Q&A: ‘This Is What We Do’ – Rural Health Center CEO on Providing Care During a Pandemic
KC Bolton is a U.S. Army veteran with almost three decades in active service as a former planner for the military. “If the president says we need 5,000 troops in Afghanistan, there’s a guy like me going, okay, 5,000 troops, where are they going? What sort of medical resources do they need?” he told me during our interview about his background.”How do we connect the dots and create an evacuation system and all that kind of stuff.”
Now based in Douglas County, Oregon, Bolton is a CEO at Aviva Health, a Federally Qualified Health Center (FQHC). With 10 locations, Aviva plays a crucial role in delivering healthcare services to its rural community. “The health center…it’s kind of like a one-stop place for a rural community to get their care. And we’re non-profit, which means we can get donations and give people tax write-off,” he said. “And so we can’t turn people away based on their income … We’re designed to fill that gap or the safety net of a healthcare clinic. And have access to federal funds. It’s not a guarantee, we have to compete for them. It’s a grant competition, but we’ve been very, very successful.”
Across the United States, FQHCs collectively constitute the largest healthcare system in the country.
But I sat down across the virtual table with KC Bolton to talk about yet another hat he wore during the last 18 months or so. As the pandemic was spreading across the country in the spring of last year, he was tapped by local officials to help coordinate the county’s response to the crisis.
His experience in the military and his team at Aviva Health have proven a match for the circumstances. Although no longer working for Douglas County, he is still involved in tackling the ongoing crisis alongside other institutions and healthcare organizations in the county.
Our conversation sheds light on the challenges and frustrations of responding to the crisis with dwindling resources, mounting misinformation, and more unknowns than ever before.
The following interview was edited for length and clarity.
The Daily Yonder: If we could just start with you briefly introducing yourself and describing the roles that you’re currently playing.
KC Bolton: I’m the CEO at Aviva Health. I was asked to help lead the county’s Covid response team back in March of last year did that, in earnest, for the first 90 days or so of the Covid response. And then we really dialed it back. I was technically still the guy kind of helping coordinate things, but recently, around January or shortly after we got the vaccines when we started doing some of those mass events, the county decided there’s light at the end of the tunnel in terms of needing the emergency response mode.
And so we disbanded that team in its original form, which is really designed to do crisis sort of stuff. And so I reverted back to using my organization versus trying to connect the dots with other resources. However, in my role as the CEO here at Aviva, we still reach out and work. It’s very similar to what I did when I was at the county. We’re still, as a community, responding to the outbreak.
Connecting the Dots
DY: Could you describe to me the experience of coordinating that response effort and how it evolved over time? I’m curious to put it through the rural lens because we are a rural community, we have certain challenges that many urban areas may not have.
KCB: Gosh, I could talk, you know, a lot’s happened since March of 2020. I guess what I’d say from a rural lens is that, first of all, I don’t work for the county. And so it’s pretty unusual to ask a private citizen to come in and be detailed and work on the county staff and really have some authority—although it’s not real authority, I mean like influence if you will—over resources. I answered to the commissioners, the county commissioners. So there wasn’t unfettered authority, but it’s still, bringing in an outsider like me, is unprecedented.
I was a planner for the army. If the president says we need 5,000 troops in Afghanistan, there’s a guy like me going, okay, 5,000 troops, where are they going? What sort of medical resources do they need? How do we connect the dots and create an evacuation system and all that kind of stuff. So the mindset is very similar. I walked in and was like, ‘Okay, this is a problem I kind of understand, as far as pockets of the outbreak and how do you contain that?’ And so I was brought in and I was honored to do so. But it was like drinking from the fire hose. So the first three or four days at the county, I almost slept there. We were just so concerned as we started running the numbers, frankly, one of the models had us, had the hospital getting slammed, like it did recently with Covid, around April 14, 2020, if the numbers stayed the same and we didn’t flatten the curve, that’s what the modeling suggested.
And so we felt really good about all the things that we put into play that avoided that at the start and the response capacity, having the hospital [Mercy Medical Center] beyond the team. And one of the things that it’s important to do, as far as the actual process and the mindset of it, is understanding who’s good at what and then aligning that against your requirements.
So you have kind of this mission set of requirements, and then, okay, who would be good at plugging in and handling that. But going back to the rural piece, you know, you go with the team you have, you don’t have additional resources. At least, you know, we didn’t. Recently the state helped, accounting for the Delta surge, but back then it was like every person for themselves mode. So you go with what you got, and that includes bringing in, you know, a retired guy to come in and kind of run your team.
And so I was matching resources to align them against their best fit against the requirements to respond to the pandemic, starting off in a planner mode, like who’s best at it. And then I had to shift over and then make phone calls and go, ‘Hey, are you willing to do this?’ Because I didn’t have any real authority to tell Evergreen [a local clinic in Roseburg, Oregon, county seat of Douglas County] you need to be the community’s cough or fever clinic and use your urgent care in such a fashion, because they’re a privately owned for-profit clinic, right? So there’s no authority just because the commissioners formed this team or whatever, you still have the realities of the business world to work around.
But the community responded really, really well. All the different things that I thought were key elements in the response, even something that we put into play, worrying about the clinical staff and their fatigue and resilience in handling this pandemic. We actually set up a hotline for medical providers, getting burnout from the process. But that’s an example of something that the public doesn’t really know about.
The Fort
KCB: The whole time the most important resource that the community had and has is the Mercy Hospital. You know, at the end of the day you try to prevent the “commie horde” from coming over the hill and taking over your fort, but once they’ve kind of got over the hill… you’ll be trying to delay them or redirect them, but once they found out what your fort is, and they’re going to attack your fort, you got to shift and then defend the fort.
