This shouldn’t have been difficult. For 50 years, the labor and delivery unit at this small rural hospital near the
But not anymore. Just three days prior, hospital administrators closed the unit, intending to get out of the business of delivering babies.
Kalafatis knew these women needed the higher level of care provided by a labor and delivery unit. But the closest facility was an hour away. Even by ambulance, even by helicopter, she worried about the risk to four lives if the hospital tried to transfer them.
Briefly, Kalafatis let the anger in. She’d tried to warn about the consequences of losing the last labor and delivery unit in this five-county region larger than the state of
But anger wasn’t going to deliver these babies. Kalafatis took a deep breath and got to work.
The hospital was able to safely transfer one of the women. But the other was too far along. She would have to deliver vaginally in the emergency room, a potentially risky proposition after having had previous C-sections.
A spokesperson for
As Kalafatis prepared this woman for labor, she heard voices she recognized — family physicians who had delivered babies at this hospital for years. These women weren’t their patients, “but of course they came,” she said.
“Someone called them, so they came,” she said. “That’s just what you’d do in
[For teens in Deep East Texas, accessing sex education and contraception is next to impossible] Together, doctors and nurses safely delivered the baby. Kalafatis left the hospital that day, relieved. Surely now, she thought, hospital administrators would see how desperately her community needed a place to give birth. They would find a way to recruit more physicians, better staff the hospital, and turn the lights back on.
But more than three years later, the unit remains closed.
Women instead travel over an hour to
Jasper is a place where money once grew on trees. While log-laden trucks still lumber through town, this region, like many rural areas, has struggled to recover from the Great Recession and now the pandemic.
Even as the “jewel of the forest” has lost some of its sparkle, Jasper remains an economic hub, saving residents of surrounding counties the hour long trip to
The wide, low-slung building was built in the late 1960s, after the
Kalafatis’ parents worked in health care and moved to Jasper to help open the new facility. In
Kalafatis grew up in the halls of Jasper Memorial. She shadowed her mother, a nurse anesthetist, and attended her first C-section when she was in eighth grade. Friends and neighbors would approach her parents at high school football games with medical questions.
“I’ve been connected to that hospital all my life,” she said. “I have more than just a clinical interest in the building. It’s my family. It’s my heritage.”
That connection, though, came with a front-row seat to the health care inequities that have long plagued
If this 35-county region was a state, it would rank among the worst in the nation for heart disease, cancer and stroke mortality, according to analysis from the
Medicaid does make it easier for pregnant Texans to get health insurance — at least 70% of births in this region are paid for by Medicaid, according to the
But a third of pregnant women in this region don’t see a doctor until at least the second trimester. Lack of prenatal care worsens other pregnancy risk factors, including the region’s high rates of smoking, obesity and diabetes.
Kalafatis saw it all when she graduated from nursing school and returned to the area. Women showed up for the first time nine months pregnant. Or they were diagnosed with gestational diabetes and weren’t seen again until it was time to deliver. She saw preeclampsia, premature babies, tiny high school freshmen preparing for childbirth.
She helped deliver them all. “Nurses don’t judge, we really don’t,” she said. “We live here too. We know how hard it is to get prenatal care, to get time off work and get to those appointments. We know how far these women have to travel.”
And it’s only gotten worse over the course of her career.
Other hospitals remain open but have been stripped of anything resembling comprehensive care, forcing people to weigh their health needs against lengthy drives, the cost of gas, and the ability to find child care or get time off of work.
At the time, health care chains were snapping up independent hospitals nationwide, promising stability through streamlining services, reducing overhead costs and balancing the books on the back of more profitable services at larger facilities.
In 1997, the
Kalafatis was excited about the change. She went to nursing school at what is today
Soon after taking over Jasper Memorial, Sisters of Charity merged with another Catholic system to become
Today, Christus is a billion-dollar health care conglomerate, with facilities in three states and four countries, including a hopscotch up the length of
In 2020, the CEO made
Seemingly overnight, Jasper Memorial went from a community hospital to a cog in a much larger system.
For one thing, Christus would not “provide services inconsistent with its values, especially in the areas of respect for life,” the lease said.
A spokesperson for Christus declined to confirm executive salaries or the hospital’s contraception policy, saying these are “new issues [that] have been unfairly raised by the Tribune that we believe are not relevant to this situation.”
Leasing the hospital to Christus came with trade-offs. But it allowed Jasper to remain an obstetrics oasis in an increasingly arid health care desert.
The disappearing family physician
McMurry remembers, as a child, seeing his mother turned away at the doctor’s office because she couldn’t pay upfront. Years later, while serving as an army medic, McMurry was reminded of that experience when he helped reopen an old hospital in rural
“I’ve seen what can be done in isolated areas with just minimal resources,” he said. “I learned then that if people have an intent to do something, they are capable of doing it.”
