GREENWOOD, Miss. — Betty Sibley had just laid down to rest after a shower last month when she realized something was wrong.
There were hives bubbling up on her arms and her throat was beginning to swell shut. Both were signs that she was suffering from a potentially life-threatening allergic reaction.
A first responder injected her with an EpiPen in her thigh and an ambulance raced her to Greenwood Leflore Hospital, roughly 5 miles away, where emergency room staff took over, administering steroid shots.
“I would have died if it had not been for this hospital,” she said.
Now, the hospital she turned to in an emergency is struggling to keep its doors open.
In the past year, the rural hospital’s cash reserves have plummeted, and patient traffic has slowed. Many of those who do come are uninsured, meaning unless they pay out-of-pocket, or pursue some other form of financial assistance, the hospital is unlikely to be reimbursed for their care. And the Medicare loan that helped the hospital in the pandemic now costs Greenwood Leflore more than $100,000 per month.
Hospital leaders have tried to slow the crisis through layoffs and slashing services. Administrators scrapped pay incentives that had helped keep the hospital staffed. This fall Greenwood Leflore closed its labor and delivery unit because there wasn’t enough staff. On Nov. 30, the hospital’s pulmonology clinic will close, a decision made after low patient volume and poor revenue.
State Sen. David Jordan, who represents Greenwood, worries about residents who will die “needlessly” if the hospital goes under.
“The only hospital we’ve got is on its deathbed,” he said.
Greenwood Leflore’s financial struggle is the latest challenge in a predominately Black Mississippi Delta community that has been hit hard over the past two decades by the closure of major manufacturers, a teacher shortage in its public schools and steep population loss — there are not enough newcomers to replace the residents who have left or died.
Throughout the town’s setbacks, generations of locals have taken their first and last breaths at Greenwood Leflore Hospital. It’s also a critical economic engine. In a region where many families struggle to put food on the table, the medical facility is one of the largest employers around.
Over a few weeks this fall, the hospital’s situation grew dire, with the interim chief executive, Gary Marchand, acknowledging in a staff memo that it could close before the end of year. On Nov. 4, talks with a larger hospital in Jackson that local officials had hoped would take over Greenwood Leflore fell through.
Marchand estimates the hospital needs $5 million to $10 million to stay open until next summer. While several banks are willing to step in, he said city and county officials will have to assist in obtaining the resources on the hospital’s behalf.
“We will not make it into 2023 without funding,” he said.
Leflore County Supervisor Board President Robert Collins said finances are already strained, but the county can most likely put up about $3.5 million for Greenwood Leflore. He cautioned that the county won’t be able to float the institution long-term.
“We can’t generate that money in the county,” he said. “We don’t have that kind of tax base.”
Greenwood City Council President Ronnie Stevenson acknowledged that the city might need to provide aid as well.
He’s adamant that he doesn’t see closing the hospital as an option, but he is blunt that he doesn’t want to “keep throwing water on a sinking ship.” At a minimum, he said, the hospital, which lost almost $2 million last month, has to start breaking even.
A more comprehensive fix could arrive in the spring, when Marchand hopes the Legislature will approve a statewide plan to push more Medicaid funding to hospitals.
“We have to find a governmental solution, if we’re going to be viable in the long-term,” Marchand said.
With the hospital’s fate in the balance, the community may have to wait months for an answer.
Some residents have already started looking for physicians elsewhere, but Dr. Roderick Givens, a radiation oncologist who has practiced at Greenwood Leflore for 15 years, said it can be a hurdle sometimes for patients to make it to even local appointments.
Some in Humphreys County, which borders Leflore County, already have to drive longer for health care than they did a decade ago, after Humphreys County Memorial Hospital closed in 2013.
If Greenwood Leflore closes, residents will have to travel to North Sunflower Medical Center in Ruleville, about 31 miles away, or South Sunflower County Hospital, about 28 miles away in Indianola, for an emergency room.
“It essentially equates to a death sentence,” Givens said. “A hospital 10 minutes away now becomes half an hour away.”
The idea of the hospital closing is grim enough that Sibley has wondered if she should move from the Mississippi Delta town she’s lived in since she was a little girl.
“If something happens with them, it happens with me,” she said of the hospital.
