RHCD to join forces with St. John’s

Mike Moore
Posted 5/5/17

The Sublette County Rural Health Care District is moving forward with an affiliation agreement with St. John’s Medical Center of Jackson.

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RHCD to join forces with St. John’s

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PINEDALE – The Sublette County Rural Health Care District is moving forward with an affiliation agreement with St. John’s Medical Center of Jackson.

The Rural Health Care District (RHCD) board approved the affiliation with St. John’s (SJMC) at its special meeting held in the Commissioners Meeting Room in Pinedale on Wednesday.

“We signed a letter of intent to take our relationship to another level,” board chair Laura Clark said at the start of the meeting. “St. John’s is committed to supporting us in every legal way possible. We are very excited about this.”

The RHCD board originally formalized an affiliation agreement with SJMC back in 2015, and with this move, it expands the relationship to bring additional services to Sublette County.

Board member Wendy Boman voiced concerns with the change shortly after Clark explained the move to the audience.

She asked that the entire special meeting agenda be tabled for 30 days, saying the extra time would allow her to continue discussions with the Board of Sublette County Commissioners, which she says were moving in a positive direction.

“At our next regular meeting, I will have more information I can share,” Boman said. “I’m concerned this will jeopardize my discussion. It is very delicate. I would like to hold off. We’ve had two years; give me a month. … We’re making progress.”

Boman then made a motion to table the agenda for one month. Board member Kathy Anderson then amended the motion to only table the SJMC affiliation agreement. The motion did not receive a second, so it failed.

A motion was then brought up by vice chair Scott Scherbel to approve the affiliation agreement, which passed, 3-2, with trustees Chuck Bacheller, Clark and Scherbel in favor, and Anderson and Bowman voting nay.

The next agenda item was for the board to approve organizational chart changes. The current chart had both the health care administrator and finance director answering directly to the RHCD board, with all of the respective departments falling underneath that.

Health care administrator Malenda Hoelscher is remaining in the RHCD position as the board moves to work further with SJMC, where Hoelscher has accepted another position.

Changes would include adding a practice manager and a clinical services coordinator to the organizational chart, with medical directors, practice manager and the executive director of finance answering directly to the board of trustees.

Anderson moved to approve the organizational chart, which passed, 4-1. Boman voted nay for reasons she stated earlier.

The board then approved new positions and job descriptions for both the practice manager and clinical services coordinator. As discussion began, Anderson offered clarification on how the practice manager position is overseen.

The practice manager position would collaborate with SJMC and be responsible for planning, directing, coordinating and supervising the delivery of RHCD health care, with additional responsibilities, Anderson stated to the audience.

Scherbel says having a practice manager is a positive for him. In addition, removing the health care administrator position and bringing in a practice manager saves the RHCD than $78,000.

“I was hoping to move to a practice manager 10 years ago,” he said. “I’m excited about it. I think we can benefit from it as we change our organization.”

Clark then clarified that the practice manager will work very closely with SJMC through collaborative efforts and will also work with the RHCD board.

“This will tighten the relationship we already had a number of years (with St. John’s), but much, much closer,” Clark said.

“We are still an autonomous board,” Bacheller added. “We will be paying this person out of our own budget. St. John’s doesn’t get the say-so in who we hire for that position.”

“They won’t have the final say,” Clark responded.

Scherbel then made a motion to approve both the practice manager and clinical service director positions, which passed, 4-1. Boman voted nay.

The board then introduced Michelle Kren, who is the SJMC administrative director. Clark told the audience that Kren will be the liaison for St. John’s and the RHCD.

“Her and Malenda are going to work closely together, along with the district,” Clark said.

According to Kren, the main takeaway from the affiliation is that SJMC can provide administrative guidance to the RHCD.

“We’re both remaining separate entities, but will work collaboratively with the (RHCD) to better health care with the Sublette County population,” she said.

The meeting then opened up to public comment, when some attendees asked why the board did not support Boman’s attempt to rectify the RHCD’s relationship with county commissioners to move forward with the critical access hospital (CAH).

“You gave Wendy permission to go to and talk to the commissioners about trying to reconcile these differences,” Michael Pompy said. “She has started that action and she asked for extra time herself, and as a board member, the majority of the board is unwilling to allow her to have that extra time. I’m curious as to what the reasoning is there?”

Bacheller responded by stating the affiliation agreement in no way changes what the board is trying to do with the commissioners at this point.

“We’re bringing expanded services to Sublette County,” he said. “I think that’s a good thing. We’re revamping our administrative structure at the top and lowering costs by $78,000, which commissioners had requested we do. I don’t see where this goes against anything we said we would do with the commissioners. I don’t see where it precludes Wendy from continuing to meet or how it damages her meetings with commissioners.”

“There was no formal approval from this board for Wendy to act on behalf of the board in her discussions with the county commissioners,” Clark added. “She, by all rights, can visit with county commissioners as a citizen. She cannot, by law, represent this board as an individual. Not that we’re precluding her from that. … Nobody has told her not to on this board, at all.”

Boman then asked if they want her to continue talking with commissioners, to which the board responded with multiple “yes” answers. She said she would continue and then asked if she has board permission to contact county CAH facilitator Mark Cross and ask him to come in and meet.

Scherbel said then the board had reached the point where her discussion was not related to agenda items and was not a public comment, ending that discussion.

Dr. David Kappenman then spoke up in support of the board’s earlier decisions.

“I’m really excited about this move,” he said. “It does show a direction for us to go, which after 33 months of not having any direction to go it’s been exquisitely frustrating … to the point where we’ve lost staff member over this. I really think one of the continued lack of confidence issues they brought up the entire time is our administration and not having the expertise. To sign this and have St. John’s to help us out in all of this capacity should alleviate a lot of that angst they have. All in all, this is something that is exciting moving forward.”

After more public comments and concerns addressed to the board, the meeting eventually came to a close after the audience provided nothing further.

The RHCD board held a strategic planning workshop on Thursday evening, to look at goals for the next five years, along with analyzing strengths, opportunities, aspirations and results. They also looked at a business plan, functional plan, financial feasibility studies, hospital design, request for proposals and a construction budget.

The next regular monthly meeting is scheduled for Wednesday, May 17, at 6 p.m. in the County Commissioners Meeting Room in Pinedale.