Ontonagon seeks E.R. solutions following hospital conversion to rural health clinic

The closing of Ontonagon's only full-service hospital has raised concerns about around-the-clock emergency medical care for residents of the rural county, with local officials searching for options to bridge the crucial gap. 

Aspirus Ontonagon Hospital converted to a Rural Health Clinic last month, closing hospital and emergency room operations. Rural health clinics are required to be able to provide "first-response" services to common life-threatening injuries and acute illnesses, according to the Rural Health Information Hub. The clinic will be open 8 a.m. to 5 p.m. weekdays.

The closest full-service ER facility — Baraga County Memorial Hospital –- is 47 miles away from the former hospital, while UP Health - Portage in Hancock is 50 miles away and Aspirus Ironwood Hospital more than 60. 

At issue: delayed emergency treatment for patients with critical conditions such as strokes or heart attacks could significantly reduce their chances of survival. 

That could be especially problematic in a community in which the average age of residents is more than 60, says Village Manager Willie DuPont. 

“I don’t see great solutions,” he says. “The only one is trying to beef up transportation to get people quickly to where they need to go.”
Aspirus, a nonprofit chain of hospitals based in Wausau, Wisconsin, announced the Ontonagon conversion earlier this year, while also sharing plans to invest $40 million into renovating and expanding Aspirus Merrill Hospital in Merrill, Wisconsin, about two hours south of the western Upper Peninsula community.

The new Aspirus Ontonagon Clinic provides primary care, same-day appointment availability, core laboratory services, imaging services, retail pharmacy services, and specialty outreach for women’s health, podiatry and diabetes care, according to the clinic's website. 

Aspirus Regional Communications and Engagement Lead Jenn Jenich-Laplander didn’t respond to requests for comment. But DuPont confirms the change was made because the Ontonagon E.R. service wasn’t cost-effective. The former hospital says it treated an average of just one inpatient per day.

“But even if an E.R. is not well used, it’s up and down,” counters DuPont.  “It could have four patients in a night. We are an elderly community, a retirement community, and I think a lot of people are a little bit leery about this … especially if they have issues like a stroke risk or a heart risk. What used to be a 5- to 10-minute trip to the E.R. has turned into an hour instead, and that difference is huge … we are talking life and death a lot of times”.  

Efficiency, staffing, regular healthcare and citizen CPR may be key 

What’s to be done?

Angela Madden, executive director of the Michigan Association of Ambulance Services, confirms village residents will still have emergency ambulance coverage 24-7, since local company SONCO Ambulance Inc. and other neighboring services hold reciprocal agreements to fill in for each other during busy periods. 

Those services can streamline patient transport to hospitals by meeting each other halfway and quickly exchanging patients, though Medicare and Medicaid need to alter standards to allow both companies to be reimbursed for their parts.

While that won’t shorten patient transport times, she says SONCO and neighboring services may be able to maximize staffing, so their on-board personnel more frequently have the medical licensing needed to perform advanced life-saving measures while en route. Per federal standards, different licensing levels among such personnel (i.e. EMRs, EMTs, advanced EMTs and paramedics) can prohibit them from administering certain procedures.  

That said, Madden believes Ontonagon residents could become safer overall if more locals became certified in CPR and first aid. When immediate care is needed, she says, a bystander able to administer CPR with support from a 911 dispatcher can be crucial. 

That’s backed up by stats showing that CPR can double or triple the chance of survival from out-of-hospital cardiac arrests, 73% of which happen in residences and 16% in public settings. “Becoming CPR- and first aid-trained is the best thing you can do for your neighbor,” she says. 

She also advises residents to take pressure off local E.R. services by maintaining regular healthcare instead of waiting for crises to occur. People often avoid regularly visiting primary care physicians because there are few in their area, because they lack the funds or because they’re afraid, she says. 

Madden is concerned that local ambulance personnel may now become overstressed by long, grueling ambulance trips that involve extensive medical demands -- and often, tough medical decisions. 

“What’s not always visible to the community is the wear and tear on the personnel onboard,” she explains. “We’re constantly thinking about what’s best for our patients, and long transport is not best. But you’re asking personnel to add a level of stress … they still have to do their shifts well and to make the appropriate hard calls, just for a lot longer. They’re doing it because they love their communities and want to be there to help their friends and neighbors”. 

Madden stresses that Ontonagon residents should still call 911 for any medical emergency 24-7; trained dispatchers will then provide directions and/or schedule ambulance transport based on their needs. Ontonagon’s Aspirus rural clinic may provide some level of emergency care but may not have the specific training or equipment needed for certain patient tests, she says.

Lack of E.R. on trend for rural communities

Ontonagon has not been the only small community to face this kind of challenge.

DuPont says he recently viewed an inter-governmental informational presentation indicating 150 communities across the U.S. have lost E.R. services over the past four years. And he believes federal government edicts that impose too many financial burdens on hospitals may be a big part of the problem. 

“I like being part of the government, but I also don’t like too much government,” he says. “And hospitals have been scapegoats of the federal government, with too many costs (imposed)”. 

DuPont says he’s heard that about half of the former hospital’s 70-some employees are expected to stay employed at the new clinic while 20 to 30 more may be offered jobs at Aspirus’ Laurium facility. A loss of 30 to 40 jobs makes “a huge impact” on a village of 1,285, he says. 

Long term, he says, the lack of local E.R. care could cause residents to move away and/or avoid moving into the community, though that might be balanced by newcomers buying up local land for vacation homes and lodgings. 

“I think a lot of locals might get skittish and sell their houses, but I’ve also seen a lot of out-of-town money buying houses,” he notes. “So, I’m not convinced either way on how this is going to play out”. 

DuPont says he understands why Aspirus chose to make the conversion, but he’s frustrated the company didn’t give the community better notice so it could adjust sooner. Aspirus could have sent a representative to meet with residents to answer questions and fully explain why the facility was just not cost-effective, he says. 

In a late March press release announcing the $40 million renovation and expansion at Aspirus Merrill Hospital, Aspirus Central Region President Jeff Wicklander attributed Aspirus’ ability to survive the past four years of industry challenges to “strategic foresight, thoughtful decision-making, and a relentless commitment to efficiency and effectiveness.”

Originally from Kalamazoo, freelance writer Michelle Miron now lives in the frozen tundra of Minnesota, where her side hustle is selling vintage clothing.
Enjoy this story? Sign up for free solutions-based reporting in your inbox each week.