Marco Phinnizee didn’t know he was having a stroke; he just knew he suddenly couldn’t walk.
Barely able to speak after he dialed 911, the City of South Fulton resident recalls that he waited so long for an ambulance that, when EMTs arrived, they said there wasn’t time for the longer drive north through downtown Atlanta to Grady. They rushed him instead to a hospital seven miles closer, Wellstar Atlanta Medical Center South, in East Point.
There, doctors diagnosed Phinnizee and dissolved the blood clot that caused the stroke, he said. After five days in the ICU, he went home, where he continues his recovery.
Phinnizee said he is glad he had Wellstar AMC South nearby. But he and his neighbors won’t have it for long. Wellstar Health System is now days away from shutting down the facility’s emergency room, operating room and inpatient beds, to leave in its place a 24-hour outpatient clinic. Of the 11 hospitals within Fulton County, AMC South is the only one south of I-20, and removing the ER will mean longer drives at high-stakes moments.
“I think that risks the lives of the people on the Southside,” Phinnizee said.
Wellstar says the shift to outpatient care is the best move for what the community needs and will allow the facility to focus more on preventative care. Numbers show most patients at the East Point center only need urgent care, not a hospital stay.
For the real emergencies, said Wellstar CEO Candice Saunders, there are other hospitals nearby, including Wellstar’s own AMC main campus in Atlanta, not far from Grady. Four hospitals with emergency departments are located within 10 miles of the East Point hospital, three of them clustered in Atlanta.
“We think that with this new model, we’ll be able to provide the right care at the right place and to meet the health care needs of the East Point community more effectively,” Saunders said.
The change in the medical center’s services will have consequences, experts say, if it delays care for conditions such as strokes or heart attacks, where clinicians like to say that “time is tissue.”
Barriers to care
The impact could be broad.
“Every hospital is overwhelmed” as patients return to catch up on health care delayed by the pandemic, said Rebecca Cash, an assistant professor of Emergency Medicine at Harvard Medical School and a former paramedic. “If a hospital closes and then the surrounding hospitals have to absorb that volume ... that affects quality of care for everyone, not just time-critical (patients).”
“There may have been good reasons for them to do this,” Dr. Daniel Wu, head of emergency medicine at Grady Memorial Hospital said of Wellstar’s decision to close some services. “But just from a medical point of view, this is (going to be) causing delays, and we already have delays.”
Experts say southern Fulton County already trails other parts of metro Atlanta in access to quality resources, and the moves by Wellstar could exacerbate the problem.
“Distance matters. Place matters,” said Justin Moore, a Medical College of Georgia and the Georgia Cancer Center epidemiologist who studies the connection between geography and health.
Residents in lower-income areas such as south Fulton County already have bigger challenges in accessing and affording health care. Unpaid sick days, low-quality insurance and transportation challenges are among them, Moore said.
“So there’s just barrier after barrier after barrier,” he said.
“So if you take a resource from a community that provides certain health services,” he continued, “I mean, that could lead to a ... loss in lives.”
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
Nationally, research has found that response times for EMS are longer in lower-income areas, and that when African American patients complain of symptoms such as pain they are less likely to be believed and receive adequate treatment. After the calls to 911 by Phinnizee and his friends, it took more than 90 minutes for an ambulance to arrive.
Some worry that the loss of services at the East Point center could hit Black residents harder. U.S. Census figures show south Fulton is heavily African American, and the ZIP code of the East Point hospital has a median household income $20,000 lower than the zip code of Wellstar’s North Fulton Hospital in Roswell.
The value of location
Wellstar’s announcement of the closure, effective May 6, has roiled public opinion. To local politicians concerned about the changes, Wellstar has strongly made the case that the community itself made the choice. When patients need more extensive care and have time, they bypass AMC South to go to other hospitals, Wellstar officials have said in interviews and in public briefings.
That is especially damaging to the hospital’s finances, because emergency care can be a financial sinkhole, while surgeries and cancer treatment are more lucrative. Although Wellstar is not-for-profit, such hospitals work to make money just as much as those run for profit.
When Wellstar bought the hospital from Tenet in 2016, the facility was part of a package of hospitals. The profitable jewel of the package was North Fulton Hospital in Roswell, according to reports at the time.
Being in an area with higher income and employment means that patients who walk in the door are much more likely to be able to pay out-of-pocket costs and to have private insurance.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
Brandon Reese, a lobbyist for Wellstar, told the Fulton County Commission that Wellstar had spent more than $120 million on the hospital since 2016.
“We hoped with all of our hearts that, by implementing a marketing campaign, hiring full time physicians instead of contract physicians, employed nurses rather than contract nurses, employed security rather than contract security, that we would get great buy-in from the members of the community,” he said. “And we did get some, but the truth is it hasn’t moved the needle.”
Others say that Wellstar spent money to buy the hospital, but has not invested in the type of significant upgrades needed to attract more patients.
A scathing 2021 summary from Lisa Medellin, chair for the Regional Health Board for the AMC hospitals in Atlanta and East Point, alleged severe lack of investment in those two hospitals. “The evidence of an authentic plan and appropriate strategy appears non-existent for revitalizing the AMC Downtown and East Point hospitals,” said the report first obtained by Georgia Health News.
Wellstar is, however, investing elsewhere.
“Distance matters. Place matters."
In documents filed with finance agencies weeks before the AMC South announcement, the health system laid out the case for borrowing $200 million to build a seven-story tower at Kennestone hospital in the more affluent suburbs of Cobb County.
The tower, expected to be finished in 2025, will be a draw for patients. Plans call for private rooms instead of semi-private, a dedicated women’s and children’s entrance, chapel and other improvements to make care more efficient.
Wellstar said it can afford the investment. Wellstar reported that it had $2.8 billion in net assets as of September and enough cash on hand to run the hospital system for more than half a year if necessary.
Credit: ALYSSA.POINTER@AJC.COM
Credit: ALYSSA.POINTER@AJC.COM
The value of an ER
While Phinnizee is among the minority of AMC South’s emergency patients because he got admitted, Justin Moore fits into the majority: Those who show up at the ER, get treated and go home.
Though Moore is now an academic in Augusta, he grew up in Fulton County and was well acquainted with that very hospital.
As a high school senior playing second baseman, he one day took a ground ball directly to his head. He was dazed and went to the bleachers to sit it out, blood running down his face.
A friend came over and told him he had to get to the doctor. They went to the East Point emergency room. After an evaluation, he was told he didn’t have serious head injuries. He got stitches and left, reassured.
Wu, the emergency medicine director, said that’s how ER medicine works.
“I get asked these questions all the time, when my kids are playing in the field: ‘Do I need to go to the emergency room?’ So, I can make that decision. But you... That’s exactly the point, is that family’s not gonna know,” Wu said.
“You don’t know if they have an emergency until you have an emergency physician or provider nearby.”
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