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Sublette County Rural Health Care District
Regular Board Meeting
Date: March 20th, 2007
Venue: Marbleton Town Hall

Board Members in attendance:
Bill Budd, President
Walt Bousman, Secretary/Treasurer
Dave Racich, Trustee
Randy Johnson, Director
Minutes taken by Amber Stark, Clerk

Board Members Absent:
Jud Faler, Vice President
Gary Eiden, Trustee

Call to order:
The regular meeting of the Sublette County Rural Health Care District Board of Trustees was called to order by Chairman Bill Budd at 7:04pm in the Marbleton Town Hall.

Mr. Racich moved to accept the agenda, asked to amend agenda to place the executive session immediately after the ratification of the minutes. Director Randy Johnson asked that item E – EMS Council report, be removed as there is no EMS report. Walt seconded the motion. Carried unanimously.

Approval of Minutes:
Mr. Racich moved to approve the minutes of the February 28th meeting. Mr. Bousman asked that the minutes be amended to indicate that Mr. Bousman believed that some issues dealt with in executive session should have been dealt with publicly and some decisions made in executive session should have been made public.

Board approved the addition to the minutes. Mr. Bousman seconded the motion to approve the amended minutes, passed unanimously.

Mr. Racich motioned to move into executive session to discuss terms of employment and the purchase of property. Mr. Bousman seconded the motion, carried unanimously.

Mr. Van expressed concern over the executive session and whether it would be a discussion of the Marbleton Clinic Land options.

Director Johnson affirmed that the executive discussion was not regarding Marbleton clinic land options but a different property purchase.

Adjourned to executive session at 7:10pm.

Reconvened to general session at 7:32

No decisions made and no motions passed.

Mr. Racich motioned to purchase the Latta property on Hennick, seconded by Mr. Bousman, carried unanimously.

Chairman Bill Budd directed Randy Johnson, SCRHCD Director, to contact First Bank and get a cashier’s check for the balance of the purchase and personally handle the business of the Latta property purchase.

Mr. Bousman moved to authorize the attorney fee increase request, seconded by Mr. Racich, carried unanimously.

Old Business:

Organizational chart – tabled until further notice

GRCS Proposal:

Mr. Bousman questioned what had been resolved regarding the GRCS proposal.

Mr. Johnson reported that to his understanding GRCS had received a letter stating that the district will not be using their services any longer and that the district had transferred their patronage to CS&T.

Mr. Bousman questioned whether such a move required board approval and a board vote.

Mr. Johnson expressed that he was unsure on that issue and was not present at the last meeting.

Mr. Bousman expressed his belief that the item had been tabled pending further consideration and approval from Mr. Boone. Mr. Bousman requested that the issue be readdressed at the next meeting when Mr. Boone will be present.

SAFV Task Force MoU – Resolved

Healthy Sublette Program – Resolved

EMS Status Change – Resolved

PMC Nurse Status Change – Resolved

Current Business:

Physician Search Update
Kris Roork was absent from the Board meeting.

Mr. Budd reported that he has been in contact with Mr. Boone and Mr. Johnson regarding provider contracts and that the contracts are now at the attorney’s office in Cheyenne for review and should be returned tomorrow. The hope is that by the end of the week contracts will be given to all providers who have indicated an interest in working for the district.

Mr. Bousman clarified to ensure that Dr. Boyle would have a contract by the end of the week.

Mr. Johnson confirmed that the preliminary work on the contract had been finished and the attorney is reviewing it and he hopes to hear back from the attorney tomorrow.

Mr. Racich clarified that per a conversation with Mr. Boone he believes Wyoming Range Medical was not interested in pursuing joining with the district but Mr. Racich recommended that since the district still needs providers in the south end of the county that contracts should be offered to Dr. Turner and Dr. Burnett.

Mr. Johnson confirmed that that was the proposal put forward by the board.

Mr. Bousman made a motion to authorize Mr. Boone to pursue with any means possible finding more doctors for the Sublette County Rural Health Care District. Seconded by Mr. Racich, carried unanimously.

Mr. Bousman motioned to authorize Mr. Boone to pursue with any means possible bringing more registered nurses to Sublette County Rural Health Care District.

