The former Atlanta Medical Center, November 9, 2022
Atlanta, Georgia CNN  — 

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For the past four years, Angelina Alford was able to walk just a couple blocks to her neighborhood hospital whenever she needed emergency health care.

Alford, 65, said that she suffers from asthma, diabetes and high blood pressure, and that there were times when the Atlanta Medical Center’s (AMC) downtown hospital, formerly known as Georgia Baptist Hospital, would keep her overnight for monitoring.

However, with the closure of AMC’s downtown location last week – AMC South, the sister location in East Point, shut down in May – Alford worries that traveling to another hospital in Atlanta traffic could be a matter of life and death. She doesn’t drive, she said, and in consequence must rely on rideshare services or family members to get around.

According to the Atlanta Journal-Constitution, the decision to close the hospital came as a shock to staff as well as residents and city leaders. The newspaper reported the pending closure on August 31.

“It’s frustrating, and it’s sad,” Alford told CNN. “And it gives me anxiety, because if I get sick, how am I going to get to the hospital?”

Wellstar Health System, which operated both hospitals, insists that the closures were due to shrinking revenue.

“Wellstar has operated AMC since 2016, investing more than $350 million in capital improvements and to support sustained operating losses. That includes $107 million in losses in just the last 12 months, amid decreasing revenue and increasing costs for staff and supplies due to soaring inflation. The pandemic and the intense financial headwinds straining healthcare organizations right now have only made matters worse at AMC,” the nonprofit said in a statement.

But community advocates and health policy experts say that the closures exemplify systemic inequality, and that the two AMC losses will disproportionately burden Black communities and low-income communities.

The closures aren’t unique. They’re part of a much larger pattern of urban hospital closures across the US. (Over the past few decades, rural hospitals also have been disappearing.) Only three years ago, facilities in Chicago, Philadelphia and Washington, DC, shuttered. Residents in the surrounding poor, predominantly Black communities were left reeling from the losses.

Angelina Alford near her apartment complex in Atlanta, Georgia, November 9, 2022

“We’ve had three hospital closures in the last year or so, all of them Black neighborhoods,” David Ansell, the senior vice president for community health equity at Rush University Medical Center in Chicago, told Kaiser Health News in 2020, adding that choosing to shut down those hospitals was “really criminal” in his mind, “because people will die as a result.”

In no time at all, Grady Memorial Hospital, Atlanta’s only remaining Level I trauma center, detected the effects of AMC’s closure.

“We have already seen an influx of patients in our emergency department and an increase in our trauma volumes. However, we have taken several steps to help absorb the increased volume. We have hired former Atlanta Medical Center trauma surgeons and primary care physicians to help meet the growing need at our trauma center and in our neighborhood health centers. Additional practitioners have been added to Grady’s Walk-In Center and our ER waiting room. We have added 41 new inpatient beds, and more are forthcoming,” Grady Health said in a statement.

Georgia Republican Gov. Brian Kemp boosted funding to Grady Health in order to “allow Grady to absorb the impact from AMC’s closure and continue providing quality care to new and existing patients.”

In an October open letter to community members, he said that Grady Health would receive more than $130 million in American Rescue Plan funds to add 185 beds to the hospital by the end of 2023.

Nancy Kane, an adjunct professor of management at the Harvard University TH Chan School of Public Health, summarized the precarious state of access to care in Atlanta and beyond the following way.

“When a hospital leaves, the whole network starts to collapse,” she told CNN. “It’s not just the trauma and maternity services. The whole care continuum starts to be affected.”

Here’s a closer look at the persistent issue of urban hospital closures:

The potential impact of AMC’s closures

Atlanta-area activists have fought for years to keep urban hospitals open, noting the hardships certain residents would face without these facilities.

Richard Rose, the president of the NAACP’s Atlanta chapter, told CNN that urban hospital closures are an issue of “racial inequality.” State and hospital officials, he said, have failed to provide the resources necessary to save the hospitals that have largely served the city’s Black and low-income residents.

Indeed, the impact of the closures of AMC’s locations in downtown Atlanta and East Point (the two are around 7 miles apart) won’t be evenly distributed. Black residents and low-income residents will most acutely feel the absence of these key providers of community care.

Atlanta – the so-called Black Mecca – is 49.8% Black, and East Point is 76.5% Black, according to the most recent data from the US Census Bureau.

Per Wellstar figures cited by the Atlanta Journal-Constitution, of the nearly 4,300 emergency room patients the two AMC locations saw in 2019, north of two-thirds (67.3%) were Black, and more than half (51.5%) were Medicaid and Medicare recipients.

The closure of AMC downtown has left a hole in the community.

There are at least three major hospitals nearby – Grady, Emory University Hospital Midtown and Piedmont Atlanta Hospital – but patients told CNN about long lines and overcrowding in these emergency rooms since AMC shuttered. Further, some residents, such as Alford, lack transportation to get to the hospitals.

Similarly, the closure of AMC South’s hospital and emergency center has left a number of families in south Fulton County – a cluster of suburbs with a mix of poor, middle-class and upper-middle-class residents – without a full-service hospital less than 7 miles away.

And while Google Maps estimates a 15-minute drive from AMC South to Grady, that commute could be many leagues worse during peak traffic hours in the bustling metropolis.

