No time like the present for good stewardship

By Cindy Van

Legal and functional power and control of health care in Sublette County is the responsibility of the Rural Health Care District (RHCD). County commissioners are involved, as the county own the clinics. Much of the angst and concern expressed by county commissioners I talked to after the meeting on Wednesday, April 12, was regarding day-to-day function of the district with exaggerated and erroneous information. The district webpage – sublettehealthcare.org – lists salaries for employees, salary range, monthly financial statements and meeting minutes. Minutes going back to October 2016 gave insight into possible district plans based on the commissioner’s decision to not support the critical access hospital (CAH).

The district has worked tirelessly for 32 months to meet demands of the commissioners to gain approval for renovation of county-owned buildings. If approval had been given 32 months ago, construction would be complete and the CAH operational. This delay cost taxpayers of the county an estimated $9.3 million in lost revenue and thousands of dollars in three independent studies that have then been discounted by the commissioners. Mr. Rawhouser referenced Niobrara County health care tax revenues in comparison with Sublette County. Niobrara County Hospital is within a hospital district with a CAH and skilled nursing facility – all developed from need based on decreasing population, decreased tax revenue and increased need for health care. They have thrived due to the CAH designation. This similar situation is facing the RHCD now.

As a taxpayer, I find the conflicts for power and control a waste of time, energy and resources. As a health care consumer, this county needs a CAH hospital. Members of my family have been hospitalized numerous times and, in most instances, could have stayed at a local CAH.

As a retired nurse and facility/nursing administrator, I certainly know the challenges of dealing with health care financing, billing, standards of care and quality management. Health care has become a complicated business that affects us all. The RHCD has made astounding strides in the past 10 years, improving care to meet present-day standards that rival care at any hospital. In the past three years, care has been provided with increased skill of the EMS service, increased efficiency of staff through cross training with a cost savings of approximately $2.3 million. The emergency room receives accolades about excellent patient care from hospitals that receive patients from the clinics. The clinics are designated Level 5 Trauma – very unusual in a rural setting.

The CAH is not a luxury; it is needed now. Emergency care with reimbursement as a physician’s office visit is not sustainable. Providing additional services without a CAH is becoming cost-prohibitive. Additional reimbursement provided by a CAH designation is the fiscally responsible action needed for sustainable health care in Sublette County and that is the conclusion of three independent studies. Sixty percent of the county residents support the CAH.

Only two commissioners have returned my calls to clarify reasons for their decision to not support the CAH. Dr. Burnett and Mr. Rawhouser engaged in a healthy dialogue. Concerns were again about operations, financial concerns and what happens to the building if the money runs out. They also requested an extensive request for proposal (RFP) after the engineering assessment, as requested by facilitator Mark Cross. The district completed an RFP but not to the specificity requested. Extensive RFPs are usually completed once a decision is made to build and are expensive.

That is just it – there is no permission to build – a stalemate again. Both commissioners indicated they were done with health care and the county is just the landlord. It will be up to the district to decide what to do next.

If only the commissioners will look to possibilities rather than creating obstacles and fear. If there was ever a time in this county when mutual respect and trust between two governing bodies was needed, it is now and the only ones stopping the collaboration are themselves.

Get over it and yourselves – for the taxpayers and the health care needs of our county. We need better and you can do better. 

Cindy Van is a retired registered nurse and a former board member of the Sublette County Rural Health Care District.