Mr. Racich added that the district needs cross-trained and lab trained nurses and recommended that the board ask the county and current providers to look out for nurses and to contact Director Johnson or board member Racich if they find any possibilities. Inquiries should be directed through Mr. Johnson until the arrival of Mr. Boone.

Mr. Racich seconded the proposal authorizing Mr. Boone to pursue nurses for the district, carried unanimously.

Nursing Policies and Procedures Update
Cindy Van reported that the policies and procedures have been completed. Six or seven of the policies are multi-discipline so Ms. Van recommend that they be considered in liaison with related members of the health profession (coroner, EMS etc.). Dr. LaSuer had recommended that several policies be held for legal before they are implemented. Ms. Van has given a copy of the procedures to Director Johnson and a copy has been sent to Dr. Schmitz for his review. Ms. Van expressed her appreciation to Katie Krieger for her work on the EMS policies which were used by Ms. Van in conjunction with policies from Jackson for the nursing policies. Ms. Van explained that the policies are awaiting any amendments from Dr. Schmitz and input from Dr. Quirk when he arrives. She recommended waiting to officially implement the policies pending these reviews.

Mr. Bousman asked if the policies had been sent to the attorney in Cheyenne.

Mr. Johnson explained that they would not be sent to the attorney until the doctors were able to look over the policies as Dr. Quirk will be the medical director for the clinic.

Mr. Racich asked the board to send a letter of thanks to Dr. LaSuer for all his hard work in the clinic and the district, Seconded by Mr. Budd, carried unanimously.

Construction project update
In the absence of Brian Gray Mr. Johnson reported that construction on the Pinedale medical clinic is ahead of schedule and is currently under budget. Mr. Gray had provided pictures of the current construction for board consideration.

Mr. Racich added that the steel has been put up and they will begin working on adding the utilities next week and, barring any stormy weather, the construction will remain ahead of schedule and below budget.

Mr. Johnson presented Bill Schertz to give a report regarding the Marbleton Clinic Site plan meeting.

Mr. Schertz expressed his concerns regarding the current plans for the Marbleton Clinic particularly regarding the use of the west side of lot 18 and regarding the helicopter landing area. Mr. Schertz clarified with Mr. Johnson that the district is not currently paying the architects to work on the Marbleton Clinic plans.

Mr. Johnson confirmed that the architects have not yet been released for design, so the architect is not being paid for related work on the Marbleton clinic.

Mr. Schertz asked Mr. Racich if the clinic needed more property. Mr. Racich replied he did not think we needed more land.

Mr. Budd read a report from the Marbleton Clinic Site Plan Committee which reported a unanimous vote to pursue the purchase of the west side of lot 18 and to pursue site plan options four and five. The report also recommended the architects look into including an enclosed ambulance bay.

Mr. Schertz explained that both he and Mr. Paul Scherbel expressed their strong opinion that the site in question should be held in reserve until it was needed.

Mr. Budd explained that the commissioners were purchasing the property and had decided to purchase whatever was available. Emphasized that the land will be purchased by the county commissioners so this is not a decision that can be made by the Health care board.

Mr. Schertz expressed his desire to see the current clinic building kept and incorporated into the new clinic, cited a conversation with the public nurse who expressed her willingness to be in the old building, close to the emergency room.

Mr. Budd explained that these issues regarding the exact plans of the clinic would be discussed in the future by professionals, including Mr. Schertz. The Davis architects had promised to send a report to Mr. Schertz.

Mr. Johnson recommended that since the site plan committee had served its intended purpose it would be advisable to release the plans so that the architects can begin working on design drawings.

Mr. Budd approved this suggestion.

Mr. Bousman asked if the land had been purchased already since he believed it had simply been approved. He is not in favor of releasing the plans to design until the land is bought. Requested that the release be held until the land is purchased.

Mr. Johnson recommended that the board release Davis partnership to work on the site plans with the ability to adapt as needed if land purchases change.

Mr. Racich expressed his approval of releasing the designs, recommended moving forward with the design process. Asked Mr. Johnson if releasing the designs meant the district was committing to something.

Mr. Johnson explained that if the designs are released that will be an indication to the architects to go ahead with the design process and the board will need to approve a site option (4 or 5) and they will begin producing design drawings so it is a commitment to the architects.

