By Taylor Sisk for KFF Health News.
Broadcast version by Shanteya Hudson for North Carolina News Service reporting for the KFF Health News-Public News Service Collaboration

On a mid-August morning, Christopher Harrison stood in front of the shuttered Martin General Hospital recalling the day a year earlier when he snapped pictures as workers covered the facility’s sign.

“Yes, sir. It was a sad day,” Harrison said of the financial collapse of the small rural hospital, where all four of his children were born.

Quorum Health operated the 49-bed facility in this rural eastern North Carolina town of about 5,000 residents until it closed. The hospital had been losing money for some time. The county’s population has slightly declined and is aging; it has experienced incremental economic downturns. Like many rural hospitals, those headwinds drove managers to discontinue labor and delivery services and halt intensive care during the past five years.

Prospects for reopening seemed dim.

But a new hospital designation by the Centers for Medicare & Medicaid Services that took effect last year offered hope. As of August, hospitals in 32 communities around the country have converted to the rural emergency hospital designation to prevent closure. The new program provides a federal financial boost for struggling hospitals that keep offering emergency and outpatient services but halt inpatient care.

The REH model “is not designed to replace existing, well-functioning rural hospitals,” said George Pink, a senior research fellow at the University of North Carolina’s Cecil G. Sheps Center for Health Services Research, which has documented 149 rural hospitals that have either closed or no longer provide inpatient care since 2010. “It really is targeted at small rural communities that are at imminent risk of a hospital closing.”

The program hasn’t yet been used to reopen a closed hospital.

With guidance from health consultants, Martin County officials asked federal regulators to explore the possibility of adopting the REH model and were ultimately given the go-ahead.

If successful, Martin County could become one of the first in the nation to convert a shuttered hospital to this new model.

Ask members of a community that has lost its hospital what they miss most, Pink said, and it’s almost invariably emergency services. Count Harrison among them, especially after a medical crisis nearly killed him.

Harrison, who lives in a smaller crossroads community a few miles south of Williamston, began experiencing leg pain in February. Under normal circumstances, Harrison said, he would have gone to his primary care doctor if his leg began to hurt. This time he couldn’t, because the practice closed when the hospital folded months earlier.

Then, one morning he awoke to find his foot turning black. It took him 45 minutes to drive to the closest hospital, in the town of Washington. There, doctors found blood clots and he was flown by helicopter to East Carolina University Health Medical Center. A doctor there told him that he’d probably had the blood clots for close to a year and that he was lucky to be alive. The medical team was able to save his foot from amputation.

Harrison, like many other community members, now had firsthand experience with the consequences of a shuttered hospital.

The state legislature’s decision last year to expand Medicaid has meant fewer North Carolinians are uninsured, which means fewer hospital bills go unpaid. But health care is evolving: Many procedures that once required inpatient care are now performed as outpatient services. Dawn Carter, the founder and a senior partner of Ascendient, a health care consulting firm working with the county, said the inpatient census at Martin General in its last few years ranged from five or six a day to a dozen.

“So you’re talking about a lot of cost, a lot of infrastructure to support that,” she said.

With no emergency care within a half-hour radius, Martin County administrators believe a rural emergency hospital would be a good fit and a viable option. REH status allows a hospital to collect enhanced Medicare payments, an annual facility payment, and technical assistance.

Carter said the team will present to the state Department of Health and Human Services a set of drawings of the portion of the building they intend to use to see if it meets REH regulations.

“I’m hoping that process is happening in the next several weeks,” she said, “and that will give us a better idea of whether we have a handful of really quick and easy things to do or if it’s going to take a little more effort to reopen.”

Officials then will take proposals from companies interested in running the hospital.

Carter said the expectation is that, initially, the facility will be strictly the emergency room and imaging department, “and then I think the question is, over time, where do you build beyond that?”

And the rebuilding could prove a challenge from the start. Many former staff members have taken positions at nearby health care facilities or left the area. The effects of that exodus will be compounded by the widespread difficulty in recruiting health workers to rural areas.

