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Hot Springs unveils new medical clinic

Monday, April 8, 2013

by Vince Devlin of the Missoulian

HOT SPRINGS – Git-'r-done? Here in Hot Springs, they already done got-'r-did.

When the town's new physician assistant, Nasreen Keyl, applied to Clark Fork Valley Hospital for the job last year, she had no idea it would soon come with a brand-new medical clinic until she interviewed.

That fact alone didn't convince her to leave her P.A. job in Wyoming after she was offered the position.

"When the CEO told me," Keyl says, "I did a little research. I wondered how they were doing this, who's footing the bill."

When she discovered the lengths the people in Hot Springs were going to in order to construct a new clinic for their community, "I was sold," Keyl says. "It speaks volumes about this area."

You could be excused if you questioned the likelihood that this small town of 550 folks on the eastern edge of Sanders County would be successful in raising the hundreds of thousands of dollars it needed to replace its dilapidated medical clinic.

After all, they kicked off their fundraising effort by loading up about 50 old washers, dryers and dishwashers sitting outside a local repair shop and hauling them to Missoula to recycle as scrap metal.

It was labor-intensive, time-consuming, and netted them all of $550.

At that rate, all they needed was approximately 30,000 more old appliances to recycle, and they'd be where they needed to be. In a town of 550 people, that shouldn't take long, right?

Well, it didn't.

Last week, just a year and a half after that first load was hauled away, Keyl began seeing patients in the brand-spanking-new Hot Springs Family Medicine Clinic.


It's quite an improvement over the old one, where wheelchairs left unattended would roll away on sloping floors, ceilings sagged, the foundation was crumbling, doors were warped and nurses had to juggle which patients were assigned to what exam rooms based on which patients were hard of hearing – otherwise, anyone nearby could hear medical personnel shouting information meant to be private through the thin walls.

Given the amount of money that had to be raised, and the rapidly approaching deadline they faced to get it done in order to hold onto a community block grant from the state, it's quite an accomplishment.

Of course, every man, woman and child in Hot Springs didn't magically produce 55 used appliances apiece to be recycled before the deadline.

What the "Tired Iron" project did do, eventually, was collect roughly 34 tons of scrap metal to recycle – everything from abandoned cars to box springs – that was good for a few thousand dollars and, more important, a lot of publicity.

It wasn't your typical spaghetti feed or silent auction fundraiser – though they left no stone unturned, and did those, too – but the scrap metal portion of the fundraising efforts caught people's attention. USA Today tossed a paragraph about it into its state-by-state national roundup.

Suddenly, they were getting donations from as far away as Florida, New York and Mexico.

But the most important ones came locally. Barbara Gonder of Hot Springs was an early supporter, with a $5,000 check.

Then Arlee resident and Plains businessman Marvin Rehbein read about "Tired Iron," and thought to himself, "Boy, that's a long road, picking up scrap."

He considered offering to help with some sort of fundraiser through Rehbein Ford in Plains, which he owns with his nephew Wade.

Then he thought, shoot, he'd just write them a check himself.

"We were thinking maybe $1,000, $2,000," said Sharon Flesch, one of the fundraiser organizers who "just about fell off my chair" when Rehbein wrote them a check for $25,000.

The surprises weren't done. Not long afterward, Rehbein called again, and told them the more he thought about it, the more he figured he could afford to do more.

So he wrote another check, for another $25,000.


Pacific Steel and Recycling of Missoula, where much of the "tired iron" was taken, was so impressed by the lengths the folks in Hot Springs were going to, it threw in a $1,000 donation – and then Pacific Recycling centers in Kalispell and Great Falls did the same.

Rocky Mountain Bank in Plains donated 22 new chairs to help furnish the clinic, and pointed fundraisers to Revett Minerals, owner of Troy Mine, and its employee community giving program. That garnered a $10,000 pledge.

When they were still short and the deadline for keeping the community block grant was just days away, Barb Gonder wrote another check, this one for $50,000.

"The majority of it happened because of news coverage for 'Tired Iron,' " Flesch says. "I've had people around the country call to ask if we'd taken out a trademark on 'Tired Iron,' because they want to use it for their fundraisers."

