Financial hardships shutter East Texas hospital 14 months after reopening

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Trinity County’s only hospital, which opened just 14 months ago, will close this week as Texas continues to struggle to keep their rural hospitals afloat.

On April 18, the Mid Coast Medical Center announced it would be closing down its operations in Trinity on Friday, citing financial concerns. They gave just a week’s notice to the local hospital board, which fought to keep the hospital operating since doors opened in February 2024.

The closest hospitals to Trinity are about 30 miles away. One is the Mid Coast Medical Center - Crockett, in neighboring Houston County. The other is the Huntsville Memorial Hospital.

Trinity is the latest addition to the growing nationwide problem with rural hospital closures. Since 2005, 109 rural hospitals have completely closed, according to the Cecil G. Sheps Center for Health Services Research. Texas led the nation in rural hospital closures between 2010 and 2020, with one of them being Mid Coast’s predecessor in Trinity County, the East Texas Medical Center, which closed in 2017.

“A rural hospital is a really, really hard thing to do,” said John Henderson, CEO of the Texas Organization of Rural & Community Hospitals. “I give them credit for trying, but the reasons that the original hospital closed the first time still existed when they tried again.”

To partner with insurance companies, Mid Coast Medical Center first had to be licensed through Medicare, hospital board chair Marjory Pulvino said. Hospital officials completed that process nearly a year after the hospital opened and the hospital received its first payment in January 2025.

“All of this time they have not been reimbursed for the care they've been providing or the staff,” Pulvino said.

It instead relied upon the Trinity Memorial Hospital District, which is taxpayer funded, to operate. Pulvino doesn’t know how much longer that would have truly been feasible.

“Despite our team’s tireless work to restore services in Trinity, we are simply unable to continue operations under the current circumstances,” said Brett Kirkham, CEO of Mid Coast, in a statement released by the hospital.

The hospital district owns the hospital building and equipment. The district’s board of directors is in active negotiations with a new hospital system in hopes to have them take over health care services, Pulvino said. Even if those negotiations conclude favorably this week, it could still be months before the hospital’s doors reopen.

Trinity County is a largely rural county in East Texas named for its proximity to the Trinity River, which drifts in a horseshoe shape around the county’s southern half. Mid Coast Medical Center’s home in the city of Trinity is in the county’s southern quadrant and about 25 miles north of Huntsville.

More than half of the county’s 14,489 residents are either living in poverty or just making ends meet. About 18% of those under the age of 65 had no insurance in 2023.

“The demographics of rural Texas generally are older, poor, sicker, less insured – which means Medicare, Medicaid or uninsured patients,” Henderson said. “It's a really, really tough recipe to try to survive.”

Lauren Threlkeld, a Trinity County resident who has lived in East Texas most of her life, is worried about what this will mean the next time she has to take one of her kids to the ER.

Threlkeld was raised in Riverside, which is just south of the Trinity County border, but now lives about 8 miles from the city of Trinity. She loves the peace and quiet of the countryside and has built a strong connection with her neighbors.

Simple living comes with some drawbacks, however. Threlkeld’s 15-year-old daughter was injured badly at a friend’s house years before Med Coast came to town. The teen was raced via ambulance to the emergency room at Huntsville Memorial Hospital. Threlkeld, who was nearly 90 miles away, beat the ambulances there.

“That is absolutely unacceptable,” Threlkeld said. “Us not having a hospital is going to put us in the same situation. That hospital could mean life or death for someone – including myself – one day.”

Mid Coast opened last year amid much celebration. Residents breathed a sigh of relief.

Threlkeld had to use the hospital multiple times since it opened. She was grateful for the short wait times and fantastic care, she said.

“It has just been great to have a hospital again,” she said.

It is exceedingly tough for a hospital to open in a rural community, and they need enough cash to get them “through the desert,” Henderson said.

It took the Trinity hospital board five years to find someone to reopen the hospital, which needed significant upgrades to the building and supplies, Pulvino said. The company and hospital district worked hard to make it work, she said.

Mid Coast had hoped to qualify as a Rural Emergency Hospital, a federal program established in 2020 to financially support small rural hospitals. Mid Coast didn’t qualify, however, because it wasn’t open in 2020.

And there weren’t many other options available to the hospital.

Lawmakers on Wednesday will mull legislation that would offer more support for rural hospitals in similarly dire situations. Henderson sees House Bill 18 by Rep. Gary VanDeaver, also known as the Rural Health Stabilization and Innovation Act, as a great next step toward improving health care for rural Texans.

The bill would establish multiple state entities, such as the State Office of Rural Hospital Finance and multiple grant programs. The bill would cost $48.8 million over the next two years. And there are some aspects that could take spending further. For example, the bill would create the Financial Stabilization Grant Program, which comes with a $100 million price tag, said VanDeaver, R-New Boston.

“A lot of the state dollars going as a result of this bill will not go directly to hospitals, but to put systems in place to avoid closing as so many have,” VanDeaver said.

He sees firsthand how few health care options in rural northeast Texas communities affect his constituents. There will be pushback, because many lawmakers don't want to create more state programs, he said. But his goal is to save rural hospitals.

The Mid Coast hospital leadership has called on Trinity residents to contact their state and federal lawmakers to help do the same.

“This is a call to action — for the Trinity community, our leaders and our nation — to recognize the unique challenges rural hospitals face and to fight for solutions that keep care close to home,” Kirkham said.

Disclosure: Texas Organization of Rural & Community Hospitals (TORCH) has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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