Chapter 2 Transcript
Editor’s Note: If you are able, we encourage you to listen to the audio of Where It Hurts, which includes emotion and emphasis not found in the transcript. Transcripts are generated using a combination of speech recognition software and human transcribers, and may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.
[Segment 1 — 0:08]
SARAH JANE TRIBBLE: You know how your heart fills up when you get a handwritten card or letter in the mail? Someone signed it, maybe even wrote a quick note. It means they thought of you and cared enough to actually do something. For many in Fort Scott, Kansas, that someone was Reta Baker. She's the president of Mercy Hospital.
Well, the former president.
RETA BAKER: And the real challenge was trying to match the [birthday] card to the employee. So I knew that I had some guys who were always deer hunters. So when I come across the card with appropriate scene on it, I would grab that card.
SARAH JANE TRIBBLE: But then that means you knew each employee well enough to figure out which card fit their personality.
RETA BAKER: Mmm-hmm.
SARAH JANE TRIBBLE: That's 400 people.
RETA BAKER: Yeah.
SARAH JANE TRIBBLE: OK.
RETA BAKER: That's part of being a good leader … is to know your people.
SARAH JANE TRIBBLE: What's going to happen to these cards now?
RETA BAKER: Um, I don't know what I'm going to do with the cards.
RETA BAKER: I will probably put them on a shelf for a while. And I did think about donating them to Presbyterian Village.
SARAH JANE TRIBBLE: Mercy is closed. But not long ago it was bustling. Hundreds of nurses, technicians and doctors — every one of them got a card from Reta.
RETA BAKER: Tried to do the whole month at a time. So I didn't get busy and forget somebody because that would cause hurt feelings.
And so sometimes I'd come in on a Sunday afternoon when I didn't have anything else to do and listen to music and address birthday cards. Crazy, I know.
SARAH JANE TRIBBLE: I'm spending the day with Reta as she packs up her office.
[Sound of packing tape]
RETA BAKER: Not sure what this is.
SARAH JANE TRIBBLE: She's in no rush to leave. So she sucks on hard caramel candies and tells me stories. So, what is this, this right here?
RETA BAKER: This was the family practice medical staff.
SARAH JANE TRIBBLE: Reta is holding up a picture of half a dozen men in white coats.
RETA BAKER: This is Dr. Self, who's still practicing. These are kids — they look like babies. He's still practicing over here. Dr. Spencer died.
SARAH JANE TRIBBLE: When Mercy announced the hospital was closing, everyone was surprised. Even her doctors. Reta Baker's fall from grace in Fort Scott was quick and brutal.
RETA BAKER: I don't even like going out in the community anymore, because I get confronted all the time, but, you know, someone confronted me at Walmart. You know, “How” —you know — “How could you let this happen?”
SARAH JANE TRIBBLE: I'm Sarah Jane Tribble, and I heard about the hospital closing from my mom. She and my dad still live on the land where I grew up, about an hour away from Fort Scott. So I went back home.
And for more than a year, I spent time with Reta Baker and City Manager Dave Martin to understand what their town lost. This is Where It Hurts, a new podcast from KHN and St. Louis Public Radio.
[Segment 2 — 3:12]
SARAH JANE TRIBBLE: Mercy Hospital sits back from the highway, just past the town Super Walmart. The first time I visited, I came at night to get a good look. You drive up a curving, wooded road to the entrance. Along the way, through the trees, a tall white cross glows in the dark. It must be around 20 feet high. Two decades ago, local residents raised about $2 million to help build this hospital. And for a long time, it was the pride of Fort Scott.
A gleaming hospital on a hill.
As Reta packs up her office, I ask her to show me around. So we close her office door and start walking.
So, the ER hallway’s one of your favorites …
RETA BAKER: It is.
SARAH JANE TRIBBLE: Is there another spot that, if you were particularly stressed out, you'd go to other than your office, maybe?