Have at it, she tells them, and answers questions about how to tackle a 68,000-pound fundraiser.

"I think one of the most interesting things we got was an old cement mixer drum" off a cement truck, says Laurence Walchuk, a member of the Eastern Sanders County Hospital District Board of Directors. "We got it on a trailer, but really, it was just this big empty space."

So they filled the drum with everything they could find and fit into it – wheelchairs, crutches, copy machines, bicycles, metal fence posts, barbed wire, computers and more, Walchuk says.

In Hot Springs, where four out of five people have incomes considered low to moderate by the U.S. Census Bureau, donating scrap metal was a way most everyone in town who wanted to could contribute to the new medical clinic.

Whether it was tossing an old toaster or rusting hot water heater onto one of the "Tired Iron" trailers, or participating in one of the many other fundraising efforts, Sharon Flesch estimates that 80 percent of the town's residents had a hand in raising money for their new clinic.


The facility has gone from 2,200 square feet to 3,775, and was designed so it can expand to the rear if demand ever warrants it.

Nurse practitioner Sally Baskett visited the site during construction, and asked one laborer what room he was working on.

"He said it was the staff break room," Baskett says he told her. "I just started laughing out loud. The idea of having a break room for the staff was just bizarre to me."

Keyl, who came from Guernsey, Wyo., to replace longtime Hot Springs physician's assistant Al Shear, never saw the old clinic. But she did "get" to work three months in the temporary one, when patients were seen in a former real estate office and a trailer hauled in and parked outside to provide exam room space.

"It was an adjustment," Keyl says. "What made it easier was the staff here, who were all so supportive and helpful. As dysfunctional as that environment was, they made it easy."

And now, to have this new building with its physical therapy department and an actual nurses' station – "I'm just blown away," Keyl says. "Since we've moved, I'm 100 percent more productive and effective."

In the old clinic, nurse Paula Stobie fashioned together a nurses' station out of two old bookshelves, and a lab area out of two corner cabinets for 15 years.

"The windows frosted over on the inside every winter, and we were always catching wheelchairs rolling across the floor," Stobie says. "Now everything is so clean and professional – we don't have to apologize to the patients anymore. They were very patient for a lot of years."


It took more than rusting farm equipment and car bodies to make it happen.

Sharon Flesch's husband, Ray, the chairman of the hospital district, says the Confederated Salish and Kootenai Tribes went out of their way to help the hospital district lease – for $1 a year – an empty lot next door to the old clinic owned by the tribes. That gave them room to construct a much larger modern facility.

The Hot Springs Telephone Company donated time, labor and equipment to help with the heavy lifting of the "Tired Iron" project.

The town had to overcome several setbacks along the way, Flesch added, starting with the loss of a federal appropriation of $300,000 that U.S. Sen. Jon Tester, D-Mont., had worked to obtain "when Congress cut back on earmarks," to an initial round of bidding on the project where none of seven contractors came within $100,000 of what they had available to spend.

Back to the drawing board they went, tweaking this and cutting that. Western Interstate of Missoula won the second round of bidding with a number the hospital district could live with.

Once the papers were signed, things flew. By the end of the day after the papers were signed, the dilapidated old clinic had vanished from its downtown location, and the new one was started on the same site.

The $900,000 project, guided by James Rexhouse and Jen Kreiner of the Sanders County Community Development Corporation, came in under budget and way ahead of schedule, and the corporation is now anxious to tackle similar projects for other entities.

Money was saved in a variety of ways. Rexhouse worked with the Montana Department of Revenue to waive a typical 1 percent construction tax Western Interstate had worked into its bid. The town of Hot Springs didn't charge for its part in project management.

The community block grant, which is federal money distributed by the state, required the replacement and burial of propane tanks on nearby businesses. Mark Russell, who is contracted to serve as city attorney, was hired to draw up the legal work surrounding that.

Russell did so, but never billed the district for his time.

That allowed Rexhouse to shift the money budgeted for those administrative costs and taxes into construction, and as a result, the Hot Springs Family Medicine facility will now have a concrete, rather than dirt, parking lot out back.

They're pretty proud of their new medical clinic in Hot Springs.

They should be. Most of the town helped build it.

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