Eagle Nest mayor seeks hospital for tiny community

The smartest thing Mayor Jeff Carr could do is visit Telluride Medical Center. The Colorado ski town has what Mayor Carr wants, but it is not a hospital. It is what has been called a community clinic and emergency center. I headed the center for two years, and was hired to solve some big problems.

The physical building is first. Telluride’s was donated by the Idarado Mining Company, later Newmont. Early on, the center bought a small condominium unit to house physicians. The facility had a driveup emergency ambulance entrance, a trauma room and x-ray. It once had a generator, but that got sold before I came. But no overnight beds, so we had a helicopter pad for evacuation to Grand Junction or Cortez.

So — capital for the facility and doctors: No doctor, no clinic or hospital, so also permanent physician lodging space.

Now, doctors: Doctors must see to coverage 24/7. As for recruitment, you need a bare minimum of two, and three is more civilized. I had a world-class, jazzy town to help recruit, and free lodging, a free ski lift pass, but even then I had to have nearly half of my shifts covered by locum tenens physicians — that is, short-term slots. Someone, a manager, needs to recruit constantly.

And rural culture: One of my responsibilities was to fix or fire the single, fulltime doctor and medical director.

Now the qualitative issue. The physicians and registered nurses must be emergency- and occupational-medicine qualified and certified: ATLS, ACLS, PALS, radiology, and on and on. And malpractice coverage. These creds do not fall like snow from pine branches.

Now, revenue: There isn’t much to speak of, owing to low and irregular volume. Telluride has a hospital district that has a mill levy, and one problem I solved was passing an increase of $225,000 per year to fill a yearly deficit. So you’ll need a hospital — Taos or Raton — to help with finance and cash flow. I noticed that Colfax County does have a hospital district, and an LTC; that’s good, but the homeowners and businesses will have to vote for a property tax increase.

That brings me back to hospitals — it ain’t going to happen. For a town of 315, like Eagle Nest, you will not get an acute care hospital. But if you adjust your sights, you may get an emergency clinic — but no overnight beds.

One issue I saw right off the bat in the article on Eagle Nest is trying to use medical care to drive commerce. Sorry, that is backwards. First, commerce and population — then, medical care. And Telluride, plus Mountain Village, has a year-round population of several thousand, and a peak population (sorry for the pun) during ski season and summer festivals, of 10,000. But no hospital.

And you have work ahead to educate stakeholders. When I met with the president of Telluride Ski and Golf to bring in paramedic ambulance service at no charge to the company, he refused, because he did not want his customers billed more than $25!