Since 2010, about 150 rural hospitals have shuttered and hundreds more have slashed services, leaving a growing number of America’s 60 million rural residents in health care deserts.

In this 2020 encore episode of the “Tradeoffs” podcast, Dan Gorenstein talks with Ģ��ӰԺ Health News chief rural health correspondent Sarah Jane Tribble about her yearlong effort to document the collapse of one rural Kansas community hospital. Nearly six years later, the residents of Fort Scott, Kansas, still live without a local hospital, a reality visited upon dozens more small towns in the years since.

“We’re talking about millions of lives affected by the kind of health care delivery that’s in these communities,” Tribble said. “Rural America, on a whole, is poorer, sicker and older than urban America. People whose lives are affected daily by chronic health issues.”

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Host Sarah Jane Tribble sets out on a mission to learn more about the Sisters of Mercy, the nuns who founded Fort Scott’s Mercy Hospital and were once prominent leaders of the community. Tribble’s first glimpse into their lives takes her to an old convent. To learn more about the founding of Fort Scott’s hospital, listen to Episode Four.

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How’s Josh?

Before Fort Scott’s hospital shut down, Josh was a teenager coping with his aging grandparents and the emotional burden of his mother’s opioid death. The family’s troubles worsened after the hospital closed. Tribble gives Josh a call to find out his next steps. If you want to hear more of Josh’s story, we tell it in Episode Six.

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“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

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Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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Family physician Maxwell Self is doing his same old job for a new employer. For two decades he was a doctor with Mercy Hospital. But when Mercy packed up and left, a federally qualified health center moved to town — into the hospital building itself — and hired Dr. Self.

The Community Health Center of Southeast Kansas does things differently.

“What CHC says really has teeth and they’re solid,” Self said. “There’s real follow-through. And I have a lot more, I feel like, freedom to take care of people the way I want to and to get them what they need.”

With nutrition counseling and mental health and addiction services, and even things like arranging rides for patients, the center offers people what they need to be healthy, clinic executives said — not only health care for when they’re sick.

In the final chapter of the podcast, we also meet Sherise Beckham, 31, who lost work as a dietitian at Mercy when the hospital closed — just as she was expecting her second child.

“Initially, I cried a lot because I would be losing my job as well as losing a place to have my baby,” Beckham said.

Beckham helps explain how much more difficult it can be to have a baby when a town loses full-service maternity care. Then, later when she gets a job at — where else? — the new CHC clinic, Beckham gives us a front-row seat to the new vision for health care in Fort Scott.

“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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Josh is 17. He said he smokes marijuana. He struggles with anger.

He’s also juggling some extraordinary responsibilities for a teenager. Josh’s mother died of a drug overdose when he was 3 years old and he has lived with his grandparents ever since. When his grandfather’s heart started failing, Josh and his grandmother followed as his grandfather was shuttled from one regional hospital to another. The family couldn’t pay their light bill and struggled to find the money to pay for gas for the car. They wanted to stay nearby as Josh’s grandfather recovered in the hospital, but paying for a hotel was another financial burden.

Josh said he had to be there to help even though it meant missing school.

“I’m just taking care of my family. I’m doing what I was raised and taught to do,” he said. “Gotta survive. Family sticks together.”

To protect his privacy and because Josh was a minor when he shared his story, we are not including his last name.

In Chapter 6 of “No Mercy,” he talks about the health care challenges his family faces — and his own struggles growing up in a town where drugs are readily available but jobs aren’t.

The podcast also spotlights new health services now available in Fort Scott. Mercy Hospital, which closed at the end of 2018, did not provide addiction or behavioral health services, but the new community health center in town does.

“I get the privilege of working with hardworking, blue-collared folks and they oftentimes view, you know, depression, anxiety or bipolar disorder or battles with addiction as a weakness,” said Eric Thomason, director of addiction treatment and behavioral health services.

“And there’s no hardworking person that wants to just sit here and admit that they have a problem. And so a lot of times we avoid it. And what happens when we avoid chronic illness, regardless of if it’s diabetes, hypertension or depression, is it gets worse.”

Thomason said part of the health center’s work is convincing people to feel comfortable enough to come in and get help.

“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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• Listen to the Oct. 1 episode of KHN’s “What the Health?” podcast, hosted by Rovner: “Election Preview: What’s Next for Health?”
• Read Rovner’s “Biden’s Big Health Agenda Won’t Be Easy to Achieve”

Columnist and California Healthline senior correspondent Bernard Wolfson discussed the possible impact of Judge Amy Coney Barrett and the Supreme Court on the ACA with KPCC’s “Take Two” on Tuesday.

California Healthline correspondent Rachel Bluth discussed California’s Proposition 14 about stem cell research funding and Proposition 22 about classifying drivers for ride-share and delivry apps as independent contracts with KIQI 1010 AM’s “Hecho en California” on Friday.

• Read Bluth’s “Californians Asked to Pony Up for Stem Cell Research — Again”
• Read Bluth’s “App-Based Companies Pushing Prop. 22 Say Drivers Will Get Health Benefits. Will They?”

California Healthline correspondent Angela Hart discussed California’s Proposition 15 — the commercial property tax ballot measure — and what it means for public health funding with KIQI 1010 AM’s “Hecho en California” on Thursday.

• Read Hart’s “Health Care Groups Dive Into Property Tax Ballot Fight, Eyeing Public Health Money”

California Healthline correspondent Samantha Young discussed California’s Proposition 23 — the dialysis ballot measure — with KIQI 1010 AM’s “Hecho en California” on Thursday.

• Read Young’s “Déjà Vu for California Voters on Dialysis”

KHN senior Colorado correspondent Markian Hawryluk discussed how health care may shape the U.S. Senate race in Colorado with Colorado Public Radio’s “Colorado Matters” on Thursday.

