Emergency treatment: Oilfield work, traffic pushing more people to Watford City ER
WATFORD CITY — Dr. Donita Diamond came to western North Dakota from Detroit to get away from crime and kids showing up in her clinic with bullet wounds.
But after five months in the trenches of the McKenzie County Clinic and the hospital’s emergency room in Watford City, she said she doesn’t feel any safer.
“We have people come in here because of all the drugs here. We constantly have to call the police because we can’t lock the hospital down and we’re here alone at night, and we’re all women here. … It’s more threatening.”
With the influx of workers to the oil-rich Bakken, emergency rooms are seeing more cases involving drugs and alcohol, injured oilfield workers and traffic accidents that are taxing hospital personnel and administrators trying to hire more help and collect payments from patients they may never see again.
Like other hospitals in the region, McKenzie County Hospital has seen a dramatic rise in ambulance runs and ER patients. In the 2014 fiscal year, which ended June 30, emergency visits to the 24-bed critical access hospital more than doubled from 2011.
From 2006 to 2013, ambulance calls jumped by 748 percent, and a 317 percent spike in trauma patients took place between 2006 and 2012, said Tom Nehring, director of the Division of EMS and Trauma at the North Dakota Department of Health.
Mercy Medical Center in Williston and the Tioga Medical Center in neighboring Williams County saw their ambulance runs increase by more than 200 percent.
Tioga’s hospital saw a staggering leap in trauma patients by 1,125 percent. Mercy had a 373 percent increase.
“(Tioga) had very low numbers at the beginning. Now the numbers have become pretty significant,” Nehring said.
‘The last frontier’
When Dr. Gary Ramage and his family arrived in Watford City nearly 20 years ago from Saskatchewan, the population was 1,250, he said. The ER averaged 15 to 20 after-hours cases (after 5 p.m.) per month, and Ramage recalls a wonderful time in what he says was “the last frontier.”
“Now we have exciting times and incredible challenges. We see the same number of cases in a day as we saw in a month,” he said. “(We see) three oilfield accidents per day. Every week we have motor vehicle collisions, heart attacks, strokes and a full gamut of everything you’d see in a big city emergency room.”
The “massive, unabated influx” to the area has brought with it drugs, violence, sexually transmitted diseases and alcoholism, Ramage said.
During her weekly 48-hour shift in the ER, Diamond said about 30 percent of her cases are drug related. The requests for prescription drugs such as vicodin and oxycontin tapered off once she realized they were a ruse to get high or feed a habit.
Watford City Police Chief Arthur Walgren, who took the helm in April after serving as New Town’s police chief, said substance abuse poses a significant problem due to the easy availability in a city in which the population is now estimated to be between 12,000 and 20,000.
Walgren said prescription drugs are the No. 1 culprit, followed by marijuana and methamphetamine, with heroin not far behind.
“If you can think of it, it’s here. We get a lot of overdose calls for prescription drugs. It’s less reported, people don’t think of them being totally illegal,” he said.
Danger in the oilfields
Two-and-a-half years after arriving from Mississippi, radiology manager Kendrick Rayburn said Watford City is not the little western town he imagined when his grandfather mentioned the oil boom.
He said 50 percent of ER visits are oilfield related: fingers crushed or cut off, extremity injuries, burns and pressure burns. Patty Berger, a nurse who travels to and from Nebraska, has seen “a lot of nasty rig accidents” in her three years at the hospital.
Dr. Abdul Jahed, who travels from Maryland to Watford City to work 36-hour shifts, said his worst case was two months ago when an oilfield worker came in with a severe head injury.
“He was working on a pressure pump, hit him and threw him up (30 feet),” Jahed said.
The worker was transferred to Bismarck and pulled through, he said.
‘We’re a 24-hour city’
The North Dakota Department of Transportation estimates that 14,000 vehicles travel through Watford City each day, with traffic sometimes backing up for miles.
In 2013, the number of fatal crashes in McKenzie County nearly doubled from 2011, according to the NDDOT.