RETA BAKER: Other than to hide in my office? I love the courtyards. This is my favorite courtyard.
SARAH JANE TRIBBLE: The one we just walked past?
RETA BAKER: Yeah. Yeah. It is … it is a great courtyard. We can go out there.
SARAH JANE TRIBBLE: Yeah.
RETA BAKER: It was a great place to take your lunch and have lunch. Although, in that particular courtyard, sometimes you felt like there was too many windows around you, with people in them.
SARAH JANE TRIBBLE: You're a fishbowl.
RETA BAKER: You're a fishbowl.
SARAH JANE TRIBBLE: It seems like everyone in Fort Scott is connected to Mercy Hospital. Either they worked here or they got their tonsils out here or were born here. We keep walking. The hospital is sprawling.
RETA BAKER: When you look down this hallway … now, we have a door closed so you don't get the full effect. It's a very long hallway. I think it's a football field and a half.
SARAH JANE TRIBBLE: Oh, wow.
RETA BAKER: So, uh, it echoes today. That door is closed. But if it was open, you can imagine how very long the building is.
SARAH JANE TRIBBLE: This Mercy Hospital building went up in the early 2000s. When it was first built, Reta and other Mercy leaders say, it was crowded. Almost too small to take care of all the people that needed care. Not now.
It's so empty.
RETA BAKER: It is very empty. There's nothing here.
SARAH JANE TRIBBLE: As we walk the hallways, we stop at a nurse’s station. It is stripped — no equipment or wires. There is an old dry-erase board. And in loopy handwriting, someone has scribbled "Gone but not forgotten."
RETA BAKER: We don't know exactly who wrote it. I'm sure it was one of the OR staff, but nobody recognizes the handwriting. So we're not sure who wrote it. Nobody would fess up.
SARAH JANE TRIBBLE: But you can't bring yourself to remove it?
RETA BAKER: Can't bring myself to remove it. Because it is true. We are gone, but we're not forgotten.
SARAH JANE TRIBBLE: I began visiting Fort Scott at the same time I was trying to come to terms with my own loss. My older sister Maggie died about a month after I started my reporting. Cancer. She was 46 years old.
Maggie was still alive that very first time I traveled to Fort Scott.
I stopped by her hospital bed before driving south. Later, after she was gone, I'd go visit my parents. Like I said, they still live on the land where my sisters and I grew up, about an hour south of Fort Scott.
And with each trip home, I realized the people of Fort Scott were going through their own stages of grief. They always thought Mercy would be there for them. That's how I felt about Maggie. I just knew she was always going to be in my life. Supporting me. When she left, a piece of me went missing.
The story of why Mercy Hospital closed is best told by Reta. She worked at Mercy most of her career. Nearly 40 years.
Like me, she grew up near Fort Scott. She's older than me, but we're both natives. For her, it was on a farm south of town. Reta went to nursing school in Fort Scott, and Mercy nuns gave Reta her first job. For the past six months, she's been here in this mostly empty building. Finalizing the end.
RETA BAKER: Whether we like to say it or not, health care is a business. And yes, we are not for profit, but that doesn't mean we don't have to have a profit. Over the ages, Mercy pulling out of communities is not a new gig.
SARAH JANE TRIBBLE: The hospital closed because it didn't have enough patients. That’s Reta’s take. The population of Fort Scott, like other small towns across the U.S., keeps shrinking. From about 10,000 in the 1950s to less than 8,000 now. A lot of the people who still live here get their health care through government-supported programs like Medicare or Medicaid. And those who do have insurance at their jobs, places like the school district or the local manufacturer, have high deductibles.
They have to pay a lot out of pocket before insurance kicks in. Maybe 25 hundred or even 5 thousand dollars, depending on where they worked.
RETA BAKER: We have a couple of industries that, if the employee has a normal pregnancy, she doesn't even meet her deductible with her prenatal care and delivery. So that has had a big impact on us, because they're working poor.
