This is the third and final installment in a series on the future of Bourbon County healthcare that is being cross-published by BourbonCountyMonitor.com and FortScott.biz. The first part can be found here, and the second can be found here.

Fort Scott, KS – While Freeman Health Systems as an organization is from all appearances on strong financial footing, the Freeman Hospital Fort Scott operation has experienced a series of documented substantial financial blows since opening in September 2025.

The Delay

Freeman began hiring for the Fort Scott hospital in spring 2025, with an expected June 1 opening. But on May 27, Four States Homepage reported the opening had been pushed to September because interior renovation issues had delayed the state survey needed before the hospital could open.

At the time, Freeman Health System Rural Hospitals CEO Renee Denton said Freeman had already hired slightly more than half the staff needed to open the facility. One employee hired during that period told the Monitor that Freeman continued paying them throughout the delay.

Medicaid and Medicare Certification Delay

The opening delay was followed by another financial setback: a lengthy wait for certification to bill Medicare and Medicaid.

At an April 16 joint meeting of the Bourbon County and Fort Scott City commissions, County Commissioner Gregg Motley, former vice chairman of the Freeman Fort Scott board, said the hospital had been seeing most patients at no cost while awaiting certification. Motley said more than 70% of Freeman Fort Scott patients were covered by Medicare or Medicaid, and the hospital hoped to retroactively bill for much of that care.

At the May 7 ribbon-cutting, Freeman Fort Scott Chief Administrative Officer Anita Walden told the Monitor the approvals had come through, but collecting payment for the previous nine months would not be simple. Walden said some payers were allowing Freeman to backdate claims to its certification date, while others were not.

A memo Motley sent to the County Commission also said Freeman had expected another health care provider to shift its lab work to the Fort Scott hospital. Instead, the provider stayed with its existing lab vendor, creating what the memo described as a seven-figure hole in Freeman’s planned budget.

“They’re not happy with their current situation.”

In an interview with the Monitor, Motley said those losses, combined with the roughly $1.4 million in lost revenue from the unlicensed 10 beds and growing maintenance problems in the building owned by Kansas Renewal Institute (KRI), have left Freeman in an untenable position.

“They’re not happy with their current situation,” Motley said. “They’ve received financial blow after financial blow. It was extremely disappointing to them that they will not be operating those 10 beds. They were hiring based on that.” Motley called it a “big budget hole.”

The Legal Action

That legal action Motley is advocating for would invoke the “clawback” clause in the original donation agreement between the county and Legacy Healthcare Foundation — which now also applies to KRI — transferring the property back to the county.

Under that clause, the county’s only remedy if the building owners default is to take back the property plus a cash repayment that shrinks over time — $1 million in year one, $750,000 in years two through four, and $500,000 in year five. After that, the county can reclaim nothing.

Motley said that window closes in November 2027. He said the $10,000 in legal fees approved by the commission during the April 14 meeting will go toward getting a legal opinion on whether the county has a strong case for reclaiming the building, and whether it can be accomplished within a reasonable amount of time and cost.

According to Motley, state officials had Kansas City-based Polsinelli Law Firm review the donation agreement, and the firm concluded the agreement had been breached. Motley said Freeman’s attorneys agreed with Polsinelli’s assesment.

The Transfer

Motley said that the lynchpin to this plan is Freeman agreeing to take the building, including all maintenance responsibilities. Motley says the healthcare provider has shown interest in doing so, but the county will require a binding legal agreement with them before initiating legal action to reclaim the building.”The county does not want this [building],” Motley said. “Before we ever file a lawsuit, we have to have an ironclad agreement with Freeman that says we are going to take over the building and the full maintenance of it.”Motley, who was voted as the commission’s point-man for the process, said that Kansas City-based MSB Law has been engaged to provide the legal opinion for the county.