Mr. Bousman commented that nothing can be done until the purchase of the land is finalized, Seconded the motion to release the plans for design pending the finalization of the land purchase.

Carried unanimously.

Mr. Schertz requested clarification of the motion.

Mr. Johnson reiterated that the motion was to release the plans to the architects for design pending finalization of the land purchase. Asked Mr. Schertz to come to his office to speak with him regarding any further questions.

CFO Report

Lorraine Gatzke requested a motion to move money from the Marbleton non-interest-bearing account into the Pinedale account.

Ms. Gatzke reported that she has given the board an accounting report through November, explained the presence of the mil levy in the accounting report. This is just for informational purposes, she will have a full report by the end of the month.

Ms. Gatzke reported on the new phone system which has been having trouble in some offices, the telephone company has been working on the problems and hopes to have them settled quickly.

Ms. Gatzke is looking into the possibility of time card machines for use in the district and will be having a web demo through Kronos to look at a system that Mr. Boone has recommended. She hopes to have a bid regarding the time card system by the next board meeting.

Mr. Budd asked if the phone problems in the Marbleton offices have been dealt with yet.

Ms. Gatzke reported that they have figured out most of it and are just fixing little quirks in the system.

Mr. Racich asked for clarification on some abbreviations in the financial statement.

Ms. Gatzke explained the abbreviations and informed the board that the complete financial report to be completed by next board meeting will be much more concise and easier to understand.

EMS Council Report removed from agenda

Appleby Aviation
Kyle Erickson reported to the board that due to comments and feedback from his last proposal he has a new idea to suggest to the board regarding the use of a helicopter for the district. He proposed that Appleby Aviation bring the aircraft, personnel and equipment to the Marbleton airport without cost to the district and then the district may use the helicopter and charge Appleby Aviation for billing and dispatch costs. He emphasized that this was an initial suggestion and, if the feedback is good he will put a formal proposal on paper with numbers/costs for board consideration.

Mr. Bousman asked if Appleby Aviation would provide flight nurses.

Mr. Erickson reported that he has two flight nurses who are well trained and experienced.

Mr. Budd asked if the helicopter would be used exclusively for Sublette County Rural Health Care District.

Mr. Erickson affirmed that it would.

Mr. Bousman asked if the district was charging the helicopter service for billing and dispatch how Appleby Aviation would make any money.

Mr. Erickson explained that the costs would be totaled and the billing and dispatch charges removed from the total and the patient charged for the remainder of the charges.

Mr. Racich questioned that since there are no figures regarding such a plan how Appleby aviation is certain they will still be able to make money.

Mr. Erickson explained that he knows the costs per call out and will have the numbers on paper for the board to consider if they are interested in the idea. The board had expressed disapproval of fronting all the costs of the helicopter in the original proposal so this is an alternate that he would like to suggest.

Mr. Budd asked Mr. Erickson to send the proposal in writing to the board with the understanding that it would need to be considered by EMTs, providers and caregivers in the district to see if the proposal is a feasible possibility.

Mr. Erickson thanked the board for their time.

New Business:

Sublette Health Care Coalition
Lee Wright expressed the coalition’s concern regarding the incident the past weekend in which there were not enough people to care for the accident except that a retired nurse stopped to help. Suggested that the district might need to hire some temporary nurses to fill in and ensure the county is fully covered. There was no one certified to x-ray on Saturday. The district needs to hire temporary nurses until permanent can be put in place. The coalition believes it is not acceptable to have inadequate coverage so the district must have a doctor on call every weekend, not just a PA. Medicare cannot be billed with just a PA. It is good that Dr. Quirk is coming and they hope things will get lined out and in good shape. Expressed their firm belief that the district needs staff now, whether temporary or permanent.

Mr. Van referred to the agenda items in Old Business that were labeled “Resolved”: computer contract is to be readdressed, items C and D were discussed and resolved last meeting but in reviewing the minutes he did not find anything regarding issues e and f although they say they are resolved.

Mr. Johnson explained that both items were discussed in executive session but no motions were made so they may be remiss in labeling them as resolved, he will look into the issue.

Mr. Van explained that many people in the county were concerned that the reasons for executive sessions were not always valid. Also expressed concern that after the past executive session they announced that Dr. Quirk would be hired as a medical provider but he is actually to be the Medical Director of the clinic. Mr. Van expressed that people would like more accurate information regarding the executive sessions.

