The phone calls were about transfers of patients so sick or injured that they had to move from Madelia Community Hospital and Clinic in rural Minnesota to a more comprehensive care facility about 25 miles away in Mankato.
Only from late September to early December 2014, the calls never went through.
"It was absolutely horrible," Madelia CEO Candace Fenske said. "This happened 20 times. One time is too many when you're dealing with a trauma patient."
Rural telephone connection problems continue to plague remote communities in Minnesota and across the country. A national test of 2,150 rural calls in 2011 showed that 344 never reached their destination and another 172 were "unacceptably delayed or of poor quality," according to the Federal Communications Commission (FCC).
Critics claim that some cut-rate long distance routers moving calls in the middle of the nation's telecommunications network simply do not connect rural calls to avoid expensive connection fees. No one is sure how many of these intermediate carriers exist because they don't have to register with the government. They can set up operations simply by downloading free software on the Internet and filing a rate plan with phone companies.
"It's outrageous to have fly-by-night carriers just dump the calls," said Sen. Amy Klobuchar, D-Minn., who with Sen. Jon Tester, D-Mont., and Sen. Jeff Merkley, D-Ore., recently introduced legislation to try to fix rural call problems that she calls "literally devastating."
When health care, law enforcement and emergency personnel cannot reach each other or the public, the threats are obvious. But telecommunications breakdowns can upend rural businesses, too.
"It almost bankrupted us," said Roger Brazier, sales manager for Mattracks Inc., a 50-employee manufacturer in Karlstad, Minn., 30 miles from the Canadian border. "People we talked to said, 'Did you guys get bought out? You never answered your phone so I ended up buying from a competitor.' "