Story by Sydney Brainard
Photos by Joe Macia
Williamston, North Carolina – A tattered sign blows listlessly in the wind at the chained-off entrance of Martin General Hospital. The hospital and its emergency department are closed, the bolded black letters on the sign announce. Now, the closest hospital is over 15 miles away.
It’s been like this since August 2023, when the hospital abruptly shut its doors, citing financial problems, and left the town of Williamston without so much as an emergency room. But now, the county might have discovered a partial solution.
Martin General opened its doors in 1950, and Williamston residents were shocked when it closed. The sudden loss of their hospital, and the only place in town where they could access emergency care, moved many to protest and speak at public meetings.
Williamston resident Paula Mobley likes to stay up to date with the meetings and events related to the hospital, especially after her own experience dealing with the lack of available care. Last April, Mobley’s mother died from brain cancer after a months-long process of bouncing between three different out-of-town hospitals. Since Martin General closed, there have been few doctors left in town. Mobley and her mother initially began searching for doctors in Tarboro, a town over 30 miles from Williamston.
“It was bad on her because she didn’t know where she was,” Mobley said. “So I kept saying, ‘We’re in Windsor,’ or when we go to Washington, she’s like, ‘Why it’s taking so long?’”
Williamston is not the only rural community in the state grappling with the loss of critical points of health care access. Since 2010, eight counties in North Carolina have had rural hospital closures, according to the NC Rural Health Research Program. Even primary care is scarce in many rural communities across the state, according to data from the US Health Resources and Services Administration.
In a press release from 2023, Martin General Hospital said its financial losses had mounted to $30 million since 2016, losing $13 million in 2022 alone. The release pointed to declining county population and decreased use of the hospital by residents as contributing to its financial problems.
“Forty plus percent of rural hospitals are losing money, and so unprofitability at the local hospital restricts their ability to replace equipment, to keep the physical building repaired in good working order, to offer new services, to expand volumes, to hire staff,” George Pink, deputy director of the NC Rural Health Research Program, said.
Martin General lacked many of the resources available at hospitals in neighboring counties meaning that, often, residents were already making long drives to obtain certain types of care. Still, the loss served to widen the already broad gaps in health care access in the area, especially for those seeking emergency care or who can’t easily make the journey elsewhere. It has left many community members on edge.
“If something happens, I’m screwed,” Judy Ewell, a resident of Williamston, said. It’s a common sentiment around town. Judy and her husband, Timothy Ewell, feel particularly at risk due to Judy’s HIV positive status and Timothy’s asthma. The two are also homeless, and in Williamston, health care resources for homeless individuals were limited even before the hospital closed.
It’s not just a hospital that the area is missing, Judy Ewell said. “I would like to see them bring some recovery to Williamston, like NA meetings, a treatment center, because there’s none of that here.”
Even health care providers and doctor’s offices who have remained in the area are struggling with the hospital’s closure.
“It’s been difficult to attract providers who are willing to come to the area. Because, again, when you look and there’s not even a hospital in the area, it’s kind of like, is there something wrong? It just raises red flags,” Candi Manning, administrative manager at AccessMedicine, said.
Manning and her husband, Dr. Steven Manning, operate AccessMedicine, a primary care practice in downtown Williamston. The two are Williamston natives and moved back to the area to provide care to the community they knew was underserved. Their practice received an overwhelming amount of interest after the hospital and other clinics closed. Now, their patient waitlist is years long, but Steven Manning is still only one practitioner.
“We have one PA and then him, and we definitely feel a huge responsibility because, again, we love this community, we know the people personally, we want to provide the care,” Candi Manning said. “But you just can’t do it all.”
While frustration builds in Williamston, Martin County officials are slowly carrying out a plan that, if successful, could allow the hospital to reopen – at least in part. It won’t bring back everything, and it won’t solve the lack of many forms of health care across the county, but it would be something.
Enter the Rural Emergency Hospital designation.
It’s a recent piece of policy, established by Congress in the Consolidated Appropriations Act of 2021, and put into effect in January 2023. Designed to aid rural hospitals facing financial struggles, the new designation permits rural hospitals with fewer than 50 beds to convert to a Rural Emergency Hospital. The hospital is then able to receive federal funding from the government, among other benefits. However, the trade-off is that the hospital can only provide emergency outpatient care, and can no longer provide inpatient services.
“It’s not a model designed for all rural communities,” Pink said. The model won’t work for communities that would adversely suffer from the loss of inpatient care, but it can be a lifeline for rural communities on the brink of losing their hospital and emergency care. So far, 36 hospitals across the country have converted, although none yet in North Carolina.
But Martin General Hospital wouldn’t be simply converting. It would be reopening, providing 24-hour emergency care to a community that’s been without it for over a year. If the transition is successful, Martin General would be the first hospital in the country to actually reopen under the designation. It could even serve as a model for other recently closed rural hospitals. The tricky part is how long it will take before it can get there.
“This has already been a lengthy process, and it’s going to be a lengthy process,” Ben Eisner, interim Martin County manager, said. On Jan. 8, the Martin County Board of Commissioners voted unanimously to allow the sale or leasing of the hospital to a new operator – a step forward towards its ultimate reopening. A public hearing for community input on the vote was held Feb. 12.
According to Eisner, if all continues to go well, there will likely be a request for bids sent to potential operators, who would then submit their bids and proposals. Then, another public hearing will be held for community input on the proposals, and eventually, another vote to select a plan. Beyond that would be the process of getting the hospital back up and running for emergency services. Safe to say, it will take some time.
“It would really be hard to pin down a timeline, and would be kind of unfair to do that, but you know, it’s working every step as you can,” Eisner said. “It really would be unfair to say, this is going to be today, tomorrow, six months, 10 months, two years. Who knows? That’s the problem.”
Despite the uncertainty, residents like Candi Manning say they’re optimistic for the future. This spring, the Mannings’ practice is taking on a new physician assistant, and in the summer, a new doctor. She hopes that those additions will help to open the door to encourage more primary care providers to the area. And if the hospital does reopen, it could encourage even more.
“It’s almost like you don’t want to hope, because you just never even dreamed that it could close,” Candi Manning said.
But if emergency care does return to Williamston, she said, then she’ll dream about what could happen beyond. “I’m excited about any possibility of it reopening at any any level.”
