Booneville Community Hospital Resilient, Promising on Arkansas Medical News Inc.

Booneville Community Hospital Resilient, Promising

By: JENNIFER BOULDEN

Posted: Monday, October 13, 2008 4:37 pm

Booneville Community Hospital Resilient, Promising

New Hospital First Phase of New Health Complex

"In Booneville, they do it differently."

That's something of a saying around the small Logan County town at the foot of Mt. Magazine, said Booneville Community Hospital CEO Dzaidi Daud. "What's more," he said, "it's apt."

Booneville, with a population of 4,117, has its eccentrics and eccentricities just like any small town, Daud said, but the city has a history of being uncommonly open to change and to service institutions other towns might not welcome. In 1909, for instance, Booneville became home to the Arkansas State Tuberculosis Sanatorium, treating more than 70,000 Arkansas tuberculosis patients over the next 63 years. That facility is now home to the Booneville Human Development Center for people with developmental disabilities.

Similarly, the old Booneville Community Hospital facilities, now replaced with a new hospital opened in July, will soon be home to a 10-bed psych unit and a 15-bed transitional behavioral crisis center.

These new developments at Booneville Community Hospital are only a small part of the major changes and progress underway for the critical access hospital, but they represent a hefty percentage of the good news 2008 has brought the town, a year that struck it a giant economic blow.

But one of those things they do differently in Booneville is refusing to give up.

Tragedy and Growth

On Easter Sunday, a series of explosions broke out at the Cargill Meat Solutions plant, where 800 area people worked, about one-fifth of Booneville's citizenry. Anhydrous ammonia fumes from the hazardous chemicals involved necessitating an emergency evacuation of the town, including the hospital's patients. When the smoke cleared, Cargill decided the devastation to the plant was too extensive. It would not reopen.

The news might have been too much for many small towns, but Booneville had a bright new hospital under construction that became a symbol of the town's progress and trust in the future.

For a while, it had looked like the hospital, which serves a 40- to 55-mile region, might have to close for good. In 2003, when Sparks Health System of Fort Smith discontinued its satellite relationship with Booneville Community Hospital, the hospital's board of directors and leadership got serious about finding a way to keep the hospital open. No one wanted to buy it because the facility, built in 1961, was cramped and outdated.

Opening Rural Clinics Selfless Priority for Booneville Hospital

One of the striking things about Arkansas, Booneville Community Hospital CEO Dzaidi Daud said, is what he finds along the roads between the major destinations.

"There are all these sad, forgotten little towns," he said. "Their heydays have gone, but the people are still there, and they have no local health services."

Daud said Booneville Community Hospital, though understandably preoccupied with its own reinvention (see main bar), has entered into talks with the small towns surrounding Booneville in Logan and Sebastian counties about opening rural health clinics there, staffed with a Booneville physician assistant, for the towns' residents.

Some of the towns discussing the option are Hackett, Charleston and Magazine, though Daud said there are more possible and some that have already decided they didn't need their own clinic.

"That's fine if they don't want us to open one; it's their choice. We just want to see where there might be a clinic needed, wanted, and see what we can do together to make it happen," Daud said.

The first such clinic opened in September in Lavaca, population 1,825. Lavaca is located about 30 miles from Booneville and 20 miles from Fort Smith.

Daud said that in town hall talks, it became clear Lavaca needed its own clinic. "Yes, they're only 20 minutes from St. Edward in Fort Smith, but going to an ER and waiting and then going through town for the pharmacy and everything else, that 20-minute trip for the flu can last several hours. We heard many stories like that," he said.

It had been more than 35 years since Lavaca had had a clinic, though they had been clamoring for one for years. Daud said the locals stepped up to make rent and rates affordable for the clinic, offering several services at cost.

Daud said that because they have no stockholders, the clinic does not have to be profitable. "If we can find a way to break even and meet a community's needs, I'm happy."

He said it is very important to him that the towns feel these clinics are theirs, that they are not beholden to Booneville. The Lavaca clinic, for instance, will not have Booneville's name prominently visible anywhere except on the state licensing certificate. "It's Lavaca's clinic. It needs to have their name on it," Daud opined. "They asked, 'What hours will you be open?' and we told them, 'What hours do you need? You tell us what you want this clinic to be. It's yours.'"

The hospital also will try to give local businesses work whenever possible, choosing local phone service, sign makers, lawn service, and so forth.

He said that, like clockwork, whenever he starts these discussions with towns, he always sees the same expression on at least one person's face: what's the catch?

"I tell them there's no catch," said Daud. "If we take care of these little towns, indirectly they will take care of us."

He explained that keeping the surrounding communities healthy helps control his hospital's beds and patient load.

"If they all came here, we couldn't handle them," he said. "And they aren't obligated to be treated here. If 100 people come to a clinic and only two of them end up coming to Booneville Community Hospital, that's great. They can go to Sparks or St. Edwards, fine with us. We are here to serve."

It was clear Booneville needed an entirely new hospital, so leaders began working. Eventually, in 2007, they secured the largest grant awarded by the U.S. Department of Agriculture to build a new rural hospital.

The $18 million new hospital, built by ECI Constructors of Fayetteville and Russellville, sits directly next to the old hospital. Visually, the contrast between the two, the future versus the past, is striking.