The fort is the Mercy Hospital. So we did a lot of things to keep people away from the hospital. I don’t mean that negatively, but really filtering demand, capacity, really redirecting as much as we could. And here recently that triage at the emergency department, that ER capability that my team set up where we worked adjacent to the ER and put one of our mobile clinics there, which, by the way, the county purchased for us.
So I had a team there kind of pulling it off, we ended up redirecting about 25% of the traffic that was going into the ER. That helps. I mean, you didn’t have people that had Covid as much, you still had some people who probably have Covid sitting in the ER, waiting to be seen, but the ones that you are pretty sure had Covid, you pulled them away and then they got treated separately. And so they’re not exposing people sitting in the ER. So it really does help the system by eliminating someone coming in to the ED or the ER, that was the plan.
DY: I wanted to ask about vaccinations because I know that there was a lot of collaboration between Aviva and Douglas County, and why do you think it stalled. And if you have experiences with people who are reluctant to get one, I’d like to get your insight as to why that may be. Why [are] folks are so hesitant or flat out hostile to the idea that you would get that lifesaving drug?
KCB: Let me go back to the mass vaccinations. [The Drive-thru vaccinations idea] was kicked around at the start of this, but we weren’t sure because the vaccines were so new. We didn’t know how people would respond after the shot. We didn’t know if that would be safe. We think it is now, by the way, which is why a lot of things have switched to drive-thru. You just have them go and park and they wait. But you know, when you’re talking, like doing 700-plus people in a day, stay in parking, because then you maybe get them through very efficiently through your drive-thru thing. And then it all bottlenecks at the parking area while you have to have them wait 15 minutes, and then that backs up.
The team did wonderfully. We had community volunteers that we reached out to that we knew. And by the way, it was also cool that we could vaccinate them early because, you know, there were so many restrictions with the starters and it was frustrating as hell. I mean, honestly, you know, telling people you can’t [vaccinate them] and knowing you have the vaccine, but it was so precious. Each drop was precious back then.
And that’s why the fire department did a great job. They just did wonderful having a call list. Like, ‘Hey, we just opened a new vile.’ Then we did the same thing. I mean, everyone did that. You have a little shortlist of people. You start off with your team. That’s how we vaccinated our staff. We didn’t have a special staff vaccination day per se. We would open a vial and then we’d pull folks in. And we did it in a very controlled way, but it was still not this one day we vaccinated all.
That’s good stuff ‘cause that doesn’t waste that vaccine. But you know, now we don’t do that. We don’t worry. Now, are we wasting vaccines a little bit? Sure. But, you know, there’s plenty of supply in the United States. So because of all the cheetah flips we had to do to not waste that vaccine, that was really slowing down our ability to actually provide normal health care.
Three-in-One
KCB: So, you know, there’s always a trade-off. Folks are like, ‘Well, why haven’t they finished vaccinating?’ Because we’re also doing normal healthcare and we’re responding to a pandemic. You understand? We’re really doing like three major things at once. Normal healthcare, pandemic and vaccinations with the same workforce. So this is why when the national guard was sent down here from the state that was super helpful for the hospital.
I’ll give you one vignette.
There was a bypass machine, which is a breathing machine. We actually use some of those that are two-way, they’re bilateral ones. So it’s not as invasive as a full ventilator, like in an ICU, but it does help people breathe. You know, there were a couple of those in Salem and what Mercy would have done is send one of their staff to go pick that up to bring it down overnight. They sent the national guard folks and Dr. Jason Gray was telling me ‘Hey, that saved one of my staff, four hours driving to Salem and coming back.’ You know, that’s just one example. But when you have the same people doing the same thing for three major missions, that’s super problematic. And that’s why some of this stuff was carried out so long.
Vaccine Hesitancy
Now, about the vaccine hesitancy. First of all, it got politicized and I don’t quite understand that. And you know, I am a registered Republican, if that means anything for this interview.
So as a precursor to what I’m about to say, the Trump administration established Operation Warp Speed to get the vaccines out. It should get some credit. Maybe not as much as some folks think he should get or they should get, but it should get some credit for fast-tracking these vaccines—which are, in my opinion, a modern miracle. They’re super effective.
So give him homage, don’t steal away that great accomplishment by you not getting the vaccine, because if you do that, that gives Biden [credit] or whatever. This has nothing to do with politics. It should be a decision that is one that you make, just like any other healthcare decision. You should go to your provider, a provider you trust, you should talk to them about it.
In context, it is irrefutable. Vaccines are amazingly effective. And you know, I don’t know what the ingredients are in it. Look, you had a hot dog for dinner last night. You don’t know what the ingredients are but you ate it.
The truth is you just don’t want to get the shot. Don’t try to justify it with science or logic. Cause you can’t, you’ve made it political for whatever reason.
By the way, people who get the shot shouldn’t weaponize that either, right? It’s a personal choice. I get it. But you know what? If you care about society, you should take the shot. And as a soldier, a retired soldier, I put myself in harm’s way for this country. I’d do it again. If people want to really honor veterans, they should go get vaccinated because we did our part down range. You can do your part here in the community and get vaccinated. That’s a great veteran’s day gift for all of us veterans.
DY: Is there anything I didn’t ask that you would like to highlight for me?
KCB: I just want to make sure that the public knows that the health care system is still plugging away. There’s still a pandemic. Maybe we don’t have the surge piece, but we still have the vaccination piece. We’re trying to do your normal healthcare. This is what we do. This is what gets us up in the morning to serve our citizens and take care of them. So, you know, as crazy as it sounds, I’ve had some moments of fun doing this because you get to do what you do and take care of your fellow citizens. It feels rewarding