospital.

“There wasn’t much we could do about it,” said Billy Slaughter, Trinity’s mayor. “All we can do is wait and see what happens.”

Perry Henderson, a senior vice president for the company that operates the hospital, East Texas Medical Center Regional Healthcare System, said in a statement that “due to changes in health care and low patient volumes at this facility, we can no longer afford to operate a hospital in this community.”

That’s a message that’s increasingly heard in Texas towns where a combination of factors — physician shortages, declining populations, consolidation, weak leadership, decreased reimbursements and increased costs — are creating a rural-healthcare crisis.

And the situation, according to a recently released study from the Texas A&M Health Science Center Rural and Community Health Institute, won’t be solved with a single prescription.

“It’s a national crisis,” said David Pearson, president/CEO of the Texas Organization of Rural & Community Hospitals. “Texas just happens to be ground zero.”

The report shows that rural Texans are more likely to be uninsured, have lower incomes and higher rates of death from heart disease and stroke than urban dwellers.

Sponsored by the Episcopal Health Foundation, the A&M report shows 17 rural hospital closings just in the 57 Texas counties that EHF serves. 

Of the total, only three re-opened; another two converted to emergency rooms.

That’s just part of the picture in a state where 1.9 million residents spread across 158  counties have no general surgeon.

In 147 counties, a total of 1.8 million people have no obstetrician/gynecologist. 

There’s no physician in 35 Texas counties, and researchers found that more than 15 percent of the rural U.S. hospitals closed since 2010 were in Texas.

“The maldistribution of the population in correlation with the location of health care providers appears to be the crux of the matter,” according to the report.

The political will to address the shortage can be tough to muster. 

A bill in Texas’ regular 2017 legislative session that would have created 36 rural residencies for new physicians failed to pass.

Yet, say the experts, in a state with 3 million rural residents  — about  11 percent  of the state’s population — curing what ails the system will take new approaches as well as additional doctors.

“We still have an American concept that every town should have a hospital,” Dr. Nancy Dickey, RCHI’s executive director, president emeritus of the Texas A&M Health Science Center and co-author of the report, said in a statement. “But the growing reality is that it’s not cost effective. 

The good news is there’s a menu of alternatives that can help optimize health care for a rural community, not shut down health care in that community.”

The report suggests regional partnerships and collaborations to meet unique community needs: working with a health system in the area to develop a primary care clinic with ties to the larger system, for example. 

Expanding telemedicine usage is also suggested. 

Yet, even as the Houston County city of Crockett, population 6,500, was dealing with the closing of its hospital in June, residents of Clarksville were shaking their heads over an equally profound, but different piece of news: construction is soon to start that will reopen its hospital, closed since 2014. 

Closing the old hospital, which opened in 1937, was like having bomb dropped on the city of 3,200, Red River County Judge L.D. Williamson said.

The prospect of a $25 million privately owned replacement was equally stunning. 

Williamson said “we have had people that probably wouldn’t have died” if they had not been faced with a 32-mile trip to the nearest hospital in Paris.

“It’s the greatest thing in the world,” Williamson said of the hospital news. “The day it was announced you would have thought we were going to get a Ford factory.”

The Department of Agriculture is guaranteeing 80 percent of a $10 million loan to finance the deal, Williamson said. 

Dr. A.J. Hashmi, a cardiologist, is spearheading the project. 

Construction will begin soon and equipment is already being tested, Hashmi said.

Hashmi won’t identify the investors, but said most are “interested in hotels and also in hospitals.”

And as the authors of the study suggest, Hashmi is looking at alternatives beyond the usual rural-hospital model.

“It will be a regular hospital to begin with but we want to create something that in time we want to build into a world-class clinic like the Mayo Clinic,” in one of Texas’ poorest counties, Hashmi said. “Why do people go to Rochester, Minnesota?

“It’s a dead town. They go because it’s the ultimate in health care.” 

John Austin covers the Texas Statehouse for CNHI’s newspapers and websites. Reach him at

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