THE UNOFFICIAL HISTORY OF POST-MERCY HEALTHCARE IN BOURBON COUNTY

Compiled by: Nick Graham

PREFACE:  I want to start out by saying that as volatile as the local political climate is right now, I think the one thing that EVERYONE can agree on is that they are genuinely thrilled Freeman is coming to Fort Scott.  In my opinion, Freeman provides a level of care that Bourbon County hasn’t experienced in a long time – dating a lot farther back than when Mercy closed.

What you’re about to read is the result of me falling down a rabbit hole.  While helping compile information on healthcare for a Facebook post for Leroy Kruger’s County Commission campaign, I ended up spending hours poring over old Tribune articles, County Commission meeting minutes and videos, and other news articles about the crazy ride that has been Bourbon County’s healthcare journey post-Mercy.  What follows is the full tale of the $3.3 million dollars committed by the Bourbon County government in its quest to bring a hospital (or at least an ER) back to our community.

THE FIRST $800,000

JUNE 25^th, 2021– The County and City sign a contract with a company called Noble Healthcare for a feasibility study regarding reopening the former Mercy Hospital. This contract is for $1 million dollars, with the City providing $200 thousand and the County providing $800 thousand of the first round of ARPA (American Rescue Plan Act) funds they received from the federal government.

According to USA Today, Noble was founded in December of 2019 by two individuals with no prior experience operating a hospital, and one of those individuals had been accused by the Department of Health & Human Services of Medicare Fraud (he ended up settling without admitting wrongdoing).  This first obvious red flag was followed by a second one, which is that no feasibility study like this in modern history has ever cost anywhere close to $1 Million dollars, at least that I am aware of.  That being said, we as a community were reeling from the traumatic loss of Mercy, and I understand how that could put us in a position to accept any and all explanations from some very slick people who told us exactly what we wanted to hear.  At the time, Noble *did* have two hospitals operating in Missouri, which gave them some leeway to explain away these red flags.

One thing that you will notice if you go through the County Commission meeting minutes and news articles during this time is that the name of Noble representative MERRILL ATWATER shows up multiple times – remember that name, it comes back into the story later on.

JANUARY 31st, 2022 – A big press conference is held at the site of the former hospital, with multiple Congressmen and Senators flown in (at whose expense, I’m not sure), where Noble Healthcare announces their intentions to reopen the hospital.  According to the February 2nd, 2022 issue of the Tribune, one of the Noble team members introduced by Noble CEO Drew Solomon at that press conference was…Merrill Atwater.  Again, keep that name in mind.

MARCH 25th, 2022 – As news breaks that Noble is ceasing its hospital operations in Missouri under very abrupt and controversial circumstances, the Bourbon County Commission holds an emergency meeting.  According to the March 26th, 2022 Fort Scott Tribune, “Commissioner Clifton Beth, who has been the Commission’s lead on healthcare issues, referenced a March 24 news release that stated Noble Healthcare Corporation – the company conducting the health care study for Bourbon County – is ceasing all of its hospital operations in Mexico, Mo., and Fulton, Mo., as of 5 P.M. Friday.”   The Tribune article also quotes Commissioner Beth as saying the County still expects to receive the Feasibility Study (which it did -though it was authored by Noble themselves), and states that Beth also said that “If I was somebody who liked to be on Facebook, I’d be careful what I said.  If I was Noble Health, I’d be suing some people, personally.  Because you don’t know what you’re talking about.”

Multiple articles in the following months, some published by USA Today, detail the devastating impact Noble’s closure had on employees and patients alike, including the fact that Noble employees had discovered that while Noble had collected money for their healthcare plans, they had failed to actually FUND them, leaving those people both jobless AND facing surprise giant medical bills.  The demise of Noble leads to multiple investigations, as well as multiple  lawsuits against the company.  Throughout 2022 and into 2023, news articles detailing Noble’s misdeeds make national headlines.

THE NEXT $2 MILLION (AND A BUILDING)

NOVEMBER  17, 2022 – It is announced that the County is transferring the former hospital building to a California based nonprofit organization named the Legacy Healthcare Foundation.  In addition to the building, the County will be giving Legacy $2 million dollars in American Rescue Plan Act funds, with the condition being that the funds be used for building and property maintenance, development of an acute care hospital, and a handful of other specific expenses such as providing reduced rents to tenants like Via Christi, who was operating an ER in the hospital building.  A November 17th, 2002  article in FortScottdotBiz quotes Commissioner Beth as stating “We have been in negotiations with them for six months…We transferred the building to them to develop. The building is the responsibility of Legacy Health Foundation as of today.” ’  I feel it should be noted that when this agreement with the County was signed, Legacy had NO LICENSE to practice healthcare in Kansas, and to this day this still doesn’t (those licenses are very difficult to obtain), which comes into play later in our story.  But that’s the not the only red flag of concern:

