Nearly 28,000 people relied on Glenn Medical center for its services, but now they will have to travel more than 30 miles for care.
For the better part of a century, Glenn Medical center dealt with all kinds of injuries, ailments and emergencies in the far northern reaches of California's Sacramento valley - heart attacks, car collisions and even plane crashes.
The only hospital in this agricultural county, not far from the rice fields and almond orchards, many of the area's 28,000 residents have a story about how the hospital saved them, or a loved one, said Lauren Still, the medical center's chief administrative officer.
But at 7pm on 30 September the hospital closed after 75 years.
Glenn Medical center could not keep its doors open after the federal government moved this year to eliminate its critical access designation, a special status for hospitals that helps ensure access to emergency health care in rural communities, officials said.
The Centers for Medicare & Medicaid Services (CMS) determined that the hospital no longer met the distance requirement for the designation - critical access facilities must be more than 35 miles from the nearest hospital.
The decision means that tens of thousands of people will have to travel more than 30 miles for emergency medical care, driving on sometimes winding country roads, behind the tractors and heavy equipment used in area agriculture or, if they're lucky, in one of the county's two ambulances.
"It's a tragedy that you're gonna leave 30,000 people without readily access to an emergency room," said Rick Thomas, the vice-mayor of Willows, the Glenn county city where the hospital is located.
Rural hospitals across the US are under threat. Nearly 200 rural hospitals have closed since 2005, and one-third, more than 700 hospitals, are at risk of shutting their doors. Such hospitals serve smaller populations, meaning there are fewer dollars coming in, and often lose money providing patient services because of the greater costs associated with providing care in rural communities and insurance reimbursement rates that do not cover costs, according to the Center for Healthcare Quality and Payment Reform.
Meanwhile, experts warn the budget signed by Donald Trump, with its massive cuts to Medicare and Medicaid, over the summer will have devastating effects on rural hospitals, which rely more on federal funding from the US's largest public health insurance programs.
Glenn county is now trying to fill the gap with expanded fire department services, and studying how it can improve emergency services delivery while the community grapples with a difficult new reality.
The Centers for Medicare & Medicaid Services did not respond to a request for comment.
Located more than an hour from the state capitol in Sacramento, Glenn Medical center opened in 1950 in Willows, a city that Thomas, who previously served on the hospital board, described as a classic American small town in a heavily agricultural region.
"We're the folks that grow and produce the food that everybody eats," said Still, the hospital administrator. "Being right on I-5, we get a lot of travelers that come through. And despite not having an active labor and delivery unit, we've had two or three [births] here in the last year."
The center used to be far larger, with a full geriatric wing, an obstetrics and gynecology department and a psychiatric hospital. Over the years, with changes in funding models, it gradually shrank and nearly closed more than once. But in 2001 it received the critical access designation from CMS, granting Glenn Medical center greater reimbursements from Medicare and allowances for certain staffing requirements.
That enabled the hospital to remain open. While the facility had its challenges owing to the age of its infrastructure and difficulty bringing staff to the area, it served some 8,000 people a year with about 225 staff, Still said.
Capped at 25 beds as a critical access hospital, its capabilities were limited compared with more advanced facilities in Sacramento or Chico, but it was a lifeline for patients—the majority of whom are on Medicare or Medicaid—said Still and local officials.
"I've always said if you're bleeding, broken and stroking, you need that hospital there to take care of you," Thomas said.
Many of the center’s patient population doesn’t have gas money or transportation to get to larger hospitals, Still said.
"We're the front door to our entire healthcare system," Still said. "If you show up on our front door and you're having a real serious situation, we can ship you out to UC Davis in 30 minutes. You can't drive that.
"We take pride in the folks that we keep alive and we bring back from the dead, and it happens more often than you'd like to believe," she added, pointing to a man who recently came into the ER with a core body temperature of 89F. "We brought him back. He wouldn't have survived the ambulance ride."
