The state of the hospital:  Times are changing

APPLING HEALTHCARE’S MAIN ENTRANCE.

By Mary Ann Ellis

The local hospital and all its branches are more or less taken for granted most of the time by most citizens. We know it’s there and we’re glad of that fact. However, if an accident happens or illness strikes at 3:00 a.m., we fly there as fast as we can. In a series of articles, we will take a look at changes that have occurred and beneficial programs that have arrived that most of us don’t know about.

The original Appling County Hospital was built in 1950 from plans drawn up in 1948. It was a Hill-Burton Hospital, a program in which the federal government planned and built hospitals in communities where they were needed and could be sustained. The old hospital is now the Senior-Care Unit. In 2001, it was transformed to a nursing home when the convalescent center was closed and before the Pavilion was built.

The current hospital or Med/Surg is attached to the hall that goes to the Pavilion. The Senior-Care Unit is a geriatric behavioral unit for 65 and up or geriatric lifestyle patients with dementia or some other problems that cannot be handled at home. They can stay for seven to fourteen days. The hospital is licensed for 34 beds, and the Pavilion for 101 beds. It was built in 2008, is the largest around this area, and is genuinely nice. Before COVID-19 arrived, it was full and had a waiting list. The pandemic curbed that trend.

Administration used to be in the hospital where respiratory and ICU are now. Then it moved to the mobile units out back. They kept medical records there too. The business office moved to Main Street at one time, then to the Chris Knox Building, and finally to the old health department building when they acquired it from the county. Half of it contained asbestos and had to be torn down, but the rest is the business office now. About 2016, it moved to its current location.

Brian Westberry said, “In 2014, we added fifteen beds to the senior care unit and a large section to the front of the hospital. We put ER on the front, added radiology, the gift gallery, and expanded the lab. The lab was tiny back then, and we didn’t have an MRI or CT back then. The CT came in ’95 and the MRI is now a permanent structure. I became the director in ’15, and the hospital continues to change. ER stands for Emergency Room, which is what it used to be. Now the Emergency Department has three nurses and a doctor full time. The ancillary staff is there full time. Originally one bed and a place for the family completed the emergency room.”

“Every decision is based on other hospitals around us, too. Alma, Wayne Memorial, Meadows in Vidalia--they all compete with us. We want to be able to bring our people here and take care of them,” said Andrea Graham. “We want to serve our community and have it embrace our hospital. Every three years we do a Community Health Needs Assessment so we can partner with local needs. It’s located on our website and identifies what the major health issues are. We added transportation for the needy as a direct result. Some people had no way to get to doctor’s appointments or services. We added the van so we can go get them and take them back. We know what services we need here and how to concentrate on them. We have cancer, stroke, diabetes, and heart disease throughout the southeast.”

Randy Crawford talked about the new groundbreaking treatment for metabolic failure including diabetes patients, (Type 1, Type 2 and pre-diabetes). Insulin is administered as a hormone rather than a drug. It’s been highly successful so far and has a huge waiting list. They are up to eight chairs now but would have to knock out walls to add more.

Several specialists come in including two cardiologists, a nephrologist, among others. Dr. Moss, a cardiovascular NP, came in March of 2020. He’s a hospitalist. The hospital staff works with them in any way they can.

The next thing to roll out will be the cardio-metabolic clinic. Crawford went down recently and met with a doctor in St. Augustine who has thousands of patients. He tells them to be successful in this program, they must control their weight and stop smoking. One of the problems now is that primary care doesn’t want to take care of heart patients. They need specialists, and these programs can close the gaps. July 19 is the target date for the new clinic.

Crawford said that they design care around things that benefit the community’s basic needs. For example, they manage the EMS for the county and staff it. They even take care of the building.

Jennifer Campbell said the pediatric office sees a lot of the children in the community, usually about 650 to 700 per month. Two primary care clinics - Appling Medical Group and South Georgia Medical - work with the hospital. The staff includes Josefina Abendan, MD; Manuel B. Cuesta, MD; David J. Faulk, MD; Orlando Fernando, MD; Errol Graham, MD; Matt Hodges, FNP-BC; Alivia McMahan, PA-C; Mary Kathryn McMahan, MD; Michael G. Moss, MD; Rachel Peterson, AGNP-C; and Melanie Young, FNP-C.

“COVID has been a struggle for us and has really hurt us,” said Rose Keller, Chief Nursing Officer. “If you look at costs during the pandemic, they skyrocketed. Things are getting better now since our last surge last December to January. We desperately need more help. Right now, we are reaching out to the colleges to do some type of job fair.”

“Our patients were so sick,” said Randy Crawford. “They needed more care or an employee or family member had to be off. We were paying a salary for that time off plus as much as $125 dollars an hour for help. We now have 78 residents in the pavilion where we use to be full all the time. There was and still is, for that matter, fear in the community. It hurt the facility. We were hit hard and early.”

Brian Westberry said, “We have 380 full time employees, about 500 total. We were the hardest hit facility anywhere around, but we did a good job. DNV, our accreditation agency said so. From the time we got our first email to be prepared, we worked hard to get ready. Our first COVID patient came on March first.”

They are now fully staffed but still using some agency nurses. They’ve had a serious CNA shortage during the pandemic. Starting immediately, they will train their own. The certification process has taken a long time, but they’ve completed it now and can even help surrounding counties. The class will be taught at the Consolation building in Pine Grove and a loan forgiveness program is available. They also have Labs for Less in that building. The charges there are significantly discounted. Anyone can use those services, not just those without insurance. Mercy Ministries is there too, but you have to qualify for that service. The staff of the hospital helps with that and with CHAC, a Coalition for a Healthy Appling County.

Currently patient rooms are being renovated to state-of-the-art rooms. Only fourteen remain to be done. All the rooms in the emergency department are already renovated.

In the area of IT and Finance, Gary Gower, CIO, has kept the computer system running since ’85. When Obama Care arrived with all the new rules, they added new pieces to keep meeting the requirements. When Randy Crawford came on as a hospitalist, they were not where they needed to be with that. The system, still a DOS, was not user friendly at all, but Gary along with consultants and contractors kept moving in a positive way. To replace the system would cost $250,000 plus a half million for salaries to set it up. There are no good systems, but that’s the best for us. They’ve worked through multiple programs.

“It’s like peeling back all the layers of a big onion,” Crawford said.

Tyler Avera has brought in another system to run on top of the old one to be the operational intelligence. It’s about forty-five percent online now and all financials are in there and clean. It can pull statistics from the old system, which they need on a daily basis. It will really help when they begin the budget process.

Avera said, “We can see trends. That system will help with clean financials and with looking for a specific expense.”

The topic of finances is super important to this small hospital that put out between three and six million in indigent care for 2019.

Stay tuned. Much more is coming about the Appling County Healthcare System. It’s the very hub of the community when illness strikes.