State budget advances plan to reopen Martin County hospital

By Jaymie Baxley 

During the prayer that opened last week’s meeting of the Martin County Board of Commissioners, chairman Joe Ayers thanked God for guiding local leaders “through the process of trying to reopen health care” in the community. 

His gratitude stemmed from the state budget signed into law on July 7 by Gov. Josh Stein. Listed among the document’s thousands of line items is a $25 million allocation to restore emergency department services in Martin County.

The funding represents a major victory in the county’s three-year struggle to reopen Martin General Hospital. 

Decades of mounting financial losses led to the 42-bed facility’s closure in 2023, leaving residents without local access to life-saving care.

Since then, residents have had to travel to other counties for emergency treatment, prompting concerns about longer ambulance trips, delayed care during medical emergencies and the broader economic toll of losing one of the area’s largest employers.

Last year, Greenville-based ECU Health approached the county with a potential solution: The state-affiliated hospital system proposed a plan to convert the shuttered campus into a Rural Emergency Hospital — a federal designation created by Congress to help preserve access to care in communities that can no longer support a traditional hospital.

Brian Floyd, chief operating officer for ECU Health, said the money set aside in the state budget gives the project momentum to move forward.

“Bringing emergency care to Martin County is our first priority, and this funding helps put us on a path to do that,” he said in an interview with NC Health News.

Building a regional system

Unlike a full-service hospital, Rural Emergency Hospitals provide round-the-clock emergency care and outpatient services but do not admit patients overnight. Patients who need hospitalization are stabilized before being transferred to another facility. 

In return, participating hospitals receive higher Medicare reimbursements and a monthly federal facility payment intended to offset the financial challenges of operating in rural communities.

While not designated as a rural emergency hospital, Atrium Health Anson, part of the Atrium Health system, has been operating in a similar fashion since 2015, replacing an aging facility and preserving access to care in that county. 

North Carolina, which has a bigger percentage of rural residents than any state except Texas, has yet to see a single hospital adopt the model. More than 50 hospitals in other states have converted, but all of them had been open when they made the switch. 

This means Martin General is poised to become the first closed hospital in the nation to reopen as a Rural Emergency Hospital. 

For the plan to succeed, Floyd said, emergency services must be paired with more inpatient hospital beds elsewhere in the region.

“If we have just an emergency department sitting in Martin County an hour away from the next inpatient capacity, it’ll fill itself with inpatients and then not have room for emergencies,” he said. 

To prevent that from happening, ECU Health wants to expand its hospital in neighboring Beaufort County with an inpatient bed tower capable of absorbing patients transferred from Martin County and surrounding communities. 

The entire project is expected to cost roughly $220 million, a price tag that includes about $70 million to establish the Rural Emergency Hospital in Martin County and approximately $150 million for the Beaufort expansion.

With the money from the state budget and $35 million that was previously appropriated through the state’s NC Care initiative, the Martin County portion of the project is mostly funded. But lawmakers approved only $15 million toward the Beaufort expansion — enough to begin planning but well short of the amount needed to build the tower.

In a news release issued after the budget’s passage, ECU Health noted that additional investment is needed to “fully implement a sustainable regional system of care model needed to improve sustainability and expand inpatient capacity for the surrounding communities.”

Long road ahead

ECU Health and Martin County officials are now shifting to the logistical work of resurrecting Martin General.

Floyd said the next step is negotiating a formal agreement to let ECU Health operate the county-owned facility. Then engineers and construction teams will assess the building to determine what repairs and upgrades are needed before emergency services can reopen.

A few other hurdles must be cleared. Floyd said North Carolina will need to establish new Medicaid policies for Rural Emergency Hospitals, given that no facility in the state currently operates under the designation. 

Another challenge will be recruiting people to work at the hospital. Floyd anticipates that some former Martin General employees will apply.

“We fully expect there will be people who have worked there and live there who’ll be the first ones on the list to say, ‘Can we come back to work in this new facility?’” he said. “Obviously, we think that’s a great thing.”

But with so many boxes left to check, Floyd was reluctant to predict when the facility might actually reopen. 

“I’d like to beat any date that I think we can hit,” he said. “We’re going to go as fast as we can to try to bring emergency care to Martin County.”

In a statement, ECU Health CEO Michael Waldrum said the state budget “represents meaningful progress toward a sustainable model of care” for Martin and Beaufort counties, as well as for eastern North Carolina as a whole. 

“Rural Americans are facing unprecedented challenges that continue to threaten the viability of health care in their communities,” he said. “We are grateful for the support of our state elected leaders for infrastructure funding as we pursue rural health initiatives designed to improve the health and well-being of the most vulnerable communities in North Carolina.”

The sentiment was echoed by David “Skip” Gurganus, vice chair of Martin County’s Board of Commissioners. At the end of last week’s meeting, he praised the General Assembly for being “gracious enough to grant us what we need to start the process of reopening the hospital.”

Gurganus, like his board chairman, also gave credit to a higher power.

“I am a firm believer that God has got his hand on this,” he said.

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