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Montana Critical Access Hospitals Prepare For A Surge They're Now Beginning To See

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Tonya Revier
Clark Fork Valley Hospital in Plains, Sanders County

Since the start of October, Sanders County in western Montana has quadrupled its COVID-19 case count. Rachel Cramer with Yellowstone Public Radio news spoke with a healthcare professional in Sanders County to learn what the rise of cases there and in nearby counties means for the critical access hospital.

Nick Lawyer is a physician assistant and provider informaticist with Clark Fork Valley Hospital in Plains, Montana. His work includes providing general primary care to around 800 kids and adults in Sanders County, making electronic health records more accessible, and monitoring disease in the community.

He says the statewide shutdown last spring gave the critical access hospital time to get enough personal protective equipment, build a new respiratory clinic, write new policies and plan for a possible surge of COVID-19 cases.

“A surge that we’re probably just now beginning to see," Lawyer says.

Lawyer says if hospitals in Missoula and Kalispell fill with COVID-19 patients, he won’t have anywhere to transfer his patients from Sanders County who need specialized acute care -- say, for someone having a heart attack.

“We do have plans in place that if we have to, if there’s not enough capacity in those major cities, we can increase our inpatient capacity by 50 percent, by closing our surgery space down and turning that space into additional inpatient rooms," Lawyer says.

He says they also have a backup plan to close down the clinic and convert that into additional space for more hospitalized patients.

Physicians Assistant Nick Lawyer
Tonya Revier
Nick Lawyer is a physician assistant and provider informaticist with Clark Fork Valley Hospital in Plains, Montana.

"You know, one of the, one of the real secondary burdens of the coronavirus pandemic is not, gosh, you know, the hospitals are full of COVID patients, but rather the hospitals are full, and we don't have room for that critical patient that we would normally see during normal times: the car accident, the heart attack victim, the severe asthmatic patient who has a massive lung contraction because of just their normal day to day lives. So when we talk about strain on the hospital system, yes, we talk about how full the hospitals are because of coronavirus cases. But we're also talking about less room for the normal, urgent and emergent patients who need life-saving care, that might be harder to access because we're all busy with other things, other patients, other critical COVID patients," he says.

RACHEL CRAMER: Do you feel like that message or that understanding maybe hasn't gotten across to a lot of Montanans that ... What you're saying there, that, you know, this is affecting hospitals' ability to treat other emergencies and other basic care?

"I know it's been said I know that I've heard Governor Bullock and his coronavirus response team saying it. We've said it here at Clark Fork. We've said it on Facebook live video posts. I've heard you guys saying it. I do wish and I think it would have been great for us to have been releasing ICU capacity data months ago so that people could be aware of this issue better," Lawyer says.

"There's a lot of people who are hearing, 'Coronavirus is, it's a virus. Most people who get sick will do fine, and so it's being blown out of proportion.' But there are still many people who do not do well and need to be hospitalized. And when they're hospitalized, it's not a short stay. They are staying for extended periods of time because the critical care they need to heal and recover, it takes a long time, and that utilization of resources is high enough that if you fall off your roof or if you have a heart attack, you may not have as easy access to lifesaving care because our facilities are full with coronavirus patients. Now, we've not reached that moment in the state, but we are, we do appear headed in that general direction," he says.

Lawyer says medical systems in rural parts of Montana face additional challenges because they have fewer staff.

"We have, [I] think there are 10 primary care physicians, physician assistants and nurse practitioners, and if two of us get sick or even one person having to quarantine because they've been exposed to someone who's been sick, suddenly you've lost a huge percentage of your medical services. It's the same with nurses. It's the same with respiratory therapists and X-ray technicians. When you see people not taking the coronavirus seriously. It's frustrating for us as medical providers because, you know, we've got a great hospital. We know we can meet the needs of our community. But if the hospital becomes strained either from too many cases or too few employees or workers, it means that people may not be able to get the care they need," he says.

Lawyer, along with healthcare providers across the state, are asking Montanans to help slow the spread of the virus by getting tested if you have symptoms, keeping yourself and kids home if sick, avoiding gatherings of more than 10 people and wearing a mask in public.