Going its own way

© 2018-Sublette Examiner

RHCD votes to acquire land, build own CAH

MARBLETON – More than 40 concerned citizens attended the Sublette County Rural Health Care District (RHCD) Board meeting last Wednesday, after the Sublette County Board of Commissioners’ voted to not deed clinic lands to the RHCD or permit it to build a critical access hospital “at this time.”

That county vote came at a special meeting on April 12.

During the “hospital development” portion of committee reports Wednesday, RHCD board vice chair Scott Scherbel reviewed a statement of the board’s position – also identified as a motion for action – regarding the critical access hospital (CAH).

Since the commissioners did not define what they meant by “at this time,” the RHCD board’s statement addressed how it hopes to move forward with the CAH.

Scherbel read aloud, “CAH designation in Sublette County is the best way to provide the level and quality of health-care services that the citizens of the county desire and deserve.”

With four feasibility studies pointing toward the CAH as the best health-care option to thrive in Sublette County, the board’s position is to stand by its commitment to construct and operate a CAH.

The motion said, “The board’s plan includes the continued operation of the two clinics and EMS. It is also committed to returning 24/7 ER to the Big Piney-Marbleton community if a financially feasible way can be reached.”

After the county commissioners’ special meeting vote against the CAH “at this time,” the RHCD board announced it would build a CAH at the Pinedale Medical Clinic, with a co-location at the Marbleton Clinic, and take a different direction to obtain CAH designation, according to the statement/ motion.

This involves purchasing a 10-acre parcel and preparing a preliminary hospital design and functional plan to the Wyoming Department of Health for a separate CAH building, the statement said.

The motion also said the RHCD board would set a construction budget, obtain construction funding and prepare a request for proposal (RFP) for prequalified architects and contractors, to receive bids.

It would then issue the RFP, hire an architect and contractor, submit construction plans for approval to the Wyoming Department of Health before initiating construction, and be surveyed and licensed to operate as a small general hospital – with subsequent survey and licensing to operate as a CAH.

After Scherbel completed reading through the motion, board member Wendy Boman said she would like the opportunity to meet with commissioners one more time in a final effort to rectify the standoff.

“I think they were put on the spot with the ultimatum,” Boman said. “They still wanted to get the tubes of expenses.”

Board chair Laura Clark said she provided county facilitator Mark Cross with that information, which he requested in January during a work session between the RHCD and county commissioners.

“Cross was supposed to provide that after we sent it to him,” Clark said.

“Apparently they aren’t satisfied,” Boman responded. “Let’s take this stuff to them and say, ‘this is what you wanted; can we talk?’ I think we should go back to the commissioners one more time.”

Scherbel chimed in, stating each time they speak with the county commissioners, new requests arise and that they already made their decision on April 13.

“They chose Wednesday night to make their decision,” he said. “We bent over backwards to give them information. I respect and understand their feeling. … I want to move forward with our feeling and our perception.”

Boman stated, “I would volunteer to get on the agenda at the next (county commissioners) meeting.”

Anderson then spoke up, stating she thought it was time the RHCD board went its own way.

“(County commissioners) have made a decision and made it publicly,” Anderson said. “I respect their decision and I think revisiting that prevents the wound from healing. I think we as a board need to move on. We have waited and have been patient. It’s our job to move on and get health care in Sublette County squared away.”

Trustee Chuck Bacheller agreed with Anderson.

“We have done everything to date they asked us to do and they know our numbers,” he said. “I’m absolutely ready to move on and ready to close that chapter. We need to keep moving. … Let’s move on.”

Following the lengthy discussion, the board voted, 4-1, to approve the statement of position and motion to buy land and build its own CAH. Clark, Bacheller, Anderson and Scherbel voted in favor, while Boman voted against it.

Vice chair Scherbel clarified to the audience that they would still use the two clinics and build a separate hospital portion.

Boman then asked for the board’s blessing to get on a county commissioner’ meeting agenda and make one last attempt to rectify the situation between the two boards. She was told “good luck” by the board, which effectively ended the conversation on the matter until public comment was heard later in the meeting.

Numerous audience members voiced their opinions during public comment, asking the board to give county commissioners one more try before taking the CAH into its own hands.

“People are going to come uncorked,” Louann Heydt said. “The attitudes have to drop. Forgive; if you have been offended, forgive. We are one county. Maybe it won’t work, but we have to do what’s best. The county commissioners need to have caution and we need to try to work together again.”


No emergency services?