The Employees

When asked what happens to the roughly 150 employees of KRI if the county is able to reclaim the building and transfer it to Freeman, Motley says that Freeman has discussed opening an operation similar to KRI in the building.”Well, again, Freeman hasn’t committed anything, but they have a KRI-like operation in Southwest Missouri called Ozark Center. And their plan would be to open a facility similar to that, get licensed for the 10 beds,” Motley said.Motley said the fate of KRI’s employees has been at the forefront of his mind. He said he told Freeman he wouldn’t pursue the deal unless they were committed, and that he asked what would happen to the workers.

“Where do you think we would get any employees to do the operation? We would look hard at the existing employees,” Motley said Freeman responded.Motley said the human cost has weighed heavily on him. He said the employees’ fate is “a huge concern of mine,” and that he pushed to keep the discussions private specifically to shield the people he knows and loves that work there.

The Lesser of Two Evils

Motley framed the choice as the lesser of two bad options. “I have to put them at risk a little bit in order to consider the whole county here,” Motley said.”I think the worst thing that could happen is we do nothing. KRI closes, all those people are gone. They don’t have a Freeman to go to now. Pasadena Lending or Legacy forecloses on the building and now we (sic) got an empty building owned by an organization that we know is ill intended.”

For Motley, the priority is maintaining ER and hospital services in Bourbon County, and that inaction on the part of the county puts those in the greatest amount of danger.”Any path we take is going to be risk. Any path. What’s the path of least risk? It is a huge risk to do nothing,” Motley said. “You know, you have two entities losing significant money every month. And what’s Freeman’s affinity for Fort Scott apart from ‘we have a break-even operation’? There is none.”

The Future

Regardless of what legal opinion the county receives, the commission’s direction remains uncertain. The board has been frequently and publicly divided.

During the March 9 meeting, which was the first time the commission discussed the potential legal action behind closed doors, the vote to go into closed session was not unanimous, with Commissioner Mika Milburn-Kee casting the sole dissenting vote.The first public vote on the legal action came at the April 14 commission meeting. Milburn-Kee again cast the lone vote against going into the executive session that preceded it, which included Pam Lanier, Freeman Health System’s director of government relations; state Rep. Rick James; state Sen. Tim Shallenburger; Fort Scott City Manager Brad Matkin; and County Counselor Bob Johnson.

After returning to open session, the commission voted 3-2 to approve a motion from Motley allocating $10,000 for legal fees and title work. Motley, Commissioner Joe Allen and Commissioner David Beerbower voted in favor; Milburn-Kee and Commission Chairman Samuel Tran opposed.

During a recess that followed, Tran was recorded saying, “We should have this conversation before we threw 10 Gs onto this dumpster fire.”During the April 27 meeting, after an identical split vote affirming the vote on April 14 and Motley’s appointment as contact person, Tran again expressed apprehension with the legal action.”And I’m saying nay for the same reason that I said no the very first time, because I don’t think this should be our wheelhouse,” Tran saidPrior to another 3-2 split vote during the May 4 meeting confirming a short list of law firms for Motley to approach for the legal opinion , Milburn-Kee requested that the details of the legal action be discussed publicly.”Can we move this discussion to the public, please, so we can talk more freely about what we’re asking them to do because I don’t even know what we’re asking them to do,” Milburn-Kee said.

Freeman’s Statement

In response to a request for comment regarding Freeman’s agreement with KRI and Freeman’s long-term viability in Fort Scott, Freeman Health System’s Media Relations Coordinator Kevin McClintock provided the following statement to the Monitor:

“As for KRI, we worked closely with their team to complete renovation of the hospital space, and we successfully passed licensure and life-safety surveys. Additionally, we look forward to working with KRI as we make necessary updates to the MRI suite. Freeman is not in a position to comment regarding KRI’s financial condition or ability to obtain licensure. Freeman Health System will continue to operate responsibly and make thoughtful decisions to ensure long-term sustainability while advancing access to care and remaining focused on meeting the healthcare needs of the rural communities we serve.”Because this reporting was expanded into a three-part series, the Monitor extended KRI an additional opportunity to comment. KRI did not respond before publication.