To better understand the unique challenge these two hospital boards would face in attempting to work together, it's helpful to know that tension between Harper and Anthony didn't begin with healthcare.

It actually dates back to the 1800s, when Anthony is said to have stolen the courthouse from Harper. Each town had built a courthouse, and there were feuds over buildings, county seals, safes, and separate records — rumored to have been brought home at night by city employees for safekeeping.

An election in 1879 was later called to decide whether Anthony or the larger population of Harper would be the county seat. Despite having only 800 registered county voters, 2,960 votes were cast, with a majority favoring Harper. When the false ballots were removed, Anthony had won. Although Harper had already built a courthouse, it was later used as a college and then as a church.

More than a century later, over cherry limeades at Irwin-Potter Drug, the old-fashioned soda fountain, and around dinner tables, locals still talk about the courthouse debacle.

Harper and Anthony were distinct communities, each with their own history and sense of pride. That rival, competitive dynamic also extended to their hospitals.

Given that history, collaboration was not an easy sell.

Before delivering his letter, Neal Patterson had engaged executives at Ascension Via Christi in Wichita to help preview his proposal with members of both boards.

"We floated the idea and they kind of sit there with their arms folded across their chest going, 'we're not real sure, you know, we think we're doing just fine the way it is,'" said Jody Gragg, former Via Christi representative, who presented Neal Patterson's proposal before the letter was sent.

Gragg felt the tension among Harper residents who feared this would become an Anthony project, since Neal Patterson's family lived in the Anthony community and his nephew, Alan Patterson, sat on its hospital board. On the other side, Anthony board members were fearful the consolidation talks would collapse again, as they had in prior years.

As a result of the meeting, the boards formed a working group - comprised of two board members per hospital, interim co-CEOs, and representatives from Via Christi and Cerner - to meet for one year to determine what right-sized healthcare looked like in Harper County.

While some community members believed the status quo should continue, independent financial analysis began to paint a stark picture. Both hospitals were operating at a loss, and projections showed little chance of recovery under existing conditions.

The data made one thing clear: maintaining two separate hospitals was not sustainable. Convinced of this, both boards voted to freeze capital expenditures, forgo available grant funding, and avoid investing additional money in their mostly dilapidated buildings.

As discussions progressed, workgroup members turned their attention to Harper County residents. Community engagement became a central part of the process. Leaders regularly held public meetings, conducted surveys, and gathered feedback at events such as the county fair, which drew hundreds of residents.

The responses revealed some excitement, but a great deal of concern and uncertainty. Residents worried about losing access to emergency care, losing jobs, or seeing their town decline without a hospital. Project leaders also encountered skepticism — some residents said they weren't aware that anything was happening at all.

To bridge the gap, volunteers spoke with residents directly. These conversations were often difficult but essential in building understanding and trust.

After months of analysis and community input, a clear recommendation emerged: build a new, single facility to serve the entire county.

From a financial and operational perspective, consolidation offered the strongest path to sustainability. Combining patient volumes would support existing services and allow for modest expansion. Eliminating duplication would reduce costs. And a new facility could be designed to meet the community's actual needs.

The most fiscally responsible path involved merging Harper's hospital tax district into Anthony's tax district — District No. 6 — while maintaining critical access hospital status under a relocation waiver found by legal counsel.

Federal rules restrict critical access hospitals to be at least 35 miles apart. The two local hospital districts had originally received gubernatorial waivers allowing them to operate just nine miles apart. Now the workgroup had to obtain CMS permission to use a different waiver: one that would allow a current critical access hospital to move and build a new facility — so long as 75% of staff, patients, and service lines were retained.

A key step was securing written community approval. Leaders needed signatures from a majority of registered voters in Harper's hospital district.

The effort demanded seven months of door-to-door campaigning. Volunteers encountered empty homes, outdated voter lists, and emotionally charged conversations — with some people walking away or slamming doors in their faces.