Rose referred to Kemp’s pledge to fund more beds at Grady as a “Band-Aid fix on an open wound,” and explained that the closures jeopardize the health of residents who live near shuttered facilities.

“If you get shot or have an accident or a heart attack at the wrong time of day, it’s a real problem to get from southwest Atlanta to Grady Memorial Hospital in downtown Atlanta,” Rose said. “It’s an unnecessary struggle.”

Kane echoed some of Rose’s sentiments, and painted a similarly sobering picture of access to care in the aftermath of urban hospital closures.

“The most obvious consequence is that if you’re in a low-income neighborhood, the distance to care is going to be greater. And if you don’t have a car, that distance can be a big issue,” she said.

Kane added, “It’s been documented in the literature that in emergency cases – if you have a heart attack or a gunshot wound – especially in a low-income neighborhood, you have a higher likelihood of dying, because people can’t get to the next hospital that easily.”

She also highlighted that, in the US, race and poverty are associated with health disparities, including uneven access to high-quality doctors and care.

“Diabetes, stroke, high blood pressure: Many things are caused just from poor health-care access and low income and stress,” Kane said. “The demand (for hospitals in communities of color and low-income communities) is higher than in other communities. So, it’s a double whammy: You’re sicker, and you have worse access.”

Observers describe a troubling nationwide pattern

If the news about AMC seems familiar, it’s because the saga isn’t anomalous. In recent years, urban hospital closures have afflicted many other parts of the country, too.

For instance, in August 2019, Westlake Hospital in Chicago filed for bankruptcy, paving the way to closure.

Just two months prior, in June, Philadelphia’s Hahnemann University Hospital, which was the chief teaching hospital affiliated with the Drexel University College of Medicine, announced that it’d be shutting its doors for good.

And in April of that year, Providence Hospital in Washington, DC, permanently closed.

Westlake, Hahnemann and Providence, much like AMC, largely served Black communities and low-income communities.

An exterior view of Hahnemann University Hospital in Philadelphia, July 10, 2019

Alan Sager, a professor of health policy and management at the Boston University School of Public Health who over the course of the past 12 years has documented hospital closures in nearly every major US city, characterized the country’s health-care system as “anarchic.”

“That word describes the forces at play: ‘Save some hospitals, close others,’” he told US News & World Report in 2019.

Bonnie Castillo, the executive director of the union National Nurses United, expressed similar sentiments.

“Urban hospital closures are more apt to happen in racially segregated communities and especially in African American neighborhoods,” she told US News & World Report.

Castillo underscored that the shutdowns’ effects can be “devastating,” since the residents of these communities rely on hospitals for primary care (and other care) to a degree that White and wealthy Americans don’t.

When Providence closed, feelings of distress permeated the surrounding neighborhoods.

“You’re hurting people. You’re really hurting people. You’re messing with people’s lives, and you can’t do that. You really can’t do that,” as Phillip Lee, a lifelong DC resident, told the CNN affiliate WUSA in 2019.

‘Profits over people’

Generally, Kane questions claims that shutdowns occur because hospitals are losing money.

“Declining revenue isn’t an event that comes from Mars. It comes from under-investment in the facility,” she explained. “That’s part of the problem. It’s not that people say, ‘Let’s not go there anymore.’ It’s that they can’t get in or the services they need aren’t there anymore or the building’s old and so they choose to go elsewhere.”

Put another way, revenue decline is an outcome.

“Facilities get years of neglect,” Kane added. “Then, the neglect gets to a point where you can’t maintain the buildings, or the physicians say, ‘We’re not going in there anymore. The elevators don’t work.’ So many things happen that are bad that companies say, ‘We have to close the hospitals. No one wants to come here anymore.’ Well, no kidding.”

Notably, urban hospital closures shine a light on the importance of local control over health systems – on the devastation that can follow when that authority atrophies.

“If you look broadly across the country, there are big chains acquiring hospitals. They might have more than 100 hospitals. The headquarters is in St. Louis. The chains might have hospitals in nine or 10 states. And the chains no longer have a sense of commitment or loyalty to the local community,” Kane said. “And so, if you’re a hospital that has lots of Medicaid patients or lots of uninsured patients, or if you’re a hospital that doesn’t get much government support, you end up looking like a poor performer in a portfolio where no one knows what’s underneath.”

In short, because chains aren’t necessarily familiar with the community, they might not have a commitment to it, and state governments aren’t demanding that they pay attention.

Todd Greene, formerly a member of Wellstar’s community board for AMC, can’t help but worry about the recent closures.

He explained that they might further chip away at the health outcomes of Black residents, because they relied on primary and specialty care doctors affiliated with shuttered hospitals.

Greene said that several AMC medical offices – including family medicine, neurosurgery and orthopedic practices – must either close or relocate. And some are moving out of the city altogether, to Whiter and wealthier Cobb County.

The result: Numerous residents will struggle to secure appointments, because metro Atlanta doesn’t have a robust transit system that can get them to other counties.

Greene was forceful in his condemnation of companies and chains.

“They’re putting profits over people,” he told CNN. “We already know that Black people have a lower life expectancy, and suffer from chronic illnesses (at a higher rate). It’s going to be very difficult for those people to access basic services.”

CNN’s Carma Hassan contributed to this report.