With a new CEO at the helm, Kaweah Delta Medical Center is starting its largest expansion since the addition of the Acequia Wing in 2009, one that will see 33 new exam rooms in the emergency department, as well as new treatment facilities.
“We will literally almost double the size of the ED,” said Gary Herbst, who took over as CEO for the Kaweah Delta Health Care District (KDHCD) in August. “We currently have 41 exam rooms, and we’re going to 74 exam rooms, and we’re increasing our waiting room capacity from about 60 chairs to more than 100.”
The construction, which saw the closure this week of the hospital’s main entrance on Mineral King Avenue, is part of a $100 million set of plans to expand KDHCD’s ability to treat patients begun under the leadership of former CEO Lindsay Mann. Mann left his position to take a mission with the Church of Jesus Christ of the Latter-Day Saints.
Covering the cost of the building boom are a set of revenue bonds issued in December of 2015, which will be repaid using the District’s future earnings.
“This is all being funded by our existing operations,” Herbst said.
Upcoming projects include completing infill of the second, fifth and sixth floors of the hospital’s Acequia Wing, the construction of an endoscopy center on the West Campus at Cypress Avenue and Akers Street, refurbishment of the Exeter Health Clinic, a $22-million upgrade to the District’s IT system, and construction of temporary parking after the demolition of two vacant
buildings on the Downtown Campus.
The hospital’s main entrance should reopen before the end of December.
Bigger ER Needed?
Many who live in the district may wonder if Kaweah Delta needs a larger emergency department, and Herbst thinks that hesitation is an issue that needs to be addressed.
“That’s not a stupid question,” said Herbst. “If you’ve ever sat in our ER waiting room, you’ll quickly come to the conclusion that what we have was designed for a much smaller population.”
As originally constructed, Kaweah Delta’s emergency department was intended to accommodate 30,000 to 40,000 patients a year.
When the Acequia Wing was added, that capacity climbed to 70,000, which still falls far short of the actual number of visits.
“We are consistently now seeing 90,000 patients a year,” Herbst said. “We’re talking about the last five years.”
The need for more room is even more acute now that Tulare Regional Medical Center (TRMC) has temporarily ceased operations of its ER. However, the improvements to Visalia’s ER will not come completely online until 2019, too late to help deal with the influx of new patients.
“It has impacted us,” Herbst said. “It’s impacted all the hospitals.”
Leadership at KDHCD hopes TRMC will be back online quickly, citing concern for patient safety.
“I will tell you that we hope it is a very temporary closure in Tulare,” said Herbst. “They’re part of the health-care delivery system fabric, so we’re rooting for them to reopen without a doubt.”
Meanwhile, the hospital has already opened an expanded waiting room in the form of a rain-proof tent that includes air conditioning, electricity and supplies, as well as staff to oversee patients, in response to an early flu season and the closure of the ER at TRMC.
Despite the higher number of emergency patients now seen at KDMC, the greatest cause of delays and long wait times at the ER remains the treatment of patients who do not have actual emergency illnesses or injuries. By law, those patients cannot be turned away once they seek treatment at the ER.
The law, Emergency Medical Treatment and Active Labor Act (EMTALA), ensures patients who cannot afford treatment receive it.
“It originally came about because there were patients that were in active labor who would come to for-profit hospitals, and they would say, ‘Thhpt! Down the road to the county hospital, because you’re not one of our patients,’” said Dan Allain, KDMC’s assistant chief nursing officer. “When you come into the emergency room, we’re bound by that law to evaluate you. By the time we’ve finished that, we usually know what’s wrong, so we just write you the prescription.”
Yet, many of those seeking treatment at the ER don’t actually require emergency treatment.
By visiting a doctor or clinic, or by visiting an urgent care center, much of their waiting could be eliminated.
KDHCD already operates three urgent-care clinics in Visalia, and a fourth is in the works for northwest Visalia.
The number of patients using those facilities is on the rise, with the District’s clinic on Court Street now seeing 60,000 or more patients annually.
It’s by urging patients to use urgent-care clinics instead of the ER that Kaweah Delta has kept the number of ER patients manageable.
“We’ve been at 90,000 (annual ER visits) for five-plus years, so that means we’re having success,” said Herbst. “We’ve opened five clinics. We’ve just opened these two urgent-care clinics. It (the number of ER visits) hasn’t grown.”
Bigger, Better ER
When construction of the ER expansion is complete, the hospital will have capacity for 130,000 annual emergency department patients. That should give the District about a decade before it has to think of expanding its ER again, said Allain.
Construction will be completed in several phases, and among the first will be a reworking of the KDMC’s main entrance. Unfortunately, that means the iconic fountain in KDMC’s lobby will have to go.
“That was hard to do,” said Allain. “This has been one of those kinds of landmarks.”
It’s a landmark many will be sad to see removed, but in its place will rise the ER’s new lab and a “fast track” urgent-care area for the treatment of patients with non-life-threatening illnesses and injuries who come to the ER for help.
“They’re designed for a quick treatment and you’re out,” Herbst said.
‘Parking Is Going to Be Gone’
After that, construction will move on to filling in space set aside for ER expansion when the Acequia Wing was constructed. In February, the fact big things are going on at the hospital will become obvious to passersby, as construction of the new ER building begins.
“That’s when it’s going to become very evident to the public,” Herbst said. “The first thing they’re going to see is half that parking is going to be gone.”
The District is working with the city to have parking designations in the two nearby parking structures changed to allow more all-day, public parking, Herbst said.
And, KDMC offers continues to offer free valet parking to ease congestion.
When that construction begins, the current ER entrance will close. A new, temporary entrance will open near the hospital’s main entrance.
Also, the helipad will not be removed to make way for construction. Members of the public raised more than $2.7 million to build the helipad, making administrators reluctant to relocate it. So far, more than 1,000 flights have come and gone at KDMC, with two-thirds of those flights taking patients to other hospitals for additional treatment.
Taking It to the Streets
In the wake of the defeat of Measure H, a bond issue to fund expand and retrofit the hospital, Herbst said the District is doing more to communicate with members of the community.
To that end, KDHCD has formed three community advisory boards for communication, identifying healthcare needs and to educate the public about the District’s future facility needs. They’ve also put together an ambassador program, providing speakers to clubs and other organizations.
“We learned from Measure H. It was a painful experience, but it was an enlightening experience for us too,” Herbst said. “Maybe we overestimated the knowledge our community had about us. We should have been working with the community for years before we went out.”
Herbst has been working with Kaweah Delta for years, 26 to be exact. He was the District’s senior vice president and chief financial officer prior to taking over the CEO role.
“When Lindsay wasn’t the CEO, I was the acting CEO,” he said. “I’ve had the opportunity to develop relationships with folks.”
Those relationships will be key as the District moves forward with attempts to establish an “integrated delivery system” for health care in the South Valley.
“When you look across the country, up and down the state, and even locally, the role of hospitals is changing dramatically,” he said. “Before, our role was only to take care of sick and injured people when they came. Now, our role is becoming much more involved in improving the overall health of our population.”
To that end, the District and a physicians group have formed Sequoia Integrated Health to align their care-delivery efforts. Recently, Sierra District Hospital in Porterville and Adventist Hospital in Hanford have been invited to join in the alliance.
“We’re natural leaders in the health-care industry,” Herbst said.