This is the second of two stories about what happens to small communities when hospitals providing vital mental health services close. Read the first story here.
On good days, Hannah Haught ate breakfast. Her morning appetite was a positive sign. On bad days, she didn’t eat and often didn’t get out of bed.
Haught had struggled with panic attacks and thoughts of suicide since she was 11. By age 20, she had seen myriad therapists and psychiatrists and was diagnosed with post-traumatic stress disorder, anxiety and borderline personality disorder.
Haught moved a lot and struggled to maintain treatment because options were scarce. Getting in with a new psychiatrist often took months.
But in 2018, Haught landed in Fairmont, West Virginia and things started to look brighter. Within two weeks, she had her first appointment with a psychiatrist at Fairmont Regional Medical Center, the only hospital in Marion County.
Her doctor prescribed her an antidepressant and sleep medication that they would adjust over time. He connected her with a therapist.
“I finally felt relief,” Haught said. “Things had been really bad, and for the first time in so long I felt like they were getting better.”
Then, at the end of March 2020, in the midst of a pandemic and just days before the governor issued a stay-at-home order, Fairmont Regional closed for good. Haught’s doctor sent her a one-page letter announcing the shutdown just one week before her next appointment. It was the last and only communication she received about the sudden loss of care.
This wasn’t the first time a West Virginia hospital abruptly ended services, leaving patients without their doctors in the middle of their course of treatment. The same thing happened just six months earlier when Ohio Valley Medical Center in Wheeling shut down in September 2019.
The common thread: both Ohio Valley and Fairmont Regional were owned by Alecto Healthcare Services LLC, a for-profit hospital management company based in southern California. Both hospitals were former nonprofits, and had been purchased by the company with the promise that Alecto would stabilize the struggling hospitals and fortify local health care. But it was to no avail. Business was bad; the company ended operations and exited West Virginia. And the communities left behind suffered the consequences.
Although it’s not illegal for a for-profit hospital to close — Alecto abided by the limited state laws in place to protect patients — local leaders in Marion County said the total closure of Fairmont Regional should and could have been prevented.
An Alecto representative said the company tried to find new owners or partnerships that might have allowed the hospital to stay open, but operations were no longer profitable and so the only option left was to close.
But documents including emails, texts and meeting notes show that for more than four months before the closure, community stakeholders raised concerns about the future of Fairmont Regional with both Alecto Healthcare Services LLC and West Virginia Gov. Jim Justice, who was called on to help formulate alternative plans for care.
Despite the sounding of early alarms and the similar closure of Ohio Valley months earlier, Alecto representatives repeatedly assured the community in Fairmont that the facility did not intend to shut down. Justice assured local leaders that officials would make a plan to prevent loss of care.
But a plan came too little, too late. The hospital closed and hundreds of employees lost jobs. The hospital’s inpatient psychiatric beds were gone, and hundreds of psychiatric patients like Haught didn’t know how to continue their treatment.
“They didn’t tell me where my doctor was going, where my therapist was going. They went from being these caring people to just cold-turkey cutting you off,” Haught said.
Wheeling was a warning sign
In 2013, Fairmont Regional Medical Center, then-called Fairmont General Hospital, filed for bankruptcy. The hospital had been a community-run nonprofit and had struggled with bills and to afford its physicians. As days ticked by without a local solution, community members feared that the hospital would shut down for good.
Then, Alecto swooped in and offered a lifeline. The California company purchased Fairmont Regional out of bankruptcy for $15.3 million in June 2014. At the time, Alecto promised to revitalize local health care and give the struggling hospital a chance to survive. Local officials were eager to help.
Between 2014 and 2017, operations in Fairmont went relatively smoothly. But trouble loomed.
The company purchased another West Virginia hospital — Ohio Valley Medical Center in Wheeling — in early 2017.
Bills at both hospitals began to go unpaid and services to the hospitals were periodically cut off, former employees said. Liens were filed, totaling more than $1 million owed for things like medical software, building materials and outstanding taxes. And the company’s issues weren’t limited to West Virginia: in California, an Alecto-managed hospital was suing the company for $30 million over allegations that Alecto was “funneling hundreds of thousands of dollars from the hospital to a closely associated adviser for a line of credit the hospital did not actually need,” according to the complaint. The case was later settled but the terms were not publicly disclosed.
