$44,000 for an Ambulance, Hour-Long Drives to an ER: The Impossible Cost of Healthcare in Appalachia

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WHEN HEATHER EDWARDS’ CONTRACTIONS BEGAN THREE MONTHS EARLY, in March, she worried about the long drive to the hospital from her home nestled in the Appalachian Mountains in Jonesville, Va., a town of fewer than 1,000 people. Edwards, 32, was carrying quadruplets and hers was considered a high-risk pregnancy. The nearest hospital with a neonatal intensive care unit (NICU) was an hour away in Kingsport, Tenn., Holston Valley Medical Center.

A decade ago she could have found an emergency room, if not a NICU, 10 minutes up the road at Lee County Regional Medical Center in Pennington Gap, Va., but the hospital closed in 2013 due to low community use, a lack of local physicians and Virginia’s refusal to expand Medicaid, which left the state’s rural hospitals to provide uncompensated care to uninsured patients. In 2012, the Lee County hospital was nearly $2.5 million in the red.

Neighboring counties do have emergency rooms, but none offered the NICU care Edwards needed. She decided to make the 44-mile drive along twisty mountain roads to Holston Valley Medical Center.

“If I went to [a different hospital], they were just going to fly me to Holston Valley or the [next] closest NICU,” Edwards says. “It would have been a waste of time.”

Edwards barely made it. Moments after she arrived, “everything just broke loose, and I went into labor,” Edwards says. “They tried to stop it and couldn’t. I had an emergency C-section.”

Edwards considers herself lucky. For the residents of rural Appalachia, long drives for emergency care are often a matter of life and death.

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