3 counties propose using PCF as COVID-19 hospital
By Reed Anfinson
Swift County Monitor-News
Four area hospitals are pursuing a plan to turn one pod of the Prairie Correctional Facility (PCF) in Appleton into a COVID-19 medical center with an initial cost of $1 million.
Called the Tri-County Covid Medical Center it would serve Chippewa, Lac qui Parle and Swift counties. The costs would be split based on county population.
The proposal was presented by Appleton Area Health Services (AAHS) CEO Lori Andreas and Swift County-Benson Health Services Co-CEO Melissa McGinty-Thompson at an emergency meeting of the Swift County Board of Commissioners Friday morning. The other two hospitals involved are Montevideo and Dawson.
County Population Contribution
Chippewa 12,010 $425,977
Swift 9,411 $333,794
Lac qui Parle 6,773 $240,228
Total 28,194 $1,000,000
It is a plan also supported by Countryside Public Health, the regional agency that covers Swift, Chippewa, Yellow Medicine, Big Stone and Lac qui Parle counties.
Appleton’s 1,600-bed Prairie Correctional Facility has sat empty since February 2010 with owner CoreCivic keeping a minimal staff on hand to do maintenance and keep the facility ready to open should the state call for it to house prisoners.
“We let them know that we would fund it,” Andreas told commissioners. “They were very open to it, very supportive and really expressed that they want to support us in this process.”
They are also asking if some of its staff can take the prisoner beds out of the rooms so they can be replaced with hospital beds. There will need to a place for an ambulance to pull up near the pod that is being used for patients, she added.
CoreCivic has been facilitating the group’s pursuit of the prison for a COVID-19 hospital. In an email to the Monitor-News Saturday, CoreCivic confirmed its ongoing conversation with the group of hospitals.
“This is an extraordinary time in the history of our country when the public and private sectors need to work together to find innovative ways to solve the most urgent problems we face,” CoreCivic President and CEO Damon Hininger said in a statement to the Monitor-News. “We see our role as supporting our government partners and the communities we together serve in any way we can,”
“CoreCivic is partnering with officials in Minnesota on a proactive, innovative approach to mitigating the potential impact of COVID-19 in their community,” the statement continued.
“The Prairie Correctional Facility is being provided to Minnesota health officials at no cost – meaning no financial benefit to the company. This is the right thing to do to help meet this critical need.
“The facility will be staffed and managed by health care professionals. CoreCivic will devote a small staff to maintain the building. We’re grateful to our team for helping provide this important public service,” the statement said.
The current plan is to get one of the prison pods ready immediately with 11 rooms. It wants to have those rooms ready by March 30. The facility could be expanded to 77 beds if the COVID-19 spread is greater than anticipated and other counties request to use it, Andreas said.
The facility would not just be for ICU patients but would also include people who are sick but couldn’t be at home.
The Minnesota Department of Health and the Minnesota Hospitals Association have been made aware of the work to convert PCF to a COVID-19 facility, she said. “We are getting the message that they are really impressed with the rural communities taking the bull by the horns and doing what they can to be prepared if the surge happens,” Andreas said.
Swift County’s commissioners have scheduled a special meeting for 9 a.m. Tuesday to vote on the funding. County boards in Chippewa and Lac qui Parle counties were also to vote on the funding.
The group of hospitals was looking for the funds to be approved as soon as possible so they can start converting the prison pod to a COVID-19 hospital immediately. It asked the money be given in the form of a grant or an interest free loan.
“Time is of the essence here,” Andreas said. “This is going to hit soon. Time is not on our side.”
While county funds are being requested to start-up the COVID-19 hospital, there is an expectation that state, federal, and insurance reimbursements will offset all the additional costs of this project, Andreas stated in a letter to the county board.
Prairie Correctional Facility ideal
Last Saturday there was a meeting with the Minnesota Hospitals Association that really started getting people thinking differently about the coronavirus and preparing for it, Andreas told commissioners. It also got them thinking about the potential surge in cases that could be seen in western Minnesota if the spread of the virus is not slowed down.
AAHS is part of the Lac qui Parle Health Network that also includes Madison and Dawson. They have been working with Montevideo on how they can combat the coronavirus if it becomes a worst-case scenario.
The group then reached out to Swift County-Benson Health Services (SCBHS) to include it in the coronavirus team it was forming.
As they discussed addressing the challenge of handling a surge in the number of COVID-19 patients they were looking for a place to convert into a hospital that could separate these patients from other patients that needed to be seen at a local healthcare facility. The obvious place to them was the Prairie Correctional Facility in Appleton, Andreas said.
A group of the administrators and medical professionals toured the prison March 18 to see if it would work. “We really felt it would be a good option,” Andreas said.
The four hospitals would pool their available resources and equipment not required for their own use to stock the prison turned into hospital.
The big advantage of going somewhere we could have patients separated from those in local hospitals is that it would reduce the risk of patients who aren’t infected but still need medical attention from getting the virus. It would also protect the medical staff at each facility, Andreas said.
The $1 million in funding to start up is being asked from the three area counties because of the delays that could happen if the requests have to go through a bureaucratic process.
