Lincoln County’s only hospital has a new CEO who starts this week. Russ Spray has managed other hospitals in southern Middle Tennessee, but now he’s tasked with turning around a facility on the Alabama border that has been bleeding millions of dollars a year.

Tennessee has had more than its fair share of rural hospitals close in recent years, partly blamed on the state’s refusal to expand Medicaid. A dozen have shut down, and many facilities that remain open are looking for some way to stabilize.

Mayor Bill Newman says the 59-bed facility in Fayetteville, owned by the county, will not be closing. And he downplays the mounting deficits in recent years,
topping $3 million in the most recent fiscal year.

“It’s like any business: There’s times you need to adjust some of the things, how you’re running your business,” he says. “And that’s where we are on running the hospital.”

Lincoln County was accepted into
a new state program that provides consultants to hatch a turnaround plan for struggling rural hospitals. That plan from Navigant Consulting, according to the mayor, involves selling off a wellness and rehab facility.

Former CEO Candie Starr was
trying to sell that ancillary business over objections from the mayor and others.

“It’s not going to be something I’m ever going to agree with,” Mayor Newman tells WPLN.

Starr was
ousted without explanation in late August. Her replacement, Russ Spray, started as interim CEO on Tuesday. The Fayetteville-native retired from running the Southern Tennessee Regional Health System in Winchester-Sewanee late last month and knows the hospital well, previously
serving three years as Lincoln Health’s CEO. He declined an interview request.

But Spray returns to a facility that’s at a crossroads with competing visions.

County Commissioner Doug Cunningham, who worked on task force to stabilize the hospital’s finances, says he’d prefer to sell or lease the facility to a private company. He isn’t convinced the county should still be in the hospital business, with many patients preferring to drive to Huntsville or Nashville to receive care.

“We just can’t compete in today’s environment,” he says. “I think we’re going to have to cut some services in order to be competitive.”

Others won’t consider a sale. Commissioner Shirley Dangerfield says the hospital isn’t a luxury for those who don’t have transportation.

“We need it because we got a lot of retirees here in Fayetteville,” she says. “They don’t need no stress and strain that they hadn’t got a hospital to go to if they get sick.”