Lakeshore Hospital was closed in February 2020. Though a sale appeared imminent in the spring, the property remains vacant. Submitted photo

Brooks-TLC Hospital System Inc. continues to exist dangerously. Classified as a rural hospital, even though it is located in the city of Dunkirk, the facility is operating independently while being highly subsidized by New York state — more than $25 million in 2020 and 2019 — for deficits that total $45 million over the last five years.

Though it is tied to Kaleida Health in Buffalo through a management agreement, Brooks-TLC is not affiliated at the moment with any major health-care provider. It is a design that is destined for failure at smaller-scale facilities.

Earlier this month, the American Hospital Association released a report highlighting a variety of causes that resulted in 136 rural hospital closures from 2010 to 2021 — with a record 19 closures in 2020 alone. These include many longstanding pressures, such as low reimbursement, staffing shortages, low patient volume and regulatory barriers, as well as the continued financial challenges associated with the COVID-19 pandemic.

Recently, expenses for labor, drugs, supplies and equipment have increased dramatically, ultimately causing difficulties in maintaining access to care for people in rural communities. “While many hospitals and health systems are facing unprecedented challenges, those faced in rural America are unique,” said AHA President and CEO Rick Pollack. “We must ensure that hospitals have the support and flexibility they need to continue to be providers of critical services and access points for patients and communities.”

These rural facilities are major economic drivers that make up about 35% of all hospitals across the nation. They support one in every 12 rural jobs in the U.S. and contributed $220 billion in economic activity to their smaller communities in 2020.

Chautauqua and Cattaraugus counties have had two of these operations closed during the time outlined in the report, both were under the Brooks-TLC umbrella. After the historic flooding struck the village and outlying area in 2009, Tri-County Hospital in Gowanda was demolished and never reopened despite a small and unsuccessful effort to build a new facility. It has since been replaced with the Gowanda Urgent Care and Medical Center.

In February 2020, right before the COVID-19 pandemic, Lakeshore Hospital in Irving closed its doors due to major fiscal losses that were no longer sustainable. That decision came with plenty of heartache and controversy.

Today, only three hospitals remain in a region that was once served by five. The smallest, Westfield Memorial Hospital, is sitting in a strong position due to its partnership with the Allegheny Health Network and Saint Vincent Hospital in Erie, Pa.

UPMC Chautauqua in Jamestown also appears as though it is built for the future. During the late 1990s, it began working with UPMC Hamot in Erie and is now fully integrated into the powerhouse Pittsburgh health-care provider.

Brooks-TLC, however, remains on an island.

Since 2017, it has been promised nearly $74 million for a new facility. Its most recent plan, which included a $10 million deficit, is to build what is considered to be a 15-bed micro-hospital that has yet to receive the blessing of the state Health Department.

Adding to the dilemma — that officials in Albany are extremely aware of — is the lack of a community consensus regarding the move to the village of Fredonia at the former Cornell Cooperative Extension site on East Main Street. Besides relocating to a high-traffic area, near the Routes 20 and 60 roundabout and the Fredonia Central Schools, there is a major concern from those in the city of Dunkirk that the hospital will be abandoning a high-needs population that also lacks transportation.

To be fair, the U.S. Census of 2020 notes both municipalities have issues when it comes to that demographic. Dunkirk’s poverty rate is near 26% with Fredonia at 24%.

Kenneth Morris, who took the reigns as president and chief executive officer at Brooks-TLC in August, understands the challenges that come from being in the outdated building on Central Avenue between Fifth and Sixth streets. Maintenance is a huge drain on expenses while being in a four-story structure adds to increasing utility costs.

“Brooks-TLC is the first line of defense when it comes to stabilizing patients and transferring to a higher level of care, and the current location challenges access to this in several ways,” Morris said in a memo to staff shortly after taking over regarding the potential move to Fredonia. “The challenges include travel through residential zones. It is not easily accessible to (Interstate) 90 and the existing site does not have a helipad for air transportation. The new site, however, will have better access to the I-90 as well as Routes 20 and 60, which would provide alternate routes for emergency transportation.”

But with the summer construction season in the rear-view mirror, there are no plans for any ground-breaking in the village for the new site. Besides, at this moment, Brooks-TLC has no clout or leverage. This is the product of 14 years of poor oversight and a lack of direction by the board of directors, which has failed the community in not being able to broker a true affiliation agreement — or get a new site built with a gift of $74 million.

John D’Agostino is the editor of the OBSERVER, The Post-Journal and Times Observer in Warren, Pa. Send comments to jdagostino@observertoday.com or call 716-366-3000, ext. 253.