When a safety net hospital closes in Atlanta, a reporter digs deeper to uncover a story of money and inequity

It was late August 2022 and Atlanta Medical Center (AMC), a safety net hospital in downtown Atlanta, was about to close for lack of funds. Local and national media swarmed the story of metro Atlanta losing one of only two state-certified level one trauma centers. 

But if you took the time, you could see the story was bigger, and more disturbing, than even that. You could stand at the nearby bus stop and see hospital workers and patients come and go. Often patients were just going to regular doctor visits in medical office buildings nearby. This closure would yank necessary care from thousands of people, assuming they could find a replacement. 

Of course, we covered the breaking news. I’m a beat reporter on health care, so normally I wouldn’t have time to do a deep dive on this larger story. The health beat is a river of news that never dries. And I especially didn’t have time this fall because I was launching my work as a fellow with the USC Center for Health Journalism, hoping to stake out time for a project on inequities in health care.

Then it became clear: Why not pivot, using the fellowship to expose the inequities in health care demonstrated by AMC’s closure? We were talking about a nonprofit hospital system that has reported a $2 billion buffer to save or spend, and is making decisions that impact people who take the bus because they can’t afford a car.

Everyone is used to rural hospitals closing by now, under the theory that rural areas are declining. The area around AMC may be gentrifying, but our project showed that AMC’s closure fit exactly the same pattern as rural hospital closures did: A hospital with a payer mix heavy on lower-income patients who don’t have commercial insurance. And it had a patient mix that was heavier on people of color than the surrounding community.

Those are people who tend to be hit hardest by Georgia’s terrible record on morbidity and early mortality from chronic diseases such as diabetes.

For the fellowship, I did a preliminary story not long after the closure announcement on the impact on the local community. Then I dug in for a longer-term story about the more than 10,000 patients who would lose their regular doctors nearby, many of whom treated chronic conditions. 

The fellowship funds allowed me to stake out the time of a new hire in the newsroom, a data specialist who acquired data sets that included populations served by hospitals across the state. That allowed us to show these patterns of who was being most impacted in this community.

The AMC closure was a powerful tool to bring this message home. It was a huge story that captured the whole community’s attention. We took that attention and focused it on a broader picture of inequities in access to care. And everyone knew the area: It was not declining in population, it was gentrifying. It was a much harder story to dismiss.

Some of the lessons we learned from our reporting:

• Be willing to pivot. We had a different project planned. But I believe the story we pursued had more impact than the original one would have.

• Be methodical. As reporters, we are curious, our minds roving and jumping at leads. But being methodical is a must for long-running projects. During the fellowship meeting last summer, we heard the different ways that distinguished journalists such as Andrea Elliott and Linda Villarosa methodically kept track of their progress. As a result, I kept spreadsheets of information and sources. Being methodical brought me comfort when some piece of the story fell through and I knew I had other options and could quickly find them.

• Cast a broad net. This is where the fellowship proved essential. All beat reporters typically follow a pattern of quickly finding a source that works for the story. But for a project, you need someone just right. Both for experts and human story subjects: The person who’s researched or experienced the story and can describe it — someone who can spike the ball with their words. For this story, so many people weren’t willing to talk. So many people were at a loss for words.  We went back, and back, and back until we found the right voices.

• Prepare for failure. I spent weeks working with a source who I thought would be my lead subject. At last it turned out he didn’t quite work. But I’d been going to doctors’ offices that depended on AMC for weeks, and I had others who did. 

• Lean in to the discrepancies. Sometimes that discrepancy itself ends up showing an important part of the real story.  It may allow you to break a stereotype for you and your readers. We think of hospital closures as being a problem of declining rural population. The AMC closure happened in a booming metro area, which didn’t seem to fit that pattern of rural closures. But when we dug into the data and analyzed it, we found new patterns. Among them: The hospitals that were closing had patient populations that tended to be disproportionately Black, and communities that tended to be lower income.