Chapter 3 — Tragedy Is Going To Happen
Emergency care gets complicated after a hospital closes. On a cold February evening, when Robert Findley falls and hits his head on a patch of ice and his wife, Linda, calls for 911, the delays that come next expose the frayed patchwork that sometimes stands in for rural health care.
Chapter 3 Transcript
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[Segment 1— 0:05]
SARAH JANE TRIBBLE: Life was good for Robert and Linda Findley. They were at an age when a lot of people retire. But not Linda and Robert. Robert's auto body shop was busy. The couple spent weekends with friends riding four-wheelers up and down backwoods trails — the muddier the better. Sure, he had diabetes and high blood pressure, but nothing too serious. So when Mercy Hospital closed, the Findleys had no reason to be terribly concerned. Except … Kansas winters can be tricky. And that February, there was a nasty cold spell.
LINDA FINDLEY: It was icy. He come in the house about 5:30. He'd been out to pick up the mail. And he laughed and said, "It's a wonder I didn't knock myself out." He said, "I fell in the driveway and hit my head real hard." We had a conversation, whether he was OK or what. And he seemed to think he was fine. And he done his normal things …
SARAH JANE TRIBBLE: Linda seems to remember every detail as she tells me about that day. Robert grabbed dinner, went down to his man cave to watch some TV and went to bed around 9:30. At 4 a.m., he wakes up with a sick stomach and excruciating headache. Robert takes a couple of extra-strength Tylenol and tells Linda he'll be fine. Then he closes his eyes.
LINDA FINDLEY: And it actually just went downhill from there. He, um, was sitting in the recliner. I thought that he hadn't had a lot of rest, and so he kind of went to sleep. Well, then I realized that his breathing seemed to be erratic. And I thought, “Oh, my God, he's got a bad concussion. I can't let him sleep.”
SARAH JANE TRIBBLE: Linda says she tries to wake him up but can't.
911 DISPATCHER: This is 911.
LINDA FINDLEY: Yes, I need an ambulance at Maple Road immediately.
911 DISPATCHER: And what's going on?
LINDA FINDLEY: My husband fell yesterday and hit his head. And now he’s went to sleep this morning and I can't wake him up.
911 DISPATCHER: OK. How old is he?
LINDA FINDLEY: Seventy.
SARAH JANE TRIBBLE: When Fort Scott's hospital shut down, so did its emergency department. Temporarily. Another hospital was planning to operate the ER, but it hadn't yet reopened. Even so, the town kept its ambulance crews. And they came fast. Linda says the EMS guys take one look at Robert's eyes and they suspect a brain hemorrhage. Robert needs to get to a hospital with a neurology center. The closest is about 100 miles north, in Kansas City. So an EMS worker calls for a helicopter medevac.
EMS WORKER: We are triage red. Can you dispatch the nearest air ambulance?
SARAH JANE TRIBBLE: Fort Scott went without its emergency department for 18 days. Local emergency workers call it the dark period. And what happened then helped me understand how complicated rural care becomes after a hospital closes. Delays in emergency care can cost patients dearly.
I'm Sarah Jane Tribble. This is Where It Hurts, a new podcast from KHN and St. Louis Public Radio. Season one is "No Mercy."
[Segment 2 — 3:39]
SARAH JANE TRIBBLE: I pieced together what happened after talking with Linda and listening to the 911 tape recording that Fort Scott officials provided. While the EMS crew work on Robert, a dispatcher in Fort Scott dials an air ambulance company.
MEDEVAC OPERATOR: Did you want to remain on the line while I check with my closest available, or would you like me to give you a call back?
EMS WORKER: Uh, I'll remain on the line.
SARAH JANE TRIBBLE: When the medevac operator comes back on the line, the news isn't good.
MEDEVAC OPERATOR: My Nevada [Missouri] crew is not available, and my Parsons crew has declined. Uh, I will be reaching out to ...
SARAH JANE TRIBBLE: The first helicopter base said no. So did the second. The operator doesn't say why — just that they can't come. So she keeps looking for a taker.
EMS WORKER: EMS 1 county. En route.
MEDEVAC OPERATOR: 10-4.
SARAH JANE TRIBBLE: Meanwhile, at the Findleys’ home, Linda says, the EMS crew was really worried about Robert's brain. They load him up and drive towards what was Mercy Hospital. That's where the helipad is. Linda gets in her car to follow.
