WILLIAMSTON, N.C. — Two years after her brother’s dying, Debra Pierce nonetheless wonders whether or not the 50-year-old would have survived his coronary heart assault if her native hospital hadn’t closed.
“The sad thing is we’ll never know if he could have been saved that night or not, because we don’t have a higher level of care in this county,” Pierce stated as she stood exterior the cellular residence the place she final hugged her brother.
Emergency crews from a neighboring city labored on Stanley Sears for a half hour however couldn’t revive him for the lengthy drive to the closest hospital, information present.
In the tall grass — which might be mowed if Sears have been nonetheless alive — Pierce swiped via the images on her telephone. She stopped at an image that confirmed Sears smiling. Pierce chuckled after which sighed: “Bless him.”
Stanley Sears and sister Debra Pierce at a Walmart. Sears died after a coronary heart assault in North Carolina’s Martin County the yr after the 2023 closure of Martin General Hospital. (Stanley Sears)
The native hospital had closed a yr earlier than Sears’ dying, abandoning a gutted healthcare system. Martin County doesn’t have paramedics on its ambulances, and it may be 20 miles or extra to the closest — and infrequently overcrowded — emergency rooms.
The healthcare gaps in Martin County illustrate the finite attain of a $50 billion rural well being fund that Republicans crafted to strengthen assist for President Donald Trump’s signature tax and spending measure, the One Big Beautiful Bill Act, final yr. Though the money has not been doled out, Republican candidates in aggressive midterm elections — together with the intently watched battle for the congressional district that encompasses Martin County — are casting the fund as a lifeline that may shore up essential rural well being companies throughout America.
The cash has been extremely anticipated in North Carolina, the place most residents reside in rural counties. Pierce, a Republican who blames county officers for the hospital closure, stated she has religion Trump will assist them. “Old man’s doing his job up in there,” she stated.
On paper, Martin County — residence to about 22,000 folks — seems to be like a high contender to obtain at the least among the $213 million that’s been earmarked for North Carolina.
Yet County Manager Drew Batts stated it gained’t be the reply for his residents.
“The $50 billion is not something that is specifically going to help our situation,” Batts stated as he walked into the shuttered hospital in April. “It’s not going to help us get this place reopened.”
Martin County gained’t get direct reduction from Trump’s rural well being fund — as a result of its hospital isn’t open. North Carolina is distributing the cash amongst current well being and social service organizations. Plus, federal regulators set limits on how a lot could be spent on building and constructing renovations.
Martin County Manager Drew Batts stands contained in the shuttered Martin General Hospital in Williamston, North Carolina, and factors to an image of his spouse, who labored there as working room nurse supervisor. (Sarah Jane Tribble/KFF Health News)
‘We Can Only Pray’
Martin General Hospital closed abruptly in 2023, stunning workers and surprising sufferers, who needed to be wheeled out on stretchers and transported elsewhere to complete therapy. The closure even shocked native elected leaders, who say the corporate working the county-owned hospital, Quorum Health, didn’t notify them it meant to close down operations and file for chapter. Quorum spokesperson Lisa Anderson stated the corporate had instructed county commissioners of the hospital’s ongoing monetary challenges.
Politicians have spent the years since making an attempt to reopen the hospital, with county taxpayers pouring an estimated $2.9 million into upkeep, utilities, and different prices within the hopes of resuming operations, Batts stated.
The county is now contemplating spending at the least $1.5 million, he stated, to create two higher-level paramedic items with quick-response autos, specifically outfitted with electrocardiogram tools or different “advanced lifesaving support.”
Pierce stated she is praying the county can add paramedics and reopen the hospital.
“There’s some answered prayers happening every day,” she stated. “So, we can only pray and hope, you know?”