SARAH JANE TRIBBLE: So some people just avoided going to the doctor and the hospital. Others shopped around for cheaper care than what Mercy offered. They drove right past the hospital to bigger towns where they could find better prices.
I met Reta a few weeks before the hospital closed. She told me that there were no patients in the beds the weekend before. Zero patients.
RETA BAKER: It's a tough market, really tough market from a fiscal viewpoint, and really hard for people to understand. I am a frequent Rotary/Kiwanis speaker and have been very transparent about concerns about outmigration, about financial sustainability of health care in the community. And when this came to light, it was like they'd never heard of these challenges before.
SARAH JANE TRIBBLE: Reta wonders if she did enough to warn the community that the hospital was in trouble, that it could close. Except she says she did warn them.
RETA BAKER: I think it's still denial.
SARAH JANE TRIBBLE: Still denial. But there are other opinions as to what happened. Fort Scott City Manager Dave Martin explained it to me. Dave and I usually meet at City Hall.
They have music coming out of the loudspeakers on Main Street, which is what you hear in the background.
Hi, Diane. How are you?
DIANE CLAY: I'm good. How are you?
SARAH JANE TRIBBLE: Good, good. I'm here to see Dave.
DIANE CLAY: I'll let him know you're here.
SARAH JANE TRIBBLE: Thank you.
DIANE CLAY: I have to tell you your article was amazing.
SARAH JANE TRIBBLE: Oh, I'm glad you liked it.
DIANE CLAY: I did.
SARAH JANE TRIBBLE: I'm working on a few more stories and I'm recording for my podcast, so …
DIANE CLAY: OK, really good.
SARAH JANE TRIBBLE: Good afternoon.
DAVE MARTIN: With a microphone.
SARAH JANE TRIBBLE: I am.
DAVE MARTIN: That sounds good. How's your family?
SARAH JANE TRIBBLE: They are good.
DAVE MARTIN: Good.
SARAH JANE TRIBBLE: They are good. I hope the roads don't get any more wet, so I …
We settle into his corner office. There is a beautiful wedding picture of his daughter sitting on his desk.
Dave raised his family in Fort Scott. He has four daughters, and all of them born at Mercy. His first grandchild was born there, too. Dave runs the city like a business, and his leadership style has earned him a certain reputation in town.
DAVE MARTIN: They call me the Trump of Fort Scott. Although I don't handle things like Donald Trump, I take it as a compliment. I have said — and I voted for Trump; I don't know if that'll be my job or whatever — but I've told people that.
SARAH JANE TRIBBLE: This is a second career for Dave. He's in his 60s and not doing this for the money. Dave manages this small town because he feels a sense of duty. It's one of the ways he thinks he and President Trump are alike.
DAVE MARTIN: Anything I've done or if I put my team behind it and we move forward, it's what we envision making Fort Scott better. It isn't what makes Dave better or this person over here better — it’s what makes the town better. The difference between Trump and I, I would not tell my message and be as egotistical as he is about things. I would listen and say thank you. But here's the way I'm … I'm still gonna go this way. Does that makes sense?
SARAH JANE TRIBBLE: Maybe a bit more diplomatic.
DAVE MARTIN: Yeah, diplomatic — that's it.
SARAH JANE TRIBBLE: Dave says Fort Scott needs a hospital.
DAVE MARTIN: Well, I feel like if Mercy would have brought us into the table and told us what their intentions were when they actually decided that they were gonna close the hospital, that we could have worked with Mercy and Via Christi in our community or other entities that were interested in coming here.
SARAH JANE TRIBBLE: Ascension Via Christi is the health system that runs the hospital about 30 miles down the road. As Mercy was closing, Dave and other city officials believed that Via Christi, or maybe even a hospital out of Kansas City, would want to take over Fort Scott's Mercy. After all, it is a big and fairly new building. Then, as the months passed, they grew more disappointed. Dave represents the town and its anguish.