LINDA FINDLEY: And so they, they just loaded him up and took off. And when I got out there, I go flying in the hospital in the emergency room and realized, you know, there's a cardboard sign in front of the door that they're closed for remodel.
And I'm like, “They just brought Robert Findley in here.” “Well, they didn't bring him in here. He must still be out in the ambulance.”
SARAH JANE TRIBBLE: There were people there?
LINDA FINDLEY: Yes.
SARAH JANE TRIBBLE: In her rush and panic, Linda forgot the ER had closed days before. She's standing outside the doors. The lights are on, but Robert's not inside. A worker comes to the door and says the EMS crew and Robert are actually parked behind Linda.
LINDA FINDLEY: So this young lady said, “I'll check.” And she went out and the EMTs were out there with Robert in the ambulance.
SARAH JANE TRIBBLE: In the back of the ambulance, Linda says, there's a tube down Robert's throat and the EMS crew is hand-pumping oxygen into his lungs. I played the EMS recording over and over and counted up the time. For more than 30 minutes, Robert lay unconscious in the back of the ambulance, waiting. While the EMS crew and Linda wait, they talk. Remember, it's a small town. Linda knows one of the guys on the crew. So, they try to prepare her for what's to come.
LINDA FINDLEY: They told me — I don't even remember now — how long it'd be. And they said, “But if you want to go home and pack a bag and stuff and meet us at St. Luke's, because this is going to be a bad deal. It's going to be a long, drawn-out deal.”
SARAH JANE TRIBBLE: When this kind of trauma happens, time matters. It takes time for the medevac operator to find a pilot to come for Robert. The pilot then has to get there. Once he's arrived, he still has to transport Robert to Kansas City.
EMS WORKER: Vitals are all stable. I'm just supporting the ventilation. We'll see you here in a few minutes.
SARAH JANE TRIBBLE: Robert was in Kansas City for several days, and he never woke up.
People who live near a rural hospital when it closes are at least 6% more likely to die after the hospital closes compared to before. Researchers did not find that same increase in deaths after an urban hospital shuts down.
A health economist at the VA in Palo Alto, California, uncovered this statistic. There are a variety of reasons for this. But being able to have good health care that's easy to get plays a role. In Fort Scott, lots of people say they need a traditional full-service hospital. Some are still holding out hope that a hospital will return. Others say they would be happy with a hybrid. They're all trying to figure out what Fort Scott needs. It's become sort of a town pastime. And it's a question I ask nearly everyone I meet. The local lumberyard owner. Former hospital staff. And farmers having coffee at the local gas station.
What kind of health care do you think this community needs going forward?
MATT NOLL: Well, we need to have a hospital and emergency room.
CHRISTI KEATING: I think you need to have primary care clinic. You need to be able to go and get your preventative medicine. You need to be able to get a mammogram. You can go in and have labs drawn, to know if you're prediabetic or diabetic. Immunizations for our children. And then, after primary care ...
LARRY COWEN: My doctor went to Pittsburg [Kansas]. To Via Christi. So, if I get very bad I'll go down there. If I've just got a cold or something, I'll go into the walk-in unit up here. But, uh, I'm just lucky, don't have to go very often, so ...
SARAH JANE TRIBBLE: If anyone is in a position to have an opinion, it's Linda Findley. I asked her, too. Linda was with her friend Susan Wood, a former nurse at Mercy. Susan spoke first.
SUSAN WOOD: Like I say, just an emergency room and maybe a two- to three-day-stay-type facility. Again, if you need a neurologist, a pulmonologist, a cardiologist, if you're having a heart attack or a blood clot in your lung or whatever, you're going to have to go somewhere anyway. Because the specialties are not here in rural America.
SARAH JANE TRIBBLE: Linda joins in. And at first her thought seems unrelated. But then ...
LINDA FINDLEY: I have a police scanner at home and it is nonstop sending people from here to Via Christi.
SARAH JANE TRIBBLE: Linda and Robert have a police scanner, and she's telling me that without the hospital, the local ambulance crews are driving out of town every day to deliver patients to another hospital, called Via Christi, in the next town over. So it's like everyone in town has an opinion. But the opinion that's going to make the biggest difference is Reta Baker's, the hospital's former president. More than anyone, Reta decided what Fort Scott's residents would have after there was no Mercy. I asked her, too.