Chief Medical Officer William R. Daniel, the hospital's medical patriarch over the past 37 years, said seeing it erected and functional was the answer to a long dream he'd had for the community.

"It's an institution the people here can be humbly proud to have serving the area.

A job well done," he said. And the staff, well, they just think it's the cat's meow."

They now have twice the space — 48,000 square feet from 24,000 square feet before — and the quality and planning of that space is an exponential improvement on the hospital's previous digs.

Daud said that the department heads painstakingly worked with the architects to design a hospital with space and intuitive workflows that would accommodate their specific needs. Whereas before, imaging had to be done in an 18-wheeler parked behind the hospital, the new 16-slice CT scanner is now in the same building. Technology and software were updated with digital functionality and automation of key administrative processes. The 25 all-private rooms are large enough to be divided in two in times of emergency. The hospital now has a second operating room, two negative air-pressure rooms, continual monitoring rooms, and nurses' stations located strategically between the emergency department, nighttime rural health clinic and inpatient rooms to maximize staff coverage and flexibility.

In short, every aspect was greatly improved.

The Five-Year Plan…

At the hospital's dedication ceremony in July, Andy Daniel, MD, chief of staff at son of William R. Daniel, told guests, "Booneville has experienced tragedy and loss recently. It is at a crossroads. If it is to stay on the straight and narrow, then good things need to happen again like the new hospital."

Doing its part to make sure good things keep happening, Booneville Community Hospital has a comprehensive and bold five-year plan for the institution.

That five-year plan has five remaining components: a Dr. William R. Daniel Continuing Education Center, a Community Wellness Center, a mission to achieve status as a National Center of Excellence for Rural Health Care, the new Behavioral Health Unit in the renovated old hospital and a comprehensive telemedicine program.

The Continuing Education Center and Community Wellness Center will share a building, to be constructed behind the new hospital by the end of 2009. Daud said the area has a deep need for local continuing education resources, as physicians and staff often must take a week or two off before the deadline to travel for their education credits. Soon, he said, the hospital will have the ability to provide continuing education for all the community's healthcare professionals, including physicians, nurse practitioners, physician assistants, RNs, LPNs, dentists, and mental health professionals.

The Wellness Center will be more than a fitness center, with a holistic cadre of public health services for area residents. Such services include cancer screenings, diabetes education, heart disease education, support groups, blood pressure and cholesterol checks, pregnancy classes and other such initiatives.

Daud said his hospital is working with Centers of Excellence in areas such as pneumonia and heart care to learn their performance benchmarks and how they achieved them. "We want to do whatever we need to do to meet those benchmarks in Booneville, and hopefully exceed them," he said.

Western Arkansas Counseling and Guidance Center approached Booneville about renovating the old hospital for an inpatient psych unit because Daud had a background in mental health as he came to Booneville from Harbor View Mercy Hospital in Fort Smith. With Fort Smith hospitals St. Edward Mercy and Sparks Regional Medical Center getting out of the psychiatric business, Daud said the need for increase psych beds was dire.

"The 10 inpatient psychiatric beds we'll have is just a drop in the bucket, but the surveys showed, that in a 34-county region, there are only 24 beds. They will definitely help," Daud said.

The partnership between the hospital and the guidance center is the first of its kind in Arkansas, in fact, in a three-state region, he added.

"We are also planning a Crisis Residential program to provide transitional care between inpatient and outpatient care," Daud said. "Patients will be able to stay overnight or come in, but the treatment will be more structured and intensive than ordinary outpatient, less so than a full inpatient."

He said Governor Mike Beebe had met with the hospital and shown much interest in supporting the mental health partnership.

"It's a problem everywhere…where do we put mental health patients? They take up enormous staff time and resources," Daud said, "so this program may be a model for how we can address those needs on a community partnership basis."

The telemedicine program, in partnership with UAMS, will enhance every new service at Booneville Community Hospital. Daud has plans to use telemedicine extensively, from continuing education, to clinical and psychiatric consults, to helping meet performance benchmarks and promoting public wellness.

"Whenever our local resources hit a brick wall, we can use telemedicine to talk to someone at Sparks, UAMS, the Mayo Clinic, wherever," Daud said. "In certain clinical cases, having an expert consult available within a matter of minutes makes all the difference, such as with stroke patients where recovery is so dependent on the timing of the care."

…And Beyond

Daud said the hospital is currently recruiting for one physician, with a husband and wife team joining the hospital next year and a UAMS matching grant graduate coming to the community in 2011.

On top of all that activity, Booneville Community Hospital is also working with surrounding communities to establish clinics in their city limits, often for the first time in decades (see related sidebar, pg. 3).

Furthermore, once the five-year plan is complete, the USDA would like the hospital to open an assisted living center in the new health complex. Daud said they were conducting the initial plans and feasibility studies for that center.

The new hospital has already added about 40 more employees in the past year, with about 75 full-time jobs expected to be created by the behavioral health unit and transitional crisis center. A new employer, Rockline Industries, is opening a plant in Booneville, which will bring 200 jobs to the town over the next five years, and Daud said several new small businesses show signs the town is recovering.

"We will make it. People here have a tendency to say, 'Why not?'" Daud, who hails from Saudi Arabia, said. "They can be surprisingly open-minded. The people of Booneville want progress and have an unusual willingness to accommodate change, so we want to do our part to reward their trust with good services that take care of the community."