• Read Hawryluk’s “Opposition to Obamacare Becomes Political Liability for GOP Incumbents”

KHN senior correspondent Sarah Jane Tribble discussed KHN’s “Where It Hurts” podcast and COVID-19 in rural America with NPR’s “Weekend Edition” on Oct. 17.

• Tribble hosts “No Mercy,” the first season of “Where It Hurts.” Click here to listen to Chapter One.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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Sixty-five-year-old Karen Endicott-Coyan is living with a blood cancer.  Her chemotherapy takes less than 30 minutes. Before the hospital closed, it was just a short drive into the small town of Fort Scott, Kansas, for her to get treatment.

But these days getting to chemo means a trek on rural roads and narrow highways, driving help from her sister-in-law and some Ritz crackers tucked into her purse to steady her stomach on the way home. The whole trip should take less than three hours. Endicott-Coyan puts on her makeup, her diamond earrings and powers through.

“If I can help it, I’m not going to go over there looking like a sick person,” Endicott-Coyan said. “I don’t like looking like a sick person. That’s just me.”

Endicott-Coyan had a long career in hospital administration, and she uses that expertise to try to smooth out her newly fractured health care. But during every minute of the trip, a nagging worry at home steals her energy and attention. In this chapter of the podcast, host-reporter Sarah Jane Tribble goes along for the ride and is witness to the stress and frustration.

The journey illuminates one reason people in rural America are more likely to die from cancer than patients in metro areas.

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And check out Sarah Jane Tribble’s previous reporting on rural cancer care.

“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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Ever since Mercy Hospital went “corporate,” things just haven’t been the same — that’s what lots of locals in Fort Scott, Kansas, said when the Mercy health system shuttered the only hospital in town.

It’s been years since Catholic nuns led Mercy Hospital Fort Scott, but town historian Fred Campbell is wistful for his boyhood in the 1940s when sisters in habits walked the hallways.

“Well, I had never, ever been in a hospital. And here came these ladies in flowing robes and white bands around their faces. And I was scared to death. But it wasn’t long ’til I found that, first thing I know, they had some iced Coca-Cola. I still remember them putting their hand on my head to see if I had a fever.”

For more than 100 years, Mercy Hospital — and the nuns who started it all — cared for local people. But in recent years, Fort Scott’s economy and the hospital’s finances faltered. Campbell hoped both could survive.

“Mercy Corporation, can you stay with us longer?” he wondered.

In Chapter 4 of Season One: No Mercy, podcast host Sarah Jane Tribble carries that question to Sister Mary Roch Rocklage, the powerhouse who consolidated all the Mercy hospitals in the Midwest.

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“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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Emergency care gets complicated after a hospital closes. On a cold February evening, when Robert Findley fell and hit his head on a patch of ice, his wife, Linda, called 911. The delays that came next exposed the frayed patchwork that sometimes stands in for rural health care.

After Mercy Hospital Fort Scott shut down, many locals had big opinions about what kind of health care the town needed.

“Words of experience is, you don’t know when that tragedy is going to happen,” Linda Findley said.

Fort Scott’s free-standing ER and the new community health center aren’t enough, she said.

“I mean, my gosh, you need to feel like you’re safe and could be taken care of where you’re at,” she said.

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“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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Closing a hospital hurts. In Fort Scott, Kansas, no one was a bigger symbol for that loss — or bigger target for the town’s anger — than hospital president Reta Baker. Baker was at the helm when the hospital doors closed.

“I don’t even like going out in the community anymore, because I get confronted all the time,” Baker said. “Someone confronted me at Walmart. You know — ‘How could you let this happen?’”

The closure put Baker at bitter odds with City Manager Dave Martin, who some in town call “the Little Trump” of Fort Scott. Martin said his town wasn’t given the chance to keep the hospital open.

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“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

Midwesterners aren’t known for complaining. But after Mercy Hospital Fort Scott closed, hardship trickled down to people whose lives were already hard. In Chapter 1, we meet Pat Wheeler, who has emphysema. Her husband, Ralph, has end-stage kidney failure, and the couple are barely making ends meet as they raise their teenage grandson. Pat is angry with hospital executives who she said yanked a lifeline from residents. “I don’t understand how they can just so blatantly close the hospital. I mean, I understand dollars and cents,” Wheeler said. “But at the same token, where’s the humanity? You know, what are people like us supposed to do?” she said.

Many others felt the same. Fort Scott City Manager Dave Martin felt betrayed. And former, longtime hospital worker Roxine Poznich said: “You just don’t know the pain that the employees were in — not just for themselves, but for the community. I mean, there were lots and lots of tears that I saw. And it was just very sad because those people, they were my family,” she said.

Each season, “” takes you somewhere new — to an overlooked part of the country to explore cracks in the American health system that leave people frustrated — and without the care they need.

The story begins in Fort Scott, Kansas. Rural. Deeply Christian. And sicker than other parts of the state. When Mercy Hospital shut its doors, the town’s sense of identity wavered. Season One “No Mercy” is about the people who remain, surviving the best way they know how. Host and investigative journalist Sarah Jane Tribble spent more than a year revisiting southeastern Kansas, where she grew up, to document the sparking tensions, anger and fear many people felt as they struggled to come to terms with the hospital’s closure.

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“Where It Hurts” is a podcast collaboration between KHN and St. Louis Public Radio. Season One extends the storytelling from Sarah Jane Tribble’s award-winning series, “No Mercy.”

Subscribe to Where It Hurts on , , , or .

And to hear all KHN podcasts,��click here.

Ģ��ӰԺ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Ģ��ӰԺ—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).