RETA BAKER: Yeah. For the people in the community getting that quick and immediate emergency care, my heart really sunk when I thought, “Maybe we won't have this.” Because to me, that is a tragedy.
SARAH JANE TRIBBLE: Reta says no ER means there's a higher chance for what she calls bad outcomes.
RETA BAKER: Because a paramedic in the field, they don't have the training to decide “Should this person really be flying from this house, or do we have time to take them 45 minutes or an hour to an emergency room?” So, to me, it is absolutely critical that this community have an emergency room.
SARAH JANE TRIBBLE: An ER, even if it's a stand-alone like the one Fort Scott has now, has nurses and physicians in charge of crucial decisions.
RETA BAKER: I think the patients that I worry for are the stroke patients, because there's irreversible brain damage.
SARAH JANE TRIBBLE: There are a lot of elderly people here who ...
RETA BAKER: There are.
SARAH JANE TRIBBLE: … can have a stroke or maybe other or worse things.
RETA BAKER: Heart attack or, you know, the traumas, the heart attacks, the strokes are the ones that I feel the most urgent need for an ER.
SARAH JANE TRIBBLE: Reta's determination made sure Fort Scott had an ER.
But is that enough?
It's June. The sun is high and sweat is sliding down my back. I'm with a small crowd at Fort Scott's historic fort waiting to see an air ambulance land.
MAN: There it is.
SARAH JANE TRIBBLE: There's lots of excitement, especially from the kids.
The helicopter circles above, getting closer, then pulling away, then closer again, teasing the crowd. Seven-year-old Kaidence is playing with a plastic bead necklace and watching the sky.
You're here to watch the EMS helicopter? Why are you interested in it?
KAIDENCE ANDERSON: Because it's going to show us how it's going to help other people because we don't have the hospital anymore.
SARAH JANE TRIBBLE: That's a really thorough answer. How do you know about the hospital?
KAIDENCE ANDERSON: Because we drove by it and we used to go there for my brother because he had asthma.
SARAH JANE TRIBBLE: I ask Kaidence what she thought of the hospital when it was open.
KAIDENCE ANDERSON: That it took care of us and we should help it, too, if it helps us.
SARAH JANE TRIBBLE: The helicopter display and landing is part of Fort Scott's Good Ol' Days festival. The pioneer fort decided to host the ambulance because they hoped it would bring families to their fairground. For the kids, it's fun to see a big bird up close for the first time. For the adults — like Kaidence's mom, Dawn Swisher-Anderson — air ambulances must seem more essential, like a lifeline, now that Mercy Hospital is gone. Dawn's 4-year-old, Connor, has really bad asthma attacks. And when he has one, they drive 35 to 40 minutes with a gasping preschooler to the hospital in the next town over.
DAWN SWISHER-ANDERSON: It's obviously scary with a young one when he's having breathing complications. I don't like to have to commute that far, but that's the closest for us. So ...
SARAH JANE TRIBBLE: I'm puzzled, though. Fort Scott has an ER now, and I want to make sure Dawn knows.
But they do have the ER still.
DAWN SWISHER-ANDERSON: He was admitted several times with his asthma issues. They would usually put him in the hospital at least overnight for observation because he's so young. And so now they send us automatically to Pittsburg for those types of services.
SARAH JANE TRIBBLE: So she's telling me that Fort Scott's new ER doesn't have what her family needs. They need a full-service hospital, so they make the drive.
DAWN SWISHER- ANDERSON: We definitely miss having an actual functioning hospital. It's good that we have emergency services. It was scary until we knew for sure that we’d keep those, but we considered moving at several points in order to be closer to a hospital that would be able to take care of his needs.
SARAH JANE TRIBBLE: So, air ambulances like the one landing here today are part of the solution.
CONNOR ANDERSON: Mommy, it's going to take off?
DAWN SWISHER-ANDERSON: In a little more.
CONNOR ANDERSON: Can we watch it take off?
DAWN SWISHER-ANDERSON: Did you like it?
KAIDENCE ANDERSON: I really like it.
MAN: Just a little more time to let it cool down.
KAIDENCE ANDERSON: It's big, too.
CONNOR ANDERSON: The repeller … is very huge.
