Jennersville isn’t just another shuttered hospital. It was my home for 2 years | Opinion

On Dec. 31, most of us found ourselves ready to put 2021 behind us and look ahead to what 2022 might bring. For Jennersville Hospital in West Grove, Chester County, there would be no looking ahead.

At midnight on Jan. 1, 2022, the rural hospital, around for more than 100 years, turned the lights off and locked its doors to patients.

To some, this may seem like an unfortunate story from “somewhere out there”; another rural hospital that’s gone under, along with more than 100 others since 2020. To me, this cuts close and deep — from April 2019 to March 2021, the Jennersville Hospital emergency department was my clinical home as an emergency physician.

Jennersville Hospital was a small, 63-bed community hospital in southern Chester County, near the borders of Delaware and Maryland. It changed ownership in 2017 and became part of the Tower Health system. It housed Medic 94, an ambulance EMS that serviced an area of more than 200 square miles.

Unlike what I was used to in Philadelphia, the patient population was largely white, nearly 20% Latino, and only 5% Black. But the people I treated in the ED reflected the diversity of the area in a way demographics alone could never illustrate. Whether it be mushroom farmers, horse breeders, farm owners, canning workers, Herr’s factory workers, students from Lincoln University (the nation’s first degree-granting HBCU), Amish families, a full gamut of white-collar professionals, retirees in assisted living communities, or urban transplants, generations in the area had gone to Jennersville ED for care. As the impending closure neared, my heart sank for all of them.

The hospital was not a trauma center, had no maternity services, no pediatricians, no on-staff psychiatrists or mental health services. But the emergency department dealt with all of it. We treated everyone, stabilized those who needed more, and facilitated transfers to other regional hospitals that could offer higher levels of care. The cohort of nurses in the ED carried a work ethic and experience base that were unmatched in the hospital as a whole. They knew the responsibilities they bore as a result of their geography and no other backup. I had to learn a new way of thinking and functioning as a clinician, far from the many services and specialties I had taken for granted. I never thought I would silently pray for no wind and good weather while stabilizing a patient whose aorta was tearing, knowing that a helicopter ride out to a cardiothoracic or vascular surgeon was their only chance of survival.

“I had to learn a new way of thinking and functioning as a clinician, far from the many services and specialties I had taken for granted.”

It was also a new experience to be the only female physician of color in the hospital setting. It took some time for people to recognize me as the doctor in charge and for others to understand that I am American. “Are you from Syria?” one man sporting head-to-toe MAGA gear once asked me. (“No, I’m from down Route 48 in Greenville,” I told him.) As they were leaving, the husband locked eyes with me and said, “You took real good care of us, Doc.” When I gave a warm blanket to a young child who stayed awake at his mom’s bedside late into the night as we assessed her injuries and fixed the wounds from her husband’s assault, he said, “Thank you, auntie.”

This small community hospital had an amazing camaraderie and support, particularly among those of us who were on the front lines. When our colleagues in the cafeteria hadn’t seen anyone from the ED, they would bring us some leftovers, knowing that it meant we had been too busy to eat. We helped one another find and purchase PPE. Leading up to the 2020 elections, ED staff helped people register to vote and encouraged them to make their voices heard through civic engagement.

Each of the more than 100 hospitals that have closed since 2020 provided a safety net for the community it served. In 2018, more than 14,000 people went to Jennersville ED. Now that it’s closed, ambulance dispatch times will increase, further lengthening 911 response times across the region. For one senior living facility, the time to the closest ER went from 10 minutes to 40 on the day Jennersville closed.

» READ MORE: Brandywine and Jennersville Hospitals will close, leaving thousands in Chester County without nearby emergency care

COVID-19 has brought to light and then destroyed the razor-thin margins of hospitals’ finances, as it has forced many to cancel profitable, non-emergency surgeries. But long before COVID, corporate business decisions — far from the hospital communities — have doomed some rural facilities. Jennersville’s owner, Tower Health, expanded rapidly in the region, then had to make dramatic cuts in staff, including doctors, and expenses to curb the huge losses it experienced as a result of the pandemic. This is when I, too, had to leave.

The story of Jennersville Hospital illustrates the complexities and far-reaching impacts of valuing “margins over missions” — or putting profits before patients. As a result of this practice, I have watched highly skilled colleagues walk away from hospital-based work. I have listened as patients rationalize their decisions not to seek care earlier due to difficulties and distance in access. I have felt the forceful ripples of fewer available inpatient beds all the way back in my Philly ED.

Will our leaders, government agencies, medical societies, and elected officials heed the lessons that Jennersville Hospital offers? Will we understand that the health of the community is not a commodity easily fit into capital markets and financial models with zero-sum bottom lines, or fodder for private equity? Until we do, the stories and the voices from within the hospitals must continue to highlight the issues of the community and providers who care for them.

Unfortunately, there will be more stories to tell. Brandywine Hospital, another Tower-owned facility in Coatesville that served more than 21,000 patients in its ED in 2020, is set to close Jan. 31.

Priya E. Mammen is an emergency physician and public health consultant. She is chair of the section on public health and preventive medicine at the College of Physicians of Philadelphia and adjunct faculty of health and societies at the University of Pennsylvania. She writes a monthly column on the future of public health in the region @PEMammen