{"id":845,"date":"2025-04-09T09:00:00","date_gmt":"2025-04-09T09:00:00","guid":{"rendered":"http:\/\/www.walkwithremar.com\/?p=845"},"modified":"2025-04-11T19:35:36","modified_gmt":"2025-04-11T19:35:36","slug":"rural-hospitals-and-patients-are-disconnected-from-modern-care","status":"publish","type":"post","link":"http:\/\/www.walkwithremar.com\/index.php\/2025\/04\/09\/rural-hospitals-and-patients-are-disconnected-from-modern-care\/","title":{"rendered":"Rural Hospitals and Patients Are Disconnected From Modern Care"},"content":{"rendered":"

If you regularly experience connection issues, click here to read a version of this story designed to open faster in low-signal areas<\/a>.<\/em><\/p>\n

EUTAW, Ala. \u2014 Leroy Walker arrived at the county hospital short of breath. Walker, 65 and with chronic high blood pressure, was brought in by one of rural Greene County\u2019s two working ambulances.<\/p>\n

Nurses checked his heart activity with a portable electrocardiogram machine, took X-rays, and tucked him into Room 122 with an IV pump pushing magnesium into his arm.<\/p>\n

\u201cI feel better,\u201d Walker said. Then: Beep. Beep. Beep.<\/p>\n

The Greene County Health System, with only three doctors, has no intensive care unit or surgical services. The 20-bed hospital averages a few patients each night, many of them, like Walker, with chronic illnesses.<\/p>\n

Greene County residents are some of the sickest in the nation, ranking near the top for rates of stroke, obesity, and high blood pressure, according to data from the federal Centers for Disease Control and Prevention.<\/p>\n

Patients entering the hospital waiting area encounter floor tiles that are chipped and stained from years of use. A circular reception desk is abandoned, littered with flyers and advertisements.<\/p>\n

But a less visible, more critical inequity is working against high-quality care for Walker and other patients: The hospital\u2019s internet connection is a fraction of what experts say is sufficient. High-speed broadband is the new backbone of America\u2019s health care system, which depends on electronic health records, high-tech wireless equipment, and telehealth access.<\/p>\n

<\/p>\n

Greene is one of more than 200 counties with some of the nation\u2019s worst access to not only reliable internet, but also primary care providers and behavioral health specialists, according to a KFF Health News analysis<\/a>. Despite repeated federal promises to support telehealth, these places remain disconnected.<\/p>\n

During his first term, President Donald Trump signed an executive order<\/a> promising to improve \u201cthe financial economics of rural healthcare\u201d and touted \u201caccess to high-quality care\u201d through telehealth. In 2021, President Joe Biden committed billions to broadband expansion.<\/p>\n

KFF Health News found that counties without fast, reliable internet and with shortages of health care providers are mostly rural. Nearly 60% of them have no hospital, and hospitals closed in nine of the counties in the past two decades, according to data collected by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill.<\/p>\n

Residents in these \u201cdead zone\u201d counties tend to live sicker and die younger than people in the rest of the United States, according to KFF Health News\u2019 analysis. They are places where systemic poverty and historical underinvestment are commonplace, including the remote West, Appalachia, and the rural South.<\/p>\n

\u201cIt will always be rural areas with low population density and high poverty that are going to get attended to last,\u201d said Stephen Katsinas, director of the Education Policy Center at the University of Alabama. \u201cIt\u2019s vital that the money we do spend be well deployed with a thoughtful plan.\u201d<\/p>\n

Now, after years of federal and state planning, Biden\u2019s $42 billion Broadband Equity Access and Deployment, or BEAD, program, which was approved with bipartisan support in 2021, is being held up, just as states \u2014 such as Delaware \u2014 were prepared to begin construction. Trump\u2019s new Department of Commerce secretary, Howard Lutnick, has demanded \u201ca rigorous review\u201d of the program and called for the elimination of regulations.<\/p>\n

Trump\u2019s nominee to lead the federal agency overseeing the broadband program, Arielle Roth, repeatedly said during her nomination hearing in late March that she would work to get all Americans broadband \u201cexpeditiously.\u201d But when pressed by senators, Roth declined to provide a timeline for the broadband program or confirm that states would receive promised money.<\/p>\n

Instead, Roth said, \u201cI look forward to reviewing those allocations and ensuring the program is compliant with the law.\u201d<\/p>\n

Sen. Maria Cantwell (D-Wash.), the Senate commerce committee\u2019s ranking minority member, said she wished Roth had been more committed to delivering money the program promised.<\/p>\n

The political wrangling in Washington is unfolding hundreds of miles from Greene County, where only about half of homes have high-speed internet and 36% of the population lives below the poverty line, according to the U.S. Census Bureau.<\/p>\n

Walker has lived his life in Alabama\u2019s Black Belt and once worked as a truck driver. He said his high blood pressure emerged when he was younger, but he didn\u2019t take the medicine doctors prescribed. About 11 years ago, his kidneys failed. He now needs dialysis three times a week, he said.<\/p>\n

