The newly installed modular hospital units on St. John, named the MKS Interim Health Center, opened quietly to the public Thursday night, marking a milestone for St. John residents who have been going to Myrah Keating Smith Community Center’s makeshift quarters inside the DeCastro Clinic for 18 months after the 2017 hurricanes.
“We basically are providing the whole gamut of emergency care, urgent care services to the residents of the island of St. John, similar to what we were doing prior to the storms,” said Darryl Smalls, vice president of facilities management at Schneider Regional Medical Center.
The 3,000-square-foot modular system sits on the parking lot of the original Myrah Keating Smith facility, which, at 28,000 square feet, dwarfs the modular system’s footprint. In spite of the massively scaled-down operation, the interim facility is well-equipped, according to Smalls.
“Myrah Keating is an interesting facility because we operate as primary-care doctor’s office, an urgent care and an emergency room,” said Nicole Sawyer, a registered nurse who has worked at Myrah Keating for four years.
According to Sawyer, she and her colleagues schedule patients Monday to Friday, but also accept walk-ins and accommodate the ambulances. As it stands, the MKS facility provides health care services to pediatric patients and newborns, and perform minor bedside procedures. Expectant mothers can also get maternal healthcare prior to delivery at the Schneider Hospital.
“We have delivered babies before but we prefer they go to St. Thomas because we don’t have an operating room, so if they need a caesarean section, we also don’t have an obstetrician-gynecologist or a certified nurse midwife so it’s safer for the patient and the bay to go over there,” Sawyer said.
The facility sees an average of 20 patients on a daily basis for a variety of concerns.
The MKS Interim Health Center houses an admitting section with a waiting area and a triage area where initial diagnostic testing is done. Right across the hall, three examination rooms provide a space where nurses or physicians make initial assessments of the patient’s condition.
There are also two observation rooms, and an emergency room that can accommodate up to two patients, like the original Myrah Keating facility had. The emergency room is directly linked to the Schneider Hospital emergency room on St. Thomas, allowing easier collaboration between medical staff on both islands, according to Smalls.
Any emergency cases that cannot be handled on St. John are put on the ambulance boat to St. Thomas. That determination is made by EMS personnel, who man the two ambulances on St. John, and make the decision to take the patient to the island’s health facility or directly to the ambulance boats.
“If the patient is critical, they go directly to St. Thomas. If they’re fairly stable, they come to us,” Sawyer said.
“Honestly, on St. John, we really don’t have shootings. We’re very fortunate for that. But we do get a lot of stab wounds, but we’ve been pretty lucky,” she added.
The modulars also have a radiology room with mobile equipment and a laboratory for diagnostic services. A locked pharmacy room contains a full stock of medication needed on the island, said Smalls, and an electronic, fully-locked Omnicell system linked to the St. Thomas hospital pharmacy that can only be accessed by a registered nurse or physician.
The MKS facility has a full complement of medical staff rotated on 12-hour shifts, Smalls said. The center has three physicians at minimum, with the ability to add a fourth physician if the need arises. At any given time, there are always two registered nurses on duty, one physician, and two patient care technicians who perform lab work, Sawyer said.
Nurses also perform laboratory services outside of the regular lab schedule between 8 a.m. and 5 p.m. Mondays through Fridays. There is also one nursing assistant on duty, a security guard station in the admitting section and various administrative staff.
In the back of the facility is an ambulance bay and a storage area for medical supplies. A 500-gallon fuel tank and generator provides the facility with up to five days of power in the event of a power outage.
The old Myrah Keating Smith Community Center facility, sitting 20 feet away from the modulars, is shuttered, according to Smalls. With metal service doors blocking the front entrance, the only access is through back doors close to the old ambulance bay.
The building suffered suffered significant water damage and is not habitable for patient care, Smalls said. Absent ceiling tiles throughout the facility expose wires and cables, and in some rooms mold has flourished from the lack of light and ventilation and the abundance of moisture. Stacks of old chairs occupy the hallways and old hospital beds crowd the defunct observation room.
Smalls said Schneider Hospital is working with the new Office of Disaster Recovery and Gov. Albert Bryan on plans to upgrade the facilities to code-compliance and harden the structure to mitigate damage if another disaster hits.
“Obviously, that’s one of our biggest goals in reconstructing all of our healthcare facilities … to harden them and to make sure that we don’t endure all of the damages that we did in these past two hurricanes,” Smalls said.
Making the needed hazard-mitigation upgrades may not necessarily mean demolishing the old structure entirely.
“For Myrah Keating, there’s no damage to any of the exterior walls or windows or anything like that. The roofs suffered damages, but we feel confident that with the proper engineering and proper reconstruction … that we can salvage this building and create a state-of-the-art facility,” Smalls said.
Electricity is running in the old Myrah Keating building, and the emergency generators are still working, opening up the possibility of using the space for storage to support the interim facility. Smalls also shared plans to create a hardened space in the old building that would allow patients and medical staff in the facility next door to shelter in place in the event of a disaster.
Smalls said it is difficult to estimate when the old Myrah Keating building can be renovated, but once an architect gets on board, it can take between nine and 12 months for the design phase, and requests for proposals can be sent out even with just 50 percent of the drawings. It can then take somewhere around 18 months for construction to be completed, depending on the extent of needed repairs, Smalls said.
According to Smalls, the goal is to employ an architect by the summer of 2019 and begin the planning. A meeting between key players, including Schneider Hospital and FEMA, is scheduled within the week, Smalls said, and is expected to yield a final report on the damage to the Myrah Keating building and the availability of funding.
“My hope and my wish is within 18 months or less, we can have a brand new, state-of-the-art facility on the island of St. John,” Smalls said.