– A motion pledging financial support from the county “not to exceed $20 million” for a proposed long-term care facility as part of a future critical access hospital died at the Jan. 7 meeting of the Board of Sublette County Commissioners. The motion was contingent “upon approval of the USDA loan” for a hospital and “the approval of the Sublette Center’s board” on a merger or acquisition with the Sublette County Rural Health Care District (SCRHCD). Commissioner Tom Noble made the motion after a lengthy public discussion with representatives from the SCRHCD and the Sublette Center. Dave Doorn, administrative director at the SCRHCD, reported that the district and Sublette Center had not yet reached an agreement and that he hoped to gain support for the project from the commissioners. “Everybody would like to know where the commissioners stand on (the merger),” he said. The motion died in a 2-2 vote with Doug Vickrey abstaining. Noble and Mack Rawhouser voted in support of the motion and Chairman David Burnett and Joel Bousman voted against. Burnett explained that the vote against the motion did “not reflect our intentions to move forward with this project and help to the maximum that we can.” Bousman cautioned against the motion, stating the commissioners needed more public input and assurances that the SCRHCD and Sublette Center “are united and prepared to move forward” before adjusting the budget. The board then passed a unanimous motion introduced by Bousman to “support in concept moving together in a joint effort between the county commissioners, the SCRHCD and Sublette Center to improve the quality of health care for Sublette County citizens and provide a facilitator to bring the entities together.” “This paves the way for us to have more public involvement with the chance to have all three boards come together, open to the public, which is what we have needed for some time now,” Burnett said. The numbers Doorn and Sharon Rutsch, clinical services coordinator at the SCRHCD, provided the commissioners with preliminary reports from Davis Partnership Architects and financial estimates from Eide Bailly. Overall, the project is expected to cost almost $47 million, according to Eide Bailly’s preliminary report. Doorn divided the total project cost between the hospital at $28 million and the long-term care facility at $18 million during the meeting. Doorn told the Roundup that the $28-million figure for the hospital was a rough estimate and included costs for “shared facilities” that both the hospital and long-term care unit will use, such as kitchens and maintenance. The figure reflected the amount the district is qualified to apply for, Doorn said, and is not a final estimate of cost. The preliminary report estimated an increase in annual revenue for the district of around $4 million once a hospital is built. The figure takes into account the availability of more services and higher rates of Medicare reimbursement.The additional revenue is projected to provide the district with almost twice the amount of cash they need to pay the debt service on the principal and interest creating a debt ratio of 1.93, Doorn said. “The USDA is looking for a ratio of 1.5 or higher, so we’re in good shape,” he added. Doorn provided a “conservative” interest rate of 3.7 percent, and said there was a good chance this figure will be lower. The architectural plans include 15,000 square feet of existing space in the Pinedale Clinic, 33,000 square feet for the long-term care unit and 35,000 square feet for the hospital. The plans involve tearing down the building currently housing Public Health, Veteran Services Office and the Sanitation Office. Rutsch said the plan is to house these agencies in the existing clinic along with the district’s administration. Burnett asked if the district discussed the demolition of the county building with the agencies, stating that Public Health or the VSO may have confidentiality issues sharing a building. “I’ve talked to them and told them what might be coming but that nothing is finalized,” Doorn said. Sublette Center and the SCRHCD – still no agreement Doorn reported that the attorney for the Sublette Center, Nick Healy, contacted him last Friday stating that there was “an issue with the SCRHCD’s proposed purchase since the district is not yet a hospital district.” The district’s attorney, Clay Kainer, and Eric Boley, president of the Wyoming Hospital Association, reviewed the statute and found no wording preventing a purchase, Doorn continued. Doorn told the commissioners the district is proceeding as if the Sublette Center and SCRHCD “are going to be one entity.” A merger or acquisition is “very important to health care in the county” with advantages for both entities, he said. “More than that, it’s an advantage to Sublette County residents to be able to have a health-care system that will take care of all their needs, whether they’re elderly or young, that will all be under the same umbrella,” Doorn said. Patty Racich, chairman of the Sublette Center board, said they needed time to discuss the recent legal issues. She emphasized that the Sublette Center is committed to “continuing the conversation with the district” and “moving forward on gathering information.” Dawn Walker, administrator at the Center, added that this is an enormous decision for the center. “The Sublette Center has very much participated in this process,” she said. “We’re an operation that runs on a shoestring budget and we’ve committed a lot of money to legal fees to make sure our fiduciary responsibility is done. At the end of the day, what this represents for the Sublette Center is an entire change in identity. It’s a change in our culture, possibly a change in location. There is no way that our board of directors is going to take that decision and make it without doing their due diligence.” The Sublette Center is still waiting on a “favorable” final financial report from Eide Bailly with “real and good numbers,” Walker added. She also emphasized the need for more public input. “We’ve relied on everybody from the churches to the commissioners to everyone who trusts us to take care of their parents since 1978,” she said. “We’re not just going to throw that away. These decisions take time. But we are absolutely committed to the process.” Racich proposed a possible meeting time between the Sublette Center, SCRHCD and commissioners in February. District board chair Wendy Boman and board member Bill Johnson expressed frustration in delaying the process, and requested an earlier meeting in late January. Johnson suggested the SCRHCD may “go ahead and apply for our loan” to build the hospital before another election cycle comes up – with or without a merger in place. “I don’t think anybody should be upset by that,” he added. “We can, on our own, I believe, get the monies that we need.” “We have waited months and months and months and we’ve answered questions and we’ve gone from one board to the other board,” Boman said. “We can’t wait any longer. We’re going to lose our building season. I really want the Sublette Center involved, but are we at the point where we need to just go ahead with the CAH?” A $20-million motion Noble stated that he made the motion pledging a dollar amount to support the long-term care facility to open the topic up for discussion. The SCRHCD and Sublette Center boards need assurance and support from the commissioners before they dove into the project of building a new health care facility together, he added. “There needs to be a light at the end of the tunnel,” Rawhouser agreed. “If we turn the light on, and all the questions are answered, we’ll help both of these organizations do what’s best for health care in Sublette County.” Bousman expressed his opposition to the motion, stating that pledging a dollar amount was “premature.” He wanted “unanimous support” from both the SCRHCD and Sublette Center boards before he was comfortable budgeting for a sum that large. Bousman also expressed concern that plans did not seem to exist for long-term funding of the proposed health-care facility and encouraged the district wait until budget season. “We’re only talking about building this facility,” Bousman said. “We still need to talk about how we’re going to run it and where we’re going to get the money to operate it. We don’t want to build and then go broke to keep the doors open because we’re not getting enough revenue.” Bousman and Vickrey spoke for the interests of the residents at the Sublette Center. The Center is located in a prime location for residents to “get out and communicate” with the community, Vickrey said. “When a merger takes place, if in fact that’s what it ends up being, where are the two boards going to be?” he added. “Is the health care district board going to usurp the Sublette Center board? I’m going to have to be convinced that when this is all said and done, the safeguards for the Sublette Center will be in place.” At the end of the meeting, County Clerk Carrie Long raised concern that the commissioners presented and discussed a motion involving millions of dollars without placing it on the agenda. Originally, the agenda only included 15 minutes for an update from the SCRHCD, and the discussion on the motions ended up taking longer than an hour. “I don’t think it’s fair to the public to have a motion prepared that’s not on the agenda,” she said. A meeting between the three boards, open to the public, is still in the planning stages and dates and times were not available at press time.