Rural prisons threaten rural healthcare

Rural Prisons threaten to sink already sunken healthcare systems with COVID-19 cases

By LJ Dawson
By LJ Dawson

Founder of The Des and freelance journalist based in Washington, D.C.

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When the traveling CEO of a small Montana county’s only hospital went for a five mile run in April, he chose to stay in the towns city limits, pounding sidewalks covered in colorfully chalked out #keeponkeepingon or the shortened #koko and past heart-covered windows.

The hashtag was started by the rural hospital to lift the spirits of the community pounded by COVID-19. It was William Kiefer’s sole run during the three weeks following his 21-bed hospital’s first COVID-19 positive patient. He and his team wrangled a facility tottering on the brink of collapse, and the rural community surrounding them rallied to help.

Toole County was Montana’s hotspot for COVID-19 deaths without a single case of the virus in a prison four miles from the outbreak which holds almost 15 percent of the county’s population.

Kiefer became emotional talking to me. It was hard to comprehend over a phone line the emotional tole that the surge in the Montana county had on the community and hospital staff.


The medical center has no ICU beds and is designed to stabilize and then transfer patients. They DID prepare early for COVID-19 in January, and the virus still overran their facility. Many rural healthcare facilities exist on a delicate knife edge to begin with.

Seventy percent of prisons are located in rural america according to John M. Eason (interviewed in the article), an associate professor in sociology at the University of Wisconsin-Madison. This story is another example of how criminal justice affects the ENTIRE community not just the people immediately impacted by incarceration.

Kiefer highlighted the resilience of rural communities, but he also echoed the fear that if the county’s hospital had closed, would it have reopened? 

And make no mistake people die when rural hospitals close. So the question remains, will we see rural hospitals sink in the face of COVID-19 and especially in places with large prison populations?

The hospital was not just fighting the virus but also the precarious situation of most rural hospitals

“We fight day in and day out to scrap together funding and put multiple hats on people so that we can keep our expenses down so that we can continue to provide health care services to the communities where we live and work,” Kiefer said.

“We almost got pushed to the limit where we didn’t have sufficient staff to maintain our emergency room open, and that would be catastrophic to a community,” he said.

And we worried that in the event that it did close for a for a period of time, would we have the resources to reopen it?”

Photo Marias Medical Center

Context: “Even before the coronavirus, roughly 400 hospitals in rural America were at risk of closing, said Alan Morgan, the chief executive of the National Rural Hospital Association. On average, the country’s 2,000 rural hospitals had enough cash to keep their doors open for 30 days.” [New York Times]


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