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Panhandle hospital's ER service in question over unpaid bills

Memorial Hospital of Texas County is pictured in Guymon, Okla. [The Oklahoman archives]
Memorial Hospital of Texas County is pictured in Guymon, Okla. [The Oklahoman archives]

GUYMON — At 3 p.m. Monday, Dr. Jeffrey Lim got an urgent call: a patient had had a stroke and was on the way to the nearest emergency room. But there was no doctor on hand.

Lim, medical director for the ambulance service run through the Guymon Fire Department, said he had no warning that Memorial Hospital of Texas County wouldn't have a doctor available to treat emergency patients. A plane took the patient on to Amarillo, Texas, about 100 miles away.

Memorial Hospital of Texas County is a 47-bed facility in the Panhandle. The closest emergency room is in Liberal, Kansas, a 48-minute drive at normal speeds. Ambulances are taking more stable patients to Kansas, but those who are dangerously ill are being flown to Texas or Oklahoma City, Lim said.

Representatives for Memorial Hospital dispute Lim's characterization of their emergency room. An executive assistant said the hospital couldn't speak to any decisions emergency medical services may have made, but that the emergency room was open as of Tuesday morning and has physician coverage for the foreseeable future.

Lim said he can't authorize sending patients to the hospital until he has confirmation it can care for them.

Fire Chief Dean McFadden said the 18 paramedics who work for his department are ready to divert patients as needed. Longer trips may put strain on their resources, but he's confident they have enough people and ambulances to meet patients' needs.

“You're going to get the care you need in the city of Guymon,” he said.

Monday wasn't the first time Lim got a call telling him the hospital wouldn't be able to help patients.

In two cases, he had to tell ambulances to take patients for a flight to Amarillo instead of driving them to the hospital, because the emergency room didn't have important medications. One patient was having a stroke and needed a drug to dissolve a clot, and the other patient had been bitten by a rattlesnake and needed anti-venom.

Lim said he didn't know if either patient experienced any ill effects from the delay in reaching a hospital. Small hospitals may not have every medication that's available in larger centers, but anti-venom and clot-busting drugs are both staples that any hospital should have, he said.

“Even in a rural emergency room,” he said.

Ambulances also have had to divert cardiac patients a few times over the last month, because the hospital didn't have the supplies to do a blood test that looks for signs of heart damage, Lim said. At times, he also had to tell ambulances to divert patients who have emergencies related to diabetes or their hearts or lungs, because the hospital didn't have a machine to measure the buildup of carbon dioxide in the blood.

“It's been going on for at least three months,” he said.

Harold Tyson, one of the hospital's three trustees, said he had heard that the emergency room was running as of Tuesday morning, but referred questions to CEO Doug Swim, an Oklahoma City attorney, and Solutions Management Group, a health care management company Swim owns.

“They're the company that's running the hospital,” he said.

SMG took over management of the hospital in fall 2017 from Texas-based Little River Healthcare, which had managed it for about a year, according to the Guymon Daily Herald. Providers said they've struggled to get paid under Swim and SMG.

Lim said the emergency room problems also started after SMG took over. He said Swim and chief operating officer Mike Carter have been largely absent from the hospital in recent months, despite its troubles.

“I think I've seen (Swim) once in the last six months,” he said. “I don't know if he's trying to manage it from Oklahoma City.”


Monday's confusion over the emergency room resulted from more than $250,000 in unpaid bills, said Shonda Rupe, chief operating officer at Emergency Staffing Solutions. Hospitals contract with ESS, which then pays emergency room physicians to work in rural markets.

ESS and the hospital had partnered for 10 years, and getting paid wasn't an issue until about six months ago, Rupe said. A letter she sent Friday to Carter, the hospital's chief operating officer, said the hospital had missed three payments on its debt, totaling $48,000.

“We make a payment plan and they don't pay,” she said.

In the Friday letter, Rupe notified the hospital that ESS would stop paying physicians to work there as of 3 p.m. Monday, unless it received $25,000 toward paying down the debt. She said the final straw was when Swim and Carter told her the hospital likely would file for bankruptcy and had “no hope” of paying its debts.

“They really just left us no choice,” she said.

Hospital representatives didn't comment on allegations of unpaid bills by Rupe or other providers.

ESS isn't the hospital's only creditor. Dr. Martin Bautista, a longtime internal medicine physician in Guymon, practices in the hospital and co-owns Panhandle Radiology with a group of local doctors. He estimated the hospital owes Panhandle more than $89,000 for imaging services provided before Swim canceled its contract, and for related costs.

The bills were due in October 2017, but the hospital still hasn't paid, Bautista said. He said SMG also hasn't managed to recruit specialists as promised, and hasn't fixed broken imaging equipment, including an MRI machine.

Eric Johnson, a physical therapist, estimated the hospital owes his practice about $130,000 for services provided over about a year. The hospital had been paying down that debt, but has fallen behind on payments again, he said.

Management told him they couldn't pay bills because Medicare was behind on payments, and because the hospital needed to pay off debt, Johnson said.

“What I told them is that doesn't help me pay my employees and pay my vendors,” he said.

Johnson said he has continued providing physical therapy because patients don't have other nearby options, and he hasn't sued the hospital for fear of hurting the community.

“We're hoping they'll become true to their word, true to their contract,” he said. “But the track record isn't great at this point.”

Meg Wingerter

Meg Wingerter has covered health at The Oklahoman since July 2017. Previously, she lived in Topeka, Kansas, and worked at Kansas News Service and The Topeka Capital-Journal, where she earned awards for business coverage. She graduated from... Read more ›