HSHS hospitals and Prevea clinic closures expected to impact county services

By LeAnn R. Ralph

MENOMONIE — The announced closures of HSHS Sacred Heart Hospital and St. Joseph’s Hospital, along with 19 Prevea clinics in western Wisconsin, will have an impact on services provided by Dunn County. 

The Dunn County Health Department is considering the impacts and will be passing that information along to the Wisconsin Department of Health, said KT Gallagher, director of the Dunn County Health Department, at the January 25 meeting of the Dunn County Health and Human Services Board.

The closures of the medical facilities will have an impact on Dunn County’s emergency response capacity. Dunn County is in the ingestion pathway for the Prairie Island Nuclear Generating Facility, she said.

According to maps available on-line, about three-fourths of Dunn County, except for the northeast corner, are in the ingestion pathway. 

An ingestion pathway is the area within a 50-mile radius of a nuclear power plant where people may be indirectly exposed to radiation by eating contaminated food or drinking contaminated milk or water. 

Stout students 

There will also be access to care issues for students at UW-Stout. 

The Prevea clinic in Menomonie provides support for the student population. Fortunately, HSHS has committed to providing care for the rest of the semester, Gallagher said, adding that with the upcoming closures, however, it may be challenging for Prevea to maintain staff.

There are also concerns about the Dunn County workforce’s access to care, she said.

One Health and Human Services Board member noted that there will be 1,300 HSHS employees looking for new employment and wondered if it would be possible for Dunn County to have a student satellite clinic.

Reaching the Dunn County Health Department would be a barrier for students since there is only one bus per day that comes to the Government Center, Gallagher said.

Gary Stene, county board supervisor from Colfax and a member of the Health and Human Services Board, asked if the closures would have an impact on the drug treatment court program.

The closures might not have a direct impact on the treatment court, but the closures could put more pressure on Dunn County, he said. 

Stene said he suspected the Health and Human Services Board would be receiving requests from several county departments for additional people to deliver services to the residents of Dunn County.

“I suspect we will be talking about this at some length. These impacts are devastating,” said Diane Morehouse, county board supervisor from Menomonie and chair of the Health and Human Services Board.

Therapists

Programs for young families as well as physical therapists and occupational therapists that provide services for Dunn County also will be affected, said Dr. Alexandra Hall, a family practice physician from Menomonie and a member of the Health and Human Services Board.

Partnering with Prevea “has been great” because Prevea bills the insurance companies and is reimbursed for the services, she said.

Some environmental health services are being done in-house because there was a need, Dr. Hall said, noting that she did not want to greatly increase Dunn County’s workforce, but occupational and physical therapy are reimbursed services.

Should Dunn County consider hiring its own physical therapists and occupational therapists? she asked.

“We will be having those conversations. There is lots to consider … the spin-off implications are huge,” Morehouse said.

Birth to 3

Paula Winter, director of Dunn County Health and Human Services, said she found out about the HSHS and Prevea closures when she received notifications about contracts for the Birth to 3 Program.

“But then I thought, wait a minute, what about this and this,” she said.

Dunn County contracts with Prevea for two part-time people for the Birth to 3 Program, Winter said. 

The Wisconsin Birth to 3 Program is an early intervention special education program that helps children under three years old who have disabilities or delays.

Could Dunn County hire someone part-time to do the Birth to 3 Program? If so, what about the person’s other hours if they want full-time employment? Winter said.

Could Dunn County partner with other neighboring counties to hire someone to do the Birth to 3 Program? she asked.

And then there is the reimbursement for services, which is a complicated, too, and involves a number of factors, Winter said.

Human Services is discussing the pros and cons of contracting with other agencies, and the department is working on setting up a meeting with other counties to discuss the issues, she said.

When meeting with representatives for seven other counties, Dunn County will be asking which other counties use Prevea services for occupational and physical therapy, Winter said.

March 22 will be the last day for physical therapy and occupational therapy, so Health and Human Services “will have to sort through” the issue by then, she said.

“I do not want to just react and then find out we cannot sustain it financially,” Winter said.

If Dunn County contracts with someone directly for services, but then that person wants more hours, “then what?” she asked.

There are “all kinds of factors,” and Health and Human Services “is trying to be smart,” Winter said.

Mental health beds

One of the Health and Human Services Board members noted that the closing of inpatient mental health beds would come with the closing of Sacred Heart Hospital.

Winter’s report to the board noted that there are never enough emergency detention beds. When Sacred Heart closes there will be 10 adult beds left in Amery and 18 beds at Gunderson in La Crosse, although those beds are usually taken by Gunderson patients.

