PINEDALE – Patience remains the watchword for the Sublette County Hospital District (SCHD) as it waits for pieces to fall in place on several fronts – the merger with the Sublette Center, the construction bidding process and a decision on grant money from the Wyoming State Loan and Investment Board (SLIB).
Delays continue to plague the merger process between the SCHD and Sublette Center. The latest revisions to the membership substitution agreement that will trigger the merger were submitted to the Sublette Center’s attorney for review, reported SCHD Chairwoman Tonia Hoffman on Nov. 30.
Attorneys for both parties agreed to a phased approach to the merger in August. Under the membership substitution agreement, SCHD trustees will replace the Sublette Center board of directors one at a time, allowing the Sublette Center to retain a degree of control in the leadup to a full transfer of assets.
The Sublette Center board met on Nov. 29, but was unable to approve the membership substitution agreement because its attorney, Nick Healy, had yet to make recommendations on the latest draft, reported SCHD trustee Kenda Tanner on Nov. 30.
The Sublette Center board of directors scheduled a special meeting on Tuesday, Dec. 6, at 10 a.m. to review the revised agreement and discuss recommendations from its attorney, confirmed board chairwoman Patty Racich on Dec. 5.
On Thursday, Dec. 1, Racich told the Examiner the board remained committed to “moving forward” with the merger.
During the Nov. 30 SCHD meeting, trustee Dave Bell said he was “really frustrated” with the pace of the merger. Drawing out the process was costing taxpayers “millions,” Bell stated.
Hoffman responded that the time lost due to a “slowdown” in negotiations was “quite significant.” While talks between the SCHD and Sublette Center have gone on for years, Hoffman expressed confidence that the entities were close to an agreement.
“I am very hopeful and optimistic that things will happen over the next week and we will move forward with the merger,” she said.
Bell proposed scheduling a signing ceremony between the two entities on Dec. 9 to make a “push” for the merger.
Attorneys initially proposed Dec. 9 as a potential target date to wrap up negotiations, explained SCHD attorney Abbigail Forwood. The date was not intended to serve as a firm deadline, she added.
The “elephant in the room,” according to Forwood, was the SCHD’s “obligation” to build a long-term care facility in order to receive grant money or access funds from its $32-million loan through the U.S. Department of Agriculture (USDA).
In February 2020, the Sublette County Commissioners pledged $20 million to construct a long-term care facility adjacent to the critical access hospital. A condition in the motion was a merger between the Sublette Center and hospital district.
If the Sublette Center continued to “push the ball further down the line,” SCHD attorneys would “re-discuss” the hospital district’s commitments and options in regards to the USDA loan and the SCHD’s deed of transfer agreement with the county, Forwood said.
“I hope we won’t get to that point,” she said.
Forwood advised patience.
“I know a (signed) agreement is out there,” she said. “We will see what shakes loose” over the coming weeks.
Delays in completing bidding process
The SCHD hoped to have a guaranteed maximum price for the critical access hospital and long-term care facility project by late October or November from Layton Construction, the district’s construction manager and general contractor.
A guaranteed maximum price contract places a cap on amount of money the owner will pay its contractor, according to the American Institute of Architects (AIA). This type of contract “keeps projects from endless costs,” the AIA website stated.
The procurement of bids from subcontractors for certain aspects of the project – notably mechanical systems, plumbing and HVAC – remained a “struggle,” reported trustee Jamison Ziegler, a member of the building committee.
Layton and Karl Leuschow, the SCHD’s owner’s representative, were both working “diligently” to keep bids from subcontractors “within a reasonable budget,” Ziegler said.
Layton and Lueschow continued to think outside the box during negotiations with subcontractors, Dave Doorn, SCHD administrator, told the board. He felt confident the SCHD’s team would “find an answer.”
Once discussions between Layton and subcontractors are completed and bids are in place for each component of the project, Layton can determine a guaranteed maximum price for the project.
SLIB – not yet
The SCHD submitted a $10-million grant application for federal health-care infrastructure funds available through American Rescue Plan Act (ARPA) and distributed by the Wyoming SLIB Board.
In November, members of the SLIB Board requested the SCHD “return to the drawing board” and rewrite the grant application to better align the district’s request with COVID-19 relief, said Kari DeWitt, the district’s public relations director and grant writer.
DeWitt told trustees she felt the revised grant application was in “good shape.” The SLIB Board will rehear the SCHD’s request on Dec. 15, DeWitt added.
Community EMS proposal
Gary Wingrove, president of The Paramedic Foundation, gave a presentation to trustees about community EMS programs on Nov. 30.
The Wyoming State Office of Emergency Services contracted with The Paramedic Foundation to study the feasibility of establishing community EMS programs in the state and to assist with deployment, said Wingrove.
A community EMS responder is a paramedic with approximately 300 hours of additional training, enabling them to collaborate with a provider in a clinic and travel to patient’s homes to deliver prescriptions, perform health assessments or conduct follow-up care, Wingate explained.
The concept for community EMS services was hatched in 2005 as a way for rural, isolated communities to expand health care, Wingate said. An international certification board now exists to license community EMS professionals, he added.
Benefits of a community EMS program included the ability to provide health care remotely, reducing 911 calls, Wingate said. Organizations like the SCHD also stood to collect higher reimbursement for community EMS services, he added.
Wingate recommended the SCHD begin the planning phase to establish a community EMS program. The Paramedic Foundation will be on hand in Wyoming through 2023 to help entities create community EMS services, he said.
Hoffman thanked Wingate, stating the community EMS proposal had “real potential.” She said the board needed time to thoroughly review the information provided by The Paramedic Foundation before making a decision.
Hoffman tasked Doorn and Mike Hunsaker, chief operating officer for the SCHD and its management partner, Star Valley Heath, with conducting a financial analysis on the feasibility of establishing a community EMS service in Sublette County.
Health Foundation – go it alone
The Green River Valley Health Foundation declined an offer from SCHD trustees to merge with the Sublette County Health Foundation, Hoffman announced on Nov. 30.
SCHD trustees established the Sublette County Health Foundation in May to raise money and resources for the hospital and improve health care across Sublette County.
Hoffman said the SCHD intended to “move full speed ahead” with the Sublette County Health Foundation on its own.
Trustees passed a unanimous motion to adopt bylaws for the Sublette County Health Foundation on Nov. 30.
The Sublette County Health Foundation was in the process of applying for tax-exempt status with the Internal Revenue Service as a 501(c)(3) nonprofit, Hoffman said. The foundation is still in the preliminary planning phase, she added.
In other hospital district news
• DeWitt reported that the SCHD had applied for $12,865,600 in grants from federal, state and local sources since July. The largest grant application was the $10 million in ARPA health-care infrastructure funds distributed by the Wyoming SLIB Board.
The district has received $279,000 in grant money since July, DeWitt said. The total includes ARPA funds to purchase a new Zoll monitor for EMS. The piece of equipment is used to monitor a patient’s cardiac rhythm in an ambulance.
The SCHD also received a grant from the Wyoming Department of Workforce Services to fund further education for nurses and medical technicians, DeWitt said.
• The SCHD’s cash position was “solid” following the receipt of $584,000 in tax revenue during November, Bell reported. Based on the latest budget released by the SCHD business office, Bell projected the district will “beat our objective” on expenses by $1 million. He thanked SCHD staff for running a “lean” operation and keeping spending within “thin margins.”
• Trustees passed a unanimous motion to continue scheduling board meetings on the fourth Wednesday of the month through 2023.