Alaska Native Medical Center begins expansion of emergency department amid growing pains

The Alaska Native Medical Center in Anchorage has begun construction on a $257 million expansion that will add rooms, beds and space to an emergency department that has long felt cramped.

The expansion was authorized by the board of the Alaska Native Tribal Health Consortium — which operates federally owned ANMC — earlier this year in response to significant capacity challenges the facility is facing, said Valerie Nurr’araluk Davidson, president and CEO of ANTHC.

Those challenges include having not enough rooms or beds for a population that is living longer and has grown significantly since the hospital first opened three decades ago, Davidson said.

In February, hospital administrator Alan Vierling sent out an email to all staff warning that the facility was dealing with “a high rate of admissions that is putting a strain on operations.”

The email warned that non-emergency surgeries were being canceled until the capacity issues were resolved, and that patients were being held in the emergency room while they waited for inpatient beds to open.

Vierling said in a statement afterward that the hospital returned to normal in less than 24 hours, but that similar scenarios could unfold without major infrastructure changes.

There are 70,000 more Alaska Native people living in Alaska now than there were when the facility was built, Vierling said. The hospital serves patients from across the state who often need to travel to Anchorage to receive care.

“If you walk through that facility today, you can see that not only is staff space tight, but so is patient care spaces. In fact, we actually have people who are in beds in the hallway because we don’t have enough emergency department rooms to be able to treat them,” Davidson said.

Many of the hospital’s rooms are double- rather than single-occupancy, “which hasn’t been designed as part of community standards in hospitals since the ‘80s,” she said.

Nearly $30 million of the funding for the expansion came via congressionally directed spending, Davidson said, which was secured by U.S. Sen. Lisa Murkowski.

The expansion will include adding 21 more rooms to the emergency department and will also allow the hospital to expand its behavioral health treatment and surgery recovery areas, Davidson said. It will include an updated ambulance bay with multiple points of entry to allow for more efficiency and faster care, she said.

The current ambulance bay has only one point of entry and “looks like somebody’s garage at home,” Davidson said.

That means that in emergencies when more than one ambulance is arriving, patients need to be offloaded in the parking lot, “which is not the best standard of care,” she said.

The new behavioral health rooms will allow the hospital to better respond to patients in crisis, Davidson said.

“The goal is to get them stabilized, and that requires quiet, typically lower lighting, to try to remove as much stress as possible. But without a dedicated space to do that, it’s really, really hard to bring that stress level down,” she said.

The next phase of the expansion — which the consortium is hoping to find an additional $200 million in funding for — will include adding three additional floors to the hospital’s emergency department to make more room and be able to add a helipad for patients being transported from remote communities; plus dozens more inpatient beds.

The expansion comes at a time when the hospital, which was built in the 1990s to serve Alaska Native and American Indian people across Alaska, has seen major growth in the population it serves, and with health improvements, longer lifespans.

In 2021, the hospital’s emergency department received around 45,000 visits; in 2023 that number was close to 55,000, a hospital spokesperson said. There were 2,000 more surgeries in 2023 than there were in 2020.

And like other hospitals in Alaska, ANMC is dealing with a higher number of long-term patients who would be better served by skilling nursing facilities, but stay in the hospital longer because of a lack of available beds in the state, Davidson said.

ANMC is also planning to break ground on construction of a new skilled nursing facility later this summer, with an estimated completion in fall 2026, Davidson said.

The goal of the expansion is to better serve the consortium’s growing patient counts, said Davidson, who added that ANMC’s growing pains are not new: the 182-bed hospital has half as many beds as the 400-bed Indian Health Services facility it replaced.

“It really shouldn’t be a surprise to anyone that we’re having capacity issues,” Davidson said.

Construction will cause some disruptions to the hospital this fall, according to ANMC: the emergency department entrance will be relocated and some parking areas will be closed. The expansion of the emergency department is expected to be completed by 2027.

Updates on building access and parking will be available on ANTHC’s website.