SUNBURY, Pa. — Candy cane lights are affixed to the streetlamps along the quaint square in the center of this Susquehanna River city. Many surrounding storefront windows are painted over with holiday characters and Christmas trees.
But behind that paint, behind the glass, there’s a lot of empty space. “Rent” and “For Sale” signs dot Market Street. The population has been dropping for a century, from a peak of more than 15,700 to 9,500. A recent announcement that the University of Pittsburgh Medical Center’s Susquehanna Sunbury Hospital on 11th Street will close this spring feels like yet another big lump of coal for the Northumberland County community.
“This whole town is unhappy,” resident Lila Million said in a cafe here on a recent rainy afternoon.
Small hospitals are disappearing all across rural America as health-care systems contract. According to the U.S. Government Accountability Office (GAO), 64 rural hospitals closed from 2013 through 2017, more than twice the number in the prior five-year period. This year, 18 were shuttered. The GAO found that most of the closures “were generally preceded and caused by financial distress" resulting from decreased demand for inpatient care, as well as Medicare payment reductions.
In a June op-ed written for The Hill, former Sens. Tom Daschle (D., S.D.) and Olympia Snowe (R., Maine) suggested that rural health care could become a “powerful topic in the 2020 election.” The two noted that residents of rural communities “have a greater risk of dying from heart disease, cancer, stroke, and chronic lower respiratory disease, and that should prompt candidates and policymakers alike to take action.”
Pennsylvania has fared better than other areas of the country. According to Becker’s Hospital Review, a health-care news source, Texas has lost 20 rural hospitals, the most in the nation. In Pennsylvania, a hospital in Ashland, Schuylkill County, once called “Miners Hospital," closed in 2014. Mid-Valley Hospital in Lackawanna County was shut down in 2012.
“Oklahoma, Nebraska, they were really hit hard,” said Lisa Davis, director of Pennsylvania’s Office of Rural Health at Penn State. “We were feeling pretty confident. The announcement of the closure of Sunbury was very surprising, and pretty unsettling.”
UPMC — a self-described “global health enterprise” with 87,000 employees and 40 hospitals — purchased the former Sunbury Community Hospital in 2017 and, according to city officials, invested millions in the property. On Dec. 5, however, it sent out a news release saying it would close the 70-bed facility by March 31. UPMC did the same with a hospital in Lancaster earlier this year.
While the announcement did not mention specific financial losses, UPMC Susquehanna president Steven Johnson echoed some sentiments from the GAO report. “According to market data, patients are utilizing facilities other than UPMC Susquehanna Sunbury for their care,” he said.
According to the Daily Item in Sunbury, the closure will mean the city is without a hospital for the first time in 125 years. It had an emergency room, and among other services, was used for mental health care. An estimated 150 jobs will vanish, though UPMC said many employees could end up at other hospitals and offices in the network.
The top employer in Northumberland County is Weis Markets, a supermarket chain founded here in 1912. H.H. Knoebel Sons Inc., which runs both a lumber operation and a popular amusement park, also is a major source of jobs. Still, Sunbury’s poverty rate, 21.5%, is far higher than the state average of 12.5%, and its median household income is more than $25,000 below the state average of $59,195.
Just a few blocks from the hospital, a former Bimbo bakery facility was shuttered several years ago and remains that way. City officials worry about finding a tenant for the empty hospital.
“It’s a blow to the morale of the residents because it’s one more place that’s closed down,” said city administrator Jody Ocker. “There’s a lot of nostalgia, a lot of memories in that place.”
Ocker said local churches and nonprofits are concerned that the hospital’s closure would affect mental health and addiction services. Republican State Rep. Lynda Schlegel Culver said she has requested state intervention.
Northumberland County is one of Pennsylvania’s 48 rural counties, though its population density — 206 people per square mile — is far greater than most of them. There are still three hospitals within a 30-minute drive of Sunbury, including Shamokin, Danville, and Lewisburg. Often, hospitals in even more rural areas, like the 21-bed Bucktail Medical Center in Renovo, Clinton County, are designated as “critical access hospitals” and rely on Medicaid and Medicare reimbursements. Those hospitals are deemed too critical because of the vast distances between them and other facilities.
Approximately 15 hospitals in the state have that designation. But Northumberland County, about 160 miles northwest of Philadelphia, isn’t rural enough.
The aftermath of hospital closures is often compounded by other issues that affect everyday life in rural America, including limited public transportation and poor broadband speeds. Often, hospitals are among the top employers in rural counties, too.
“I mean, any time you have a community hospital close, the availability for medical care becomes a big concern,” Schlegel Culver said. “People can usually walk or ride their bike to a community hospital.”
Lila Million, 64, moved to Sunbury several years ago from Tucson, Ariz., not realizing there was no public transportation here. She does not own a car. Neither does one out of every five residents, Ocker said.
“Hopefully, by New Year, I’ll have a car,” Million said. “I might have to wait for my income tax to come in.”
At Pop Snyder’s Lunch, a small cafe on the city’s square, owner Dawn Walburn said many of her customers are devastated by the news.
“People were pretty happy with the place,” she said of the hospital.
Pop Snyder’s was open for 68 years in Sunbury before it closed, briefly, in 2015, and reopened under Walburn a few months after that. The same quick turnaround for the hospital is unlikely.
“We don’t want to see that building become a totally empty building,” Ocker said. “We don’t need another empty building.”