Despite these challenges, the petition campaign succeeded. With those signatures in hand, the two hospitals officially moved forward with consolidation.

Because of the brutal injustice of cancer, Neal Patterson did not live to see the facility break ground on his birthday — December 10, 2017 — on 60 acres of land purchased from a local farmer. The site was chosen to sit equidistant between Harper and Anthony, symbolically and geographically uniting the communities.

The plan for the new facility was to reduce inpatient capacity from 50 beds across two hospitals to 16 beds — a more appropriate size for the population and average daily usage — while expanding outpatient and specialty services to reflect how healthcare is actually delivered today.

The project brought together public U.S. Department of Agriculture funding, private investment, and community support to create a $42 million, 62,500-square-foot hospital designed for modern rural healthcare delivery. Through his estate plans and family foundation, Neal Patterson fulfilled his promise to serve as the project's lead private donor.

In July 2019, Patterson Health Center opened its doors. Speaking at the ceremony, Neal Patterson's daughter, Lindsey Patterson Smith, said: "Neal set a challenge, he made some connections, and he opened some doors. He planned for a future that, at some point, he knew he would not be around to see. But it's you who walked through the door and set out on the rocky path."

Through the years-long process, the hospital boards and staff came to understand that to truly survive and prosper, they needed to work together rather than compete. This was the first time two critical access hospitals had collaborated and consolidated in Kansas, preserving access to care in rural communities facing demographic shifts, depopulation, and economic pressure.

During the construction process, work had been underway to unify staff and operations. Keeping a promise made to the community, the joint board chose not to lay people off, relying instead on natural attrition. Employees worked together under a new slogan: "Together for a healthy future."

Crissa Foley, Patterson Health Center emergency department and trauma services director, said she was grateful the hospitals merged before the facility was built — it allowed the independently minded nursing staff to work together, get to know one another, and work through conflicts in a lower-stakes environment.

"I thank God we did that," Foley said. "Those personality conflicts that most likely would have happened out here happened as we allowed them to work together and get to know each other." Shortly after opening, the COVID-19 pandemic hit — and the collaborative teams were essential. "Somehow we survived that, too."

Today, Patterson Health Center serves as a regional healthcare hub for Harper County and the surrounding area. The facility includes emergency care, primary and specialty clinics, therapy services, and advanced diagnostic capabilities — including hydrotherapy, diabetes education, and telehealth.

Patient visits have increased, with most of the community embracing the new facility. "In the end, the community really stepped up and supported Patterson Health Center once we came together and they saw what we could do," said Lori Allen, PHC COO.

The facility has also become an important community gathering space — residents come together to catch up over coffee at the café, attend weekly community meetings, and gather for farmers' markets on the front lawn. It sits next to the consolidated Chaparral Jr/Sr High School, creating student learning opportunities as well.

Neal Patterson is seen as a catalyst who inspired a divided community to reimagine what was possible together. His leadership sparked the collaboration, trust, and shared vision that empowered Harper County residents to shape their own sustainable future. It's what led them to name the facility Patterson Health Center after him.

"Although Neal Patterson wasn't the kind of person who'd want his name on the wall or make it a requirement of accepting funds," Hadsall said, "the name just felt right."

Today, Patterson Health Center stands as proof of what is possible when communities come together with a shared purpose. Their journey offers valuable lessons for other rural communities facing similar challenges.

The most important thing Harper County built wasn't a new facility — it was the trust and shared vision necessary to tackle difficult challenges together. The process required difficult decisions, sustained effort, and a willingness to set aside long-standing divisions. It demanded transparency, community engagement, and strong local leadership with the ability to look to the future.

Above all, it required a shift in perspective: from protecting individual institutions to preserving community-wide access to care.

This is the second story in a three-part series about the formation of Patterson Health Center and its transformative rural healthcare model. Watch the Patterson Family Foundation's website and newsletter for the final story in the series.