In March 2025, Nowata resident Joe Thornbrugh ended up at Ascension St. John Medical Center in Tulsa. Delayed treatment for what turned out to be a kidney stone led him to experience sepsis, a life-threatening condition.
While hospitalized, Joe developed bed sores, making it impossible to walk. He was sent to different hospitals in Broken Arrow, Fairfax and Bartlesville for several months. It wasn’t until he landed in Nowata’s critical access hospital that he started to feel better.
“I'd see my grandkids every day, my wife every day,” Joe said. “I thought, ‘I want to go home, I want to get better. This is why I'm here. This is what I've worked my whole life for.’”
Joe spent 100 days at Ascension St. John Nowata through its swing bed program, which allows patients to transition from an acute hospital stay to skilled rehabilitation while remaining in the same hospital. He was two minutes away from his wife, Krista Thornbrugh. After he received wound care and physical therapy, she got to see him walk again.
“It was one of the best things that I don't know if we would have ever been part of anywhere else. And I'm just so thankful,” Krista said. “I couldn't imagine [this community] losing … the ability to have the kind of care that Joe had.”
Ascension St. John is seeking federal approval to turn its Nowata hospital into a rural emergency facility, which would mean ending acute inpatient and swing-bed services. Congress established the designation in 2020 to help maintain local access to outpatient and 24/7 emergency services amid growing concerns over hospital closures. Rural emergency facilities receive a monthly payment of around $295,000 to do this.
The nonprofit health system said the move would support the long-term viability of local healthcare. But many residents oppose the change, arguing that inpatient care is essential for Nowata County, where residents are older and more likely to live in poverty than Oklahoma’s population as a whole.
What Ascension St. John says is driving the change
StateImpact requested an interview with Ascension St. John officials and received statements from a spokesperson. They said conversations with staff and community members about the transition began in April, and there are no planned layoffs.
Rural emergency hospitals can’t exceed an annual per-patient average length of stay of 24 hours. After the transition, patients who need to be admitted to the hospital would be sent to Ascension St. John’s locations in Bartlesville, Owasso or Tulsa, the spokesperson said. Transfers to these facilities would be paid for by Ascension St. John, and the spokesperson said it is working closely with EMS partners to ensure they are smooth.
The rural emergency model has created challenges for local EMS in other states. Last year in Mississippi, county officials demanded its ambulance service stop picking up patients from a hospital in Batesville, which became a rural emergency facility in 2023, to transfer them to higher-level care. They argued numerous transfers were leaving county ambulances unable to respond to emergencies.
Nowata Fire Department Fire Chief Brandon Jarvis said the city's EMS serves all 581 square miles of Nowata County. It has one ambulance that runs 24/7 and a backup used when the other vehicle has an issue or requires maintenance. It receives around 700 calls a year.
Jarvis, who joined the department about a month ago, said he would like to see the community get another ambulance to help handle emergency calls and transfers during the daytime so the primary ambulance can stay in the county. That could cost $250,000 to $350,000, he said, and would require him to hire part-time staff members.
“If it ended up being multiple transfers a day out of there, it's going to be hard to keep up with the load with our current resources that we have,” Jarvis said.
The Ascension St. John spokesperson said that, since 2020, the Nowata hospital has experienced a 58% decline in inpatient admissions, while emergency department visits have increased by 12% since 2022, “highlighting a shift in patient utilization patterns.” They said the rural model better reflects the community’s needs.
Hospital cost reports show that the facility’s average daily inpatient census over the past decade is 4.85 patients. Though the hospital saw modest increases during the COVID-19 pandemic, this number has remained generally consistent. StateImpact asked the spokesperson for clarification on the data they cited. They referred back to their original statements.
Tanner Holt, president of Ascension St. John Jane Phillips in Bartlesville, and Jason McCauley, the Nowata hospital administrator, met with two members of the recently formed Save Our Hospital community group June 8 at the Bartlesville facility. Save Our Hospital has collected about 1,000 signatures around Nowata County in favor of the hospital maintaining inpatient care.
In a recording obtained by StateImpact, Holt said Ascension didn't push them to make this transition. They wanted to be proactive to ensure Nowata is sustainable.
“There's obviously money that is associated to that, and that will go to the [profit and loss] for Nowata every single month. It will allow it to be profitable,” Holt said. “And as a hospital is profitable, you're taking kind of a laser eye of a corporation off of you, saying, ‘Hey, do we need to close this? What do we need to do?’”
According to tax records, the hospital has had some profitable years over the past decade. But it lost about $1 million in fiscal year 2023 and most recently, around $200,000 in both fiscal year 2024 and 2025.
“The alternative is somebody coming to Jason or I and saying, ‘You just got to close it. You've been bleeding far too long,’” Holt said. “And the only reason Ascension hasn't done that is because they've got a very strong balance sheet.”
In May, Ascension reported a net income of $621 million through the third quarter of fiscal year 2026.
McCauley said the rural emergency model has surfaced in past discussions with the Nowata hospital’s advisory board. A Save Our Hospital member asked why the board wasn’t made aware of the transition until the application was filed.
“We knew this was going to be a big change for folks,” Holt answered. “The way I look at it is, do you get somebody's permission to throw them a life raft when they're drowning, right? And that is what is happening here.”
StateImpact asked the Ascension St. John spokesperson for comment on this meeting. They referred back to their original statements.
How the rural emergency hospital designation could work in Nowata
Over 1,500 health care facilities in the U.S. are eligible to become rural emergency hospitals. About 50 total have obtained the designation, and six are licensed in Oklahoma.
For some facilities, the model has worked. Clinton Regional Hospital closed at the end of 2022 after AllianceHealth, the private company managing it, decided not to renew its lease. It reopened through support from the city and is now running as a rural emergency hospital.
“It's not clear that there was a problem in Nowata that required this particular program,” said Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform.
If its application is approved, Ascension St. John Nowata would become the second critical access hospital in the state to become a rural emergency hospital.
Critical access hospitals get paid by Medicare based on cost. If Nowata becomes a rural emergency facility, it would lose out on this benefit. Instead, it would get paid five percent above what larger hospitals receive for outpatient services, Miller said, which is typically less than what a critical access hospital is paid.
He added that, generally, nurses who work in the inpatient unit will often provide support for the emergency department because facilities may not have enough patients to dedicate a full-time nursing staff to it. These nurses would still be needed if inpatient