A hospital slowly fades away in rural Pennsylvania

BERWICK, Pa. — The emergency room was dark, the doors locked for months now, and a young woman stood outside in the rain, clutching her stomach and sobbing. No one was coming out to help.

The frantic people who drove the ailing woman to the hospital stood, dumbfounded, in the mostly empty parking lot.

“This is insane,” the driver said. “I’m going to have to call 911.”

On Sept. 17, the Pennsylvania Department of Health shut down Berwick Hospital Center’s emergency room because of a lack of staffing, accelerating a closure its owners planned out earlier that summer. Signs on the doors still advise patients to head to hospitals in Hazleton, 20 miles to the south, or Bloomsburg, 14 miles west, for emergencies. The 90-bed facility is currently operating only as a 14-bed inpatient geriatric psychiatry facility — but not everyone in this town of 10,349 on the Susquehanna River in Columbia County, knows that.

On that dreary March morning, the ill woman was carried back to a car to wait for an ambulance. Bette Grey, a Berwick resident and private medical advocate who fought, unsuccessfully, to keep the hospital open, was there to talk to The Inquirer. First, she watched her fears unfold.

“Hey, stay awake. Open your eyes,” Grey yelled, to the woman in the car, clapping her hands.

In 1903, physicians in Berwick lamented the closing of a small hospital there. There simply weren’t enough patients at the time, they told a newspaper. A new hospital opened, two years later. Berwick’s population peaked at 14,000 around midcentury and in May of 1959, the hospital’s current location was opened on 16th Street to much fanfare. The Berwick Enterprise dedicated nearly a dozen pages to the opening.

“A new hospital shows a progressive area,” one headline stated.

By 1999, the hospital was losing money and was sold to Community Health Systems for $33 million. The sale, according to a Wilkes-Barre Times Leader article, marked the first time a nonprofit hospital was sold to a for-profit company in Pennsylvania. Two decades later, the hospital was losing money, again. Total patient revenue was down from $51 million in 2018 to $33 million in 2020, the year the hospital and its clinics were sold to Priyam Sharma, of Michigan, for an undisclosed price.

The Sharma family, including Priyam’s husband, Sanjay Sharma, and their son, Sanyam Sharma, have purchased and run at least two other hospitals, one in Galesburg, Ill., and another in Pontiac, Mich. The family owns a medical school and tried, unsuccessfully, to purchase Philadelphia’s Hahnemann Hospital in 2019.

Neither the Sharmas nor their bankruptcy attorney returned multiple requests for comment.

One doctor who worked at Berwick said red flags went up among the staff shortly after the purchase, with concerns about the billing process, how records were being handled, and overall patient care. Some staffers contacted the FBI, the doctor said. An FBI spokesperson in Philadelphia declined to comment.

A defunct website for one Sharma affiliate — SBJ Group — claimed the company specialized in “hospital turnaround.” The former Berwick doctor believes the Sharmas wanted the hospital to fail so it could be flipped.

“From day one, they knew what they were doing,” a former hospital doctor, who asked not to be identified, said. “They conducted massive layoffs, essentially running a skeleton crew in the hospital.”

In July, Priyam Sharma notified Pennsylvania’s Department of Health that she planned to transition the facility into a smaller psychiatric hospital. DOH rejected that plan, citing insufficient details, but Grey said staffers saw the writing on the wall and began leaving. Sharma, at the time, said there were too few patients to continue as a hospital.

“To serve the community, to save jobs, to create more jobs, we have to have more heads in beds,” Sharma told the Berwick Press Enterprise around that time. “The only way we can do it is to become a psychiatric hospital.”

A month later, in August, Berwick residents filled a council meeting, urging elected officials to do something. Council members said their hands were tied. With staffing shortages, DOH stepped in and wound up closing the emergency room. Sharma filed for Chapter 11 bankruptcy protection around the same time.

One Sharma hospital, 200 miles southwest of Chicago, was closed in January 2021 after the state found numerous health and safety violations. The Sharmas have since sold that hospital. In Pennsylvania, DOH received a complaint about Berwick and found that Priyam Sharma was using the old gift shop as living quarters in lieu of hotel rooms when visiting. One former staffer told The Inquirer a dog was living there, too. The DOH also found the hospital was lacking on-call anesthesia coverage and not properly checking credentials.

“Something clearly wasn’t right here,” Grey said outside the hospital.

Grey, a lifelong Berwick resident, is a private patient advocate. She helps patients navigate appointments, remedy treatment delays, and obtain their medical records. She’s emerged as the biggest critic of the hospital’s management in recent years. She ran a free health clinic for eight years and is hoping to open a “micro-hospital” in town with some former Berwick employees.

“I’m doing this because I care about health care,” she said.

According to the Pennsylvania Office of Rural Health, five rural hospitals have closed since 2005 in the state, though that number doesn’t include others that have shuttered specific units, like emergency care. Nationwide, according to the U.S. Government Accountability Office, over 100 rural hospitals closed between January 2013 and February 2020. The Inquirer visited one of those hospitals, 40 miles southwest of Berwick, in 2019. That facility, University of Pittsburgh Medical Center’s Susquehanna Sunbury Hospital, also experienced financial losses.

Some rural hospitals across the country have taken the opposite approach to Berwick. They’re refocusing what they have left on emergency care.

“We want to be the facility that saves lives,” a hospital administrator in New Mexico told Kaiser Health News.

Berwick turned to elderly psychiatric care instead. Few argue that service isn’t needed, but many locals are concerned about Sharma’s plan to expand capacity to 53 beds for psychiatric patients of all ages.

“We believe the hospital could be utilized in a better manner than that,” said Berwick council member Jeri Wozniak.

Grey said she once spoke to Priyam Sharma about possibly purchasing the hospital, but the price was too high and the conversation didn’t go anywhere. She’s since given up on that idea.

“There’s just too much bad karma now,” Grey said.

Grey said the woman who came to Berwick’s shuttered emergency room survived.