Debra Pierce holds up an image of Stanley Sears, her brother, whereas standing within the yard of the cellular residence he was renovating earlier than his dying in 2024. Pierce believes North Carolina’s Martin County wants higher-level emergency companies and a hospital. (Sarah Jane Tribble/KFF Health News)
‘They Just Want To Not Die’
With its 9 hospitals, the area’s largest well being system is ECU Health, related to East Carolina University. The system has develop into a de facto security internet for 29 counties. Batts and Brian Floyd, the Greenville-based system’s chief working officer, have lobbied state and federal lawmakers, strolling them via the shuttered hospital and asking for assist.
“It’s a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost,” Floyd stated. “They just want to not die because there’s nowhere to go when you have an emergency.”
Eleisa Ann Evans drove 2½ hours from a small city close to the Outer Banks on a latest night so her aunt might get care at an ECU Health ER in Greenville. Once there, Evans stated, workers instructed her to depart her 79-year-old aunt within the ready room and wait exterior due to capability points.
Evans stated she was outraged on the manner the workers handled her. She stated she had been standing behind her aunt’s wheelchair whereas inside and “wasn’t using nobody’s chair.”
With Martin General gone, all the encompassing counties are “also in jeopardy,” Floyd stated. “No one knows what to do” with that giant of a healthcare “desert,” he stated.
What healthcare is left within the county contains one pressing care middle, run by a non-public firm, and a nonprofit well being clinic, operated by Agape Health Services, which accepts sufferers from 5 counties and plans to construct one other main care clinic to fulfill demand.
ECU Health signed a letter of intent last year to reopen Martin General as a rural emergency hospital that would offer outpatient care in addition to an ER. Under the phrases of the deal, Martin County would pay to refurbish the hospital, and the North Carolina General Assembly must give ECU Health $210 million, of which $150 million would pay for the development of a brand new inpatient tower at ECU’s Beaufort Hospital.
The well being system, via its affiliate Access East, gained a portion of North Carolina’s $213 million first-year payout from the agricultural fund. But the federal cash can’t be used to reopen Martin General, Floyd stated.
The five-year Rural Health Transformation Program is slated to be delivered in $10 billion annual increments to states, which utilized and competed for the cash.
North Carolina’s plan creates a hub-and-spoke model that allots cash to 6 massive regional leads, together with nonprofits reminiscent of Access East. Those hubs will distribute cash to native entities and coordinate broad initiatives reminiscent of bettering main care and fortifying the healthcare workforce, in addition to creating “digital solutions,” in line with the state’s hub application.
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An Election Issue
The lack of emergency care within the area has emerged as a high speaking level in an in depth U.S. House race between Rep. Don Davis, a Democrat who represented the district when Martin General closed and is searching for his third time period, and Republican Laurie Buckhout.
The rural well being fund was added on the final minute in 2025 to win votes for the One Big Beautiful Bill Act, which is anticipated to scale back federal Medicaid spending by greater than $900 billion over a decade — cuts which are projected to hit rural hospitals and clinics particularly onerous. Rural well being executives say the fund gained’t come near offsetting these losses.
Matt Mercer, a spokesperson for the North Carolina Republican Party, referred to as the agricultural fund a “once in-a-generation opportunity” for the state.
But U.S. Sen. Thom Tillis, who was considered one of three Republican senators to vote towards the invoice — and who introduced shortly earlier than the ultimate vote that he deliberate to retire from Congress — warned of devastating penalties forward for healthcare in his state.
Buckhout, who declined an interview, plans to assault Davis — a susceptible incumbent whose district was not too long ago redrawn to favor GOP candidates — for voting towards the invoice.
“Martin County lost its hospital on his watch, and he still opposed the funding meant to help communities like it,” Buckhout marketing campaign spokesperson Stephen Gallagher stated in an announcement to KFF Health News. The marketing campaign didn’t reply to further queries about her plans for healthcare entry, if elected.
