One Monday in February, 65-year-old Karen Endicott-Coyan gripped the wheel of her black 2014 Ford Taurus with both hands as she made the hour-long drive from her farm near Fort Scott to Chanute. With a rare form of multiple myeloma, she requires weekly chemotherapy injections to keep the cancer at bay.
She made the trip in pain, having skipped her morphine for the day to be able to drive safely. Since she sometimes ?gets the pukes? after treatment, she had her neighbor and friend Shirley Palmer, 76, come along to drive her back.
Continuity of care is crucial for cancer patients in the midst of treatment, which often requires frequent repeated outpatient visits. So when Mercy Hospital Fort Scott, the rural hospital in Endicott-Coyan?s hometown, was slated to close its doors at the end of 2018, hospital officials had arranged for its cancer clinic ? called the ?Unit of Hope? ? to remain open.
Then ?I got the email on Jan. 15,? said Reta Baker, the hospital?s CEO. It informed her that Cancer Center of Kansas, the contractor that operated and staffed the unit, had decided to shut it down too, just two weeks later.
?There are too many changes in that town? to keep the cancer center open, Yoosaf ?Abe? Abraham, chief operating officer of the Cancer Center of Kansas, later told KHN. He added that patients would be ?OK? because they could get treated at the center?s offices in Chanute and Parsons.
From Fort Scott, those facilities are 50 and 63 miles away, respectively.
For Endicott-Coyan and dozens of other cancer patients, the distance meant new challenges getting lifesaving treatment. ?You have a flat tire, and there is nothing out here,? Endicott-Coyan said, waving her arm toward the open sky and the pastures dotted with black Angus and white-faced Hereford cattle on either side of the shoulderless, narrow highway she now must drive to get to her chemo appointment.
NATIONWIDE, more than 100 rural hospitals have closed since 2010. In each case, a unique but familiar loss occurs. Residents, of course, lose health care services as wards are shut and doctors and nurses begin to move away.
But the ripple effect can be equally devastating. The economic vitality of a community takes a blow without the hospital?s high-paying jobs and it becomes more difficult for other industries to attract workers who want to live in a town with a hospital. Whatever remains is at risk of withering without the support of the stabilizing institution.
The 7,800 residents of Fort Scott are reeling from the loss of their 132-year-old community hospital that was closed at the end of December by Mercy, a St. Louis-based nonprofit health system. Founded on the frontier in the 19th century and rebuilt into a 69-bed modern facility in 2002, the hospital had outlived its use, with largely empty inpatient beds, the parent company said. For the next year, Kaiser Health News and NPR will track how its citizens fare after the closure in the hopes of answering pressing national questions: Do citizens in small communities like Fort Scott need a traditional hospital for their health needs? If not a hospital, what then?
When Wichita-based Cancer Center for Kansas closed its Fort Scott location, patients were told to travel to Parsons or Chanute to continue seeing their oncologist and receiving treatment. This map provides a look at what that meant in miles.
Endicott-Coyan and her husband, John Coyan, laugh while sitting in their kitchen. John, 74, began showing signs of dementia in 2015. Together, they run a cow-calf operation on 240 acres south of Fort Scott and go to church every Sunday. KAISER HEALTH NEWS/CHRISTOPHER SMITH/KCUR.ORG
RETA BAKER, the hospital?s president who grew up on a farm south of Fort Scott, understood that the hospital?s closure was unavoidable. She scrambled to make sure basic health care needs would be met. Mercy agreed to keep the building open and lights on until 2021. And Baker recruited a federally qualified health center to take over four outpatient clinics, including one inside the hospital; former employees were bought out and continue to operate a rehabilitation center; and the nonprofit Ascension Via Christi Hospital in Pittsburg reopened the emergency department in February.
But cancer care in rural areas, which requires specialists and the purchase and storage of a range of oncology drugs, presents unique challenges.
Rural cancer patients typically spend 66% more time traveling each way to treatment than those who live in more urban areas, according to a recent national survey by ASCO, the American Society of Clinical Oncology. Dr. Monica Bertagnolli, a cattle rancher?s daughter who is now chair of ASCO?s board, called this a ?tremendous burden.? Cancer care, she explained, is ?not just one visit and you?re done.?
