Last Wednesday morning the OBSERVER headline proclaimed “DOOMSDAY IN IRVING” above the picture of Lakeshore Hospital on a cold, snowy, and gloomy December day.

I wasn’t surprised by the headline because I felt that Lakeshore Hospital was operating on borrowed time anyway. I’ve lived in Silver Creek for 40 years and when we moved here it was a plus to know that the community and surrounding area had a full-services hospital.

When Lakeshore Hospital opened it was described as badly needed in the area. Now as we face its closing in a few weeks, it is still needed. The hospital’s impending closure is made sadder when one considers the efforts made by community leaders, citizens, and health-care professionals a half century ago in its creation.

Rural hospitals are shutting at a rate that in time may make rural health care more akin to third world health care. There are several reasons given for rural hospitals closing and the diminution of rural health care.

¯ Rural areas like northern Chautauqua County have fewer commercial payers than urban markets meaning that hospitals like Lakeshore and Brooks depend on a higher volume of state funded healthcare with lower reimbursement rates.

¯ Declining rural populations.

¯ A decline in the number of days patients spend hospitalized.

¯ Rural areas have a harder time attracting physicians, especially in the specialties meaning that specialty care can only be given on a limited basis. But it really isn’t all that much better with regard to primary care family physicians who tend to look for greener pastures.

A recent study by the University of Washington of 92 rural hospitals in California between 1995 and 2011 found that while the closing of urban hospitals had little or no impact on the surrounding communities, rural closings had a severe impact on their surrounding communities who experienced a 5.9% rise in mortality. These rural closings mean longer travel time to receive care causing many to delay that care. Closings are another factor why healthcare professionals seek greener pastures, exacerbating an already serious shortage.

On a personal level, my wife and I were in our early 30s when we moved to the area and now while we still enjoy good health, we are in our early seventies, an age when medical emergencies are more common. Where once it would have been a short ride to the Lakeshore emergency room by ambulance under the care of EMTs we will now face a much longer ride to Brooks — and frankly can we count on Brooks even being there in the future?

The majority of rural hospital closings have occurred in states that chose not to extend Medicaid coverage under the Affordable Healthcare Act. That’s not the case in New York state where we already had the “Cadillac” of Medicaid plans. What then are the reasons for the closure of Lakeshore?

Perhaps it’s plain and simple bad management by administrators, short-sighted moves by the board or perhaps an inability to think outside the box about rural medicine. We don’t know because the Brooks-TLC Hospital System, as John D’Agostino pointed out in his “Publisher’s Notebook” following the closing, kept us in the dark for most of the last decade. Certainly, their method of making the announcement of the closing of Lakeshore was a public relations disaster.

Unfortunately, I suspect that their problem is that they have a sort of “inside the beltway” mentality that tells them that there are things hospital customers don’t need to know and wouldn’t understand if they were told. Attitudes like that get people in trouble.

There are success stories in rural medicine even one in our own state. In 1970 the Carnegie Commission called for drastic improvements in rural health care and cited Bassett Hospital in Cooperstown as the prime example of a health organization already engaged in that type of care.

From that beginning, over the last 50 years the Bassett Healthcare system has grown to serve eight counties stretching from the Mohawk Valley south to Oneonta in the southern tier, a region facing many of the same social and economic problems we face in Chautauqua County. It now logs more than 700,000 outpatient visits a year and employs a staff of 4,300.

Its facilities now include the Louis Busch Hager Cancer Care Center in Cooperstown, 28 community-based healthcare centers, 19 school-based centers and six corporately affiliated hospitals in the region. In 1985 it established the Bassett Research Institute and in 2010 launched the Columbia-Bassett Medical School offering a curriculum and a course of studies focusing on ethics, healthcare systems, leadership, business management and evidenced based medicine, that integrates clinical experience and patient values with the best available research information.

That’s what happens when people with vision think outside the box and develop a healthcare delivery system that fits the real needs of the region and its people. It’s the type of thinking that needs to happen here in Chautauqua County and in other rural areas.

We can no longer depend on cobbled together health-care delivery systems but must look to the development of an integrated healthcare system that meets the needs of the people and not the other way around. That will take vision. Do we have that vision?

Thomas Kirkpatrick Sr. is a Silver Creek resident. Send comments to editorial@observertoday.com