While lying in the hospital bed, Walker talked about his dialysis session the day before, on his birthday. As he talked, the white sheet covering his arm slipped and revealed where the skin around his dialysis port had swollen to the size of a small grapefruit.<\/p>\n

Room 122, where Walker rested, is sparse with a single hospital bed, a chair, and a TV mounted on the wall. He was connected to the IV pump, but no other tubes or wires were attached to him. The IV machine\u2019s beeping echoed through the hallway outside. Staffers say they must listen for the high-pitched chirps because the internet connection at the hospital is too slow to support a modern monitoring system that would display alerts on computers at the nurses\u2019 station.<\/p>\n

<\/p>\n

Aaron Brooks, the hospital\u2019s technology consultant, said financial challenges keep Greene County from buying monitoring equipment. The hospital reported a $2 million loss<\/a> on patient care in its most recent federal filing. Even if Greene could afford a system, it does not have the thousands of dollars to install a high-speed fiber-optic internet connection necessary to operate it, he said.<\/p>\n

Lacking central monitoring, registered nurse Teresa Kendrick carries a portable pulse oximeter device, she said \u2014 like ones sold at drugstores that surged in popularity during the covid-19 pandemic.<\/p>\n

Doing her job means a \u201ccontinuous spot-check,\u201d Kendrick said. Another longtime nurse described her job as \u201ca lot of watching and checking.\u201d<\/p>\n

Beep. Beep.<\/strong><\/p>\n

The beeping in Room 122 persisted for more than two minutes as Walker talked. He wasn\u2019t in pain \u2014 he was just worried about the beeping.<\/p>\n

About 50 paces down the hall \u2014 past the pharmacy, an office, and another patient room \u2014 registered nurse Jittaun Williams sat at her station behind plexiglass. She was nearly 20 minutes past the end of her 12-hour shift and handing off to the three night-shift nurses.<\/p>\n

They discussed plans for patients\u2019 care, reviewing electronic records and flipping through paper charts. The nurses said the hospital\u2019s internal and external computer systems are slow. They handwrite notes on paper charts in a patient\u2019s room and duplicate records electronically. \u201cOur system isn\u2019t strong enough. There are many days you kind of sit here and wait,\u201d Williams said.<\/p>\n

<\/p>\n

Broadband dead zones like Greene County persist despite decades of efforts by federal lawmakers that have created a patchwork of more than 133 funding programs across 15 agencies, according to a 2023 federal report<\/a>.<\/p>\n

Alabama\u2019s leaders, like others around the U.S., are actively spending federal funds from the Biden-era American Rescue Plan Act, according to public records. And Greene County Hospital is on the list of places waiting for ARPA construction, according to agreements provided<\/a> by the Alabama Department of Economic and Community Affairs.<\/p>\n

\u201cIt is taking too long, but I am patient,\u201d said Alabama state Sen. Bobby Singleton, a Democrat who represents the district that includes Greene County Hospital and two others he said lack fast-enough connectivity. Speed bumps such as a need to meet federal requirements and a \u201cbig fight\u201d to get internet service providers to come into his rural district slowed the release of funds, Singleton said.<\/p>\n

Alabama received its first portion of ARPA funds in June 2021, which Singleton said included money for building fiber-optic cables to anchor institutions like the hospital. Alabama\u2019s awards require<\/a> the projects to be completed by February 2026 \u2014 nearly five years after money initially flowed to the state.<\/p>\n

Singleton said he now sees fiber lines being built in his district every day and knows the hospital is \u201con the map\u201d to be connected. \u201cThis doesn\u2019t just happen overnight,\u201d he said.<\/p>\n

Alabama Fiber Network, a consortium of electric cooperatives, won a total of $45.7 million in ARPA funding specifically for construction to anchor institutions in Greene and surrounding counties. James Hoffman, vice president of external affairs for AFN, said the company is ahead of schedule. It plans to offer the hospital a monthly service plan that uses fiber-optic lines by year\u2019s end, he said.<\/p>\n

Greene County Health System chief executive Marcia Pugh confirmed that she had talked with multiple companies but said she wasn\u2019t sure the work would be complete in the time frame the companies predicted.<\/p>\n

\u201cYou know, you want to believe,\u201d Pugh said.<\/p>\n

<\/p>\n

Beep. Beep.<\/strong><\/p>\n

Nurse Williams had finished the night-shift handoff when she heard beeps from Walker\u2019s room.<\/p>\n

She rushed toward the sound, accidentally ducking into Room 121 before realizing her mistake.<\/p>\n

Once in Walker\u2019s room, Williams pressed buttons on the IV pump. The magnesium flowing in the tube had stopped.<\/p>\n

\u201cYou had a little bit more left in the bag, so I just turned it back on,\u201d Williams told Walker. She smiled gently and asked if he was warm enough. Then she hand-checked his heart rate and adjusted his sheets. At the bottom of the bed, Walker\u2019s feet hung off the mattress and Williams gently moved them and made sure they were covered.<\/p>\n

Walker beamed. At this hospital, he said, \u201cthey care.\u201d<\/p>\n

As rural hospitals like Greene\u2019s wait for fast-enough internet, nurses like Williams are \u201cheroes every single day,\u201d said Aaron Miri, an executive vice president and the chief digital and information officer for Baptist Health in Jacksonville, Florida.<\/p>\n

