As of 7 a.m. Friday, the small town of Celina has no functioning hospital.
Cumberland River Hospital became the 11th rural hospital in Tennessee to close in recent years — more than any state but Texas. Now the remote lakeside community of 1,500 people is bracing for inevitable ripple effects, which include a blow to the city's economic development plan to attract retirees.
It's pretty obvious where this community's priorities lie by looking at the humble government complex: Half the building is used as a senior center, where Susan Scovel is hosting the local chamber of commerce's retirement committee.
"We're planning a murder mystery weekend and trying to get people up here and see this gorgeous area," Scovel says.
The Seattle transplant has been tapped to lead efforts to market the town to retirees like herself. When she toured, Scovel and her husband, who had Parkinson's, scoped out the 25-bed hospital, on a hill overlooking the sleepy town square. Scovel has rushed there four times since he died in 2017.
"I have very high blood pressure, and they're able to do the IVs to get it down," Scovel says. "This is an anxiety thing since my husband died. So now, I don't know."
She says she can't in good conscience suggest a senior with health problems come join her in Celina.
"I'd say look elsewhere."
Adding Time To Emergencies
The hospital has been operated by the city-owned medical center in Cookeville, which decided in late January to cut its losses after trying to find a buyer. Cookeville Regional Medical Center officials declined to be interviewed for this story, but they explained in writing that the facility faced the grim reality for many rural providers.
"Unfortunately, many rural hospitals across the country are having a difficult time and facing the same challenges, like declining reimbursements and lower patient volumes, that Cumberland River Hospital has experienced," CEO Paul Korth says in a statement.
The closest hospital is now 18 miles away, in the town of Livingston. That adds another 30 minutes through mountain roads for those who need an X-ray or blood work. For those in the back of an ambulance, it could make the difference between life or death.
"We have the capability of doing a lot of advanced life support, but we're not a hospital," says emergency management director Natalie Boone.
The area is already limited in its ambulance service, with two of its four trucks out of service.
Once a crew is dispatched, Boone says, it's committed to that call. Adding an hour to the turnaround time means someone else could likely call with an emergency and be told — essentially — to wait in line.
"What happens when you have that patient that doesn't have that extra time?" Boone asks. "I can think of at least a minimum of two patients [in the last month] that did not have that time."
Doctors Follow Hospitals
Susan Bailey hasn't retired yet, but she's close. She's spent nearly 40 years as a registered nurse, including her early career at Cumberland River.
"People say, 'You probably just need to move or find another place to go,' " she says.
Bailey and others are concerned that losing the hospital will soon mean losing the only three physicians in town. They plan to keep their practices going, but for how long? And what about when they retire?
"That's a big problem," she says. "The doctors aren't going to want to come in and open an office and have to drive 20 or 30 minutes to see their patients every single day."
The cascading effects have residents in a somber mood. Some employees come to tears at the prospect of finding new jobs out of town and the fact that their hometown is losing one of its largest employers, second only to the local school system. Staffers, many of whom are receiving severance pay, were discouraged from talking to reporters.
John McMichen is an emergency physician who would travel to Celina to work weekends at the ER and give the local doctors a break.
"I thought of Celina as maybe the Andy Griffith Show of health care," he says.
McMichen, who also worked at the now shuttered Copper Basin Medical Center, says people at Cumberland River knew just about anyone who would walk through the door. That's why it was attractive to retirees.
"It reminded me of a time long ago that has seemingly passed. I can't say that it will ever come back," he says. "I have hopes that there's still some hope for small hospitals in that type of community. But I think the chances are becoming less of those community hospitals surviving."