Former RHCD board member Cindy Van raised a concern stemming from Senate File (SF) 57 that addresses “freestanding emergency centers” (FSEC) during public comment.

“The way I read this, it looks like after June 30, 2019, we will no longer have emergency services in the county,” she said. “My thought about that is, that’s only if you are an FSEC, which you would have to apply for that licensure and certificate of occupancy as an FSEC. If you do not do that, then you continue to function and provide emergency care we do now.”

Scherbel responded by stating anyone in Wyoming that provides emergency services needs proper licensing following the date outlined in SF 57.

“If you want to provide emergency services, you will have to be licensed,” he said.

“We don’t want to provide emergency services that are reimbursed as emergency services until the critical access hospital is up and running,” Van responded. “Because, right now we’re providing emergency services and getting reimbursed at the rate of a clinic visit. Right now, we’re not licensed as a rural health clinic; we’re not licensed for anything, other than a certificate of occupancy as a clinic. We are providing this robust emergency service without any licensure to do that. Is the state coming in and saying to us, ‘You are providing a service that you can not do?’”

“That’s our understanding, yes,” Scherbel responded. “It’s not the reimbursement that’s the issue, it’s that type of medical service. If you’re going to do emergency care, you’re going to have to be licensed after June 30, 2019.”

RHCD administrator Malenda Hoelscher then spoke up to elaborate on what she learned from her talk with Wyoming Hospital Association President Eric Boley earlier that day.

“They don’t want people doing this very high level care without going through the surveying and licensing process,” she said. “It’s essentially safeguarding people that enter the ERs.”

“Unless you’re going to have the CAH ER opened by June 30, 2019, this is a critical issue for everyone in Sublette County,” Van continued. “Not only do we not have emergency services close by, we don’t have anything for a huge geographic area. I would like to see this issue somehow addressed in the CAH plan of action, so that there is not a gap in service. Whether that is talking to county commissioners about this again and at least getting one of the quote ‘emergency rooms’ ready and able to take care of this issue.”

The reason Van suggested that plan of action is because it will be difficult to have a CAH built and certified for occupancy before June 30, 2019., she said.

Hoelscher was confident that if they show progress in moving the right direction, the RHCD would be fine.

“One of the things we feel pretty confident in is that if we can show that we’re in construction and in the process of making this happen, that more than likely they will take that into consideration and allow us to continue doing what we’re doing,” she said.


Bonuses and contracts

After calling the meeting to order, the board went immediately into executive session to discuss personnel. The board returned shortly thereafter and moved on to a finance report from executive director of finance Lorraine Gatzke. During her report, she asked that the board give a 5-percent bonus to all non-provider employees – after stating that the RHCD will come in approximately $741,000 under budget. The bonuses would cost the district $141,000, she added.

Trustee Boman said she regretfully disagreed with the bonus, as the district can’t afford to keep the Big Piney/Marbleton ER after-hours service open.

“They are doing double duty in Marbleton,” Gatzke responded. “These people deserve some recognition.”

“I agree they deserve it, but what about the community. … It doesn’t sit well with me,” Boman said.

After discussion, Scherbel made a motion to approve the bonuses. Boman then requested to amend the motion to exclude administration from the list of bonus recipients.

The board then voted on the amended motion, with Bacheller, Scherbel and Clark voting against it, and Boman and Anderson voting in favor of it.

The motion died; the board then voted on the original motion to include administration. Anderson and Boman voted against it, while Bacheller, Scherbel and Clark all voted in favor of raises for all non-providers.

In new business, the board approved to contract with St. John’s Medical Center for Hoelscher until her RHCD employment ends on July 31. The contract states that Hoelscher can work at St. John’s, but that her primary responsibility is to Sublette County. St. John’s will reimburse the RHCD for her services rendered. Clark clarified that this does not yet make her an employee of St. John’s.

“She’s still our employee,” she said. “But she will be doing some work with St. John’s.” Boman was the only board member to vote against the extension, saying it was for reasons she stated in the executive session.

The board then approved Dr. Eliz Albritton-McDonald’s contract extension as they need to have an EMS medical director without a gap. Albritton-McDonald is willing to serve in the position for an additional six months while living in Colorado. Clark said she can legally work in the Wyoming position as long as she holds her Wyoming license.

The board unanimously approved the extension until the RHCD can find a permanent solution.

The RHCD board’s next regular monthly meeting will be on Wednesday, May 17, at 6 p.m. in the Sublette County Commissioners Meeting Room in Pinedale.

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