By Reggie Ellis
visalia – Kaweah Delta is planning to build a second urgent care clinic in north Visalia to alleviate overuse of its current urgent care clinic and the emergency room at the hospital.
The 6,100 square foot urgent care medical clinic is planned for the northeast corner of Demaree Street and Flagstaff Avenue, closer to the City’s rapid growth to the north. The office will take up about 1 acre of a 4.66 acre parcel. The remaining three and a half acres is planned for a senior care facility.
The Visalia Planning Commission approved a zone change, parcel map, conditional use permit and specific plan amendment for the clinic at its May 23 meeting. The clinic is part of The Village at Willow Creek Specific Plan to develop 21 acres of commercial, 4.6 acres of multiple family and 1 acre of office space on the northeast corner of Riggin Avenue and Demaree Street. Approved by the Planning Commission in 2006, the plan area is about 65% build-out.
Dan Allain, director of emergency trauma for Kaweah Delta, said the urgent care clinic will operate on the same model as the hospital’s current clinic on Court Street and Paradise Avenue in the old community hospital building. While larger in square footage, Allain said the new urgent care clinic will have about the same number of treatment rooms (15) and have radiology, lab blood draws, EKG tests and some treatments. A second urgent care is needed on north side of town to service the City’s growth area but also to alleviate overuse of its current urgent care and the emergency department at the hospital. Allain said an average of 180 patients per day visit the urgent care this year and the flu season doesn’t even start until November, when daily patient visits can rise to as high as 250 per day. The new clinic is expected to see 75 patients per day who are currently being treated at the current urgent care. Allain said last flu season numbers were lower than average because the Centers for Disease Control identified the correct influenza strain on which to base vaccine mass production.
“Having such an effective flu vaccine every year is not something you can hope for,” said Allain, who’s been in health care for more than 30 years. “They are essentially guessing right now what the dominant flu strain will be and will mass produce the vaccine based on that assumption. The CDC does a great job but there is a lot of guess work so you have to ready for when they guess wrong.”
The problem at the ER is much worse. Legally the ER cannot turn away patients based on their health insurance or ability to pay but does try and redirect patients with less serious injuries that can be handled at urgent care or a clinic, depending on the time of day. But this causes another problem with people’s perceptions of how the ER works. Allain said patients become agitated when someone comes in off the street and is seen by a doctor right away when they have been waiting for hours.
“They don’t know that that person may be having a heart attack or stroke, all they know is that they get to see a doctor before someone else,” Allain said. “In the ER, you are seen based on the acuity of the care. Low level acuity patients will have to wait longer than those with high acuity needs.”
Kaweah Delta’s ER sees nearly 275 patients per day on average. This creates a backlog of care because there are only so many treatment rooms and doctors available at any given time. The average amount of time a patient spends in the Kaweah Delta ER is over three hours and well over the national average of two hours and 15 minutes, according to 2013-14 data from the Center for Medicare and Medicaid Services.
“This is not just a Tulare County or Valley issue, it’s a nationwide issue,” Allain said.
Allain said the problem in Tulare County is two-fold. First, many patients do not have access to health insurance and do not have access to a primary care physician. Second, even if everyone had health insurance, there wouldn’t be enough primary care physicians to see all of the patients.
“We have a severe doctor shortage in the Valley,” Allain said.
Allain said just as important as the construction of a new urgent care clinic is Kaweah Delta’s Graduate Medical Education program. The program offers medical school graduates to complete their residency at Kaweah Delta Medical Center as a teaching hospital. The goal of the program is to not only give residents the experience to be quality doctors but also that some of them will choose to stay in the area after they complete their residency. And it’s already working, as Kaweah Delta just announced that five residents of its initial dozen will remain in Tulare County.
“That is a wonderful program that this area needed badly,” Allain said.
The education component of urgent care goes a step further as Kaweah Delta must inform the public on what types of injuries and illnesses should be taken care of at urgent care and which should seek medical attention at the emergency room. As a general rule, Allain said minor strains, sprains, lacerations, fractures and cold and flu symptoms for the elderly and those with related health concerns (such as asthma) should go to urgent care. For open fractures, severe trauma (such as a traffic accident or falling off a roof), gunshot wounds, chest pains, emphysema or patients who are not responsive should go the emergency room at the hospital.
“The urgent care is really a go-between a primary physician and the emergency department,” Allain said. “But the goal is for everyone to have a primary care physician.”
If a patient in the ER or urgent care doesn’t already have a primary physician, Allain said they are provided with a list of doctors and clinics. For example, Allain said patients may make one or two visits to the urgent care to follow up on the initial medical issue, but could then be referred to Kaweah Delta’s Family Medicine Center adjacent to the hospital or one of its rural health care clinics in Exeter, Woodlake, Lindsay of Dinuba.
“We don’t give them a name of who to go to but we do provide a list of everyone who has the capacity to take on new patients,” Allain said.
Kaweah Delta Urgent Care on Court Street is open from 8 a.m. to 11 p.m. seven days per week and is located at 1633 S. Court St. in Visalia. The new clinic’s hours will likely be shorter, 9 a.m. to 8 p.m., until Kaweah Delta can identify the demand between the two urgent care centers.