SARAH JANE TRIBBLE: Kaidence and her brother are very impressed by the helicopter. And it is quite exciting. The blade stops spinning. A pilot and his crew step out and the crowd rushes forward, jockeying for spots to meet them. After the landing, I caught up with Dawn.
How do you feel now that you've seen it?
DAWN SWISHER-ANDERSON: Relieved, I guess, knowing that we at least have some, some type of transport, if there is an emergency.
SARAH JANE TRIBBLE: In Dawn's mind, the ER wasn't enough. But this air ambulance makes her feel better. I'm not so sure.
[Segment 3 — 14:27]
I decided to come to the helicopter landing today because I have some unanswered questions about what happened to Robert and Linda Findley and why they waited so many minutes for that helicopter to arrive.
You're my last interview of the day. I'm going to get a funnel cake afterwards and sit down. So you're Mike Samuelson, right?
MICHAEL SAMUELSON: Yes, that's right.
SARAH JANE TRIBBLE: And you're a pilot?
MICHAEL SAMUELSON: Yeah, I'm a pilot.
SARAH JANE TRIBBLE: He doesn't know about Robert's case, but he's been a medevac pilot for about 15 years. First, I ask him why a pilot would say no or decline a flight. Mike told me that if the weather is bad, it's not safe for pilots to fly. The second big question I have is about how long it took for the air ambulance to get to Fort Scott.
What kind of, um, response times do you have if you get a call from, say, Fort Scott? When would you expect to get here? And what standards?
MICHAEL SAMUELSON: By the time we get the call, it takes us about 10 minutes to get the helicopter ready and get airborne, and then of course whatever time it takes to fly. For example, from Pittsburg to Fort Scott, it's about a 15-minute flight. It's pretty fast.
SARAH JANE TRIBBLE: As Mike keeps talking, I have one of those moments where my heart feels like it's pounding in my head. Only 15 minutes to get to Fort Scott? But you can hear on the 911 call, the operator tells Fort Scott's EMS crew that it will take an estimated 38 minutes for the air ambulance to arrive. Plus, Mike tells me it's another 40-minute flight from Fort Scott to the hospital in Kansas City.
It's difficult to know if, for Robert, those minutes mattered. Linda said he went to bed and slept after hitting his head. So maybe with the brain bleed, the damage was already done. But that EMS crew must have thought every minute counted. That's why they called for an air ambulance.
In the world of emergency medicine, there's this thing called the "golden hour." It's a way of saying that the first 60 minutes or so after trauma is important for survival. No matter where you start counting up the minutes — when he hit his head, when the EMS crew gets there — that time ran out for Robert.
The same weekend I meet Mike the pilot, I visit Linda, too. It's been a few months, and I'm guessing her emotions are less raw. Findley Body Repair sits around a curve on a paved road about two miles outside of town. The auto shop is a big aluminum building. The house is off to the side and, in between, there's a small garden. The body shop was Robert's; the vegetable patch is Linda's. It's early summer. Robert's been gone about five months, and the tomatoes look weak and sickly.
LINDA FINDLEY: They look so bad. And I've replanted. And then we got way more rain again. And ugh. Horrible. I doubt that they produce very well. I may just have to go buy my tomatoes from the Amish this year.
SARAH JANE TRIBBLE: In other years, Linda had enough fruits and vegetables to give away.
LINDA FINDLEY: This is my pantry of canned goods.
SARAH JANE TRIBBLE: Wow. Is this all from last summer?
LINDA FINDLEY: A lot of it is, yes. Would you like a jar of homemade salsa?
SARAH JANE TRIBBLE: Wow.
Salsa. Dill pickles. Green verde sauce.
SARAH JANE TRIBBLE: That's what I thought it was. That's amazing.
LINDA FINDLEY: Want some of that, too?
SARAH JANE TRIBBLE: You must spend a lot of time doing this. How long have you been canning?
LINDA FINDLEY: All my married life.
SARAH JANE TRIBBLE: From the beginning, their life revolved around cars. Linda told me about it.
LINDA FINDLEY: I laugh because when we first got married, he had, like, a '68 Chevy Camaro, and it was a four-speed on the floor. And I used to tell people I would drive it to the grocery store and have scrambled eggs by the time I got home from jerkin' at all the stoplights taking off. And people would pull — he was known for his drag racing — they would pull up beside us and rev their engine. And then what was called "Three Mile Corner," which is just down the road from where I still live, they would go out there and drag-race on the highway — till someone called the highway patrol, and then we'd all disappear. It was like something you see on TV, but yeah.