It’s early yet, Pink said, to assess the success of the rural emergency hospital model. “All we have are armchair anecdotes.” It seems to be working well in some communities, while others “are struggling a little to make it work.”

Pink has a list of questions to assess how an emergency hospital is faring in the long run:

• Is it at least breaking even? And if not, do administrators foresee a solution?


• How is the community responding? If someone believes they have an issue that might require inpatient care, Pink suggested, perhaps they’ll bypass the REH for a hospital that can admit them. And to what extent does bypassing their doors carry over to all services?


• Are patients happy with the care they’re receiving? Are the clinical outcomes good?

The rate of rural hospital closures rose through 2020, then dropped considerably in 2021. Congress had passed the CARES Act, and the Provider Relief Fund offered a financial lifeline, Pink said. That money has now been distributed, and the concern is that “many rural hospitals are returning to pre-covid financial stresses and unprofitability.”


If the trend continues, he said, more rural hospitals may turn to the REH model.


Ben Eisner serves as Martin County’s attorney and interim manager. He acknowledges that the health and well-being of this community require a lot more than a hospital. He cites, for example, a new nonprofit with a mission to address the social determinants of health.


Advancing Community Health Together was created in response to the hospital closure. Composed of community members, its focus is addressing inadequate health care access and poor health outcomes as a consequence of generational poverty, said Vickey Manning, director of Martin-Tyrrell-Washington District Health.


“We can’t address rural health care in a vacuum,” Carter said. Her organization, Ascendient, is part of the Rural Healthcare Initiative, a nonprofit commissioned by the North Carolina General Assembly to study sustainable models of health care for rural communities.


Like most of rural eastern North Carolina, Martin County is in transition, Eisner said. Diminishing family farms, less industry. “And so the question becomes,” he said, “‘What happens for all these communities? What happens next?’ And it’s an answer that is not yet fully written.”


Harrison, still relying on crutches to get around, recently drove 45 minutes north on U.S. 13 to the town of Ahoskie to have a doctor examine his foot. He said a hospital that offers basic emergency care isn’t a perfect solution, but he’ll have some peace of mind once the cover is peeled from that sign and his local hospital reopens.




Taylor Sisk wrote this story for KFF Health News.


get more stories like this via email

By Sophie Kevany for Sentient.
Broadcast version by Roz Brown for New Mexico News Connection reporting for the Sentient-Public News Service Collaboration

It's a well-known fact that factory farms rely on antibiotics to treat animals raised in cramped, unsanitary conditions. Lesser known is the rising quantity of antibiotics needed to do just that. Sales of medically important antibiotics for use in U.S. livestock farming rose over four percent in 2022, compared to a year earlier, and show an overall upward trend since 2018, risking greater human mortality from antibiotic-resistant infections.

Medically important antimicrobials - a broader term for drugs, including antibiotics, that kill microorganisms - are those considered essential for treating human disease. Globally, the livestock industry fed an estimated 99,502 metric tons of antimicrobials in 2020 to the billions of cattle, sheep, chicken and pigs raised for food that year.

Such widespread antimicrobial use has been linked to the development of resistant bacteria and other organisms like fungi. Infection from antimicrobial-resistant organisms is described as a "growing crisis" by the American Public Health Association and other health professionals and scientists.

People and animals infected by resistant organisms are harder to cure. In the U.S., the Centers for Disease Control estimates there are over 2.8 million antibiotic-resistant infections every year. Of those, over 35,000 people eventually die. Globally, one study found there were an estimated 4.95 million deaths associated with bacterial antimicrobial resistance.

Factory Farms Depend on Antibiotics to Raise Billions of Animals

The Food and Drug Administration data show sales of medically important antimicrobials approved for use in farm animals rose 4.3 percent to 6.25 million kilograms in 2022. The 2022 figure is a significant decrease on the 8.36 million kilograms sold in 2016, the earliest year shown in the data. But the 2022 figure is higher than all other years since 2016, indicating a more recent trend in the wrong direction.