Alecto operated Ohio Valley Medical Center for just over two years when the company announced it would shut it down in August 2019. Just 28 days later, Ohio Valley closed for good.
The consequences were devastating, especially for those who relied on the hospital for behavioral health care.
David Collins was treated for substance abuse at Ohio Valley. Collins, who is experiencing homelessness, said he was born into addiction but had made progress toward recovery because of the help he got at the hospital. Since Ohio Valley closed, he’s started using again.
“Anything I can get,” Collins said. “When you can’t get them prescribed, you medicate yourself.”
Kate Marshall, a Wheeling resident who works closely with people experiencing homelessness in the city said the loss of the hospital has had devastating effects on the people she serves. Many suffer from mental illness and used to get mood-stabilizing medications from the hospital.
“We’re literally talking about life and death situations,” Marshall said. “The carpet was pulled out under people’s feet. The hospital was their safety net and their lifeline to keeping them alive.”
Marshall said that since the hospital closed and the pandemic began, she’s seen an uptick in overdoses and suicides among the people she serves.
False hope
Ninety miles southeast of Wheeling, Marion County Chamber of Commerce President Tina Shaw was worriedly watching Ohio Valley’s closure in 2019.
“What was alarming to us, was that it was the same owner as our hospital. And so we thought this is concerning,” Shaw said.
So she sprang into action. In the four months following Ohio Valley’s closure, Shaw organized and conducted several meetings with community leaders to address the future of Fairmont Regional.
The meetings included a mix of hospital representatives, state officials, county leaders and Alecto executives.
During one of the first meetings in September, Shaw said Alecto executives acknowledged cash flow problems, but suggested Ohio Valley had drained funds from the hospital in Fairmont. Now that Ohio Valley had closed, they told Shaw things would be better.
Two days later, Alecto laid off 25 employees from Fairmont Regional, citing efforts to enhance operations and eliminate duplication.
But still, the company indicated Fairmont Regional’s future was solid.
A list of talking points the company distributed read: “FRMC is proud of the care it has provided during the past five years and looks forward to providing excellent healthcare to all members of the community for years to come.”
Jonathan Board, chairman of the Marion County Chamber of Commerce, cited that message as an example of what he said were misleading tactics used by Alecto to buy executives time to plan their exit. That, said Board, hindered months of local efforts to find a solution that put the needs of patients first.
“At just about every turn, we were told that we were being alarmists, that there was nothing to worry about,” Board said. “Alecto, at every interaction until December or January said ‘oh, we’re fine, we’re going to stay here forever.’ I believe firmly that they were playing a game.”
Chamber of Commerce. Photo by Chris Jones, via
Report for America/100 Days in Appalachia.
At a meeting in October, Alecto officials presented a 22-slide PowerPoint detailing steps the company would take to secure the hospital’s future and ease community concerns. Those steps included recruiting more specialists to Fairmont and forming partnerships with local health systems, converting to nonprofit status and developing a detoxification program. None came to fruition.
Meeting minutes and emails show Board and Shaw also worked to get state officials involved, coordinating multiple meetings with the governor and West Virginia’s federal representatives, beginning in November 2019.
But by early 2020, the situation looked bleaker. In February, after Alecto submitted a layoff notice they were legally required to deliver to employees, Board said he, along with local delegates, asked the governor to take action to keep the hospital open in Marion County. At one point, it was suggested that the state tap into some of the $150 million the governor’s budget set aside from a projected Medicaid excess fund for a “rainy day.” The governor didn’t do it.
Despite the sounding of early alarms, local leaders said company representatives and the governor’s office repeatedly assured the community that Alecto didn’t intend to shut Fairmont Regional down. That delayed efforts to find a replacement provider. Meanwhile, the governor’s office continued to assure Marion County officials that they were making a plan to keep services local, but such a plan was slow to materialize.
“We rallied very quickly and met with the governor and convinced him to try and bring the parties together, but nothing seemed to happen until [Alecto] finally pulled the trigger on this,” Delegate Mike Caputo, D-Marion, said in a House floor speech the week the hospital closed.
Board said although his immediate fear following the announcement was the loss of emergency services and jobs, long-term the loss of psychiatric care was one of his top concerns.
