How notorious billionaire Leona Helmsley’s foundation is saving lives in rural America

When Marcy Smith’s oncologist told her she needed radiation treatment for breast cancer, her first response was no. She’d already had a lumpectomy and four rounds of chemotherapy. The radiation would require six weeks of treatment in Billings, Montana — 220 miles from her Glendive home.

It was too far away to drive there each day, and she couldn’t miss work or leave her foster children to relocate.

Then the oncologist came back with good news — a cancer center was about to open at the hospital in Miles City, a town of 8,000 an hour away. Smith changed her mind. For six weeks straight, she picked up her foster daughter from kindergarten, drove to get her treatment, and was home in time to make dinner.

A year later, Smith is cancer-free. “Thank the lord,” she says. “Getting the radiation was probably life-saving for me.”

Much of the support for the new cancer center came from an unlikely source — a trust established by a notorious New York billionaire.

Leona Helmsley — the “queen of mean” hotel owner— has enjoyed a posthumous reputation boost in the Upper Midwest and Rocky Mountain regions. That’s because the Leona M. and Harry B. Helmsley Charitable Trust has spent more than $850 million on rural health care in the regions since 2009 to support innovative work in telemedicine and psychiatric, cardiac, and cancer care. The trust provided $6 million of the $17 million needed to create the new cancer center at Miles City’s hospital.

Helmsley’s successes in rural health care come at a time when those systems are under intense strain. From 2005 to 2023, 81 rural hospitals shut down — and cuts to Medicaid will cause more pain. Congress tried to soften the blow by allocating $50 billion over five years for rural health care, but independent estimates indicate that sum is only a third of what rural hospitals will lose due to the Medicaid cuts.

Though philanthropic efforts like those from Helmsley can’t make up for the loss of federal funds, when done well they can help close the gap with urban hospitals. Helmsley expects to spend $84 million on rural health care in its fiscal year that ends in March.

“Your ZIP code should not determine your health outcomes,” says Walter Panzirer, the Helmsley trustee who started the rural health program, “and yet for so many rural Americans, it does.”

A visionary with lived experience

The Helmsley Foundation’s interest in rural health care did not originate with its famously urban namesake. Instead, it was due to her grandson, Panzirer, who spent nearly a decade as a South Dakota cop after he moved to the state to pursue his love of the outdoors. Panzirer witnessed how limited health care options impact low-income rural residents — especially people struggling with mental health, since psychiatrists and counselors are often unavailable.

Leona died in 2007 and named Panzirer as one of the trustees of her philanthropy. After a dispute over how the funds could be used — Helmsley famously wanted the money to be spent caring for dogs — Panzirer pushed for a program in rural health care, since few other national foundations focused on it.

“I understood the challenges, the differences, and sometimes the inequities with rural America not always having state-of-the-art medical equipment or not having access to specialty care,” Panzirer says. “That was kind of a lived experience for me.”

The trust quickly realized it needed to open a local office where it was planning to work. It settled on Sioux Falls, South Dakota, which already had two major health care institutions. Four program officers now travel extensively throughout the region to talk to hospital executives, doctors, nurses, and first responders and get a feel for local needs.

The trust has granted $60.4 million for more than 24,000 automated external defibrillators for police officers and other first responders. The devices can help reestablish a regular rhythm following a heart attack, and the trust says there have been more than 600 known cases in which Helmsley-funded devices helped save lives.

“In rural America, if you have a heart attack, law enforcement will show up,” Panzirer says. “A lot of times they’ll get there quicker than the volunteer ambulance service.”

The trust also provided funding for more than 70 mammogram machines throughout the region, with a goal of ensuring patients wouldn’t need to travel more than 60 miles for breast cancer screening. Helmsley has invested more than $100 million in telemedicine, enabling rural residents to get care from doctors in distant cities.

In South Dakota, Nevada, and Wyoming, Helmsley started what it calls “virtual crisis care” — a program that provides police officers with tablets to connect people in crisis with remote mental-health counselors.

Panzirer knows firsthand why the program is important. As a police officer, he remembers having to hold suicidal people in jail so they would not harm themselves.

In recent years, Helmsley has brought comprehensive cancer centers to five rural communities. Helmsley reached out to the Central Montana Medical Center, in Lewistown, Montana, as part of its effort to ensure that rural residents don’t have to travel more than 100 miles for cancer care.

Cody Langbehn, the hospital’s CEO, says a cancer center isn’t something he would have dreamed of without Helmsley’s help. But the Helmsley support kicked off fundraising that allowed the project to be nearly entirely covered by philanthropy. Helmsley paid $9 million, and local families and businesses chipped in most of the remaining cost of the $19 million facility.

Helmsley has spent $128 million to expand access to chemotherapy and radiation services at 20 health centers and to build the five new ones.

Karen Costello, who was president of the Miles City hospital when its cancer center was being built, says Helmsley’s vetting of sustainability plans is just as important as the money it brings to the table. “The worst thing you can do is bring a wonderful service to a market and then have it peter out after five or six years,” she says. “That’s worse than never having it at all.”

Investing in the right models and people

Helmsley also focuses on small cities in predominantly rural areas, which play an important role in providing specialty care and in training health care professionals.

At Billings Clinic, Montana’s largest hospital, Helmsley has been the primary funder behind at least four major projects: Montana's first internal medicine residency program; its first psychiatric residency program; its first surgical intensive care unit; and a new center to support rural hospitals and handle the transfer to Billings when a higher level of care is needed.

Jim Duncan, who recently stepped down after 30 years leading the clinic’s foundation, says Panzirer’s firsthand experience with rural health care will continue to pay off for health systems throughout the Upper Midwest and Mountain West.

“He has a very strategic eye for where the needs and gaps are — and how to creatively pursue ways that philanthropy can be transformational.”

______ Ben Gose is a senior editor at the Chronicle of Philanthropy, where you can read the full article. This article was provided to The Associated Press by the Chronicle of Philanthropy as part of a partnership to cover philanthropy and nonprofits supported by the Lilly Endowment. The Chronicle is solely responsible for the content. For all of AP’s philanthropy coverage, visit https://apnews.com/hub/philanthropy.