Essentia Health is investing $13 million to expand the emergency department in its Virginia, Minn., hospital, which has struggled financially since the COVID-19 pandemic but remains a key resource for Iron Range residents and Boundary Waters travelers.

When renovations are finished in late 2026, Essentia Health-Virginia's ER will increase its capacity from seven to 12 rooms, including a separate unit of four rooms that are equipped for patients in mental health crises.

Comingling patients with urgent physical and mental health needs can create problems, especially when the ER is full and patients receive triage care in hallways until rooms open up, said Sam Stone, hospital administrator and vice president for Essentia's operations in the northeast Arrowhead region.

"It can be a challenging experience for everyone," he said.

Essentia Health-Virginia is considered by the state to be a financially distressed hospital because it lost money on operations in six of the last eight years. An increasing number of rural hospitals in Minnesota have reached this level of financial vulnerability, especially mid-size, regional hospitals, amid rising staffing and administrative costs.

The expansion won't reverse the hospital's fortunes or draw many more patients, but Stone said it is necessary because the ER sees more than 12,000 patients per year. National guidelines suggest the hospital needs at least 12 ER rooms to meet that demand, he said.

The hospital also operates a Level 4 trauma center, which treats patients with severe injuries or stabilizes them before transport to larger medical centers. Essentia Health-Virginia was a first stop a decade ago, for example, for a teenager with traumatic injuries who was evacuated from the Boundary Waters after lightning caused a tree to crush his tent.

Duluth-based Essentia Health is financing the expansion with support from local donors and the Minnesota Department of Iron Range Resources & Rehabilitation, a public agency funded by mining tax revenue.

Emergency care has been an enduring service for rural Minnesota hospitals, even as they have discontinued services such as childbirths and encountered declines in surgeries and inpatient admissions. In a first, Minnesota hospitals eclipsed 2 million ER visits in 2023, according to state data.

Essentia Health-Virginia has seen a 23% decline in patients admitted to its inpatient beds since 2019, partly because more treatments and procedures can be handled on an outpatient basis, including at Essentia's nearby clinic and urgent care center. But the hospital's ER numbers have remained steady.

Stone said patients with mental health concerns make up a rising share of the ER population, including 20% of all patients transferred from emergency care to other hospitals because they need higher-level medical attention. (The hospital does not have its own inpatient psychiatric unit.)

In addition to the distinct, four-bed mental health unit, the expanded ER will include three general-use rooms that can be converted for mental health care.

The entrance will feature heightened security and an improved triage area to assess patients and the immediacy of their medical needs, Stone said. Wait times at the ER have swung from eight minutes to more than an hour this week.

"It's not [going to generate] additional reimbursement," Stone said. "This is strictly improving our care to the community, making sure that everyone is seen in a timely manner."