Early this month, as the Butte County Public Health Department prepared paperwork that convinced Gov. Gavin Newsom’s office that the county could accelerate reopening plans, Public Health Director Danette York sent another request to the state.
Pointing to the same information regarding the county’s coronavirus outbreak, which at the time was the smallest per capita in the nation, York sought permission to shutter the federal medical station set up the previous month at Enloe Rehabilitation Center—putting the beds and equipment in storage, ready to redeploy if required.
May 12, the governor allowed Butte County to implement plans to reopen businesses more extensively than any other county except El Dorado. Concurrently, California’s Emergency Medical Services Authority (EMSA) approved plans to pack up the medical station.
County Supervisor Tami Ritter, in discussing the reopening plan with the CN&R, expressed concern about those overlapping developments, saying that “the timing seems ill-conceived.” She questioned why Public Health, which administered the medical station, didn’t wait two weeks, since COVID-19 can incubate up to 14 days, before closing the field hospital.
Short answer, according to York and Enloe CEO Mike Wiltermood, is that county health leaders feel the hospitals have the capacity to handle a surge.
That assessment will have to stand, because the medical station is no longer here.
After initially supporting the proposal to store the “pack” on-site, EMSA informed York that the state would reclaim the medical station. An Air National Guard corps moved it out, and Enloe relocated its Outpatient Therapy Services back from Chico Sports Club last week. The county would have to request the federal facility’s return.
“It was a surprise to me to get a phone call that the state made that decision, but I support that,” York said told the CN&R by phone Wednesday (May 20), “because other parts of the state may see a larger surge than we ever do and they may need it immediately—and it can be mobilized quicker if it’s centralized.”
At the time York made the request to the state, Butte County had 18 coronavirus cases, a figure that had held steady over a two-week span. As of Friday (May 22), in under two weeks, that number nearly doubled to 34, still with no fatalities.
“Overall I’m not surprised to see an increase in some cases as two things happened,” York said. “As we reopened up a little bit and as we gained the capacity for testing, we expected more cases to be found, and that appears to be happening. It, to date, has not really affected our plans that would require tightening back up, but we are watching those metrics closely to make sure that we do not need to do something different.”
Wiltermood also monitors the data, as one of six members on the county’s health panel that guides reopening plan policies. (He serves with York, Public Health Officer Dr. Andy Miller, Public Health scientist Linda Lewis, Oroville Hospital CEO Robert Wentz and Orchard Hospital CEO Steve Stark.)
Speaking with the CN&R at his Enloe office Thursday, Wiltermood said the three hospitals “felt that, because of the very low volume of COVID-19 patients that we’ve had so far, that we have significant bed capacity—and if there was a reasonably large surge of patients, we didn’t feel that we would not be able to adjust accordingly … to accommodate.”
‘No problem with that’
The medical station, with a capacity of 125, opened April 8 in the event of a surge that the county’s three hospitals couldn’t accommodate. Government officials had selected eight such medical station locations across the state, with Shasta County designated for northeastern California; however, regional health officials decided to split the station’s “pack” in half. Redding and Chico became the sites, with Enloe Rehabilitation chosen specifically because of its configuration as a patient care building.
It was never used.
Meanwhile, Enloe transferred some rehab services into the main hospital and others to Chico Sports Club, which it leased. Wiltermood said finances did not motivate Enloe to seek its facility back, as it expects to receive federal reimbursement for housing the medical station, but rather felt it could operate better—for coronavirus patients and others, even amid a surge—if it could reclaim its ward space within the hospital.
“The big cost to hospitals nationwide has been the reduction in services, the effort to keep beds open in the event of a COVID surge,” he said. “That’s been the huge expense.”
When Enloe conferred with Public Health about mothballing the medical station (having heard Shasta County planned to do likewise), Butte County was ranked last in coronavirus concentration last among 302 designated health care sites mapped by the Dartmouth Atlas Project.
“Our plan initially was, ‘Let’s kind of pare it down initially and see how things go,’” Wiltermood said, a move that was green-lit by state officials. “From that, it just sort of snowballed into a full-fledged removal into the [federal medical station].”
The California Office of Emergency Services (CalOES) announced Wednesday that six of the eight stations would go into a “warm shutdown” and that the state is deploying a federal medical station to Imperial County. That announcement said that the Butte-Shasta station’s equipment “will be staged for future deployment.” (CalOES, which EMSA referred to the CN&R, did not respond with the staging location by publication deadline.)
“We have no problem with that [state decision],” Wiltermood added. “We felt that if there was in an increase in COVID patients, which you might expect a little bit with moving into Phase 2 of the governor’s plan, we would see the train coming. Our experience in Butte County, because we’ve had such a low concentration of COVID patients, is that we actually have some advantage because of our semi-rural nature. We’re not going to get the [amount of] patients that, say Sacramento or some other metropolitan area might get, and we feel we could pivot very quickly.”
Dr. Roy Bishop, a family medicine physician in Chico, is not alarmed by the closure. By email, he told the CN&R that the federal medical station “was built to house an expected flood of COVID-19 patients which has not happened and now probably never will.
“The most COVID patients Enloe had at any one time was four, and the max on a ventilator at any one time was one,” he added. “Of course, in March, nobody knew how bad COVID would be—a lot of hospitals retooled to become COVID hospitals, stopped elective work, and the surge never happened.
“If everyone follows advice on social distancing and not gathering in large numbers, especially in enclosed spaces, then we won’t get that.”