Final day arrives

LEMMON, S.D. -- Today is the last day the Five Counties Hospital here is officially open for the surrounding communities. The closing is the result of staffing and proper supervision of the 24-hour emergency room, decreasing use of the emergency facilities and increasing costs.

West River Health Services, Hettinger, and the Rapid City Regional Hospital have worked together since 1988 on maintaining staff, services and other facilities for the hospital and combined services in Lemmon.

The hospital is a four-bed critical access facility with a single emergency room. The laboratory and radiology department will continue with the Lemmon Primary Health Care Clinic manned by West River, which has been using those services.

Although the closing results from a combination of things, it is the connection with West River which provides physicians and mid-level staff to support the hospital and clinic that prompted changes. The clinic will most likely extend its hours in the immediate future to accommodate patients, and emergencies will go to the hospital in Hettinger.

How it began

The road to closing began when physicians approached West River Health Services Administrator Jim Long to talk about concerns regarding the ability to supervise the mid-level staff at the hospital.

"The hospital facility was constructed and equipped some 50 years ago and has pretty low frequency use," Long said. "The ability to have current technology and be able to maintain staffing for things like advanced trauma and cardiac life support is difficult there. There were incidents which alerted the physicians to this."

Not going into details about the incidents, Long said the fear was someone would rely on the hospital and emergency room to be fully staffed and lose valuable time going to a place better equipped to help them.

"You can't have mid-level providers without physician supervisors and they (Five Counties) are not an independent provider," Long said. "The physicians who brought this up to me didn't recommend we pursue other providers to cover it because the same concerns would be there."

Five Counties Hospital Administrator Jan Van Beek said the emergency room is open 24 hours a day, but there is no surgeon in town, so most traumas picked up by the volunteer ambulance service go to Hettinger.

"At the emergency room here we do a lot of stitches and X-rays for things like kids falling off monkey bars and that," Van Beek said. "The hospital changes won't affect the rest of our facility and services. The nursing home and assisted living apartments will stay intact."

In fact, the four hospital swing beds will be absorbed by the nursing home facility and will be used for other patient care.

Meetings were held during the summer between the hospital boards and administrators on the impending changes.

Making changes

The first possible changes when discussions began on closing the hospital were to have an urgent care facility and on-call physician in case of emergencies.

"Then that was not considered due to costs and staffing issues," Van Beek said. "There was an original offer working on having the clinic open from 9 a.m. to 7 p.m. Monday through Thursday and 9 a.m. to 6 p.m. Friday."

The clinic has been mostly open until 5 p.m., she added.

Long said the proposal to be open later at night on week nights did not work out. The clinic staff's personal schedules were not conducive to the changes.

"They indicated to me they wouldn't be able to continue with us under those new hours due to their own schedules," Long said. "Replacing them wouldn't be in the best interest of our patients."

Extending hours until 6 p.m. and starting an hour earlier in the morning is now being considered.

"It won't be a middle of the night service, but we want to try to cover things like sore throats and ear aches that arise unforeseen," Long said. "We want to have those times for after or before work and school when people can come in without typical appointments. It's just really trying to take care of the needs of the patient."

For years, the community has depended on the emergency room as more of a convenience clinic, he added.

"On average, we are pretty close to having two doctors at the clinic a day, plus a mid-level provider, with reception and nursing staff," Long said.

The hospital started pretty big with labor, delivery and surgery upstairs, but it has slowly been downsizing, Van Beek said.

"The nursing home was added later and then the assisted living," she added.

West River has been working in the Lemmon area for more than 20 years, Long said.

"When I came here in 1983, we already had a relationship with the Five Counties Hospital," he added. "That relationship has changed throughout the years."

When Long came to the area, the Lemmon facility was leased from the Lemmon Area Medical Association and was operated by Lutheran Hospital and Homes, which later became Banner Healthcare and decided it couldn't make things work, he said.

"It wasn't profitable to operate for Banner and they discontinued being there in 1980 and West River Health Services got involved around 1981," Long said. "In 1988, we couldn't continue operations in the way it was as a hospital and nursing home, so it either needed to be converted into a full nursing home or as a hospital. It was elected to continue with both and partner with Rapid City Regional Hospital."

Counting the costs

Long and Van Beek know cost is always a concern for any rural facility, and the Five Counties Hospital is not immune to the affect of a decreasing population impacting the drop in use of hospital services.

"The number of people and use of the hospital's facilities has been declining drastically," Van Beek said. "In 2001, there were 500 emergency room visits, while in 2006 there were only 280."

People from Elgin, Mobridge, Eagle Butte, Phillip and Sturgis come to Lemmon for health care, she added.

The emergency room sees less than one person a day, Long added. Most people who come to it did so for convenience issues and don't use it as a full emergency room, he said.

The cost of maintaining the emergency room would be significant, around $200,000, Long added.

"Both sides have been paying for the emergency room services for the last several years," Long said. "The cost increased a little this year after McIntosh's clinic no longer shared mid-level support costs with us."

The West River clinic will assume the lab and X-ray services and staff which went with the hospital.

"We will assume those salaries and support, but that will have pretty much zero impact on us since the cost has been shared with Five Counties," Long said. "Our patients were the majority of their volume there. We don't anticipate any huge gain or loss for us or Five Counties, but there will be additional costs to incur in the whole works."

Along with sharing the X-ray and lab, West River and Five Counties also shared the Aero Transit transportation services based in Lemmon for the surrounding communities.

"We'll be assuming a full share from the standpoint of the patients' organization," Long said. "We used to share in the costs of providing the mid-level position for the emergency room, but now we're going to take and retain the mid-level and extend it and other staff hours to be added."

Costs to West River could be around $100,000, he added.

"I think there will be an extra cost for West River to keep a mid-level person there full time, even though by rural health clinic guidelines we'd really only need to be keeping them there for 2½ days," Long said. "By the time we're done paying additional rent for those spaces used for lab and X-ray and the utilities for extended hours at the clinic, our financial cost will increase by $100,000."

Working it out

The hospital was to originally close by the end of September, but an extension was made in order for a fact finding committee involving people in the area to look at what can be salvaged. The committee consists of Van Beek, Perkins County Commissioner Mike Schweitzer, Lemmon City Council President Neal Pinnow and Lemmon Chamber of Commerce Vice President Melissa Reede, who began meeting in early September.

"The basis for us to meet was to look out for the best interest of the city of Lemmon, which is why we put together a group of mostly elected officials and those involved with the city," Pinnow said.

Long is aware there are people in the community who want to see West River do more about the situation.

"We're as squeezed as any other rural provider in the state and there are other places in the region who are in the same boat as us," Long said. "We will try to do as much as we can afford to do. We will try to take care of our patients with the financial means we have."