Construction is underway at Sunnyview Lane on a chilly Friday morning in October. There’s an unfinished atrium staircase, exposed wires and plumbing, and workers slathering white paint on a hallway wall.
It’s a work in progress, but it’s ramping up quickly into the $40 million first floor of the new Montana Children’s Medical Center, a 190,000-square-foot facility adjacent to Kalispell Regional Medical Center designed to make Kalispell a regional destination for pediatric care and slated to open on May 1, 2019.
In the two years since construction began on the Children’s Center, there have been several high-profile changes for Kalispell Regional Healthcare: two CEO turnovers, the completion of a new ER wing and the $12.9 million Digestive Health Institute, and a federal investigation into the hospital’s compensation and referral practices that resulted in a $24 million whistleblower settlement last month.
Throughout the tumult, the building of the Children’s Center, both in infrastructure and personnel, has continued quietly in the background. Over the past couple of years, the Montana Children’s Center has assembled the largest team of pediatric subspecialists in the state of Montana — 42 physicians who specialize in pediatric medicine ranging from surgery to gastroenterology to neonatal care.
Kalispell Regional leadership has long stated that the construction of a subspecialist-heavy, family-focused pediatric center was an investment in the future, intended to keep Flathead Valley families from traveling long distances out of state for intensive care. Though the new building won’t open until the spring, that future is now, according to the Children’s Center administrative team — Dr. Federico Seifarth, Dr. Courtney Paterson and Kalispell Regional Chief Nursing Executive Teresa Fisher.
“We’re already here,” said Seifarth, a pediatric surgeon who joined Kalispell Regional Healthcare in spring 2016.
“For the first time in the history of Montana, we have a continuum of care. That means that people can walk in 24/7 and have the same high level of care on a Saturday, Sunday, Christmas night or day. And that is new. There have been spotty high-end treatment options in Montana, but never a continuum of people who live here, who work here and who cover 24/7.”
To illustrate what this looks like in practice, Seifarth used the example of a car accident patient; in such a case of major trauma, a child would likely have bone injuries, internal organ injuries, a potential brain injury.
“It takes a neurosurgeon, it takes the hospitalist, it takes the intensive care unit at a 24/7 level, it takes the pediatric surgeons, it takes the nurses,” Seifarth pointed out.
In short, to treat such a case in Kalispell would require a lot of coordination and specialized knowledge. “We have the specialists here on site, constantly, that allow us to take care of these kids,” he added.
Another example of the new level of care is oncology, said Paterson. With the hiring of oncology specialists, “we have kids now who receive all of their care here, in the state of Montana, a lot of it here in Kalispell, and they never have to leave the state, which was unheard of just five years ago throughout the state of Montana,” she said.
THE PROJECT was always meant to be built in phases, the first being the $40 million first-floor treatment center, which expands the room for patients and the hospital’s capacity for the pediatric cases. This phase will include the new neonatal intensive care unit, which is expanding from six beds in one room to a full 12 private rooms, and the pediatric intensive care unit, which will have 18 total beds, six for intensive care and 12 more for long-term pediatric care.
The rooms were designed to prioritize privacy and a home-like comfort, based on feedback from parents in the valley, said Rochelle Mertz, nursing director for Women’s and Children’s Services.
“First and foremost, we need to feel like we’re at home,” she said of the feedback they received. “Secondly, they want to be with their children. They don’t want their family unit destroyed. Which is how they feel. It’s a strong word, but it’s a word we’ve heard from them.”
The central question of design from a patient’s perspective, she said, became “How do we care for the whole family? We do a great job of caring for the child. And now we want to do a great job of caring for the family — the siblings, the parents, the grandparents. What happens to them when they come from Helena, Missoula, Great Falls? We need a space for them. We need to be able to care for them as a whole unit.”
As a result, both the new NICU and the PICU units contain private rooms large enough to fit several sleeping family members with storage space, a family room that feels more hotel than hospital, an internet business-area ideal for parents working remotely, and a laundry facility.
“When you’re focusing on family-centric care, which is really important for pediatrics, whether it’s from neonate up to a grown kid, is how to incorporate the family. How can they be a care partner with you?” said Corrie Casey, manager of the Pediatrics Unit and Pediatric Intensive Care Unit 3, of the design features aimed toward the loved ones accompanying a kid to the hospital — an outdoor play area, more seating and open space for waiting and individual bathrooms for each room, as opposed to the current single shared PICU bathroom.
