When Mountain Medical Center in Ridgway got its start 20 years ago as an experiment in rural taxpayer-subsidized medicine, nobody imagined it would one day become ground zero for local testing in a world pandemic.
Community members at that time were faced with losing their only clinic, which had previously been operated by St. Mary’s Hospital. Local voters decided it was important enough to have a doctor in Ouray County that they passed a mill levy to purchase and maintain the building where the clinic was housed, and to subsidize its rent for a full-service family medical practice.
Long accustomed to offering strep throat cultures, sports physicals and blood draws, Mountain Medical is now the only testing site for COVlD-19 in Ouray County. That has been a game changer for clinic staff, who suddenly find themselves donning white hazmat hoods like the scary-looking government spooks in Steven Spielberg's "ET," and inserting 4-inch swabs up patients' noses out in the parking lot.
MMC managing physician Joel Gates says his staff has embraced the challenge.
"Everyone is so ready to jump in and make adaptations, and care for the community with a positive attitude, even with gulps of personal exposure and risk," he said. "I am totally proud of my staff."
Each day at the clinic begins with a team huddle. The staff goes over their upcoming day, even though they know by now that the best-laid plans and schedules are just a bowl of kibble to be knocked over by the voracious pandemic. The end of the day arrives in a messy heap, and never really looks like the tidy little huddle where it started.
As front-line healthcare workers, just trying to handle the call volume of so many individuals wondering whether they should be concerned or not about their symptoms can be a challenge.
"Managing our own internal processes of protecting our staff and our patients and learning how to calm people's fears on the phone was a huge challenge, almost more so than the testing," said office administrator Josey Scoville. "We have spent a lot of time reassuring people that if their symptoms are mild - especially in the beginning when there wasn't a lot of testing available - it's OK to just stay at home and quarantine."
Coronavirus testing at Mountain Medical is done through car visits. First, patients call the clinic and talk to someone who lets them know they need to stay in their vehicle while being tested.
When the patient arrives, a medical assistant in a gown, face mask and gloves heads outside to get the patient's vitals and medical history. Then, a provider gowns up too - the full "ET" treatment and goes outside to evaluate the patient and makes a decision whether to test. Often, they'll opt to do a flu swab first, which takes about 20 minutes to process onsite.
The provider walks that swab back into the building and waits for somebody from another part of the building to come out and get it. They can’t walk through the building with personal protective gear on, because that would potentially contaminate the building.
"So you have to do this transfer to someone who takes the flu swab, and you do the in-house flu test that takes 20 minutes, before you decide that's negative, and now we are going to do the nasal swab for the coronavirus," Gates said.
It’s a cumbersome process, going back and forth between the potentially contaminated testing arena and the clinic, juggling stethoscopes and otoscopes and clipboards and swabs and charts, and trying to enter data on a laptop computer without getting it contaminated. Everything has to be disinfected in the airlock area before it is carried back into the building.
Meanwhile, if a patient arrives with a laceration or non-coronavirus symptoms, the doors are still open for chronic care and management.
A full-time screener stationed at the door checks each arriving patient for symptoms, dramatically slowing how quickly people can come into the office. Only one person at a time is allowed in the lobby, so as not to violate social-distancing regulations.
"It's hard because our day-to-day routine is so upside down right now, and it has been for two months, so we don't know when that change in workflow will ever go back to quote-unquote normal," Scoville said.
Staff at MMH wear a mish-mash of personal protective equipment that has been purchased, donated from the community and distributed through the Ouray County Unified Command. Volunteers sewed washable and reusable gowns for the staff out of shower curtains.
"We go out in colorful designs," Gates chuckled. "I think we have had incredible community support with people volunteering to buy the entire staff lunch, bringing out sweets and cookies and saying, 'Thank you.' The outpouring of support has been wonderful."
The criticism also stings, especially when people are not happy about the availability of testing, which was scarce until recently, and further limited by strict Centers for Disease Control guidelines about who could be tested.
Testing criteria have changed considerably as the crisis has dragged on. Initially tests were reserved for symptomatic people over age 65 with underlying problems, or healthcare workers. In late March, the CDC loosened the criteria to allow a second level of testing for essential workers with symptoms. Now, there is a third level that allows health care providers to use their own judgment about whom to test.
Gates bases his own judgment on the number of tests he has available, and whether that testing would truly change a particular health outcome based on a patient’s symptoms. “If you have a positive coronavirus test, and a patient is saying, ‘My symptoms are getting worse,’ that presents a lower threshold for going to the hospital,” he said.
So far, the COVID-19 outbreak appears to be holding steady in Ouray County. There are currently seven known positive cases in the county, three of which were tested through Mountain Medical.
“For a long time it felt like there was not enough testing to know the prevalence of the virus, but more and more, we are testing now and things are coming back negative,” Scoville said. “We have done nine antibody tests in the last couple weeks. One was positive and the other eight were negative. That is shaping our understanding of the prevalence, in our community. It will take a long time to know how much it was really here or not."
Fortunately, nobody at Mountain Medical has contracted the virus.
"We take daily temperature logs twice a day, and if anyone was symptomatic they would be instructed not to come to work," Scoville said. "At the office we wear masks all day, and we have for eight weeks now. People who are patient-facing wear gloves, and we are making sure we have lots of good hand-washing protocols. When we go out in the community, we are wearing our masks in public. We are trying to lead by example."
The experience has underscored the importance of ensuring there is a local clinic in Ouray County. This is timely, given the fact that there may be a tax question on the ballot this fall to continue funding the Ouray County Regional Service Authority, which owns the Mountain Medical Center building and equipment and leases it to Mountain Medical.
The original mill levy that made the purchase of the clinic possible expired in 2010. The RSA's current 0.25 mill levy, which sunsets at the end of 2020, brings in about $50,000 annually to offset the cost of facility maintenance at MMC. RSA board members will decide in June whether to put a new funding question on the ballot.
"The coordination of the RSA is why there is still a medical clinic in Ridgway," Gates said. "We have seen other practices come and go, and have seen different models come and go. Having a clinic that serves all patients in the county, that's what Mountain Medical Clinic and the Ouray County RSA are about. That's why we have this relationship. It is working. It is what has allowed us to stay afloat."