A search of the Kansas Secretary of State’s office website shows that the Legacy Healthcare Foundation was incorporated in Kansas on September 26th, 2022, with the Registered Agent being listed as…MERRILL ATWATER.  A registered agent is “an individual or a company that will be the LLC’s or corporation’s official point of contact in the state to receive service of process, other legal documents, and official communications from the state, and forward these documents and communications to the LLC or corporation for which it is acting as registered agent.”   Mr.  Atwater, according to his Linkedin (which is listed under Merrill Atwater Eisenhower)  now serves as the Chief Strategy Office (CSO) for Legacy, as well as their parent company The B/R Companies.  Did this information cause any pause with those negotiating on behalf of the County (presumably Commissioner Beth and the Director of REDI)?  I want to make it clear that I am NOT implying that Mr. Atwater has done anything wrong, but I would think that his previous, public involvement with Legacy would have given anyone major pause prior to donating $2 million dollars and a building to them.

In fact, the opposite seems to be true: In an article in the November 30th, 2022 Tribune about community concerns regarding the agreement with Legacy, Commission Clifton Beth is quoted as saying “They’re not Noble.  We paid for a study, Noble delivered a study.  I don’t understand what people don’t understand about that.  We, as a county, paid for something and got that something.  I’m sick and tired of hearing about Noble.  They’re not the same company.”  The Tribune article also quotes Commissioner Harris as saying “The County was in a position we had to make some decisions with the building,”, and “We can discuss more detail at a later date…Noble has nothing to do with Legacy.”  No one seems to have any concern that someone who was presented as a top member of Noble’s management team appears to be involved on a high level with Legacy.

OCTOBER 13th, 2023 – The Bourbon County Commission holds an emergency meeting due to rumors of an imminent announcement from Ascension Via Christi that they will be closing their ER in Fort Scott.  Commissioner Beth makes a motion that the County contribute $500,000 towards Amberwell Health, Inc. for operation of an ER, with the understanding that other taxing entities such as the City and the Community College will also contribute.  The motion passes 3-0.  Per the official minutes of that meeting: “Clifton made a motion that we support, along with other taxing entities in the county, an entity that Legacy Health has brought to the county and has been working with for many months, which is Amberwell, to provide ER services in Bourbon County soon if not as close to possible after January 1st, 2024.  The amount that Bourbon County would need to contribute is $500,000 contingent upon a signed MOU along with them coming and providing the services.  Justin Meeks clarified that if other entities don’t agree to fund, the county’s share would go up.  Jim seconded the motion and all approved.”  Note that the motion specifies Amberwell as the recipient of this $500,000 contribution.

OCTOBER 31st, 2023 – Just under a year after the agreement with Legacy is signed, Ascension Via Christi announces it will be closing it’s Emergency Room operations in Fort Scott on December 20, 2023, leaving Bourbon County without an ER for an indefinite amount of time for the first time in modern history.  It is announced that the Bourbon County EMS will continue services, but will have to transport patients out of the County for emergency care.

JANUARY 23rd, 2024 – Commissioner Clifton Beth makes three motions during a Tuesday night meeting of the Bourbon County Commission.  The first motion is to allow Commissioner Jim Harris to sign a Memorandum Of Understanding  with Amberwell Health, Inc. out of Atchison, KS regarding possible collaboration for emergency healthcare services.  It is stated that this motion does not guarantee Amberwell will be able to provide those services, but it allows the County to start laying the groundwork for those services should Amberwell be able to get the licensing to open an ER in Bourbon County.  The second motion is for the County to begin the process of preparing a 1/2 cent sales tax ballot question to be placed on the ballot in April to subsidize an ER and other healthcare services. Commissioner Beth states that this one-half cent sales tax will provide “$1.5 million, give or take” towards healthcare services. The third motion is for the Commissioners to sign a donation agreement from Ascension Via Christi, donating the equipment from their closed ER to the County.

Amberwell is ultimately unable to obtain the licensing to open an ER in Bourbon County.

THE FINAL $500,000

MARCH 11th, 2024 – The County Commission unanimously approves language for a 1/4 percent sales tax to go towards funding an ER question to be placed on the ballot for a special election on May 14th.  Why did it go from 1/2 percent to 1/4  percent?

According to the March 13th issue of the Tribune: “On Monday, the original question presented asked for a one-half cent sales tax, but Commissioners approved a motion by Commissioner Clifton Beth to change the amount to a one-quarter cent sales tax.”  The article goes on to say that Beth said the reason that he asked for a change in the amount of sales tax is the funds would be used to help an ER cover a loss. “One half-cent is around $1.5 million,” he said. “The loss in an ER is closer to half, to $750,000.  We are not in the business of providing them a profit.  This is strictly to make up their loss.”   The article then states that Citizen Anne Dare asked the Commission’s response if a company needed $750,000 up front.

“I would say no,” Beth said.

“They don’t get a blank check.” Commissioner Jim Harris said.