[Segment 3 — 12:44]
SARAH JANE TRIBBLE: Fort Scott’s movers and shakers have a club of sorts: the chamber coffee. Each week, business owners, city leaders and local gossips gather. The chamber coffee is the place to be.
I'm going to … Hi. I'm good. How are you guys doing? I hear you’re with the largest employer in town.
MAN: I'm sorry?
SARAH JANE TRIBBLE: I hear you're with the largest employer in town.
People sip coffee and talk. Pretty soon the announcements begin and Dave moves to the front of the room.
DAVE MARTIN: Since Sarah is here today … Sarah is doing a great job of tracking how we handle this as a community. I know she visits with me every time she's in town. And I’m meeting with you at 9 o'clock, I think. And she meets with Reta and she's talked to a lot of citizens.
SARAH JANE TRIBBLE: It's a few months after the hospital closed and Dave is trying to control the message. He and everyone here wants the big-city reporter to know that Fort Scott is vibrant, and he's putting a positive spin on the loss of health care.
DAVE MARTIN: And I just want everybody to know that I feel like we are in a very good place. And I've tried to talk to people about that.
SARAH JANE TRIBBLE: As the meeting breaks up, a tall woman makes a beeline for me. I'm already surrounded and she leans in to tell me her husband was an orthopedic surgeon at Mercy.
KIM SCHWAB: The thing that is happening to rural health care in America is an absolute crisis. They're closing rural hospitals across the mid part of the country right and left.
SARAH JANE TRIBBLE: She's very urgent.
KIM SCHWAB: And all because of Obamacare. And so people are eventually going to die because they don't have good health care close enough to where they live.
SARAH JANE TRIBBLE: First of all, she's wrong. It's not all because of Obamacare, the Affordable Care Act that was passed by former President Barack Obama. In fact, if Kansas had expanded Medicaid under the Affordable Care Act, that would have given more people insurance. Mercy probably would've stayed open longer. But she is right about this: After a hospital closes, people die at a higher rate in rural America than in urban areas.
SARAH JANE TRIBBLE: When the doctor's wife calms down a bit …
KIM SCHWAB: Closing the hospital has a ripple effect. And, you know, we were on such an upswing, expanding. This town was on fire. New businesses, new things, renovations. Everything was going wonderfully. And then that. That was our biggest employer, and it just sucked the wind out of everything. And it's so sad.
SARAH JANE TRIBBLE: These folks are convinced Fort Scott has enough people and money for a hospital. They say, just look around town. The Dairy Queen sparkles. The economic development director says a new Burger King and other businesses are coming. There's already a busy hotel, and city leaders say there are plenty of jobs available. To them, it doesn't seem right that Mercy shut the hospital down.
MATTHEW WELLS: It was more than just losing the hospital.
SARAH JANE TRIBBLE: Matthew Wells — he's a small-business owner and youth pastor in town. He's also the last person I talked to before leaving the chamber coffee.
MATTHEW WELLS: You broke people's hearts and their spirits. People who believed in what that mission was, and a large portion …
SARAH JANE TRIBBLE: Matthew believes Mercy abandoned its Christian mission to provide care.
Years ago, as hospital president Reta Baker began closing units of the hospital, Roxine Poznich watched it firsthand from her post in the pathology department.
ROXINE POZNICH: They kept shutting down different parts of the hospital, like they shut down intensive care and they didn't do cardiac rehab anymore. And I don't know, it was just sad. And of course, the doctors lost their business because they, you can't do pathology without surgery. And they're not doing surgery, of course.
SARAH JANE TRIBBLE: I talked to a national expert about this. Mark Holmes leads the Center for Health Care Research at the University of North Carolina.
MARK HOLMES: Well, as a potential patient, I look at that and say this is a hospital that may not be around and I don't know if they're gonna be there next week. I'm going to get my care elsewhere.
