Clark Fork Valley Hospital

photos & story by Amy E. Fox

"Everyone here wears a bunch of
different hats," says nurse Danita Grossberg. "It's usually pretty fast-paced." Grossberg works at Clark Fork Valley Hospital (CFVH) in Plains, Mont. She is the manager of acute care and surgical services, which also includes the intensive care unit, labor, and the emergency room.

Grossberg explains that in rural medicine, health care providers must have more extensive training and the ability to float from position to position.  She recalls a case not long ago when a woman came into the ER who had almost cut herself in half.  Nurses and doctors had to work together to stabilize the patient.  “Nurses in really big hospitals don’t deal with that kind of stuff,” Grossman says.  “They rarely even leave the floor they’re assigned to.” 
         Health care professionals who work at CFVH all have one thing in common:  They like having to wear multiple hats.  Being prepared for any kind of injury, not just those they specialize in, makes work more interesting. 
Dr. Donald Damschen is the hospital’s general surgeon.  He is also the physician at the Plains Family Medical Facility, which is connected to the hospital.  To balance his time between the two, Dr. Damschen sets his surgery schedule for days he isn’t seeing patients in the clinic.  “It’s a 24/7 job,” Damschen says.  “I’m always on call.”  
         Clark Fork Valley Hospital is the only hospital in Sanders County.  It opened in 1971 with the help of Senator Mike Mansfield, who convinced President Nixon to release the necessary funds.  According to Human Resources Director Barry Fowler, when the hospital first opened, it was a for-profit facility.  However, between 1993-1994, CFVH started to run as not-for-profit.  From 1994 to 2004, the hospital was partially owned by Community Hospital and St. Patrick’s Hospital of Missoula, MT.  Finally, Plains took over ownership in 2004.  It is now a not-for-profit hospital that no longer belongs to any corporations.  Aside from running the hospital, there are four small family medical clinics that are scattered throughout Sanders County.  They are located in Plains, Thompson Falls, Hot Springs, and Bull River. 
         By definition, CFVH is considered “frontier medicine” rather than rural medicine because of its size.  The hospital only has 16 beds.  To be considered rural, a hospital must have over 100 beds.  The number of beds in a hospital typically represents the kinds and number of services the hospital can offer.  With its own cardiologist, surgeon, anesthetists, and a full nursing staff, Clark Fork Valley Hospital is far from what one may think of as “frontier”.
         Yet, regardless of the extensive capabilities of the facility, CFVH faces its challenges.  Mainly, the challenges lie in funding and in recruiting.  As Fowler puts it, “challenges come, your meet the challenges.”  In order to meet the challenges of the current economic situation, the hospital has worked hard on not cutting positions, which they have been able to uphold. 
         “We have found ways to be more resourceful,” says Tanya Revier- Marketing Director. “We just switched propane companies and saved over $25,000 that way.  Or if someone leaves the hospital to retire or take a different job, we spread the staff we have to cover the vacant position, rather than hire someone new.”  Another way they have been able to sustain is by offering more services in order to keep people from travelling elsewhere for their care. 
         “We have the ability to give people the care they need from start to finish without having to send people away,” states Fowler.  “Personally, I feel that the economic situation has caused a sort of boom.  People aren’t as willing to travel to bigger hospitals for services we offer right here.  Instead, they come to us, which is what we want.”
         By becoming trauma designated, the hospital is able to get more reimbursement for care they provide in the emergency room, which is the most expensive branch in hospital care. 
         Aside from financial setbacks, hospitals in small, rural communities, such as Plains, face challenges when it comes to recruiting employees. Fowler says that often, finding physicians and qualified personnel who are interested in frontier medicine is not difficult.  “Our biggest problem,” he continues, “ is spousal [sic] location.”   
         When a person is interested in practicing medicine in a rural area, he or she understands that they will need to be more than just one thing, Fowler says.  But usually, the spouse of an interested person will have a more difficult time adjusting to the size of the community and finding a job.  Aside from difficulties in finding a couple or family that are able to adjust to a small community like Plains, finding people who are both able to find full-time work is another challenge.  “In a community like Plains, we really try to be as honest about living and working in this size of a town,” says Fowler.  “We do not want to recruit a family if we do not feel like a small town is right for them because it will lead to problems later on.” 
CFVH is the largest employer in Sanders County.  Finding work in an organization aside from the hospital is difficult. “Finding a family who will be comfortable in a place like this if they are not from a small community is hard, but not unheard of,” says Fowler.
         “The great thing about working in a small community like this is that everyone knows your business,” Fowler says.  “The tough thing about working in a small community like this, is that everyone knows your business.  People have to be prepared for the closeness of a small community.”
         Dr. Damschen says that often, people feel that frontier medicine is often thought of as a lesser practice, as compared to urban medicine.  It does not take a person long to understand that, in fact, the opposite is true.  Physicians and nurses alike are required to have skills that excel far outside the reaches of what is normal in large hospital settings.  It is all about which hat to put on.  


A project by the University of Montana School of Journalism