MEXICO, Mo. — It’s been more than three years since the closure of Audrain Community Hospital, ending more than a century of continuous local care in the mid-Missouri community.
Once a cornerstone of rural health care in the region and the first community cancer center in the state, the hospital shuttered in March 2022 after a series of management failures under Noble Health and its successor, Platinum Health. For the thousands who relied on it, the closure didn’t just change where they went for care, it changed the very rhythm of their lives.
This same story has played out in rural counties throughout Missouri and the Midwest. Twenty-one hospitals have closed in Missouri in the past 10 years, many in rural areas. Residents now must drive long distances for care, or make the decision that it’s just not worth traveling — until the pain is too great or the symptoms too strong to ignore.
No one knows that better than Joseph Corrado.
Corrado spent more than 40 years operating at Audrain. Now, he spends his time on the road, driving to Columbia three days a week and to Jefferson City another two. His 2016 Cadillac Escalade, once a means of local commuting, has traveled more than 6,000 miles this year alone.
“Well, I mean, as a surgeon, it’s very, very difficult to not have a hospital,” Corrado said. “I can’t, you know, do your operation in the garage.”
Corrado used to roll out of bed and get to the operating room in three minutes, often beating the ambulance there.
Before the closure, patients could see him in his Mexico office on Monday, and be on an operating table by Tuesday. Today, everything is more complicated and farther away.
But what was lost wasn’t just convenience, it was trust, built across generations. Corrado said most of his patients didn’t want to go elsewhere for care. They preferred seeing someone they knew, someone local.
After more than four decades in Mexico, he had developed a bond not just with individuals, but with entire families, treating grandparents, parents and their children. His medical charts, he noted, are “42 years thick.”
That kind of relationship made health care personal, Corrado said. “I can’t go to Walmart without my patients coming up to me in aisle five and telling me, ‘Oh doctor, look at my incision.’”
‘A five-minute appointment takes half a day’
Rural areas of the state have higher poverty rates and older demographics, and about one in four rural Missourians rely on Medicaid. With fewer patients using private insurance, it has become harder for rural hospitals to offset losses.
The unemployment rate has also grown in many rural areas with hospital closures, as these towns lose a major contributor to the local economy.
For Elizabeth Berry, 72, and Randy Dickson, 63, not having a hospital means more than not having a place to get the care they need. There is another layer of difficulty when it comes to actually getting to the closest hospital, which, for most in the Mexico area, is about 40 miles away in Columbia.
“You pretty much know, if you have an emergency, you are in serious trouble,” Dickson said. “It’s a bad situation. And when you do get down there, it’s so crowded that you can’t get in. You have people who are being treated in the waiting area.”
These struggles impact everyone in the area and the impact is greatest on people who are older, can’t drive or have health issues and are on their own.
“The only way I can get there is in an ambulance, and I can’t afford it,” Dickson said. “So if I have an emergency, I just have to hope I don’t die before I get there.”
Berry’s husband died after years of battling kidney failure and heart issues. She is still struggling to pay off the debt that came with his medical bills, which were exacerbated by the lack of local care.
“He had to be airlifted a number of times or had to take an ambulance because of his issues, and I am still dealing with the bills that are coming in for transportation,” Berry said.
Patients sometimes live with injuries and illnesses for long stretches of time before seeking medical attention. Due to the high cost of emergency medical transportation, some people, when injured, wait to heal instead of immediately seeing a doctor.
This has created a layer of caution for a lot of people in Mexico, knowing “they are only going to a hospital if it is ‘life or death,’ ” Dickson said, adding “if we had an emergency room with some good doctors, that would be so much better.”
Angela and Steve Teeter travel weekly to Cape Girardeau for Steve to receive radiation and chemotherapy. He was diagnosed in early January with Stage 3B lung cancer, the disease having spread to his lymph nodes. On May 13, a spot was found on his brain, indicating the cancer had spread and leading to a Stage 4 diagnosis. The Teeters will need to drive an additional 3½ hours to St. Louis so he can receive radiation treatment.
Angela walked through what a typical appointment looks like for Steve.
“He’s doing chemo now, and he goes weekly for the treatments every Friday, and they’re usually anywhere from, I would say, on a short day, probably five hours, and then on a long day, probably like seven hours,” Angela said.
“Once we go in, we do a blood draw, then we wait, and then we see the doctor, and then we wait, and then we start the infusion. In a month and a half, we will (go) back and forth about 30 times. It’s three hours there and back. So, you know, a five-minute appointment takes half a day.”
With no nearby hospital, his initial diagnosis was delayed. “There was a lot of sickness going around, you know, flu and stuff like that. And so he went to the doctor, and they gave him antibiotics and a steroid, and then it kept on,” she said.
“He kept coughing. And so he went back to the doctor a month or so later, and they did the same thing,” she said. But the coughing persisted, and she eventually brought him to urgent care to get an X-ray.
“And then they found the tumor,” she said, “and sent him to the emergency room.”
By the completion of Steve’s weekly chemotherapy in June, the Teeters will have traveled an estimated distance of 13,400 miles.
‘Padlocks on the doors’
In Audrain County, the hospital’s decline began quietly in early 2020, after Noble Health acquired it. Under their tenure, and later that of Platinum Health, chaos seeped into every corner of the operation. Vendors weren’t paid. Employee health insurance was dropped, without notice. Scores of lawsuits mounted.
“I’ll never forget the day they put the padlocks on the doors and said we’re closed,” Corrado, the surgeon, said. “What do you mean we’re closed?”
Now, emergency care in Mexico often starts with a race against time. Patients are stabilized by the local ambulance district and rushed to the nearest available emergency room, typically in Columbia. There they may face hourslong wait times.
A potential path forward has emerged. In October 2024, Mexico city officials signed a letter of intent with Boone Health, entering exclusive talks to bring a critical access hospital back to town. The proposed three-year plan outlines a Medicare-certified facility with emergency services and outpatient care. But for now, it’s just that — a plan.
Meanwhile, health care advocates warn that the impact of a rural hospital closure goes far beyond emergency care. Heidi Lucas, executive director of the Missouri Rural Health Association, said the collapse of one service affects the entire system.
“In rural health, really in health care altogether, it’s very much a continuum of care,” Lucas said. “If you’re not addressing one section of it, it affects other portions. And you kind of have to look at all of them to move the needle in health care access.”
Lucas and others point to the fragile financial state of rural hospitals. COVID-era relief funds gave many a temporary cushion, but that money has long since dried up. One rural CEO told her he was “making about $0.36 for every dollar I spend.”
Community Health Specialist Jennifer Eldridge of the University of Missouri extension program said the grant programs that once propped up rural health initiatives are vanishing too.
“I’m sad about their future,” she said. “They do depend on a lot of the grants … that I’m guessing may not exist anymore.”
Eldridge recently attended a public health conference where some scheduled presenters never arrived. “They’d already lost their jobs,” she said.
For farming communities especially, preventive care is becoming harder and harder to access.
“You don’t really get a day off unless it rains,” Eldridge said. “And it’s hard to predict rain a month out.”
Some residents, she added, simply don’t want to go. “I’ve been sitting with my extension council and they’ve told me they know people who would rather stay on their farm and die than drive to the city for health care.”
For Corrado, the distance is not just a commute, it’s a constant reminder of what his town lost.
“We had an excellent medical center,” he said. “We got all kinds of accolades and recognition and that’s all gone.”
As the community waits to see if Boone Health’s proposal will materialize, Corrado keeps driving. The miles pile up. The surgeries continue. And the absence of a hospital in Mexico remains a wound that hasn’t healed.