SARAH JANE TRIBBLE: Mark's group tracks data and watches hospital closures. Mark says the steady cutting of services that Mercy did happens all the time.
MARK HOLMES: And so it offers this kind of spiral element that we might see in any sort of firm facing a bankruptcy.
SARAH JANE TRIBBLE: As Mercy stopped offering services, the number of patients dropped even more. More patients left town to find the service they needed and the amount of money the hospital made kept falling.
RETA BAKER: Pretty soon you have to say, do we cry uncle now, or do we wait until we can't meet payroll? Until we have vendors beating at our door because we can't pay our bills? And then close the doors at midnight and put a sign on the door that says, 'Sorry, we're not here anymore.'
SARAH JANE TRIBBLE: That happens in a lot of small towns. But Fort Scott's city leaders had a blind spot. Mercy had been around for more than a century. They couldn't see the possibility that Mercy would actually go away. Still, Reta can't help but think Dave Martin, a businessman and the city manager, must have seen this coming. She says he knew about the cuts and how tight money was at the hospital.
RETA BAKER: He's always been involved in our board and well aware of our challenges. But I'm sure they can give you a totally different viewpoint, because they very much think a traditional hospital is absolutely essential.
SARAH JANE TRIBBLE: So Reta just shakes her head when Dave says another hospital could take over Mercy.
RETA BAKER: He and I will never come to an agreement in my term here in this town.
Reta knows no one is coming to rescue the hospital in Fort Scott.
RETA BAKER: Initially, I campaigned really hard to make this public and to share that at the time. And the question was asked, "What will change?" Does your city or your county have the funding to pick up the shortfall or to take over the hospital? And we would be looking at a minimum of $5 million a year.
SARAH JANE TRIBBLE: Ah.
RETA BAKER: And I sit on …
SARAH JANE TRIBBLE: Mercy was asking that question?
RETA BAKER: They said, is the community in a position to make a difference on the financial sustainability of the organization? I sit on the chamber board.
SARAH JANE TRIBBLE: Right.
RETA BAKER: I've been on committees. I've heard the comments about “we can't afford to increase our taxes, we're broke,” etc., etc. So when I was asked, is the city or the county in a position to make a difference on the financial sustainability of the hospital today? The answer I had to give was: No, I don't see how they would be.
SARAH JANE TRIBBLE: Reta knew the town couldn't bail the hospital out, so she began making a plan.
RETA BAKER: I feel a deep love and a deep passion for the community. And I will go down working hard for the community. And they say a good captain goes down with their ship. And I guess in one hand I feel like I'm going down with the ship.
SARAH JANE TRIBBLE: Instead of telling the town about corporate's plan to close the hospital as soon as she found out, Reta quietly worked behind the scenes. She arranged for at least some health services to stay in Fort Scott. There was no one better for the job. She knew exactly what the people of Fort Scott needed. I once asked her about the fact that Fort Scott is one of the unhealthiest places in Kansas under Mercy's watch.
Mercy has been the foundation of health care in the community since 1886. Right? However, the community is not healthy. So then it begs the question: Was Mercy doing a decent job? And you guys have been here all along. So what happened?
RETA BAKER: We ate at Chicken Annie's and Chicken Mary's. What can I say?
SARAH JANE TRIBBLE: They're very good.
RETA BAKER: They are very good. Well, you know, that's … that is a really good question.
SARAH JANE TRIBBLE: For the record, I prefer Chicken Annie's. And my favorite is the dark meat — you know, crispy fried goodness with mashed potatoes and coleslaw. Anyway, Reta’s not saying that the delicious chicken at either of these restaurants is inherently bad for you — just that a steady diet of fried food isn't the healthiest. On the more serious side, Reta does tell me that hospitals are made to take care of acute care, emergencies and surgeries. Hospitals like Mercy, they don't make a lot of money doing the kind of everyday care that keeps people healthy. Things like food coaching, diabetes checks and primary care doctor visits. But these are the sorts of things that could help alter those awful statistics in Fort Scott.