After medical school, McMurry returned to Jasper. He opened his family practice and vowed to never turn someone away because they couldn’t pay. He served a stint as director of the
“We had a lot of problems in rural areas at that time, some of which were worse than Third World countries as far as access,” Mc-Murry said. “So I just tried to do whatever I could to address that as much as I could.”
As a rural doctor, McMurry did a little bit of everything, caring for friends and neighbors from the time they were born to the day they died. He was, at certain points during his career, one of the only doctors delivering babies in a seven-county region. Some women traveled more than three hours to
He estimates he’s delivered just over 1,000 babies.
“At one point, I had 11 women in the hospital in labor at once,” he recalled. “I don’t know how I got through that, but I did.”
As family physicians like McMurry will tell you, theirs is the only speciality that provides comprehensive health care to the entire patient population — young, old, male, female, anyone who walks in the door. Family physicians are certified to deliver babies vaginally or by C-section.
Family physicians are often the entire health care system in rural areas where the patient load can’t sustain a wide range of specialists. A patient in
But full-scope rural family physicians like McMurry are a dying breed, or at the very least, a retiring breed. McMurry, now 74, hung up his white coat in 2008 and closed his private practice.
“We have always had a physician shortage out this way,” he said. “But things really became critical as physicians grew older and retired, or left the area. We lost services, primarily because we did not have a good physician recruitment effort.”
It’s not just Jasper: The entire country is facing a critical shortage of primary care physicians. In 2021, only five
Why is not a mystery. Family physicians treat a wider range of patients but earn, on average, 40% less than specialists. In rural areas, family physicians may have fewer resources and less support as they try to care for an older, sicker, poorer client base.
“We’ve got really passionate, really smart people in family medicine,” said
Over the years,
“You’re not going to see [it] immediately, but nine years down the line … you’re really going to feel the effects,” Dr.
He was right. More than a decade later,
A rural hospital can bring in a cardiologist weekly or monthly, depending on demand. But an obstetrics unit has to be staffed around the clock, with at least two nurses and a doctor on call.
“If you have one or two doctors on call 24/7, and they take a vacation or aren’t available, that hospital can’t provide obstetrics services,” Briggs said.
Facing that difficult math — fewer physicians and diminishing births, as well as nursing shortages, skyrocketing costs and reduced reimbursement rates for Medicaid births — many hospitals just close the unit.
When McMurry retired, he was confident that the remaining doctors would allow
McMurry hoped Christus would wield its vast resources to recruit more doctors and lighten the load. Kalafatis said word around the hospital was that management was working on recruiting an obstetrician. But Christus determined there wasn’t enough demand for a full-time OB-GYN, hospital administrator
The cavalry wasn’t coming, so in 2018, McMurry took matters into his own hands and ran for the
McMurry warned in a 2018 op-ed that two area doctors, a married couple, were planning to resign at the end of the year and that Christus was going to close the obstetrics unit.
“The loss of appropriate health care services means fewer people will retire here, fewer businesses will relocate here, and the population will be spending hours on the road for basic health needs,” McMurry wrote. “As it happened with the ancient Greeks, we will slowly slip into a downward spiral of decay.”
Moore dismissed McMurry’s concerns, writing in a counter op-ed that Christus was working closely with its physician partners to continue to provide “these valuable services.”
“We have no intention of stopping the provision of obstetrical (OB) services to those expectant moms and their families,” Moore wrote in
Moore, a 30-year Christus Southeast Texas employee, came to Jasper Memorial after serving as vice president of clinical operations and leading the now-shuttered Christus hospital in
In a recent interview, Moore said that at the time, the hospital was offering doctors
“We can’t do it without physicians, regardless of how much we wanted to have OB,” Moore said.
“I think [Christus] does a good job, but they’re a multistate, international health care organization,” McMurry said. “When they get a new physician, they go to where their system needs them the most. I guess that just wasn’t Jasper.”
When McMurry first started practicing medicine in
“It’s sad when you realize that someone that goes into labor in
Lives on the line As soon as
Walker had been braced for this moment for weeks. After she’d started prematurely dilating, the 18-year-old spent the final months of her senior year of high school on bed rest, trying to hold off labor long enough for her baby to have a chance of surviving outside the womb.
But now she’d expelled her mucus plug, which can be an early sign of labor.
“I called my mom into the bathroom, and she was just like, ‘Don’t freak out,'” Walker said. “But the way she said it sort of freaked me out even more.”
Walker lives in
The on-call nurse at the hospital in
“I was just like, ‘Excuse me?'” Walker said. “I am expected to go into preterm labor, I am already 2 centimeters dilated and I am an hour away from the hospital. I can’t wait until I’m three to five minutes apart.”