Keep that in mind…

MAY 14th, 2024 – The sales tax ballot question is approved by a wide margin of voters.  In my opinion this was largely due to a volunteer group of well respected local medical professionals and business owners taking the reins of the issue and having town hall meetings about it.  In my opinion this group of citizens helped eliminate a massive trust deficit that existed due to the back to back Noble and Legacy “investments”.

JUNE 13th, 2024:  Thanks to the sales tax passing, Freeman announces they are bringing ER services back to the hospital, as well as a 10 bed hospital.  This is a huge, desperately needed shot in the arm for Bourbon County’s morale.  Freeman CEO Paula Baker announces that they hope to have licensing in place to open by April 2025.  Based on what I’ve been told by multiple ER sales tax committee members, and confirmed by the Director of REDI at the June 27th, 2024 County Commission meeting, Kansas Renewal Institute’s TJ Denning, who has local ties and is well connected with the Freeman board, was the lynchpin in bringing Freeman to Bourbon County.

JULY 8, 2024 – The front page of the documentation packet provided at the July 8, 2024 County Budget meeting shows that the County plans to drain $394,863 from the General Equipment Fund to go towards startup costs for Freeman.  At the regular Commission meeting immediately following the budget meeting, citizen Anne Dare asks about this $394,863, and Commissioner Beth clarifies that the County is actually going to provide $500,000 toward startup costs for Freeman, and that the City also pledged $600,000.  However, that is in reference to the motion and vote back on October 13th, 2023, which as shown above was specifically for Amberwell Health.

If the County was going to offer Freeman (or any potential ER provider) an additional $500,000 from the already incredibly depleted County budget, why not just keep the ballot question at one-half cent, which would have provided an additional ~$750,000?  If you watch that July 8th County Commission meeting on YouTube, Commissioner Harris states that this is because the newly voted on sales tax won’t start accumulating until “late next year”.  This isn’t correct, as the sales tax goes into effect in October, and the County will begin receiving it in January of 2025.

AFTERWARD:  After finishing putting together what you’ve just read, I heard from a member of the ER sales tax committee who offered me some additional context.  The sales tax committee was under the impression that the County’s commitment of $500,000 to Amberwell wasn’t specifically bound to Amberwell, but to whichever ER provider they could get across the finish line first.  The committee intended to utilize that $1.1 million ($500k from the County, $600k from the City) if the prospective ER provider could start operations prior to the when the sales tax would start coming in (which will be January 2025). This committee member also informed me that there will be startup costs involved, as the ER and the equipment therein  was not in the turn-key condition that was originally presumed.

Sources for THE FIRST $800,000:

1) Fort Scott Tribune, Saturday, January 26th: “County to look at feasibility of hospital in Fort Scott”
2)https://www.usatoday.com/story/news/health/2023/03/22/noble-health-investigation-missouri-hospital-closures/11510166002/
3)https://www.bourboncountyks.org/march-29-2022-commission-meeting-minutes/?highlight=merrill%20atwater
4)https://www.bourboncountyks.org/june-14-2022-commission-meeting-minutes/?highlight=merrill%20atwater
5) Fort Scott Tribune, Wednesday, February 2, 2022: “A step closer to Bourbon County Hospital”
6)  Fort Scott Tribune, Saturday, March 26, 2022: “Commissioners address rumors about company performing hospital feasibility study”
7)https://www.usatoday.com/story/news/health/2022/08/15/missouri-hospitals-failed-provide-staff-health-insurance/10307764002/

Sources for THE NEXT $2 MILLION (PLUS A BUILDING)

1) Fort Scott Tribune, Saturday, November 19, 2022: “Hospital building transfer a done deal”
2) Legacy Healthcare Foundation registration with Kansas Secretary of State
3) Fort Scott Tribune, Saturday, November 19, 2022: “Questions surround county’s agreement for hospital building”
4) October 10th, 2023 Bourbon County Commission Meeting Minutes
5) October 10th, 2023 Bourbon County Commission Meeting Video (13:15 in)
6) Wednesday, October 11, 2023 Fort Scott Tribune: “County to subsidize ER – if other entities follow their lead”.
7) Fort Scott Tribune, Wednesday, November 1st, 2023: “Official: ER is closing”
8) January 23, 2024 Bourbon County Commission Meeting Video (1:23:47 in)

Sources for THE EXTRA $500,000 YOU MIGHT NOT KNOW ABOUT…

1) March 11, 2024 Bourbon County Commission Meeting Video (41:51 in)
2) March 11, 2024 Bourbon County Commission Meeting Minutes
3) Wednesday, March 13th, 2024 Fort Scott Tribune article: “Commissioners approve language for sales tax question on May ballot”
4) June 17th, 2024 Bourbon County Commission Meeting Video (31:39 in)
5) July 8th, 2024 Bourbon County Commission Meeting Video (20:45 in)