RETA BAKER: We really just engaged in preventive health and population health probably in the last four years. And it's going to take a lot longer than four years to break the unhealthy cycles that we have in southeast Kansas.
SARAH JANE TRIBBLE: When she knew Mercy would close, Reta called in a backup from a colleague and a friend.
KRISTA POSTAI: I can make Reta laugh, and she makes me laugh. It's still very hard for Reta, though. I think today was the last day for server staff. The final staff goodbye. And they had a lunch today and I think it was real hard for her. These were all family to her, and they still are family to her.
SARAH JANE TRIBBLE: Krista Postai is the woman who runs the region's big health center — the person who raised her hand to take over Mercy's outpatient clinics in Fort Scott. She and Reta worked together as Reta closed up Mercy Hospital.
RETA BAKER: While the Sisters of Mercy pulled out, they made sure there was resources and methods available to care for the poor. They didn't walk away and say, OK, there are no resources and the poor people’s just going to die on the streets.
SARAH JANE TRIBBLE: That's why Reta took months to pack up her office.
RETA BAKER: I just could not walk away and not see this through to the end, plus a little bit.
SARAH JANE TRIBBLE: Reta knew Krista could provide health care to Fort Scott without losing too much money. Health clinics can get extra funding from the federal government to take care of low-income patients. Reta worked with Krista to keep family doctors in town treating patients. She also made sure ambulances kept running. The final piece of her strategy is to make sure Fort Scott has an emergency room. Somewhere for a heart attack patient or a gunshot victim to be taken and treated before being transferred to an out-of-town hospital. But that turned out to be the biggest challenge. Reta called the hospital president down the road for months, trying to get him to take over the emergency department — this guy named Randy Cason.
RETA BAKER: I said, hey, I want this in my back pocket. Would you consider this? And we hammered it back and forth a little bit. And he said he would consider it but wouldn't commit to it. Poor Randy. I felt like I was kind of battering him a little bit.
SARAH JANE TRIBBLE: Randy wouldn't say yes. What if someone in town was having a stroke and needed medicine fast? Where would you drive to take a toddler who cracked his head open? Next time we meet a local couple who call for help as Fort Scott is still trying to answer those questions.
How scared were you that Via Christi wouldn't do the ER?
RETA BAKER: Absolutely terrified. Honestly.
[Audio from 911 call]
911 DISPATCHER: 911.
LINDA FINDLEY: Yes, I need an ambulance immediately.
911 DISPATCHER: And what's going on?
LINDA FINDLEY: My husband fell yesterday and hit his head. And now he's went to sleep this morning and I can't wake him up.
911 DISPATCHER: OK. How old is he?
LINDA FINDLEY: Seventy.
911 DISPATCHER: EMS 1 county. In route
SARAH JANE TRIBBLE: It didn't take long before not having a hospital in Fort Scott made emergency care a lot more complicated.
This season of Where It Hurts is hosted and reported by me, Sarah Jane Tribble. The multitalented Tarena Lofton is our production assistant. Taunya English, managing editor and managing producer for the podcast, is KHN's senior editor for broadcast innovation. Greg Munteanu at St. Louis Public Radio is our sound and design engineer, along with Diane Webber, national editor for broadcast, and Elisabeth Rosenthal, editor in chief at KHN are editorial liaisons to the show.
Kerry Donahue, Stephanie Kuo, Jeanette Woods and Tim Lloyd all shared sage storytelling expertise in the early stages of this episode and podcast journey. The Where It Hurts podcast would not have happened without help from my family, including my kids and incredibly patient husband, Michael Tribble.
My parents and little sister in Kansas gave their time and hearts to this podcast, and season one, “No Mercy,” is dedicated to my older sister, Maggie. The podcast is a co-production with St. Louis Public Radio and KHN, a nonprofit news service about health care in America.
KHN is an editorially independent program of KFF.