While Walker sat in the bathtub, practicing her deep breathing, her then-fiance started throwing their bags in the car. He was the one who would have to drive her over an hour through a national forest with no cell service to the nearest hospital, and as he often reassured her, he was prepared to drive 110 miles an hour to do so.
This anxiety had permeated her entire pregnancy. She was always scrambling for gas money or borrowing her grandmother’s car to make the 140-mile round trip. She worried constantly about going into labor and having to give birth on the side of the road.
After one labor and delivery unit in
As time passed and her panic subsided, Walker realized she wasn’t contracting. Part of her still wanted to go to the hospital to make sure she and her baby were OK. But she had another appointment coming up, and she couldn’t justify making the trip twice in a matter of days.
When she did go into labor, several weeks later, she was already in
Her daughter is now almost a year and a half and, according to Walker, quite the handful. Her husband says he knows where she gets it from.
“He always says that’s why she has a bad attitude, because I was so anxious all the time when I was pregnant with her,” she said.
Many of his patients come from over an hour away.
“They just have no other choice now,” he said. “We just have to work really hard to educate them on what to expect and when to come in.”
With an uncomplicated pregnancy, Johnson said, he typically schedules an induction to save a stressful, mid-labor drive through the forest. Woodland Heights also recently opened a women’s clinic in
“It seems like when physicians finish residency, they are not looking for a small community,” he said. “If you go to
Johnson, on the other hand, takes most of his own calls. It’s fine, he said, since he lives near the hospital. Like many rural practitioners, Johnson was looking for community- centric care when he set out, and he feels his mission ever more acutely as services dry up across the region.
“If you’re getting into medicine to serve people and work where you’re needed, I’d make the argument that you’re needed much more desperately in these communities than in downtown
Without an influx of doctors to deliver babies, pregnancy will only become more dangerous than it already is in a country that ranks worst in maternal mortality among developed nations.
Black women in Deep East Texas know the risks of pregnancy because they’ve heard the stories from their mothers, sisters, friends and neighbors.
Williams, 24, lives 20 miles north of Jasper. She delivered two babies at Jasper Memorial, but when she went into labor with her third child last year, she had to make the hour long drive to
She made it in time and delivered safely. As she prepared to head home, she stood up from the bed and picked up her new baby girl.
“And it was all of a sudden like a murder scene,” she said. “Just blood everywhere.”
Williams was hemorrhaging. Doctors and nurses rushed in and got her on the bed as her blood pressure dropped. They pressed on her stomach so hard it felt like she was in labor again, she said, and pumped her with medicine to stop the bleeding.
“I thank God I had some good nurses that knew what they were doing,” she said. “I didn’t have to have a blood transfusion, and I didn’t lose my life.”
Obstetric hemorrhage is the leading cause of maternal death in
Like many postpartum complications, hemorrhage doesn’t always happen immediately. Nearly a third of maternal deaths occur more than a month after childbirth, according to state data.
“Thank God I was still at the hospital because if I would have made it home and did that, and had to drive all the way to
When she looks at her three children, it’s sometimes too much to even imagine what could have happened.
“I think I’m done having kids,” she said. Video: Kalafatis talks about some of the risks to babies when mothers have to travel a long distance while in labor to get to a hospital. Credit: Jinitzail Hernández / The Texas Tribune This video is available at https://www. texastribune.org/2023/01/05/jasper-east-texas- maternity-crisis/
These are the fears women in Deep East Texas live with every day, shaping their decisions about pregnancy, childbirth, family and their futures. There’s the foster mother who stopped taking in pregnant teenagers, the midwife who worries about her clients needing emergency care. It’s even changed how the area tries to recruit new businesses to town.
“But the first thing they ask, almost always, is about schools and health care,” Hopkins said. “I just have to be honest with them. And I personally cringe thinking about going through two pregnancies with my wife, and could we have made it to
“I don’t think the hospital can drive growth in population or anything like that,” she said. “We have … a very high geriatric population, and so I think we respond to the needs as we see them with what we have.”
Goodwin said the hospital’s role is as a safety net, a place to stabilize patients until they can get to a bigger facility for more significant care.
Ask around town, though, and that’s not what most people in
Without that, it’s hard to know what the future of Jasper looks like. This is the existential question facing rural communities across
Stabilizing the system When the labor and delivery unit closed in 2019, McMurry felt like the community was finally waking up to the health care crisis he’d been warning about for years. He used that outrage to recruit candidates for the first competitive hospital district board elections in years.
“The real solution is where the problem is,” McMurry said. “It’s with the people that are suffering, and getting them to believe that they can do something, and then getting them the resources to do it.”
The hospital district has resources — 20 years of rent payments from Christus translates to about
For McMurry, the answer is simple, if not easy.
“We’ve got a place to practice. We’ve got patients,” he said. “We have everything but the doctor.”
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