Thomas van Boeckel, an expert in global antimicrobial usage and resistance in farm animals, fish and humans, says the upward swing indicates that "unlike some European and Asian countries ... the U.S. is clearly not on a trend that shows its commitment to sustainably reduce antimicrobial use in animals."

The data, he adds, shows the problem is "mostly a pig and cattle issue" and reveals "a dependence" by the livestock sector on antibiotics that has "potential consequences on the continued development of resistance."

Prior to 2016, the use of medically important drugs for livestock was even higher, says Steven Roach of the Food Animal Concerns Trust. To control the problem, federal rules were tightened in 2017 to prevent farmers using the drugs for growth promotion.

By species, the administration's data shows 2022 sales of medically important antibiotics for cattle were up 4.3 percent to 2.57 million kilograms, higher than any other year since 2016. For pigs, sales rose almost 5 percent to 2.66 million kilograms, again higher than any year since 2016.

Treating Healthy Animals Has Deadly Consequences for Humans

Farmers use antimicrobials in three ways, Roach says. "Treating a sick animal, which everyone supports. Treating a particular group of animals, for example if there is a risk of infection from one sick animal, which we also support," he says.

The third use, which Roach opposes and is prohibited in Europe, is treating healthy animals to prevent disease, a practice known as prophylaxis. For example, Roach says, months of preventative treatment of cattle can happen in feedlots where the animal's weight promoting, high energy diet produces a bacteria that can infect their livers. To prevent liver problems, medically important antimicrobials called macrolides are used, Roach says.

Most antimicrobials are fed to livestock via their feed and water. Research has linked the addition of antimicrobials to water with the faster breeding and spread of resistant bacteria between animals and feedlot workers.

The FDA data, Roach added, does not "tell us the percentages of how much of each antimicrobial is used for which category," making it hard to know the level of preventative use.

Not only does Roach agree that the U.S. livestock sector is falling behind other countries in using more, not less, medically important antimicrobials, he says the government appears uninterested in the problem.

"We can't even get anyone in the U.S. government to say that there is a need to reduce medically important antimicrobials in food animals," he says, blaming livestock industry lobbying for the current predicament.

Roach hopes the FDA "will realize it has to act and follow the EU and prohibit the use of [the drugs] for disease prevention." He adds, "the FDA could also set a public health goal to reduce their use, say by 50 percent by a certain year, which is what other countries have done."

Absent government action to prevent prophylactic use of the drugs, Roach says the most successful route to reducing their use in livestock is consumer pressure. "We have had good luck getting big meat buyers to put pressure on companies. The good news is in chicken, it is going down and part of that was pressure on the companies [to reduce their use of medically important antimicrobials] and a choice by Tyson and Perdue to quit using them."

Some companies are avoiding antibiotics altogether. "[Our] family farmers and ranchers prove every day that routine antibiotic use is not necessary when animals are provided a low-stress environment with extra space, fresh air and humane animal care," says Chris Oliviero, who leads the Niman Ranch network of independent meat producers. Niman Ranch animals that must be treated with antibiotics are not sold as meat.

FDA and American Veterinary Medical Health Association Push Back

Neither the National Cattlemen's Beef Association nor the National Pork Producers Council replied to Sentient Media's requests for comment.

Answering the criticisms raised here, the Food and Drug Administration said in an email that it is "committed to the judicious use of antimicrobials in food-producing animals" and that it continues to take "many actions to promote judicious use, reduce inappropriate use .... [and] try to curb the development of antimicrobial resistance (AMR) that could stem from antimicrobial use in food-producing animals."

Those actions, it said, include rules that now ensure "all medically important antimicrobials for food-producing animals are only available under the supervision of a licensed veterinarian."

Asked about policies to restrict antibiotic use on factory farms elsewhere in the world, the email said U.S. laws and livestock population "are not the same as that of the EU or other countries. The FDA's initiatives to promote judicious use and reduce AMR were devised specifically for the U.S."

It added that there are "many factors to consider" when analyzing antimicrobial sales data. These include sales volume fluctuations "in response to various factors, including changing animal health needs or changes in animal populations that may make certain antimicrobial drugs more medically important at various times."