The hospital sees a large portion of patients with chronic illness, including diabetes, COPD, asthma, as well as cancer—Glenn county has some of the highest lung and colorectal cancer rates in the state. Funding was always a challenge, which was why the critical access status—and the regulatory relief it provided—was so crucial, Still said.
Earlier this year, Still learned CMS was pulling the hospital's critical access certification because the federal agency had erroneously determined that Glenn county was no longer rural, she said. Still believed it was a mistake that the agency would correct. But CMS then told the hospital it had found that Glenn Medical center was ineligible for the designation because it was too close to the nearest hospital, according to Still.
Doug LaMalfa, the area's congressman, said in a statement that CMS began calculating the distance between hospitals with a different route that uses a "rural cut-through", decreasing the distance between Glenn Medical center and the nearest hospital from 35.7 miles to 32.5 miles, putting the facility out of compliance.
Hospital and county officials argued that ambulances and residents typically take a different route that spans more than 35 miles to avoid winter flooding common in this area; to no avail.
"I am deeply frustrated about this decision as the hospital has maintained its CAH status since 2001 and no new roads have been built nor have the hospitals picked up and moved three miles closer during this time frame," LaMalfa said in his statement.
CMS moved to revoke the critical access status in April. Hospital leadership and local officials advocated for months to preserve the certification—including a trip to Washington—and residents sent nearly 2,000 letters. But CMS said it had determined that the hospital never should have received the designation in the first place. The agency denied requests for reconsideration late this summer; LaMalfa said in his statement meaning Glenn Medical center would lose reimbursement rates associated with the status in spring 2026.
"We're hung out on a technicality," Thomas said.
Still said she pointed out to CMS that some 500 critical access hospitals across the US don't meet the distance requirement and that the agency suggested it planned to decertify all of them. Such a move would have enormous ripple effects; said Lisa Pruitt,a professor and rural law expert at UC Davis School of Law.
"The funding for lots of hospitals is pretty fragile,but with rural hospitals it's kind of like a house of cards in that all these different funding streams are not local,"Pruitt said."If you've already got a fragile house of cards then you take away one of those cards it means that facility is lost."
LaMalfa said he had urged CMS and its administrator Dr Mehmet Oz to reconsider without success.
"This is not how government is supposed to operate - it's unfair and just plain wrong,"LaMalfa said."I refuse to believe CMS's hands are tied,and I will do everything in my power to fix this situation for Glenn county."
He said he has asked administration officials to set aside funds from $50bn Rural Health Transformation Program which will cover only just more than one-third expected losses rural hospitals Medicaid.
Once Glenn Medical center learned decision it announced plans shut down October but as staff some departments scrambled find new jobs elsewhere hospital had close earlier.
The halls at sprawling one-story facility were quiet hospital's last day. Outside,a staffer stood smiling man wheelchair woman walked toward hospital parking lot saying:"I should have told them that without this hospital,I probably would have died."
Lisa Hill,lives down street,similar story. She has used hospital countless times over years,last month inside home,Hill suddenly couldn't breathe. Her lips turning purple she knew needed get Glenn Medical center.
The 64-year-old thought would pass out as she walked two blocks emergency. She nearly collapsed upon entering staff quickly admitted her.
"If Glenn Medical hadn't been there I would have died. I would not have made it another 32 miles,"
she said of the incident. Several years back, when her grandson was in a bad car crash that broke his neck, the hospital had him sent on a helicopter to a larger facility farther south.
"I'm more than disappointed. Every time I think about it, I want to cry my eyeballs out. They are shanking our community, our friends, our family. How much more are they going to strip us down?"
The county is racing to provide more services. The Willows fire department recently obtained an EKG machine, and plans to offer an advanced life support program next year,Thomassaid.
Glenn Medical center plans to keep some of its clinics open and will advocate for funding from the rural health fund to build a proper emergency hospital that can meet the community’s needs,including behavioral healthand substance abuse treatment,Stillsaid.
"This fight is much bigger than any one person or any one hospital or community,"Still
said.
"It's not over yet. I know this is scary. I know this is frustrating. We haven't given up."