Miri, who served under both Democratic and Republican administrations on Department of Health and Human Services technology advisory committees, said hospitals need at least a gigabit of speed \u2014 which is 1,000 megabits per second \u2014 to support electronic health records, video consultations, the transfer of scans and images, and continuous remote monitoring of patients\u2019 heartbeats and other vital signs.<\/p>\n

But Greene\u2019s is less than 10% of that level, recorded on the nurses\u2019 station computer as nearly 90 megabits per second for upload and download speeds.<\/p>\n

It\u2019s a \u201cheartbreaking\u201d situation, Miri said, \u201cbut that\u2019s the reality of rural America.\u201d<\/p>\n

The Beeping Stopped<\/strong><\/p>\n

Michael Gordon, one of the hospital\u2019s three doctors, arrived the next morning for his 24-hour shift. He paused in Room 122. Walker had been released overnight.<\/p>\n

Not being able to monitor a cardiovascular patient\u2019s heart rhythm, well, \u201cthat\u2019s a problem,\u201d Gordon said. \u201cYou want to know, \u2018Did something really change or is that just a crazy IV machine just beeping loud and proud and nobody can hear it?\u2019\u201d<\/p>\n

<\/p>\n

Despite the lack of modern technology tools, staffers do what they can to take care of patients, Pugh said. \u201cWe show the community that we care,\u201d she said.<\/p>\n

Pugh, who started her career as a registered nurse, arrived at the hospital in 2017. It was \u201ca mess,\u201d she said. The hospital was dinged four years in a row<\/a>, starting in 2016, with reduced Medicare payments for readmitting patients. Pugh said that at times the hospital had not made payroll. Staff morale was low.<\/p>\n

In 2021, federal inspectors notified Pugh of an \u201cimmediate jeopardy\u201d violation<\/a> \u2014 grounds for regulators to shut off federal payments \u2014 because of an Emergency Medical Treatment and Labor Act complaint. Among seven deficiencies inspectors cited, the hospital failed to provide a medical screening exam or stabilizing treatment and did not arrange appropriate transfer for a 23-year-old woman who arrived at the hospital in labor, according to federal reports<\/a>.<\/p>\n

Inspectors also said the hospital failed to ensure a doctor was on duty and failed to create and maintain medical records. An ambulance took the woman to another hospital, where the baby was \u201cpronounced dead upon arrival<\/a>,\u201d according to the report.<\/p>\n

Federal inspectors required the hospital to take corrective actions and a follow-up inspection<\/a> in July 2021 found the hospital to be in compliance.<\/p>\n

In 2023, federal inspectors again cited the hospital\u2019s failure to maintain records and noted it had the \u201cpotential to negatively affect patients<\/a>.\u201d<\/p>\n

Inspectors that year found that medical records for four discharged patients had been lost. The \u201cphysical record\u201d included consent forms, physician orders, and treatment plans and was found in another department<\/a>, where it had been left for two months.<\/p>\n

Pugh declined to comment on the immediate jeopardy case. She confirmed that a lack of internet connectivity and use of paper charts played a role in federal findings, though she emphasized the charts were discharge papers rather than for patients being treated.<\/p>\n

She said she understands why federal regulators require electronic health records but \u201cour hospitals just aren\u2019t the same.\u201d Larger facilities that can \u201cget the latest and greatest\u201d compared with \u201cour facilities that just don\u2019t have the manpower or the financials to purchase it,\u201d she said, \u201cit\u2019s two different things.\u201d<\/p>\n

<\/p>\n

Walker, like many rural Americans, relies on Medicaid, a joint state and federal insurance program for people with low incomes and disabilities. Rural hospitals in states such as Alabama that have not expanded Medicaid coverage to a wider pool of residents fare worse financially, research shows<\/a>.<\/p>\n

During Walker\u2019s stay, because the hospital can\u2019t afford to modernize its systems, nurses dealt with what Pugh later called an \u201castronomical\u201d number of paper forms.<\/p>\n

Later, at Home<\/strong><\/p>\n

Walker sat on the couch in the modest brick home he shares with his sister and nephew. In a pinch, Greene County Hospital, he said, is good \u201cfor us around here. You see what I\u2019m saying?\u201d<\/p>\n

Still, Walker said, he often bypasses the county hospital and drives up the road to Tuscaloosa or Birmingham, where they have kidney specialists.<\/p>\n

\u201cWe need better,\u201d Walker said, speaking for the 7,600 county residents. He wondered aloud what might happen if he didn\u2019t make it to the city for specialty care.<\/p>\n

Sometimes, Walker said, he feels \u201cthrown away.\u201d<\/p>\n

\u201cPeople done forgotten about me, it feels like,\u201d he said. \u201cThey don\u2019t want to fool with no mess like me.\u201d<\/p>\n

Maybe Greene County\u2019s health care and internet will get better, Walker said, adding, \u201cI hope so, for our sake out in a rural area.\u201d<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

This story can be republished for free (details<\/a>).<\/p>\n","protected":false},"excerpt":{"rendered":"

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