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.' "

It happens in small communities all over the state, from Chokio, where an insurance agent got angry e-mails from would-be customers who said they would not do business with him because they could not reach him by phone to Brainerd, where a tire dealer plagued by failed calls made a symbolic point by slapping his local phone company with a bill for $50,000 in lost business.

In Morris, the local high school sent out a telephone weather closure notice that never got through to many students and parents.

"In rural areas it costs more to deliver long distance calls [than in urban areas] so they just don't put them through," explained Brent Christensen, who heads the Minnesota Telecom Alliance, a group of rural phone service providers. "We've been dealing with this for years."

In January, the FCC fined Verizon $2 million for failing to investigate dropped rural calls in 22 counties in 2013. Regulators also required Verizon to invest $3 million in a program to keep better track of rural connection problems. ­Verizon at the time said its long-distance networks were "highly reliable" and that it had worked proactively with industry partners to "confirm proper delivery of calls to rural destinations."

The $5 million settlement was the latest step in a regulatory push to help people in sparsely populated areas keep in touch. But the fine and a series of remedial measures, including appointment of a rural call completion ombudsman and a seminar on rural call completion last week in Washington, D.C., still don't address the major problem.

When it comes to dropped rural calls, said Kevin Beyer, general manager of Minnesota's Federated Telephone Cooperative, "you know where the call originated, but you can't tell where it went to [in] Never Neverland."

Scarce oversight

Long distance calls do not pass directly from an originating phone company to a connecting phone company. Instead they travel a circuitous route of multiple intermediate carriers usually selected by computer because they offer the cheapest fare.

For instance, a call made from Washington, D.C. to rural Minnesota may pass through California or even outside the U.S. "Least-cost carriers," as they are known, also may pass calls off to lower-cost carriers who may keep passing them off in a continuous loop that may not break before calls time out.

Oversight of intermediate carriers, who may number in the thousands, is scarce. A 2013 FCC order required phone companies with more than 100,000 lines to retain data from long-distance calls for six months and file quarterly reports about connections. But finding and punishing call dumpers remains difficult because they can go in and out of business so easily.

"You can go buy a computer anyplace and publish a long-distance rate deck, and it will be used," said Fritz Hendricks of Onvoy, a Minneapolis firm that helps move long-distance calls over 80 percent of the country.

Quoting very low rates ensures business and profits as long as the calls go to urban areas with cheap destination rates. But if an intermediate carrier picks up a call to a rural area with expensive destination rates because of small call volume, it becomes a money loser.

Among the ways that some companies tried to avoid connecting rural calls is what Hendricks calls "false ring-backs."

"Carriers provide ringing before you are connected on the far end," he explained. "It's actually not ringing where you're trying to call, but you've heard it ring nine or 10 times. So you think the person is not in."

The FCC banned that practice with its 2013 order. But enforcing the ban is hard, if not impossible because people making calls have no idea if their calls are being dumped or the person they are trying to reach is simply not around.

At Mattracks, which makes rubber track conversion kits that let vehicles operate in rough and snowy terrain, Brazier said the company's phone would sometimes ring once with no one on the other end of the line when employees answered. Other times, the call counts ran feast or famine — dozens of calls some days, a handful the next. There was, he said, no logical reason except routers hitting the rural exchange in Kittson County and dropping the calls.

Meanwhile, when companies like Beyer's Federated Telephone Cooperative try to track what happened for angry customers who never heard a ring, the trail often goes cold because calls pass through so many carriers.

Beyer wants a system that has all carriers registered so they can be held accountable. "If you're not completing calls," he said, "then you should not be allowed to route calls."

Beyond business

Klobuchar, Tester and Merkley hope to get the FCC to establish basic quality standards for rural phone calls with their "Improving Rural Call Quality and Reliability Act."

Tester sponsored a similar bill last year that did not get out of committee. Klobuchar helped get a different resolution about rural call completion passed in 2013 by the Senate Commerce Committee that led to some FCC action, but did not completely resolve the problems. Pushing for carrier registration and the disqualification of carriers who do not complete rural calls are keys to combating a destructive technological breakdown, she said.

"If customers can't get through to you, you lose the customers," she noted. "But this goes beyond business. It happens to homeowners and emergency services."

In Madelia in south central Minnesota, Andy Innis of Christensen Communications believes changes must take place before that becomes the case.

Dumping rural phone calls breaks the law, Innis said. "But there are so many intermediate routers that the FCC can't get a handle on following these things. It's like playing Whac-A-Mole."

Jim Spencer • 202-383-6123