Only 14 of the nearly 60 hospitals in the state provide inpatient psychiatric services. Fairmont Regional was the most utilized provider, according to data from the West Virginia Department of Health and Human Resources.
Those are services the state desperately needs. West Virginia has one of the highest suicide rates in the country. But there are gaps in psychiatric services. According to data from the U.S. Department of Health and Human Services, as of June 30 West Virginia needed an additional 122 practicing psychiatrists in order to sufficiently meet patient needs.
When Fairmont Regional closed, both Marion County and West Virginia lost access to 34 of the state’s inpatient psychiatric beds— around 3.5 percent of the total available in the state.
A slide from the presentation given by the hospital back in October specifically detailed the necessity of mental health services in the area and called for the expansion of the behavioral health unit.
“FRMC’s Psychiatrists and Mental Health Professionals believe there is a need for additional beds and services including inpatient adolescent services,” it read.
But instead of expanding operations, those that did exist are now gone. There are no current plans to replace them.
To make things worse, the spread of coronavirus meant alternate providers were dealing with new restrictions on in-person treatment and increased demand for their services. And although telehealth providers have expanded some services in the state, those are only accessible to people with stable internet and flexible insurance plans, and create additional barriers to care.
“We’re talking about our most vulnerable people. We gave our government and every stakeholder on the planet an opportunity to save [the hospital]. I believe that the governor wanted to help. But the government failed to act,” Board said in April. “People will die because of inaction and indecision.”
Eventually Fairmont Regional’s emergency services were replaced: WVU Medicine opened a small emergency room in the former building at the end of June, four months after the hospital closed. But while both Mon Health and WVU Medicine plan to open small-format hospitals in the area in the coming year, there are no current plans to replace the psychiatric beds and behavioral health services in Marion County.
The governor’s office has not responded to multiple requests for comment.
‘I’m prolonging the inevitable’
Dr. James Abel had been a psychiatrist at Fairmont Regional for a decade, treating residents in north central West Virginia for everything from minor anxiety and depression to schizophrenia and bipolar disorder.
When Fairmont Regional closed on Thursday, March 19, 2020 at 5 p.m., Abel was among the 500 employees, including doctors and nurses, cafeteria workers and cleaning staff who gathered for a final walkthrough of their departments, clearing their belongings and collecting their exit paperwork as they went.
Tina Fisher, a nurse practitioner who had worked at the hospital for three years, was with Abel the night of the closure. Fisher said they had tried to obtain contact information for their patients so they could notify them once Abel began work somewhere else, but requests went unanswered by hospital management.
“We were escorted out by security,” Fisher said.
Soon after the hospital’s closure, Abel found work and moved his office to United Summit Center, an outpatient mental health clinic managed by West Virginia University Medicine. His patients, including Hannah Haught, were sent a letter by the hospital that listed six alternate providers in the area, but did not specifically state where Abel’s new practice would be located.
For mental health patients, forming a connection with a trusted doctor is especially important. Experts say that losing that consistency can be detrimental to a patient’s ability to manage their illness.
“We’re a bunch of mental health patients trying to get treatment and we can’t do that if we don’t know where to go,” Haught said.
Patients also lost access to their medical records, which are still onsite but haven’t been made accessible. An Alecto representative cited technical issues as the reason for the lost access, but said the company is working on getting records to people who requested them. But patients like Haught who have requested but not received their records are left without a roadmap of their previous care to give to a new prescribing doctor.
Lisa Tomblin was an inpatient at Fairmont Regional around April 2019. Tomblin, who said she was diagnosed with multiple personality disorder, had called 911 for herself during a suicidal episode. She was taken by ambulance to the hospital’s adult inpatient psychiatric unit and admitted the same day.
“I felt comfortable there when I was a patient. It’s probably the only time I have when I’ve gone into the hospital,” Tomblin said.
During her stay, Tomblin was prescribed the mood stabilizer Tegretol and arranged a follow-up with one of the psychiatrists who worked at the hospital. But when the hospital closed, she lost contact with the doctor who wrote her prescriptions. Two months later, she was running out of the medication and had begun rationing her pills, taking half the daily dosage to try to make it last.
Tomblin’s medications help prevent hallucinations and delusions. When a patient abruptly stops taking their medication, progress is reversed, sometimes leaving a patient worse off than they were before seeking treatment.
