The closed sign went on the door of Lake Shore Health Care Center's Emergency Room in the Town of Hanover at 7 p.m. Sunday.
It was the latest closing as parent TLC Health Care has systematically closed most services on the hospital site. The behavioral health unit also closed over this weekend. Inside, security patrols what was once a large hospital and nursing home.
Ambulances will be ready to shift cases for several weeks. One from Gowanda Ambulance Service waited under a roof in case an emergency case came in, not knowing the ER had closed.
Local 11-99 SEIU attacked the quick closing and praised union members who kept the facility going to the end. The union called it a "rushed and irresponsible closure."
Louis Pelletter, a retired Silver Creek police chief and Town of Hanover deputy supervisor, said patients will have to go a long way for help now.
"This is also a 939 facility which is able to take on mental health patients, in addition to the ER," said Pelletter. "Now, they'll be taking them to WCA in Jamestown, which is approximately 50 miles, or ECMC in Buffalo, which is 30 to 40 miles."
The health center near Irving provided service across three counties and on Seneca Nation land. Parent Brooks Hospital TLC says there were not enough patients to keep it going.

State Senator George Borrello lives around a mile away from the facility. He is blasting Brooks for rushing to close operations at Lake Shore, saying there were alternatives.
"We already have multiple parties interested in buying the hospital. I've spoken with folks that are interested in operating the ER as a robust urgent care facility. There are folks that would like to continue the mental health services there and behavioral health, the addiction services that were being provided there," Borrello said.
Closing this emergency room removes nearby care, leaving the nearest care either in Dunkirk at Brooks, which is part of the same organization, or heading toward Buffalo, perhaps to Mercy Hospital. In a life or death situation, care will be a long way away. It also causes a strain on volunteer ambulance services since a round-trip to a hospital might take four or five hours.