ALBERT LEA, MINN. – Stung by the news that their hospital will eliminate some services, including baby deliveries, and fearful that more dire changes are on the way, residents here are fighting back.

Homeowners have jammed "Save Our Hospital" lawn signs in their front yards. Hundreds have attended city meetings to denounce the hospital's plans. Politicians from U.S. Rep. Tim Walz, D-Minn., to Gov. Mark Dayton have sensed the community's mood and weighed in with sometimes fiery words of support.

This scrappy fight pitting town residents against their own hospital would be remarkable for any number of reasons, but here the hospital is run by the Mayo Clinic, the prestigious, world-class institution currently engaged in a multibillion dollar renovation of its main campus in Rochester.

That's just two counties away, but it feels like another world to residents of Albert Lea, who are hoping for a pause in Mayo's plans or, even better some say, a divorce.

"We want them to give us back our hospital," said Mary Packer-Umstead, who runs a thrift store in this southern Minnesota city of 18,000 residents.

A crisis of rural hospital closings has shuttered some 80 institutions nationally since 2010, according to the Chartis Center for Rural Health. The problem has worsened since the recession, and health experts are warning of yet more closings to come.

Locally, some 49 Minnesota hospitals have closed since 1987, according to the state Department of Health. That's happened even though rural Minnesotans tend to be older, poorer and sicker than the rest of the state. The trend has driven doctors out of rural Minnesota, which is home to about half of the state's population but workplace for only about a sixth of its doctors.

The closures are due to a variety of factors, according to the Cecil G. Sheps Center for Health Services Research in North Carolina, including a slow recovery from the recession, demographic trends, market trends such as increased rates of mergers and affiliation, decreased demand for inpatient services and new models of care.

The Mayo Clinic announced in June that it will move most inpatient services, including labor and delivery, surgeries requiring hospitalization and intensive-care hospital stays to Austin, about 23 miles away. Emergency room and inpatient behavioral health care plus outpatient services will stay in Albert Lea.

There's no fixed timeline for the move, though its first stages are expected in early October.

Mayo's explanation for the decision was primarily economic, with a Mayo vice president saying that it's no longer feasible to have identical services offered in both cities. The two hospitals lost nearly $13 million in the past two years, Mayo said.

Immediate backlash

A rally at Albert Lea High School shortly after the decision was announced drew more than 700 people, many of whom angrily denounced the plan. Albert Lea officials said they felt blindsided.

To many here, Mayo's decision would upend the local economy.

The loss of the hospital will jeopardize the town's growth, said Brad Arends, one of the leaders of the Save Our Hospital campaign. Families won't come and businesses won't expand here if the city doesn't have its own medical facilities, he said.

Mayo nurse Linda Ferguson, a Save Our Hospitals supporter, said she's seen health care services dwindle in rural southeastern Minnesota year by year, with cutbacks to positions and services.

Small towns that once had regular access to a physician now have a nurse practitioner, and waits for appointments have grown longer, she said. The step-by-step elimination of health care services from rural Minnesota is creating a "health care wasteland" where people can't get the services they need, she said.

She sees the grass-roots strategy in Albert Lea as the start of a larger campaign.

"This is being noticed as a kind of grass-roots movement for rural health care," she said.

Mayo unmoved

Mayo so far has said it will go through with its plans for Albert Lea, despite the pushback.

Dr. Annie Sadosty, who was named regional vice president for Mayo Clinic Health System in southeastern Minnesota one week after the Albert Lea plan was announced, said a national shortage of physicians and nurses has made it difficult to find staff.

Medicine has changed too, she said, with rapid advancements creating a demand for more specialization. A single family physician can't take care of everything anymore, said Sadosty.

She said she knows some people in Albert Lea hope Mayo will leave.

"I have heard that message," she said. "It is so painful to hear."

Mayo spokeswoman Ginger Plumbo said that even if the financials were stellar in Albert Lea, it wouldn't solve the issue, since staffing has been so difficult.

"We care very much about the people who feel affected," Plumbo said. "There was a lot of very thoughtful discussions that led up to this. This seemed like the best option from all who have looked at it."

That explanation has done little to convince people in Albert Lea, where trust in Mayo has run low.

Arends, a financial planner, said one of the Save Our Hospitals committees has been studying other Minnesota cities of the same size to see how they manage to support a full hospital. The group plans to hire its own accountant to look at the Albert Lea hospital and determine if it could be profitable.

Another Save Our Hospitals committee has been talking with alternative health care providers in hopes that Mayo will move out and allow Albert Lea to start over.

Arends and co-chair Mariah Lynne said they've been especially irked by Mayo's apparent violation of agreements reached when it took over the Albert Lea hospital in 1995. Minutes from those meetings include language that a supermajority of the hospital's board of trustees would be needed to approve a decision to discontinue any medical service in Albert Lea.

Asked about that, a Mayo representative said the clinic regards the Albert Lea and Austin hospitals as part of one system, so nothing is being discontinued, just reshuffled.

That kind of language has only deepened the distrust of Mayo, said Arends, who says the spirit of those 1995 agreements has been violated.

"Mayo was a selling point for us," he said. "We would brag about it. And I'm telling you the city has lost trust in Mayo because of how they've handled this."

For the Save Our Hospital campaign, the fight is only beginning. Friends have told them that it was a waste of time to take on Mayo, said Arends. But the campaign has won the attention of state officials, including Attorney General Lori Swanson and Lt. Gov. Tina Smith, both of whom have come to town to meet with locals.

Swanson sent a letter Aug. 16 to the Mayo Clinic asking that it provide more information about its decisionmaking process and use of funds intended for Albert Lea's benefit. Mayo last week responded, saying many things will remain in Albert Lea, including primary and specialty care clinics. Some $700,000 in funds donated specifically for the Albert Lea hospital remain available, Mayo added.

Dayton and Smith have issued a joint statement saying they have serious concerns about Mayo's decision. Some in Albert Lea were hopeful that Smith, who chairs the Destination Medical Center Corporation's board of directors, could use her leverage with the Mayo Clinic to hold up the public dollars supporting the DMC plan because of what's happening in Albert Lea. Smith, however, said she's bound by the state law that allocates that money to Rochester; she told the Save Our Hospital campaign leaders she will meet privately with Mayo officials to ask them to delay their plans.

For now, the campaign plans to keep fighting, even if it means taking on one of Minnesota's biggest names.

"This brand is this holy grail that we're all supposed to accept as an industry leader in everything," said Lynne, speaking of the Mayo Clinic. "There are certainly things that they are best in the world at."

Rural health care, she said, "is not one of them."

Matt McKinney • 612-673-7329