Letter to the Editor: Randy Nichols


Subsidizing emergency room care is a direct investment in critical services to secure our community’s safety and wellbeing.  Recently, concerns have been raised about resources used to sustain the existing hospital building as an asset for future medical/community services. That is a legitimate debate. Let’s remember though how we got here and then consider the difference between support for a building and support for needed ER services.

Following Mercy’s departure, a combined city/county task force contacted multiple hospital systems.  There was no viable path forward to re-establish an acute care hospital. The county subsequently negotiated with Mercy for ownership of the building and funds representing demolition expenses.  Based on public opinion, the county commission and their economic director chose to keep the building and attempt to establish a “medical mall.”  The ongoing county decisions to use financial resources to engage Noble Health and subsequently Legacy Health is directly related to this “medical mall” decision.   We now have a building available for expanded health or community services, a building with Legacy Health responsible for utilities and maintenance at no ongoing tax payer expense. This building houses our current and hopefully future ER services

The prior support for a building is different from support for emergency room services. The community needs to understand we are on the verge of losing our emergency room.  Without subsidizing ER care it will not be available.   Here is the issue.  Emergency Rooms lose money.  In a traditional system, the ER loss is made up by down stream revenue through admissions to the supporting/receiving hospital.  This system has allowed Ascension Via Christi -Pittsburg (AVC-P) to do our ER services and we should recognize the excellent job they have done.  However, the adverse financial impact of Covid on health systems across the nation has changed the dynamics of AVC-P ability to continue our ER services.  To their credit, Legacy Health has engaged Amberwell.  Amberwell has an innovative business, health care approach with proven success in rural Kansas.  However, to insure long term, stable ER services, a subsidy is justified and reasonable. Based on the critically important need for ER services and the high risk of completely losing these services altogether we should not view the subsidies as expenses but as investment in our future.

An investment in our personal health and wellbeing.  People you know will die unnecessarily without access to a local ER.  An investment to avoid increasing the cost of EMS transport for emergencies that don’t require transport to regional hospitals.  An investment in maintaining our current population as well as attracting new people to live in Bourbon Co.  People will leave and others won’t come because of no ER. An investment in supporting our current businesses and manufacturing and demonstrates support for services that will attract new industry.  An investment in future overall economic development.  Basically, an investment in sustaining our vitality and overall quality of life.  We stand at a crossroad.

Many communities have traditionally subsidized their health care systems.  With over 50 hospitals in Kansas at risk for closure, many more will have to do the same.  For 150 years we were not faced with this decision. Now we are and our elected officials have stepped up to financially support ongoing ER service.  We need to support that decision or suffer the consequences.  Arguing about past handling of the building is a fatal distraction.

One last topic.  Although, subsidies are needed right now, we need to pursue and encourage two sources of outside funding that could dramatically reduce or eliminated our subsidies all together.  First is expanded Medicaid. Expanded Medicaid would reduce the amount of unpaid services delivered in the ER and thereby reduce ER financial losses. We need state legislation to become involved.  Expanding Medicaid simply gives us access to federal tax dollars we are already paying and 40 other states are spending on their healthcare. It’s just common sense.  The second, and possibly more important source, is Rural Emergency Hospital (REH) designation.  REH is federally funded through a bill introduced by Republican Senator Grassly.  Reimbursement is made on a cost plus basis for emergency services and expanded 24 hour observation beds.  Efforts are currently under way for acceptance into this program.  There are some stumbling blocks but it is realistic to think in time this can be accomplished.  Calls and letters to our elected state and federal officials in support of these funding opportunities would be helpful.  To support expanded Medicaid contact state representative Trevor Jacobs.  To support REH contact Senators Jerry Moran and Roger Marshall as well as representative Jake LaTurner.

We’ve lost our hospital, let’s not lose our ER.



Randy Nichols MD

[email protected]

4 thoughts on “Letter to the Editor: Randy Nichols”

  1. Well written, Randy. I was raised in Fort Scott but no longer live there. I took the hospital for granted when I was there. You are right that history needs to be transitioned to just that: history. It’s time to move forward with whatever the new model will be. Hopefully Fort Scott will be able to retain much needed emergency services. It will take the work of many people to accomplish this. Let’s hope there is a solution to be found.

  2. Randy, I would agree with your premise for the new facility at the former Mercy building up to the point that you state, “Arguing about past handling of the building is a fatal distraction.” The distracting past handling added $23.6 million to the Legacy Healthcare balance sheet. Their implementation of the “medical mall” must have generated some rental income for Legacy to offset salaries, utilities and repairs. But now, as you have stated, Legacy has invited Amberwell to take over the ER. So why should Bourbon County taxpayers subsidize the new ER provider? If just 5% of the capital gifted to Legacy was leveraged to cover the $1.5 million yearly needed for operations, no taxing entity in the County needs to contribute anything. The fatal missing part of the operation equation is how this ER facility is going to move patients to a Legacy profit center or hospital facility if no hospital is built. The Amberwell model is structured now moves patients from their hospital ERs and clinics to Amberwell hospitals for revenue generating procedures and care; Amberwell doesn’t have a hospital in this area either. Medicaid expansion and an REH facility requires an operating hospital as well and the REH had an operational deadline of December 2020. So still no hospital.

  3. Not all ER are created equal. If an ER is ill-equipped, it would not be helpful for the EMTs to make the stop. Randy, what would you say constitutes an ER that is really equipped with lifesaving tools that make a difference, given there is no operating room within 30 minutes? Perhaps we should put all of our eggs in the ambulance/EMT basket and make that top-flight with an additional West-county location. Earnestly asking.

Leave a Reply

Your email address will not be published. Required fields are marked *