The private rooms for the NICU are another major improvement the staff pointed to as crucial for better family connection and patient outcomes. As of now, neonatal patients and families gather in one room with six beds. In the new expanded facility, each family will have their own room, with neonatal specialists on hand to prevent families having to travel to out of state for their newborns.
“I’ve had a child in the NICU, and I would have loved to have had the opportunity to stay in a room with my baby, just to have that opportunity to bond,” said Adriane Haragan, a perinatologist at Montana Children’s. “Before we had this space, moms and babies were being separated by hundreds and hundreds of miles, because these babies were flown to Denver and Seattle.”
Clinical aspects aside, the design team — which “talked with everyone from food services all the way up to directors of labs and ancillary services” for input, Project Manager Matthew Higgins said — planned the first floor specifically for children. The furniture will be smaller. The colors have a playful feel, with floor tiles that mock a river flowing through the PICU.
Overall, said Dr. Timothy Stidham, a pediatric intensive care specialist, “I feel pretty strongly that outcomes will be better because families will be more comfortable, patients will be more comfortable.”
THE SECOND phase of the project has the shell and wiring in place but not a set date for full construction to begin. Fisher, Montana Children’s administrator, said this is not because of financial difficulties, but because they are re-evaluating design plans made three years ago, which originally used the space for specialists’ offices and an infusion center.
“We have to go back to the blueprints, we have to make sure we’re even ready architecturally,” she said. “Are we designing it based on current need? So much has changed in three years. For me, it’s not a funding question. It’s programmatic, operational, with my physician partners — what do we need in that space now that volumes have doubled, tripled?”
Fisher said that Montana Children’s anticipates beginning construction on the second floor next summer, with a budget of $20 million, including the oncology infusion center. While the $40 million for the first phase was procured through loans, the second floor will be funded largely through philanthropic donations. “That’s very common” for large pediatric centers, Fisher said.
The third phase is still an open question with no concrete date for beginning construction. It’s “still future needs space,” said Fisher. “We’re waiting for the patients and community to help us guide what we need in that space.” Potential ideas include an operation room or more ER space, she added.
In total, Fisher projected the full costs of the center to be roughly $100 million, though she added that “I’m hesitant to say total cost of project because I don’t know that third floor yet. And I’m really waiting for the families to tell us...if we have a huge request for surgical services, we may have to put in ORs and surgery suites, which are expensive, so it might change the costs. Or we might have families who say, ‘we want more outpatient care.’ The cost will definitely change depending on what we need for that third floor.”
THE ADMINISTRATIVE team acknowledged there’s been some confusion over such an ambitious project in Northwest Montana. The cost, for one, especially in light of the hospital’s recent settlement with the Justice Department and the hospital’s credit outlook downgrade.
Seifarth, Fisher and Paterson said the settlement and investigation process have had no effect on the Children’s Center, and that patient growth will justify the expense.
“I think the growth that we’ve seen in the last two years will absolutely support the new building, and we have a back up plan for when we run out of space,” said Paterson.
According to numbers provided by Kalispell Regional, the hospital saw 25,000 total pediatric specialist visits over 2017 and 2018, and a 47 percent increase in new patient visits across its facilities, including KRMC and outreach clinics. The outreach clinics in Polson, Missoula, Anaconda, Bozeman, Helena and Great Falls saw a 45 percent increase in total visits, while the Kalispell NICU, PICU and pediatric unit saw a 13 percent visit increase this year, with more expected when capacity expands in the new facility.
Seifarth said the growth indicates that “our existence is already justified.”
Regarding the patient base required to support such a specialized facility, Seifarth said “we don’t want to be naive. If you look at a small part of the state, that does not support this facility. But if you reach the population beyond the valley, absolutely, there is a huge need and the population is there.”
The vision, said Fisher, is that Montana Children’s will be a statewide facility in alliance with other Montana hospitals.
“We want to be an excellent community partner for the Flathead Valley and serve our families here, but we also want to provide that service to families throughout the state,” Paterson said.