Financial challenges faced by rural hospitals show no sign of a turnaround, prompting MedWest hospital leaders to consider what was once a last resort.

MedWest hospitals are entertaining the idea of selling or merging with a larger hospital system that would bring a cash infusion to the table.

The 10-person Haywood Regional Medical Center board will now include an 11th member.

The Haywood Board of Commissioners Monday approved a change to the hospital board’s bylaws to up the number of members and appointed Neil Budde to the 11th seat.

Dr. Janine Keever still remembers that do-or-die moment in her undergrad chemistry class like it was yesterday. The grades just came back on her first exam of the year, and it wasn’t pretty. Her dream of medical school seemed to vanish on the spot.

In late February, a Macon County youth was checked into the local emergency room in need of psychological care. Because the hospital, Angel Medical Center, does not provide that type of service, he spent the night in the ER while awaiting transfer to a state inpatient facility that treats juveniles with mental health issues.

MedWest hospital leaders have hired an outside consulting firm to help them analyze the pros and cons of staying together versus dissolving their fledgling partnership. Also at stake: whether Carolinas HealthCare System will stay on as the hospitals’ management company.

Janie Sinacore-Jaberg has run a lot of hospitals — small hospitals, financially precarious hospitals, turf-war embattled hospitals, hospitals in the midst of a merger, even hospitals in the midst of hostile take over.

The new CEO of MedWest-Haywood is rounding on the county, asking residents about the hospital’s past performance and how to improve in the future.

“I really want to engage your community,” said Janie Sinacore-Jaberg, who came on board with the hospital late last year.

By Martin Dyckman • Guest Columnist

The United States spends twice as much on health care as most other modern nations, with less to show for it in terms of longevity and other true measures of health. The reasons why — and what we could and should do about it — make the March 4 edition of TIME probably the most important single issue of any magazine ever published.

Steven Brill’s cover story, “Why Medical Bills Are Killing Us,” takes up nearly the entire edition. Anyone who cares about this — and who doesn’t — needs to buy or borrow the magazine now or download the article from TIME’s website. It’s a keeper.

Macon County emergency vehicles will soon be equipped with new state-of-the-art cardiac defibrillators.

Commissioners voted 3 to 2 this week to spend nearly $400,000 on 12 pieces of the live saving equipment. One will be placed in each of the county’s ambulances, and two will be placed in the county vehicles of medical staff. They will replace existing defibrillators, some of which are 10-years-old.

When pediatricians at Cherokee Indian Hospital retreat to their desk between patients to log data, research puzzling symptoms or review lab results, they’re constantly looking over their shoulders.