WILLIAMSTON, NORTH CAROLINA — ECU Health signed a letter of intent last year to reopen Martin General Hospital in Williamston, North Carolina, as a rural emergency hospital providing outpatient care and an emergency department. Under the terms of the agreement, Martin County would pay to refurbish the facility and the North Carolina General Assembly would allocate $210 million to ECU Health, including $150 million for a new inpatient tower at ECU's Beaufort Hospital.

Martin General Hospital closed abruptly in August 2023, when patients had to be wheeled out on stretchers and transported elsewhere to finish treatment. Quorum Health, the company that operated the hospital, intended to file for bankruptcy when it closed the facility and did not notify local elected leaders of that intention, according to those leaders. A Quorum Health spokesperson said the company had informed county commissioners of the hospital's ongoing financial challenges.

Since the closure, Martin County taxpayers have spent an estimated $2.9 million on maintenance, utilities, and other costs in an effort to resume hospital operations, County Manager Drew Batts said. The county, which has about 22,000 residents, is considering spending at least $1.5 million to create two higher-level paramedic units with quick-response vehicles equipped with electrocardiogram equipment and other advanced lifesaving support. Martin County ambulances do not have paramedics on board, and it can be 20 miles or more to reach the closest emergency room from parts of the county.

Emergency crews from a neighboring town worked on Stanley Sears for 30 minutes after his heart attack but could not revive him for the drive to the nearest hospital, according to records. Debra Pierce, who knew Sears, described the situation. "The sad thing is we'll never know if he could have been saved that night or not, because we don't have a higher level of care in this county," Pierce said. Pierce also said of Sears: "Old man's doing his job up in there."

Eleisa Ann Evans drove 2.5 hours from a small town near the Outer Banks so her aunt could get care at an ECU Health emergency department in Greenville. Evans said she "wasn't using nobody's chair."

"It's a real healthcare crisis that has already proven itself to have lost lives that perhaps didn't have to be lost. They just want to not die because there's nowhere to go when you have an emergency," ECU Health Chief Operating Officer Brian Floyd said. ECU Health is the region's largest health system, with nine hospitals connected to East Carolina University.

Republicans crafted a $50 billion rural health fund as part of the One Big Beautiful Bill Act last year, and North Carolina has been earmarked $213 million from the fund. The cash has not been distributed yet, and federal regulators have set limits on how much of the money can be spent on construction and building renovations. Martin County will not receive direct relief from the fund because its hospital is not open. North Carolina is distributing the money among existing health and social service organizations, and Access East, an affiliate of ECU Health, received a portion of the state's first-year payout.