Kaweah Delta plans for the future

John Lindt

The hospital district feels confident enough in their response to COVID-19 to begin long-term planning that includes taking on large projects, adjusting their visitation policies

VISALIA – The pandemic is surging across much of the country this fall, but at Tulare County’s largest hospital they are full of patients with more traditional complaints. And that’s good news.

COVID-19 cases being treated at Kaweah Delta hospital are down to 16 this week compared to a high of over 90 in July, says Kaweah Delta CEO Gary Herbst.

“It’s been an unprecedented and challenging seven months for Kaweah Delta” Herbst said recalling that the hospital lost around $37 million in the last fiscal year that ended in July. The red ink has continued to flow through the summer with mostly federal stimulus funds making the difference.

COVID cases required more staff time, filling beds with older patients that stay longer who need more intensive care. The pandemic gobbled up the hospital’s resources from supplies to overtime pay. Meanwhile, “We put our regular services on pause” Herbst described—services like every day surgical procedures that are the bread and butter of the district’s finances. Staff also faced unprecedented pressures impacting front line workers who got COVID, worked incredible hours and struggled to get enough protective equipment.

Occupancy plunged and most in-person services were shut down. Not just the main campus was affected as COVID fears caused residents not to seek services at Kaweah Delta’s extensive network of outpatient clinics, urgent care facilities and specialty service centers. The Lifestyle Center continues to be shuttered and even births at the hospital have declined.

The Demaree Urgent Care for example saw just 26 patients a day in April compared to 112 patients a day just two months earlier, before the virus hit.

Kaweah Delta has experienced a huge drop in the number of patients in most categories as elective procedures were postponed.

Gary Herbst
CEO, Kaweah Delta Health Care District

Other district projects have been affected too. In 2016 Kaweah Delta approved construction of a new 120-unit independent, assisted, and memory care senior living—Quail Park at Shannon Ranch. But new occupants have not moved in and occupancy in August was just 9% with the project generating a loss in the last fiscal year of $3.2 million.

Now with COVID cases falling the board heard a report in September that “Quail Park at Shannon Ranch will see a significant increase in deposits and people moving into the facilities,” concludes a staff report.

In May the hospital announced it would resume elective surgical procedures. Helping to move toward the goal of restarting services, new tests and procedures allowed all surgical patients to be tested as well as COVID-19 antibody test for its employees. Every patient every day started to get tested.

“We started to reintroduce other services knowing that we have the flexibility to stop at any time. If we see that surge coming, we can ramp right back. If we see the numbers continue to fall, we can accelerate,” Herbst said. That worked.

“We deliberately stopped doing non-essential elective surgery to create that surge capacity that really has never materialized,” Herbst added.

A lot of these surgeries that have been put off are important. Patients are looking for that painful knee to be replaced, that shoulder, that torn rotator cuff to get repaired. They are still in pain, but they have been putting up with it. But that took time and some convincing.

Safest place

Herbst assured prospective patients early in the summer that “the hospital is probably one of the safest places you can be right now given the amount of disinfection we are doing, the constant hand washing, the constant wearing of the personal protective equipment.”

The COVID emergency appeared to peak as doctors learned there were practices and treatments that could reduce mortality, early intervention procedures allowing slowly a re-start of a line of services helping cancer patients, offering cardiac surgeries and birthing babies.

The hospital today is at 92% occupancy.

Visitors return

In the past few weeks Herbst says some positive signs are allowing front line staff and administrators at the hospital to catch their breath, loosening some rules that should also affect how patients recover.

A clear sign is the announcement that visitors are again being allowed in non-COVID patients rooms as of Oct. 19. Again, you can thank testing. “We understand the importance of having a loved one with you during hospitalization. We are taking measured steps to safely bring back visitors at our downtown campus for admitted patients,” Herbst said. The visitor must remain in the patient’s room during their visit. A loved one who is visiting should have no symptoms of illness and must not have had a recent positive COVID-19 test.

And those COVID related emergency room tents will be coming down says Herbst. Another sign of change – the hospital board of directors has had several face-to-face meetings instead of virtual.

Herbst says while COVID shut down much of the activity at the hospital construction continued on the expansion of the emergency room and will now be completed in April. Space for ER patients will be doubled.

Meanwhile COVID also did not stop construction of the fifth and sixth floor of the Acequia tower that opened now offering surgery on the fifth floor and neonatal care on the sixth.

In the midst of plenty of bad news there were several pats on the back this summer as Kaweah Delta was named one of the 250 best hospitals in the U.S. as well as one of the top 50 cardiac care hospitals in the nation, now affiliated with the Cleveland Clinic.

Also, this summer the hospital’s medical education program graduated 35 young residents and brought on 47 more. Herbst said during the past four years of the program 260 new physicians began practicing in the area as a result of the residency program that is now affiliated with USC. That’s big news in an area that has trouble attracting new physicians to settle here.

Also, in the past few weeks the hospital was notified it would get a grant to expand its outpatient behavioral health program that will now move forward with better outpatient psychiatric care.

Back to the future

Herbst says perhaps the biggest sign that the worst may be behind us is news that the board will again look to the future and “re-engage our architects from the firm RBB to begin meeting with staff and the hospital’s community advisory group in November.” The goal is to revisit plans to replace the Mineral King wing rooms. That discussion, like the rest of non-pandemic activities was put on hold when COVID hit.

Last winter Los Angeles-based RBB Architects proposed Kaweah Delta’s next hospital tower could be built in the shape of huge triangle up to eight floors tall—a design modeled after a structure to be built at the UCLA Medical Center. Hospital leaders had been meeting with the architects since 2018. Herbst says a large tower or perhaps two smaller phased towers could be built on the Downtown campus west of the existing Acequia tower.

COVID has not eased the deadline for seismic upgrades of California hospitals set at 2030. For years the hospital has been trying to convince the state to let up on the standard even as it struggles to get widespread community buy-in since the multi-million-dollar project requires a local general obligation bond to pay for part of it. A few years ago, Kaweah Delta’s bond request failed at the ballot box—something leaders do not want to repeat.

The pandemic stopped the recent planning process that was well underway early this year—how to replace the 1960s Mineral King wing and its 224 beds that do not meet the standard and must be replaced just nine years from now.

Discussion of replacing the Mineral King wing’s 224 rooms is caught up in  the hope the state will postpone that 2030 replacement deadline and now a bill is being discussed in Sacramento supported by the state hospital association.

We hate them too

Herbst admits that replacing the wing’s small pie-shaped rooms is a top priority anyway and not best for patients.

“We understand that people hate them and we hate them too” he joked.

To replace these rooms, “We have to come up with an affordable plan” offering flexibility and a phased approach.

One more piece of better news, Herbst said they are anticipating a light flu season because of the widespread need to wear masks to stem COVID.

As more people adjust to the reopening of medical services, they are less fearful to get the medical attention they have been putting off and getting the care they need. Still the district’s out-patient clinics are still seeing fewer patients and the ER this year will see about 70,000 patients—down from about 90,000 last year. Herbst said part of the answer is that people are not out as much where they may fall and break a leg or suffer from a car accident because fewer are traveling.

From a business perspective, this is important stuff. Consider that Kaweah Delta infuses nearly $1 billion into the local economy each year, according to a recent study. When the hospital sneezes Tulare County’s economy gets a cold.

Helping the hospital look long range without checking over their shoulder is an expectation that even though financial losses will spill over into next year, Congress already passed more stimulus funding that has not been spent to backstop hospital ledger books with a new round recently announced.

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