Kerkhoven is not affiliated with a hospital, Commissioner Eric Rudningen, District 5-Kerkhoven, said. He serves on the Kerkhoven Ambulance Service and asked that it be included in future discussions about the development of the COVID-19 hospital.
If the facility is up and running, then the Kerkhoven ambulance staff would want to do some prescreening and go there if the signs indicated the person had COVID-19, he said.
Gearing up for a surge
Based on how the coronavirus has been spreading worldwide, the number of infections has been doubling every six days. Of the patients that are infected, 5 percent are going to require hospitalization, 1.25 percent would require ICU beds, and 1.25 percent will require ventilators, Andreas said.
What those percentages may mean for the area is that 31 days after it opens March 30 the COVID-19 hospital can expect 34 patients. There will be one patient on a ventilator and one person in an ICU bed.
The staffing at the facility by day 31 would have to be:
- 20 registered nurses
- 20 respiratory therapists
- 8 physicians.
By day 49 (May 19) there could be 258 patients requiring hospitalization. “That is when it gets to be a critical mass,” Andreas said.
By day 67 (June 6), if the social distancing measures undertaken by the state and locally are working, the coronavirus medical emergency could be over for the summer months.
The expenses to ramp up the facility and handle the patients being cared for by day 31 would be $802,601, Andreas estimates. By day 67, the cost would be at $6.9 million. The staffing is going to be the biggest expense since it will involve some contract staff since the local hospitals have to maintain their staffs during the pandemic to care for other patients.
“The cost is significant, we recognize that, but the cost to human life you certainly can’t put a dollar value on,” she said. Andreas also acknowledged that rural Minnesota has a high percentage of elderly residents that are vulnerable to the coronavirus.
“This is our best option for protecting those people and providing the care,” she told commissioners.
While the four independent hospitals in Montevideo, Dawson, Appleton and Madison are not affiliated with a health system, SCBHS is managed by CentraCare/Carris Health.
“We are going to be doing double duty. We are going to continue with our incident command with CentraCare/Carris, but we are also tapping into what our partners in the region are doing, which makes the most sense,” McGinty-Thompson said. She further said that SCBHS fully supports the effort on Prairie Correctional Facility and will assist in any way it can.
We will take the criticism for being proactive
Medical providers in the region are trying to be proactive with this proposal, McGinty-Thompson said. “We are hoping with all the social distancing, the closing of businesses, the limit of public exposure to the each other, that we don’t get to this point. But we have to have something in place because if we get to this point and haven’t done the planning, we are not going to be able to provide the services for the people who are going to need it,” she said.
CentraCare and Carris are not going to be equipped to take all the patients who could be showing up at SCBHS needing care, McGinty-Thompson told commissioners. They are going to be at their capacity. Even before COVID-19, there were times when CentraCare did not have space for SCBHS patients that had to be transferred, she said. That means that SCBHS has to look regionally at what it can do to take care of its patients.
If those COVID-19 patients have to be taken care of locally, SCBHS may not be able to handle the numbers and it would put its staff and other patients at risk, she said.
“This is an instance where we are willing to put our necks on the line to be laughed at down the road because we need this,” McGinty-Thompson said.
There will be FEMA dollars that will be available to help out counties with the expenses they are going to incur in taking care of COVID-19 patients, Andreas said. However, the individual hospitals and clinics are also going to need some of that funding to make up for a significant loss of business. They have now stopped elective surgeries and outpatient services have basically ended. Andreas said she is expecting a 30 to 60 percent decline in outpatient services revenue.
Meanwhile, it is going to take longer to get paid. It could be 70 days or longer for the medical providers to get reimbursed for their services because of the growing demand due to the pandemic, she said.
Too few people being tested
Two tests for coronavirus have been sent from SCBHS to the Minnesota Department of Health with neither verified yet.
Countryside Public Health’s Executive Director Liz Auch said she believes that all of her five counties had sent tests to MDH of possible COVID-19 infections. Andreas agreed, saying she was pretty sure there are people in the area who have the virus.
Right now, the general public is not being tested for the coronavirus because there is a lack of the reagent that is necessary for processing the tests, McGinty-Thompson said. A person who comes in with a fever, shortness of breath and a cough, is questioned on whether or not they have been traveling. If they meet that criteria, they may be tested.
Those who are healthcare workers, or who live in communal places like senior living facilities, are also being tested.
The first test is for the influenza virus because the symptoms are similar. There is still a lot of influenza A and B, and strep going around, she said.
If a person is well enough to recover at home, they will be told to self-isolate. “Stay home. Don’t go to the grocery store. Don’t go visit your family. Stay home. That is really the biggest thing we can stress – don’t congregate with people. If you have to, stay your distance apart,” she said.
Whether or not there is a significant surge is going to depend on what people do today and in the coming days, Auch said. “If we social distance, if we do the things we are supposed to do, it depends on us it is that simple…in the next 11 days.”
Auch told commissioners she had never seen this level of coordination and cooperation between local medical facilities. “When you hear about rural hospitals and critical infrastructure other places, they don’t have available what the Prairie Correctional Facility offers. “This is an incredible proactive concept.”