It may seem obvious, but come May 1st, babies will still be born in Elk County. 

But for those born in Elk County after that date, they will no longer be delivered by Dr. Koch and his dedicated labor and delivery team at Penn Highlands Elk. Not exactly, anyways. Rather, some small, unknown number of unfortunate babies will be born in an emergency room, the back of an ambulance, or worse yet, the back of a car – perhaps in the parking lot of a gas station roughly halfway between the forty-five minute drive from Saint Marys and DuBois.

Around the same date, the twenty-one elderly residents of the Ridgmont personal care facility will not disappear. But their presence will disappear from the community they call home, and they’ll move away from loved ones that look after them. In most cases, their new residencies in Penn Highlands’s facilities in Brookville or New Bethlehem will be more than an hour away.

If the announced closures of Penn Highlands Elk’s labor and delivery service and the Ridgmont personal care facility proceed, Elk County – a rural community of 30,000 in north central Pennsylvania – may soon find itself unable to care for its newest and oldest residents.

Community members are attempting to halt these closures and prevent further reductions in service. Business, nonprofit, education, and local government leaders are making themselves heard. I’m personally involved with a core group dedicated to engaging Penn Highlands and our elected officials as we seek solutions to prevent these closures. It has been a struggle, but we are optimistic. 

The source of community frustration is that Penn Highlands cuts services in its rural communities while acquiring new hospitals, expanding services at its flagship facility in DuBois, and constructing a new hospital in Centre County, which is already saturated with healthcare options. 

This occurs while Penn Highlands enjoys tax breaks that accompany their 501(c)(3) status. Meanwhile, Penn Highlands Elk, one of the more financially stable in Penn Highlands’s system, subsidizes the spurt of acquisitions, expansions, and construction. 

It raises the question: Whom exactly do nonprofit health systems serve?

But to understand how the community reached this question, which confronts other communities in Pennsylvania, some history is necessary.

Penn Highlands Healthcare operates a system of hospitals, healthcare clinics, and other medical services throughout western Pennsylvania. Their footprint is concentrated in the rural central and northern regions of the state.

In 2013, Penn Highlands acquired what was then known as the Elk Regional Health Center, which operated facilities in Saint Marys and Ridgway, the two largest communities in Elk County.

At the time, officials associated with Penn Highlands and the now-absorbed Elk Regional Health Center cheered the acquisition. A Penn Highlands press release, reported on at the time, said “the communities served by each of the member hospitals will enjoy increased local access to physician specialists, improved quality and coordination of care, as well as enhanced physician recruitment and retention efforts.”

These hopes were rooted in Penn Highland’s nonprofit mission. According to their website, Penn Highlands “believe that healthcare should be managed by local board members” and their mission statement is, “To provide you with exceptional care through our community-based health system while maintaining a reverence for life.”

The optimism quickly wore off. In March 2015, Penn Highlands Elk announced 28 layoffs, hour reductions for 25 staff, and the elimination of fifteen positions through attrition. The explanations for this move made sense in isolation. Community members, however, feared further staff reductions and decreases in service.

Community chatter caused Penn Highlands to respond later that summer. An article from The Bradford Era seems as though residents possessed prophetic powers given what is known today.

The article notes, “Some critics have interpreted the [acquisition] as a gradual phasing out of the St. Marys hospital — a local economic cornerstone and the largest employer in Elk and Cameron counties —  in favor of larger regional affiliates,” and that residents “fear a consolidation effort of sorts is now under way, one that will see the hospital converted into a staging ground for transfers to partner hospitals, primarily that in DuBois, and local services drained.”

In response, “Penn Highlands officials said that version couldn’t be farther from the truth, claiming efforts are instead under way to enhance services at the facility with the recruitment of new specialists and the unveiling of new area outpatient services.”

To further quash the “rumors,” hospital spokespeople stated “emergency room and maternity services will remain open.” (Emphasis mine.) 

Thus emerges the pattern Elk County faces: Penn Highlands reduces or cuts services; provides surface-deep explanations; insists Penn Highlands is dedicated to providing better care locally; calls future concerns mere “rumors;” then builds, expands, and acquires facilities elsewhere.

