SUBLETTE COUNTY – After hours of phone calls to reach the bottom line on what codes the clinic at the proposed critical access hospital would be required to meet, the chairman of the Sublette County Rural Health Care District board called for a special meeting and another vote about its location on Monday.
On July 18, the board had just voted, 3-1, with Wendy Boman voting nay and John Godfrey absent, to select its preferred location in the BloomField subdivision. The board and public had just heard from engineers and architects about potential obstacles at the current Pinedale Medical Clinic, including its closure for two to six months – or perhaps longer – while being remodeled to code.
Chair Scott Scherbel told board members Wendy Boman, Chuck Bacheller, John Godfrey and Laura Clark that he received new information – that the Pinedale Clinic does not need to close at all if the CAH is built at that site.
Boman was critical of Plan One Architects and Sletten Construction for not bringing them the correct information at its regular meeting July 18 when they voted on the location.
At the end of the July 23 meeting, the board voted unanimously to reconsider the county-owned Pinedale Clinic site and Pinedale’s adjacent ball fields, giving Boman until Aug. 29 to represent it before Sublette County commissioners and the Pinedale Town Council – which each have two meetings before that date.
The county offered to sell the Pinedale Clinic site, appraised at $10 million, to the district for $4.2 million. Pinedale officials also expressed willingness to consider relocating its adjacent ball fields for CAH expansion with an unofficial estimate of $2 to $3 million.
The day after the board majority voted for the BloomField site, which was priced at $1 million and since dropped to $550,000, Scherbel informed the board, county and town officials that he received “new information.”
“… If our district board had had the information yesterday at our regular meeting (it) may have influenced one or more of the board to vote differently on the location of the hospital,” he stated, adding it was his “obligation” to call a special meeting.
The board’s goal for the CAH is to include outpatient and surgical services for revenue along with emergency, overnight and trauma rooms. The associated clinic would ideally become a provider-based rural health clinic to reap the best federal reimbursements.
Scherbel told the board he just learned that there are no federal requirements for that category of clinic, only state and local codes that it already meets. The 48,000 square-foot CAH design BloomField could be reduced to 40,000 square feet by using existing buildings. The basic CAH construction at BloomField is estimated at $17 million and could drop to around $15.5 million or less at the clinic site.
“We may not have to do the clinic code remodel of approximately $800,000 in order to use the clinic as a provider based rural health care clinic. If this is correct, then the Pinedale clinic remodel with its cost and loss of service for two to six months is no longer part of the comparison equation,” he said.
To become licensed as a CAH clinic, as the design team had proposed, remodeling to a higher standard would be required and federal reimbursements would be lower.
Both the Pinedale and Marbleton clinics are now private physician clinics with freestanding emergency services; the goal is to get both designated as rural health-care clinics, according to Scherbel.
He prepared revised unofficial spreadsheets showing the BloomField CAH and clinic would cost about $27.85 million. The CAH at the clinic (with the original building demolished) is an estimated $33.68 million and the version without demolishing it is about $33.2 million.
Monday, the board generally agreed that cutting $6 million from CAH construction to make up the difference would gut the optional revenue sources and leave just bare essentials.
“We’re talking about a facility that is exactly what we have here with one patient room added,” Scherbel said. “That’s not our goal.”
Boman said she felt the $33-million price tag was “really elevated.” She again brought up the current ambulance’s replacement cost at BloomField for an estimated $1.2 million. Others have said it could be built from future CAH revenues.
Of the new information, Clark said, “I am very very happy here we don’t have to close the clinic down but it is $6 million over what we submitted to the USDA. … The only thing to reconsider is if the Town of Pinedale would give us the ball field and the county would give us the clinic.”
Bacheller agreed that bringing down site acquisition costs is the only way the CAH would work financially at the current clinic site.
Scherbel cited several conditions he feels should accompany the possible clinic and adjacent field’s purchases, including a net 10-acre minimum, warranty deeds, a town reversion clause and relocation of the large irrigation ditch along the east side of the clinic property.
Citizen Bill Johnson, who supports the CAH at the clinic, said he doesn’t want to see 6,000 square feet cut from the CAH either and suggested making a stronger effort to negotiate with the town and county. “I feel like there’s something here that’s missing.”
Attorney Doug Mason reminded the board that its BloomField purchase option expires on Aug. 1; the board considered another special meeting. He also clarified the special meeting’s motion was to amend the previous action taken at the July 18 meeting.
Bacheller moved to delay the final decision on site selection until no later than Aug. 29 to give Boman until then for further negotiations. Godfrey made a second; the vote was unanimous, 5-0.