Traffic safety, Walgren said, is among the top three issues facing Watford City. With lengthy rush hours, infrastructure trying to catch up and a steady rise in accidents, the risks are real.
“We’re a 24-hour city. The sheer volume of vehicles — people from a rural area are not used to this. … You don’t have the availability to make mistakes around here,” he said.
While traffic accidents are sending more people to the hospital, it also prevents some older people who may be afraid to drive to receive medical care, said Ken Hall, community researcher and evaluator with the Center for Rural Health at the University of North Dakota. There is a fear they may later wind up in the emergency room because they’re not getting preventive care.
Cycle of debt
Some patients also skip clinic appointments and show up in the ER to avoid being charged for an office visit. Some patients have no insurance and others have out-of-state Medicaid, Diamond said.
Such practices have contributed to the ER being a money-losing operation.
In March, the hospital decided to rein in an ever-increasing bad debt level when it became apparent the ER was a major contributor, Chief Operating Officer Michael Curtis said.
“The trajectory we were on was insolvency,” he said.
The hospital began to pursue upfront collections (insurance co-pay or a deposit for the one-quarter who are uninsured) in non-emergency cases.
“We should be collecting somewhere in the neighborhood of $30,000 a month for the ER. We’re at roughly $15,000, which is a lot better than $0,” Curtis said.
Certified nurse assistant April Davis, wearing salmon-colored scrubs, has worked in the ER for three months. She and her husband, a truck driver, moved from Arkansas about a year ago.
“I love it, nice country, nice people,” Davis said in a honeyed drawl. “I love my job. I take my job seriously.”
On a recent morning, Berger and Davis started at 7 a.m., admitting seven patients in three hours. One woman, tears streaming down her face, appeared at the nurses’ station saying she was a diabetic and had run out of insulin.
Berger and Davis ushered her into an exam room and quickly looped in Jahed, the doctor on shift, and a care plan was set in motion.
Jahed is among eight to 10 temporary physicians who work on rotation to bridge the gap in patient care. An increased patient load fuels a need for more staff that is in short supply.
“All health care providers in the Oil Patch are facing unprecedented challenges with a high demand for their services, but also struggle to have enough providers and staff to meet that demand. They’re struggling with kind of a perfect storm with workforce issues,” Hall said.
Two of CEO Dan Kelly’s top issues concern recruiting and retaining employees amid the high cost of housing and an inability to compete with oilfield wages.
“For an employee making even $20 per hour, they cannot afford a two-bedroom apartment that rents for $2,400 per month,” Kelly said.
Setting the course
In June, Watford City residents voted overwhelmingly to increase a sales tax for two new facilities, including a 120,000-square-foot McKenzie County Healthcare Systems facility that will combine the hospital, clinic and long-term care facility into one central location.
The $59 million medical complex will include 10 ER bays, 18 primary-care patient rooms and 12 specialty-care rooms. Curtis said the layout would be far more efficient and provide treatment for more patients with fewer staff.
“This sets a course for the next half a century,” Kelly said at the June 27 groundbreaking.
The hospital project is financed with a variety of sources, including a $39.2 million loan from the U.S. Department of Agriculture’s Rural Development agency, a $12.5 million loan from the Bank of North Dakota, community sales tax dollars and private fundraising.
Some community leaders, however, think state government should play a bigger role in lending support to hospitals in oil-impacted counties. McKenzie County alone accounts for nearly a third of the oil being produced in the state, according to the the most recent state statistics.
“The top two counties, McKenzie and Mountrail, accounted for 55.2 percent of all oil produced. … Many of us in McKenzie County believe that we need a greater portion” of state spending, Kelly said.
He echoed other leaders in McKenzie County calling for 60 percent of the state’s gross oil production tax to be returned to the oil-producing counties. Currently, 25 percent is returned to local governments in oil counties.
Ramage bristled at the state’s shortfall and said the lack of reasonable rent and shortage of single-family homes was known as the “Bakken surcharge — on everything.”
But still, there is hope.
“I’m optimistic, excited about new challenges going forward. I look forward to new the health care facility — proud of all the work the community has done to make it happen,” Ramage said.