These skirmishes between Penn Highlands and the residents of Elk County continued over the next decade in fits and starts. But in the fall of last year, a couple canaries dropped dead in the coal mine.

In October 2023, Penn Highlands announced the closure of a clinic in Bennetts Valley, Elk County. At the time, a small group of residents wrote to Penn Highlands’s board protesting the decision.

“The recent, voracious growth strategy and need to make financial investments in communities across a ’39-county service area’ have resulted in precious dollars going elsewhere,” their letter stated. It also reminded Penn Highlands that it “is not a for-profit company that is obligated to make hard decisions in order to provide a financial return to investors.”

Later that month, Fitch Ratings revised its outlook for Penn Highlands from “Stable” to “Negative.” Penn Highlands finished the year by reporting an operational loss of $11.8 million for the three months ending on December 31.

When the proposed labor and delivery services and Ridgmont closures were announced in early February, the community had enough.

Lobbying and advocacy efforts began in earnest after Penn Highlands convened local business, nonprofit, and government leaders to explain the decisions. I wasn’t in the meeting, but it apparently did not go well. Penn Highlands’s executives deflected questions, blamed prevailing economic and employment trends in healthcare, and insisted it was expanding services in the area and living up to its nonprofit mission.

This last point did not sit well. Many of the “expanded” services were acquisitions of existing, local community healthcare providers, such as the purchase of a pharmacy and eye clinic. 

Since then, the community pursued a flurry of activity. Our group and others engaged all state and federal elected officials, met with state and federal agencies, communicated repeatedly with Penn Highlands’s executives and board members, while several media stories track the issue.

The core mission of the group is to delay these closures so the community can partner with Penn Highlands, as a nonprofit organization, in a search for resolutions. While it will not be easy, our group is confident solutions available. So far, elected officials, Republican and Democrat, have done an admirable job of addressing our concerns.

The strongest case Penn Highlands put forward is that financial and personnel constraints make the labor and delivery service at Penn Highlands Elk and the assisted living facility in Ridgmont unsustainable. These are valid concerns. However, efforts to solve these problems with the cooperation of Penn Highlands have been rebuffed.

The question remains unanswered: It isn’t clear who nonprofit health systems like Penn Highlands serve. But it is becoming evident it isn’t Elk County.

Unfortunately, our story isn’t unique, but recent actions are holding nonprofit hospital systems to their stated mission.

Last year, Pottstown School District successfully brought a suit against Tower Health. As reported, “Judge Christine Fizzano Cannon found that the nonprofit Tower Health system was operating a Montgomery County hospital with the motive of profit” and that “Tower Health charged the hospitals exorbitant management fees and rewarded executives for the financial success of the hospitals.” 

These actions violated the principle that nonprofits must “operate entirely free from private profit motive,” which is one of five standards nonprofits must follow, according to a 1985 state supreme court ruling.

While such rulings may make nonprofit hospital systems more responsive to communities’ needs, bringing lawsuits requires a tremendous amount of money and political effort. The most disadvantaged communities are unlikely to muster such resources, meaning nonprofits have little incentive to serve areas most in need of their services.

Unfortunately, well-intentioned efforts in Harrisburg may exacerbate the issue. Following the failure of for-profit Crozer Health in southeastern Pennsylvania, “Delaware County elected officials unveiled a bill on Thursday that would prohibit for-profit entities from owning or managing hospitals in Pennsylvania.” 

While introducing the bill, state Senator Tim Kearney said, “We’re here to send a clear message to predatory private equity firms and Wall Street looters, that their days of raiding our hospitals and nursing homes of their assets and then abandoning them to bankruptcy are numbered.”

Instead of focusing exclusively on private equity and “Wall Street looters” in other states, I hope lawmakers see the issues emanating from nonprofit healthcare providers within our own borders.

So, whom do nonprofit health systems serve? We’re still searching for the answer. But regardless of where that search leads, come May 1, our group remains committed to welcoming babies into the community in which they’ll be raised and allowing the elderly to remain in the place they call home. We hope Penn Highlands shares this mission. But if not, so be it, we’ll find solutions on our own.

Seth Higgins, a native of Saint Marys, Pennsylvania, specializes in bringing conservative thought to local government. Seth is a former Tablet Magazine Fellow and a former Krauthammer Fellow with The Tikvah Fund.