SARAH JANE TRIBBLE: So, everyone in the county knew Robert drove fast cars. And if yours was broke, you could count on him to fix the car.
To know Robert, we had to spend time in his shop. So I work up the courage to ask Linda to see it.
LINDA FINDLEY: This was his office.
[Sound of police scanner]
LINDA FINDLEY: See? Scanner.
Linda is pointing to Robert's old police scanner. It was how he could keep tabs on car accidents and potential customers around town. And it's also how Robert and Linda knew about every emergency that happened in Fort Scott. Between the static, beeps and garbled voices, Linda and Robert heard every day what kind of emergency care Fort Scott needed. As I think about the scanner, I'm looking around. There are ribbons on the walls and papers everywhere — packed shelves.
LINDA FINDLEY: You could find just about anything you want in his drawers. They are all full.
SARAH JANE TRIBBLE: Suddenly, I'm a bit overwhelmed.
What are you going to do with all of this?
LINDA FINDLEY: I don't know.
SARAH JANE TRIBBLE: Are those 4-H ribbons for ... for cars?
LINDA FINDLEY: For … every year, we always bought … usually a pig from the 4-H kids at the livestock auction. Every year. Yeah.
SARAH JANE TRIBBLE: She tells me Robert grew up in Future Farmers of America. And 4-H. So he knew what it meant to the kids. Plus, he shared some of the meat with his workers. I follow Linda out of the office into this wide-open space where cars are still sitting up on lifts.
No, really — what, what are you going to do with all this?
LINDA FINDLEY: I don't know.
I … see those, these folders were all estimates on cars to be done that … the ones we had here, we finished the jobs and then I had to let these people know that we couldn't work on them. So …
Back in the house, I ask Linda again whether Fort Scott has the right kind of health care.
LINDA FINDLEY: Just for regular doctors’ appointments, whatever, that's, that's more or less fine. But, words of experiences, you don't know when that tragedy is going to happen.
SARAH JANE TRIBBLE: If anybody can tell me exactly how much Fort Scott has lost, it's Linda, and she gives it to me straight up.
LINDA FINDLEY: You know, I don't think losing the hospital is the end of the world for Fort Scott, but I sure think it put an ugly notch in our belt. And not just Fort Scott. All these other hospitals that have closed down. I mean, my gosh. You need to feel like you're safe and could be taken care of where you're at.
SARAH JANE TRIBBLE: What does it mean to be taken care of? To have the health care you need in a small town? For a long time in Fort Scott, that meant a nun from the Sisters of Mercy sitting by your bedside, taking your temperature with the back of her hand. But health care has changed.
Next time, we meet the town historian, who can't believe Mercy Hospital is gone.
FRED CAMPBELL: I wondered what happened to Mercy's mission. In other words, at what point did they put the dollar over service?
SARAH JANE TRIBBLE: He hasn't had the chance to ask the Mercy nuns that question. But I can.
Special thanks to the Reporters Committee for Freedom of the Press and Max Kautsch at Kautsch Law Firm in Lawrence, Kansas. They answered questions and provided pro bono advice on the Kansas Open Records Act, which we used to obtain the 911 tape you hear in this episode. Thanks to Fort Scott City Clerk Diane Clay, who aided in the release of the tape, and to Fort Scott City Manager Dave Martin, who ultimately approved the tape's release.
This season of Where It Hurts is hosted and reported by me, Sarah Jane Tribble. Tarena Lofton is our production assistant. Taunya English, managing editor and managing producer for the podcast, is KHN’s senior editor for broadcast innovation. Greg Munteanu at St. Louis Public Radio is our sound and design engineer. Diane Webber, national editor for broadcast, and KHN's editor-in-chief, Elisabeth Rosenthal, are editorial liaisons to the show. Sarah Geiss loaned us her fresh ears to help improve this episode. And my husband, kids and family in Kansas sacrificed to make Where It Hurts a reality. Season one, “No Mercy,” is dedicated to my older sister, Maggie. The podcast is a co-production with St. Louis Public Radio and Kaiser Health News, a nonprofit news service about health care in America.
KHN is an editorially independent program of KFF.