An empty ready room contained in the shuttered Martin General Hospital. The hospital’s closure in 2023 stunned workers and sufferers, who needed to be wheeled out on stretchers and transported elsewhere to complete therapy. (Sarah Jane Tribble/KFF Health News)
Davis, who signed a letter from lawmakers in assist of North Carolina’s rural well being fund utility, stated the cash “is essentially putting a band-aid on a much, much broader situation that needs dire help.” He has introduced legislation that might enhance Medicaid reimbursements for rural hospitals, although it has not moved ahead.
During latest testimony on Capitol Hill in Washington, ECU Health CEO Michael Waldrum stated his system expects to lose a billion {dollars} over the subsequent 10 years from the looming Medicaid cuts.
Overnight Waits for Emergency Care
The area’s emergency rooms supply a stark glimpse of a healthcare system in disaster.
Martin General’s ER handled about 11,000 patients yearly earlier than it closed, in line with state knowledge. An indication nonetheless hangs within the workers break room exhibiting that 23 sufferers have been seen within the ER the day it closed.
ECU Health, which owns all however one of many rural hospitals round Martin General, reported a 132% enhance in its every day ER visits because the hospital’s closure. The firm’s practically 1,000-bed hospital in Greenville, about 40 minutes from Williamston, is the state’s solely Level 1 trauma middle east of Raleigh.
The Greenville hospital’s median affected person ER wait and therapy time was practically 4½ hours, in line with probably the most recent federal data. That’s longer than 96% of hundreds of hospitals reporting nationwide. The wait occasions “don’t reflect poor care,” ECU Health spokesperson Brian Wudkwych stated in an emailed assertion. He stated the system’s ERs deal with practically 300,000 sufferers yearly.
While the system has seen a rise in Martin County sufferers, the wait occasions primarily stem from shortages of inpatient and behavioral well being beds, Wudkwych stated.
Floyd, the ECU Health chief working officer, stated many rural sufferers who arrive on the system’s ERs have a number of continual circumstances that require longer visits. Often medical doctors begin treating one drawback after which discover the affected person’s “blood sugar is out of control, your hypertension is far out of control,” he stated.
ECU workers encourage people who find themselves not too sick to skip Greenville and, as a substitute, search care at one of many system’s group hospitals, which aren’t as busy, Floyd stated.
A safety officer guarded the Greenville emergency division’s doorways on two nights in April. The “capacity notice” signal close to the doorway meant members of the family of sufferers needed to wait in vehicles or on benches exterior.
“We’ve only been here six hours,” Tonya Miles stated after bringing her mom for a possible blood clot in her leg. The household had left the day earlier than after ready for 2 hours, as a result of her mother “wasn’t prepared” for such a delay in therapy, Miles stated.
Tonya Miles (proper) sits with household exterior ECU Health Medical Center in Greenville, North Carolina. Miles stated they’d “only been here six hours” after bringing her mom to the emergency room for a possible blood clot in her leg. (Sarah Jane Tribble/KFF Health News)
On one other night, Olivia Lewis stated she had introduced her mom two nights beforehand and left with out care after their wait stretched from 10:30 p.m. to 7 a.m.
“She tore off her hospital bracelet and said: ‘I’m out. I’m done,’” she stated. Now, they have been again.
On a latest Friday in Martin County, Vannessa Little was sitting at a McDonald’s along with her youngsters simply down the road from the closed hospital. Little pointed to considered one of her ladies and puzzled how her care would have been completely different if the hospital had been open.
Her daughter, then 6, suffered extreme burns over 30% of her physique in 2024, and the journey to therapy was “just crazy,” Little stated. An ambulance arrived at her Williamston residence from neighboring Bertie County to move them to ECU’s Greenville ER.
“That was a long time,” Little stated of the 30-mile drive. The woman was finally airlifted greater than 100 miles to Chapel Hill. Little stated she hadn’t heard of Trump’s rural well being funding. “The only changes that people are making is they’re taking away everything.”
She voted towards Trump in 2024 and stated she didn’t assume she would vote this yr.
“It’s a waste of my time.”