“I don’t know what’s going to happen to me,” said Tomblin at the end of April, who at the time had tried to reach her primary care doctor for help, but couldn’t because of the COVID-19 restrictions. “I’m just prolonging the inevitable.”
The present
More than four months after the closure of Fairmont Regional, Hannah Haught reconnected with Dr. Abel via telehealth services. She said the months in-between were hard, but she’s relieved to get back on track with her care.
“There was a period of time where I didn’t have my medications and things did get really dark,” Haught said.
She still doesn’t have access to her medical records. According to Haught, neither does Abel.
“He’s working with me from memory and personal notes that he had,” Haught said.
But things haven’t worked out as well for Tomblin, the patient who was cutting her medications in half in order to make them last. She says the situation has been “a living hell.”
“It’s hard to trust anyone, especially with my diagnosis,” Tomblin said. “I had been to doctors for years and [the one at Fairmont Regional] finally got it right.”
When she ran out of her prescriptions, Tomblin began experiencing delusions. She has multiple personalities. When she’s not being treated, Tomblin said she experiences life as three people rather than one. The loss of control leads to breakdowns, and an inability to function outside of her house. She recognizes that; the pain of knowing she needs help, but not knowing how to find it sends her into a depression. It’s a dangerous cycle.
In September, six months after the hospital closed and still without her medicine, Tomblin made an appointment with a family doctor. When the physician’s assistant said she wouldn’t prescribe her the mood stabilizer, Tomblin broke out into sobs.
“Please, I’m a wreck,” Tomblin pleaded through tears. “I’m not at my best right now. I didn’t choose to be this way. Life brought this to me and now I’m being punished.”
Tomblin’s primary care doctor eventually gave in and agreed to fill a 30-day prescription. But without access to long-term psychiatric care, Tomblin will again be searching for another solution after she runs out of her medication next week.
This story includes additional reporting by journalist Jean Lee.
Resources: Mental Health Clinics in West Virginia
Appalachian Community Health Center
Randolph County
Phone: (304)-636-3232 Or Toll-Free at 1-888-357-3232
Website: http://www.achcinc.org/
Hours of Operation: Monday through Friday, 8 a.m. to 5 p.m.
East Ridge Health Systems
Berkeley County
Phone: (304) 263-8954
24/7 Crisis Line: 1-855-807-1258
Website: https://www.eastridgehealthsystems.org/
Hours of Operation: Monday through Friday, 8 a.m. to 4 p.m.
Jefferson County
Phone: (304) 725-7565
24/7 Crisis Line: 1-855-807-1258
Website: https://www.eastridgehealthsystems.org/
Hours of Operation: Monday through Friday, 8 a.m. to 4 p.m.
Morgan County
Phone: (304) 258-2889
24/7 Crisis Line: 1-855-807-1258
Website: https://www.eastridgehealthsystems.org/
Hours of Operation: Monday through Friday, 9 a.m. to 4 p.m.
FMRS Health Systems, Inc.
Raleigh County
Phone: 304-256-7100
24/7 Crisis Line: 304-256-7100
Website: https://www.fmrs.org/
Fayette County
Phone: 304-574-2100
24/7 Crisis Line: 304-256-7100
Website: https://www.fmrs.org/
Monroe County
Phone: 304-772-5452
24/7 Crisis Line: 304-256-7100
Website: https://www.fmrs.org/
Summers County
Phone: 304-466-3899
24/7 Crisis Line: 304-256-7100
Website: https://www.fmrs.org/
HealthWays Inc.
Brooke County
Phone: 304-723-5440
24/7 Crisis Line: 304-723-6593
Website: https://www.healthwaysinc.com/
Hours of Operation: Monday through Friday, 8:30 a.m. to 5 p.m.
