This story by Sarah Jane Tribble, KFF Health News; Holly K. Hacker, KFF Health News; Caresse Jackman, Emily Featherston, Owen Hornstein & Brandon Wissbaum, appeared on InvestigateTV.com on April 9, 2025. We are sharing it in two parts.
Leroy Walker arrived at the county hospital short of breath. Walker, 65 and with chronic high blood pressure, was brought in by one of rural Greene County’s two working ambulances.
Nurses checked his heart activity with a portable electrocardiogram machine, took X-rays, and tucked him into Room 122 with an IV pump pushing magnesium into his arm.
“I feel better,” Walker said. Then: Beep. Beep. Beep.
The Greene County Health System, with only three doctors, has no intensive care unit or surgical services. The 20-bed hospital averages a few patients each night, many of them, like Walker, with chronic illnesses.
Greene County residents are some of the sickest in the nation, ranking near the top for rates of stroke, obesity, and high blood pressure, according to data from the federal Centers for Disease Control and Prevention.
Patients entering the hospital waiting area encounter floor tiles that are chipped and stained from years of use. A circular reception desk is abandoned, littered with flyers and advertisements.
But a less visible, more critical inequity is working against high-quality care for Walker and other patients: The hospital’s internet connection is a fraction of what experts say is sufficient. High-speed broadband is the new backbone of America’s health care system, which depends on electronic health records, high-tech wireless equipment, and telehealth access.
Greene is one of more than 200 counties with some of the nation’s worst access to not only reliable internet, but also primary care providers and behavioral health specialists, according to a KFF Health News analysis. Despite repeated federal promises to support telehealth, these places remain disconnected.
During his first term, President Donald Trump signed an executive order promising to improve “the financial economics of rural healthcare” and touted “access to high-quality care” through telehealth. In 2021, President Joe Biden committed billions to broadband expansion.
KFF Health News found that counties without fast, reliable internet and with shortages of health care providers are mostly rural. Nearly 60% of them have no hospital, and hospitals closed in nine of the counties in the past two decades, according to data collected by the Cecil G. Sheps Center for Health Services Research at the University of North Carolina-Chapel Hill.
Residents in these “dead zone” counties tend to live sicker and die younger than people in the rest of the United States, according to KFF Health News’ analysis. They are places where systemic poverty and historical underinvestment are commonplace, including the remote West, Appalachia, and the rural South.
“It will always be rural areas with low population density and high poverty that are going to get attended to last,” said Stephen Katsinas, director of the Education Policy Center at the University of Alabama. “It’s vital that the money we do spend be well deployed with a thoughtful plan.”
Now, after years of federal and state planning, Biden’s $42 billion Broadband Equity Access and Deployment, or BEAD, program, which was approved with bipartisan support in 2021, is being held up, just as states — such as Delaware — were prepared to begin construction. Trump’s new Department of Commerce secretary, Howard Lutnick, has demanded “a rigorous review” of the program and called for the elimination of regulations.
Trump’s nominee to lead the federal agency overseeing the broadband program, Arielle Roth, repeatedly said during her nomination hearing in late March that she would work to get all Americans broadband “expeditiously.” But when pressed by senators, Roth declined to provide a timeline for the broadband program or confirm that states would receive promised money.
Instead, Roth said, “I look forward to reviewing those allocations and ensuring the program is compliant with the law.”
Sen. Maria Cantwell (D-Wash.), the Senate commerce committee’s ranking minority member, said she wished Roth had been more committed to delivering money the program promised.
The political wrangling in Washington is unfolding hundreds of miles from Greene County, where only about half of homes have high-speed internet and 36% of the population lives below the poverty line, according to the U.S. Census Bureau.
Walker has lived his life in Alabama’s Black Belt and once worked as a truck driver. He said his high blood pressure emerged when he was younger, but he didn’t take the medicine doctors prescribed. About 11 years ago, his kidneys failed. He now needs dialysis three times a week, he said.
While lying in the hospital bed, Walker talked about his dialysis session the day before, on his birthday. As he talked, the white sheet covering his arm slipped and revealed where the skin around his dialysis port had swollen to the size of a small grapefruit.
Room 122, where Walker rested, is sparse with a single hospital bed, a chair, and a TV mounted on the wall. He was connected to the IV pump, but no other tubes or wires were attached to him. The IV machine’s beeping echoed through the hallway outside. Staffers say they must listen for the high-pitched chirps because the internet connection at the hospital is too slow to support a modern monitoring system that would display alerts on computers at the nurses’ station.
Aaron Brooks, the hospital’s technology consultant, said financial challenges keep Greene County from buying monitoring equipment. The hospital reported a $2 million loss on patient care in its most recent federal filing. Even if Greene could afford a system, it does not have the thousands of dollars to install a high-speed fiber-optic internet connection necessary to operate it, he said.
Lacking central monitoring, registered nurse Teresa Kendrick carries a portable pulse oximeter device, she said — like ones sold at drugstores that surged in popularity during the covid-19 pandemic.
Doing her job means a “continuous spot-check,” Kendrick said. Another longtime nurse described her job as “a lot of watching and checking.”
Beep. Beep.
The beeping in Room 122 persisted for more than two minutes as Walker talked. He wasn’t in pain — he was just worried about the beeping.
About 50 paces down the hall — past the pharmacy, an office, and another patient room — registered nurse Jittaun Williams sat at her station behind plexiglass. She was nearly 20 minutes past the end of her 12-hour shift and handing off to the three night-shift nurses.
They discussed plans for patients’ care, reviewing electronic records and flipping through paper charts. The nurses said the hospital’s internal and external computer systems are slow. They handwrite notes on paper charts in a patient’s room and duplicate records electronically. “Our system isn’t strong enough. There are many days you kind of sit here and wait,” Williams said.
Read Part Two, tomorrow…