The American Veterinary Medical Health Association also replied, arguing that antimicrobial sales data is "a valuable indicator of market trends" but that it "does not necessarily reflect the actual use of antimicrobial drugs." Pointing to more detailed biomass data, which includes animal weights, the association further suggested that higher animal numbers might be a factor saying that "... overall, animal populations have been growing annually since 2016 ... [which would] impact the amount of antimicrobials sold and could be one factor contributing to an increase in antimicrobial sales."

Yet according to FACT's Steven Roach, a closer look at the data suggests sales may be even higher. "If you look at the more detailed biomass data referred to by the AVMA it shows that animal numbers were down in 2022 compared to 2021 so when corrected for biomass the [medically important anti-microbial] sales increases are even larger."


Sophie Kevany wrote this article for Sentient.


get more stories like this via email

A newly installed rooftop solar power system will help the Free Clinic of Simi Valley keep its doors open and the lights on for the area's disadvantaged patients.

The Ventura County facility annually serves more than 10,000 uninsured or underinsured, low-income residents. Funding for the project was provided through a grant from the global nonprofit humanitarian aid organization Direct Relief.

Fred Bauermeister, executive director of the clinic, said being mostly "off the power grid" allows them to fund other priorities.

"Despite the fact that we got this building donated, we still have to pay $3,000 a month in electricity, which from a nonprofit point of view, is hard money to raise," Bauermeister, explained. "It's not very compelling when I go out in the community and say, 'Hey, would you give money so we can pay the electricity bill?'"

He pointed out the solar array, combined with soon-to-be-completed battery backup, will provide 53 kilowatts of power, enough to make the clinic officially net-zero in terms of carbon emissions.

The $165,000 grant from Direct Relief comes through the group's Power for Health Initiative, born amid the aftermath of Hurricane Maria in Puerto Rico.

Sara Rossi, managing director of the group's Health Resiliency Fund, said health providers' biggest need was to get the power back on.

"That could include making them more resilient to the effects of climate change through rooftop solar and battery backups that help them weather power outages," Rossi outlined. "Or helping them increase their ability to store cold chain medications and vaccines."

Bauermeister added Direct Relief's solar power system is a gift to their patients that will keep on giving.

"They were generous enough to give us a grant to install 135 solar panels on our roof," Bauermeister noted. "So far, we saved $8,249.87 and that will go on forever. We're forever going to save money on electricity."

get more stories like this via email

Nebraska was among the states affected by the recent E. coli outbreak traced to onions in McDonald's hamburgers. Federal officials said they are now certain about the source but broader questions about the overlap with beef production linger.

The outbreak caused at least one death and sickened dozens of people. This week, key federal agencies closed the investigation, which pinpointed onions from a Colorado farm, while also ruling out burger patties. Ahead of the conclusion, some food safety experts wondered more about bacteria in manure from factory farms, where livestock is raised, finding its way to produce operations.

Prashant Singh, associate professor of health, nutrition and food science at Florida State University, explained the problem with having the different farming operations so close to each other.

"Manure, sometimes, if not properly processed in large operations, can spill over into a fresh produce area," Singh pointed out.

More specifically, contaminated dust particles from waste at concentrated animal feeding operations can land on fields of lettuce, for example, or get into irrigation canals. Separately, a California carrot company last month launched a voluntary recall because of an E. coli outbreak. Environmental groups noted many carrots in California are grown near factory farms.

Singh emphasized meat production has accelerated under evolving technology, with regulations enforced by the U.S. Department of Agriculture but produce is monitored by the Food and Drug Administration and he said the resources are vastly different.

"On the FDA side, they lack everything," Singh observed. "Their hands are very full. "

Even with the resource imbalance, other food safety experts note the meat lobby has focused heavily on avoiding strict regulations under the USDA, and existing laws have limits. Meanwhile, data from the Centers for Disease Control and Prevention show there have been nine multistate foodborne illness outbreaks in 2024.

This story is based on original reporting by Nina Elkadi for Sentient.


get more stories like this via email