How Safety-Net Hospital Closings Affect PCPs

"Even within the nearby Kaiser system, because those patients didn't have anywhere else to go, they just showed up in the ED and they couldn't be turned away. Then there were referrals through the ED with specialty care. You saw those delays building up."

The study did not specifically examine the emigration of physicians from the area after MLK closed, but Odom Walker says there is anecdotal evidence to support their departure.

"People did talk about how their colleagues were leaving and not going down the street—they were going to different parts of the state or out of state," she says. "It was not so much in primary care, but many of the specialists who were committed to serving an underserved population said, 'If I can't practice here anymore I will go somewhere else.'"

Odom Walker says she's not sure what could have been done differently when MLK closed.

The hospital lost its accreditation and shuttered with little warning. "But if more primary care physicians were at the table they would have thought about how to get the word out a little better so patients wouldn't have experienced so many delays in care, or put off getting medications refilled, that there were doctors still in the area to take care of them, and an action plan to get them to the care that is needed," she says.

With Medicare and Medicaid facing possible budget cuts, Odom Walker says it's time to develop some uniformed procedures for hospital closings so that other communities aren't thrown into disarray if their safety-net hospital shutters.

"That would be an important next step—thinking through who, what, when, where, and how to do this in a way that doesn't affect people's lives," she says. "Right now there is no true oversight of a hospital closing. It is a contract with the community and no one is there to oversee that bond."