Brooks Memorial Hospital in Dunkirk.

Long before the COVID-19 crisis, rural hospitals across the United States were facing a dire situation. Forbes recently reported 2019 to be the single worst year in the last decade for these types of facilities as 19 of these health-care institutions went dark.

On a local level, 2020 began on an ominous tone. Lakeshore Hospital in Irving, which nearly closed in 2013 when it was being overseen by the University of Pittsburgh Medical Center, officially shuttered operations on Feb. 2 despite plenty of staff and community support to keep it open.

Lakeshore, just by scanning the 990 Internal Revenue Service documentation provided by Guidestar.org, had tremendous financial troubles in the last 15 years. From 2008 to 2012 alone, the facility reported losses of $16.7 million before declaring bankruptcy in 2013.

Making matters worse, its neighbor and partner to the west has been barely keeping its head above water. Brooks Memorial Hospital in Dunkirk has not had a positive balance sheet since before 2008 when its board of directors made the decision to join forces with Lakeshore, which was also known as the TLC Health Network. At that time, the two facilities worked under the now defunct Lake Erie Regional Health System of New York moniker.

Based on the name alone that never caught on with the public, it was a marriage that seemed doomed from the start. Both facilities at that time kept separate identities, staffs and administrations with a few exceptions, most notably the chief executive officer. That meant no efficiencies or cost savings that could be generated through a merger.

It appeared as if there was little planning and execution.

That leads us to where we are today when examining the local health-care landscape. In looking at the four hospitals serving Chautauqua and Warren counties, only one has recently recorded a positive bottom line: Warren General Hospital in Pennsylvania.

According to the most recent available 990 from the IRS, Warren’s hospital showed a $1 million surplus for 2017. It was quite a turnaround as the facility lost $4.3 million in 2016.

In Jamestown, UPMC Chautauqua reported being $325,961 in the red for 2018. It was an even darker picture for the combined Brooks-TLC Hospital System, now tied to Kaleida Health, which reported a combined deficit of $4.2 million that same year.

Westfield Memorial Hospital’s most recent IRS documentation is from 2016. It reported a loss of $1.6 million at that time.

How COVID-19 affects all these institutions is something worth watching in the future. When the virus became a true threat to Americans in March, revenue streams from hospitalizations, outpatient and emergency room visits dropped drastically.

As the nation watched in horror as the deaths piled up, facilities here were told to prepare for a surge that never really happened in either Chautauqua or Warren counties. Based on today’s numbers, we can remain hopeful it will never come.

That being said, all rural health institutions are bleeding money. Payroll is always the largest cost. For UPMC Chautauqua in 2018, it was more than $1 million per week, according to the documents filed with the IRS. Brooks-TLC payroll was about $731,000 per week then as well.

What’s kept most of these institutions afloat during the major crisis has been an infusion of cash, some of which may have to be paid back. Jamestown’s hospital received more than $10 million while Brooks had $5 million from the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act.

“Front-line workers have risked their lives and fought tirelessly to keep New Yorkers safe during the COVID-19 outbreak,” U.S. Sen. Kirsten Gillibrand said when funds were announced in June. “Our safety net hospitals treated patients regardless of insurance status and because of their sacrifice, New York is progressing toward a safe reopening. As we move forward, this funding will provide direct relief to help these critical hospitals recover financially.”

Those comments, however, seem to be far too optimistic.

New York, as many readers are aware, is in the midst of a major funding dilemma. Most recent estimates peg the gap to be about $16 billion.

Knowing recent state subsidies to hospitals in the past, specifically $17 million to the Brooks-TLC System over a three-year period, is one more worry for these already cash-strapped institutions. Too many, including those outside of our region, are hanging by a thread.

John D’Agostino is the regional editor for the OBSERVER, The Post-Journal and Times Observer in Warren, Pa. Send comments to jdagostino@observertoday.com or call 366-3000, ext. 253.