An incomplete ER

Rapid City Regional Hospital serves not only our city, but communities within about a 250 mile radius with a wide variety of medical services. On Wednesday of this week, Regional opened its new emergency room after a couple of years of construction. There has been a maze of construction around the hospital, including a new parking garage, a new landing area for medical hospitals and an entirely new emergency department. Construction continues with the demolition of the old rehabilitation hospital and additional construction underway to replace those rooms. Additional patient care rooms on the second and third floors of the hospital are also part of the construction plans for the hospital.

The new emergency department has a larger and more private waiting area for families and those needing treatment, an expanded and much more private triage area, additional care rooms and resources. It is a state of the art facility, with video cameras and all kinds of other new technology designed and built into the facility.

The reason today’s journal entry is being posted late is that I spent a couple of hours in the new emergency room this morning. It wasn’t because of any medical emergency in my family. I was there to provide support to another family, who had experienced a traumatic set of circumstances and had special needs this morning. I received the request for help at 4:36 am, just minute after I sat down at the computer to write. I’m pretty faithful to the process of writing the journal, but there are interruptions that cannot be ignored.

So I dressed and headed down to our new state-of-the-art emergency room. While I was there I was reminded of a huge failing in the hospital’s construction plan. It is not something of which I had not been aware before, but once again, something that seems so obvious to me seems to have escaped hospital planners.

While the emergency room has quick access to CT scanners and a MRI machine, x-ray machines, ventilators, defibrillators, surgical suites and a host of other resources, it has no resources for treating mental health crises and no behavioral health tools.

To back up for a moment: Rapid City Regional Health does operate a Behavioral Health Hospital. It is across the city, in a building from which the hospital moved in the 1970’s. It is whatever the opposite of “state-of-the-art” is. The patient care rooms are only slightly remodeled from what had been general hospital rooms. These days there are security cameras and locked doors and other devices to isolate the patient care rooms from the offices that occupy the rest of the building. As it is, the behavioral health unit is nearly always full. It is difficult to find a bed for a patient in need of critical care.

The behavioral health hospital is also in the wrong place. It is across town - a 15-minute drive from the main hospital. Admissions for those in psychological crisis is still through the hospital emergency room, but treatment is across town. Sometimes that trip across town is made in an ambulance, other times in a family member’s private automobile and still other times in the back seat of a police or sheriff’s cruiser.

It is obvious where the hospital’s priorities lie. There are no plans to put a behavioral health unit where it belongs - right next to the emergency room. There are no plans to provide additional care for those experiencing psychological distress. In the hospital’s defense, the costs of such care are staggering. Insurance covers only part of the cost of providing care. Many who come to the hospital in psychological crisis don’t have any insurance or ability to pay. Providing such care is a loss for the hospital. And in health care, as in other arenas of our lives, money talks.

Still, it is not accurate to state that our hospital provides full care for all emergencies who come into the hospital. And, as was illustrated again this morning, it is a matter of life and death. Chronic depression can lead to suicide and failure to obtain prompt treatment can lead to death.

That brand-new, state-of-the-art, only open 4 days emergency room was not equipped to handle the trauma of one who had just witnessed a violent death. That fancy and expensive multi-million-dollar facility didn’t have what was required to support a family who were trying to come to terms with what had happened. They didn’t design private counseling rooms into the facility. They didn’t design private family areas. They didn’t design offices for psychologists. They have surgeons on call at all times, but not psychiatrists. The building doesn’t seem to reflect the latest medical research which scientifically provides absolute links between physical and psychological health.

We, who were there to try to provide some comfort, spent the morning improvising. Law enforcement officers who were conducting interviews and trying to provide support to the family were left with facilities that were a bit newer, but in other ways just as inadequate as the old emergency room. The surgeons and nurses may love their new facility, but for some of the rest of us, it is a huge sign that the planners and architects and engineers were focused on only part of the care of patients. That narrow focus seems to have also restricted the vision of hospital administrators and the hospital board.

We won’t have complete medical care in our city as long as we don’t have state of the art psychological and behavioral health facilities, complete with a fully-functioning emergency room and staff trained in psychological care and suicide prevention. For right now, those seeking treatment are sent to a 70-year-old building across town where the front door is locked and not attended during the night and early morning hours. Those who are suffering crises end up across town in an emergency room that is not prepared for the emergencies they present.

The hospital may have spent millions on construction, but their facility is far from complete.

Copyright (c) 2019 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!