But making those types of contingency plans means having access to resources, like cash and cars. Nearly 30% of residents in Greenwood and 25% of the population in Leflore County live in poverty. And almost 13% live in homes without a car, according to census data.
Since Greenwood Leflore’s labor and delivery unit closed, many pregnant residents have to travel 45 minutes to a satellite hospital of the University of Mississippi Medical Center in neighboring Grenada County to give birth. The only option left in Greenwood is the hospital’s emergency room.
This is a community where lower life expectancy rates already meant residents bury their loved ones earlier in life, compared to those born in more prosperous areas.
Residents here know a full tank of gas and reliable transportation won’t always be enough to outrun the disparities underlying the state’s maternal and infant health crisis.
Mississippi has the nation’s highest infant mortality rate, while pregnancy-related deaths here are more likely than the national average. Black women in the state are almost three times as likely as white women to die while expecting, or within a year of giving birth, or their pregnancy’s end.
In the Delta, where some counties lack OB-GYNs, pregnant women and newborns are particularly vulnerable.
Kayla Wheeler had several close calls during her pregnancy before safely delivering a baby girl at Greenwood Leflore last year.
The 24-year-old has epilepsy. Shortly after learning she was expecting, she had a seizure in a shoe store and was taken to the hospital.
She was taken again when she was 30 weeks pregnant. Wheeler had just arrived at her sister’s house and was preparing to leave for a day trip to Jackson when she looked down and noticed she was bleeding.
Wheeler had already picked out a name for her little girl. Now, she worried her baby wouldn’t make it.
“I thought I was going to lose her,” she said.
Her sister’s fiancé got Wheeler to Greenwood Leflore within 10 minutes, and she and her baby were fine.
“It’s good I got to the emergency room in time. Otherwise, things could have went left,” Wheeler said.
When Greenwood Leflore opened in 1906, it initially operated out of a mansion repurposed as a medical facility.
By the time Jordan, the son of a sharecropper and now a state senator, was attending Mississippi Valley State University, a historically Black university in the Mississippi Delta in 1955, the hospital had moved to its third location, a short distance from the town's main street, where it remains today.
Jordan remembers being quarantined there briefly in 1964, after he and his wife, who worked as a nurse, tested positive for tuberculosis, before being transferred to a sanatorium to recover.
Now, Jordan, 89, who has represented Greenwood for almost three decades, said that when he goes to the store, he’s often approached by residents with concerns about the hospital’s future.
“People up here are in tears almost,” he said.
Jordan pointed out that the hospital’s financial decline has taken place as Mississippi remains one of 11 states not to adopt Medicaid expansion under the Affordable Care Act. Economists have estimated that the first year of increased Medicaid eligibility would bring $1.6 billion in federal funds to the nation’s poorest state.
“It’s just been an injustice to the poor, rejected and downtrodden,” Jordan said.
The retired school teacher is frustrated that lawmakers have not jumped in to address the hospital’s crisis. The state Legislature, which normally begins meeting in January, was brought back to Mississippi’s Capitol in a special session this month to approve nearly $247 million in tax incentives to a private aluminum mill company.
Jordan voted in favor of the project, which is expected to bring 1,000 high-paying jobs to an already thriving region of the state, but questions why potential economic deals are met with urgency, “but when our hospitals are closing, nobody wants to come to our rescue.”
“I’m looking at the unfairness of the process,” Jordan said.
Gov. Tate Reeves, a Republican, did not immediately respond to a request for comment.
Marchand, the interim CEO, hopes lawmakers find a way to increase Medicaid payments to hospitals, an intervention that is also among the Mississippi Hospital Association’s legislative priorities, according to Mississippi Today, a nonprofit newsroom.
Marchand did not provide details on how that could work but said the proposal is different from the Medicaid expansion under the Affordable Care Act that Reeves rejected.
In the meantime, many in the Delta are growing dismayed that one of the most vulnerable areas in the state is losing health care access. In nearby Washington County, the region’s last neonatal intensive care unit closed this summer.
Serita Wheeler, Kayla’s mother, has had enough. She doesn’t see a future for her children and grandchildren in Leflore County if it loses its hospital. If Greenwood Leflore folds, she might move north to Maryland, where she has family.
“I know if I move to Baltimore, Johns Hopkins isn’t closing,” she said.