Without the beds available at Sacred Heart, Dunn County will have an increased cost for transporting mental health patients to the state hospitals at Winnebago and Mendota, Winter said, noting that the state hospitals have limited space available.

The L.E. Phillips Libertas Center in Chippewa Falls, which provides detoxification and substance abuse services, will be impacted for both youth and adults, and there are no other local resources, she said.

The closing of the L.E. Phillips Libertas Center will result in the loss of 24 detox beds and 18 residential beds, Winter said.

The impacts on families will be significant because their loved ones will be all the way across the state, she said.

The impacts on law enforcement to transport patients to the state hospitals will be significant as well because it takes a full day, round trip, to go to Winnebago or Mendota, and that means a law enforcement officer cannot be doing his or her job here, Winter said.

The Talon Protection Agency provides transportation services to the mental health hospitals at Winnebago and Mendota, but the cost is $600 per trip, she said.

In addition, the impact on the person who needs care will be significant, too, because someone who is in a mental health crisis is not helped by being placed in the back of a squad vehicle and then taken far away from the local supports of friends and family, Winter said.

Youth who are crisis now are taken to Sacred Heart, but youth in crisis will have to go to Winnebago when Sacred Heart closes, she said.

Detox

The L.E. Phillips Libertas Center is going to close almost immediately, and it is the only detox facility in this region, Winter said.

L.E. Phillips has its own medical staff, but if someone is really having a medical problem with detox, it is right next door to St. Joseph’s Hospital in Chippewa Falls, she said.

Arbor Place is not licensed for detox and would need a medical provider, Winter said.

Winter noted that she had participated in a regular monthly meeting with the staff at Arbor Place earlier in the day, before the Health and Human Services Board meeting.

Arbor Place would be open to seeing what the facility can do about providing a detox facility, but funding will be an issue, and Arbor Place will need to find funding for it, she said.

More crises

There also is a potential for an increase in people being in crisis and an increase in emergency detentions when people are not able to receive mental health services locally or are not able to get medication or refills on their medication, such as anti-depressants and anti-anxiety medications, Winter said.

Sacred Heart had sought funding to expand the number of mental health beds. A mental health facility is expensive to run, carries high liability and there is a lack of psychiatrists, she said.

The mental health beds “were not a money maker” for Health Sisters Health System, but the Sacred Heart ward was kept open because of a commitment to the community, Winter said.

No one can make money on in-patient psychiatric care. The market forces have failed, and capitalism cannot address the problem. Government must do what the market forces cannot, noted one member of the Health and Human Services Board.

When Stene asked about the cost for a stay at Winnebago or Mendota, several people at the meeting replied that the cost is well over $1,000 per day.

And yet, no one is making money from the amount charged, Stene observed. 

Winnebago and Mendota, which are state facilities, are often at capacity and do not have room for more people, but they cannot turn anyone away who needs treatment. That’s how youth end up housed in the hallways, Winter said.

Perhaps the closures of St. Joseph’s and Sacred Heart and the Prevea clinics will elevate the issue with the state, she said.

Medication

People in crisis are made worse if they cannot get the medication they need, Winter said.

How are people going to get medication refills for anti-depressants and mood stabilizers if there are no mental health facilities in the area? Dr. Hall asked.

The Mayo Health System might have an appointment available in six months, but someone’s medication is going to run out in three weeks, she said.

Dr. Hall said she was “feeling salty” at HSHS for saying the organization would help people find a new provider.

“WHERE and WHO?” Dr. Hall said.

HSHS and Prevea “are leaving the community in the lurch,” she said.

The Hospital Sisters Health System still has health care facilities on the east side of the state, so could HSHS offer a prescription refill service for six months “rather than making an appointment with someone who doesn’t exist?” Dr. Hall asked.

In a couple of months, there will be hundreds of people in the area who cannot get a refill on their prescriptions, she said. 

HSHS was required to notify the state that the hospitals and clinics are closing and cannot simply drop Medicaid and Medicare patients. The organization is required to have a transition plan, Winter said.

More people will most likely be walking into emergency rooms because they are in crisis or cannot get their medications, she said.

“We need to look at how do we help people,” Winter said.

The Department of Human Services has approval in the 2024 budget to hire a new mental health therapist as of July 1. Maybe there is a way to be able to do that sooner, she said.

Dunn County will have to focus on looking for opportunities. There will be great therapists who will be looking for positions, Winter said.

“We may need to pounce on those opportunities as they present themselves,” Morehouse said.