Logan Mingo Area Mental Health
Mingo County
Phone: (304) 235-2954
24/7 Crisis Line: (304)-235-2954
Website: http://www.lmamh.org/
Mingo County
Phone: (304) 475-3366
24/7 Crisis Line: (304)-235-2954
Website: http://www.lmamh.org/
Logan County
Phone: 304-792-7130
24/7 Crisis Line: (304) 792-7130
Website: http://www.lmamh.org/
Northwood Health Systems
Ohio County
Phone: 304.234.7777
Website: https://www.northwoodhealth.com/
Brooke County
Phone: 304.217.3050
Website: https://www.northwoodhealth.com/
Marshall County
Phone: 304.845.3000
Website: https://www.northwoodhealth.com/
Wetzel County
Phone: 304.455.3622
Website: https://www.northwoodhealth.com/
Potomac Highlands Mental Health Guild, Inc
Grant County
Phone: (304) 257-1155
24/7 Crisis Phone: 1-800-545-4357
Website: https://potomachighlandsguild.com/index.html
Pendleton County
Phone: (304) 358-2351
24/7 Crisis Phone: 1-800-545-4357
Website: https://potomachighlandsguild.com/index.html
Hampshire County
Phone: (304) 822-3897
24/7 Crisis Phone: 1-800-545-4357
Website: https://potomachighlandsguild.com/index.html
Hardy County
Phone: (304) 538-2302
24/7 Crisis Phone: 1-800-545-4357
Website: https://potomachighlandsguild.com/index.html
Mineral County
Phone: (304) 788-2241
24/7 Crisis Phone: 1-800-545-4357
Website: https://potomachighlandsguild.com/index.html
Prestera Centers for Mental Health Services
Boone County
Phone: (304) 369-1930
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Cabell County
Phone: (304) 525-7851
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Clay County
Phone: (304) 587-4205
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Kanawha County
Phone: (304) 341-0511
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Lincoln County
Phone: (304) 824-5790
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Mason County
Phone: (304) 675-2361
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Putnam County
Phone: (304) 414-3076
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Wayne County
Phone: (304) 272-3466
24/7 Crisis Phone: (877) 399-7776
Website: https://www.prestera.org/
Seneca Health Services Inc
Greenbrier County
Phone: (304) 497-0500
Website: https://shsinc.org/
Nicholas County
Phone: (304) 872-2659
Website: https://shsinc.org/
Pocahontas County
Phone: (304) 799-6865
Website: https://shsinc.org/
Webster County
Phone: (304) 847-5425
Website: https://shsinc.org/
Southern Highlands Community Mental Health Center
Mercer County
Phone: (304) 425-9541
24/7 Crisis Phone: (800)-615-0122
Website: https://shcmhc.com/
Hours of Operation: Monday through Friday, 9 a.m. to 5 p.m.
McDowell County
Phone: (304) 436-2106
24/7 Crisis Phone: (800)-615-0122
Website: https://shcmhc.com/
Hours of Operation: Monday through Friday, 9 a.m. to 5 p.m.
Wyoming County
Phone: (304) 294-5353
24/7 Crisis Phone: (800)-615-0122
Website: https://shcmhc.com/
Hours of Operation: Monday through Friday, 9 a.m. to 5 p.m.
Westbrook Health Services
Wood County
Phone: 304-485-1721
24/7 Crisis Phone: (304) 485-1725
Website: https://www.westbrookhealth.org/
Hours of Operation: Monday through Friday, 7:30 a.m. to 5 p.m.
Valley Healthcare System
Marion County
Phone: 304-366-7174
24/7 Crisis Phone: 1-800-232-0020
Website: http://www.valleyhealthcare.org/
Hours of Operation: Monday through Friday, 8 a.m. to 5 p.m.
Monongalia County
Phone: 304-296-1731
24/7 Crisis Phone: 1-800-232-0020
Website: http://www.valleyhealthcare.org/
Hours of Operation: Monday through Friday, 8 a.m. to 5 p.m.
Preston County
Phone: 304-329-1059
24/7 Crisis Phone: 1-800-232-0020
Website: http://www.valleyhealthcare.org/
Hours of Operation: Monday through Thursday, 9 a.m. to 5 p.m.
Taylor County
Phone: 304-265-3947
24/7 Crisis Phone: 1-800-232-0020
Website: http://www.valleyhealthcare.org/
Hours of Operation: Monday through Friday, 8 a.m. to 5 p.m.
United Summit Center
Crisis line: 1-800-786-6480
Serving the following counties:
Marion County
Barbour County
Braxton County
Gilmer County
Harrison County
Lewis County
Monongalia County
Preston County
Taylor County
Upshur County