Mr. Racich explained that contracts, once signed, were public knowledge and if each contract was reviewed in general meetings that would be an extensive use of time.

Mr. Van explained that he felt it was important to know if Dr. Quirk was a medical provider or a director as there is a large difference between the two jobs.

Mr. Racich explained that the board probably didn’t realize that they had not expressed the difference in the general meeting and that they must consider perception; the board will work on trying to consider the public perspective. Anything the board does is public knowledge and citizens may come to the district office to find out anything they need to know.

Mr. Van commented that they would like to know during the meeting rather than having to go back to the office to find things out. Asked the board to explain the purchase of land for the district; a decision made in executive session and the board did not give an explanation of the purchase. The public do not need to see the price and specifics etc. but they should know what is going on instead of waiting until after the decision has been made.

Mr. Bousman explained that the property is housing to use for Locums and EMTs to guarantee a place for them to stay without worrying about high rent.

Mr. Budd commented that he would prefer to discuss such things in public session but they have been legally advised that they cannot talk about such things in general session.

Mr. Van commented that it would help the credibility of the board if they did not do so much in executive session and secrecy.

Mr. Racich commented that the board does not do everything in secrecy but that they must abide by their legal council. He agrees with Mr. Budd in that he would prefer to discuss things in public session but that some lawyers, providers and contractors are afraid of being undercut if their proposals are discussed in general session. He explained that none of the board likes going into executive session.

Mr. Van explained that the public would like to know the rationale for why the board does go into executive session.

Cindy Van expressed concern regarding the change of computer contractors and that the sensitive information held on back up discs etc. be taken care of properly to comply with HIPPA regulations. Ms. Van asked what the response time would be for a critical down with the system since the new computer assistance is in Kemmerer; particularly once the clinic moves to keeping digital medical records.

Ms. Van reiterated the coalition’s previous concerns regarding the financial status of the district and repeated her request for an interim audit before the budge cycle. She expressed appreciation for the staff’s dedicated work in trying to get up to speed but there still have been problems. Ms. Van asked if, regarding the helicopter proposal, Mr. Erickson has talked with the receiving hospitals.

Mr. Erickson responded that he has already been in contact with the receiving hospitals and their emergency directors.

Mr. Budd commented that such details will be discussed once a helicopter contract is discussed.

Ms. Van asked for clarification regarding an earlier comment that stated contracts would be offered to all providers in the district who expressed an interest.

Mr. Budd clarified that he misspoke and that the contract will be offered to all providers except for Dr. Burnett who stated he is not interested in working for the district.

Public Comments:
Sam Sharpe asked why the public were not given a copy of the financial statement given by the CFO in the meeting.

Mr. Budd offered to give Mr. Sharpe his copy of the financial statement.

Mr. Sharpe asked why the board cannot explain things that happen in executive session. Why was there an increase in the attorney fees? Requested that the board explain why they are doing things in executive session and not just state what decisions have been made. Expressed his opinion that the public should not have to go into the office to find out information when it could be provided immediately in the meetings.

Bev Sharpe asked how long the office has to do Medicare billing.

Mr. Johnson replied that it was 15 or 18 months.

Ms. Sharpe asked what would happen if they were not billed within this time frame.

Mr. Johnson explained that the district would lose the opportunity to bill the patients but that the staff is working very hard at getting everything in order and they are getting closer. Mr. Johnson offered his office phone number for anyone to call if they had any questions and if it is legal then he will be able to share what information is available.

Cat Urbigkit reminded the board that in a previous meeting she had given the board a copy of the public records regulations and the board had decided it may have been given bad advise. If the board is still being advised to go into so many executive sessions then it would be a good idea to bring the attorney into the executive sessions to ensure that they are doing what they need to do. Ms. Urbigkit suggested that the board observe the Sublette County Commissioners as mentors because they also deal with millions of dollars and many employees but they very rarely go into executive session.

Amanda Key asked Mr. Budd if he was aware that GRCS had been terminated.

Mr. Budd answered yes, he was aware of that.

Mr. Bousman and Mr. Racich stated that they were not aware of the decision.

Ms. Key asked who made the decision? Was it voted on by the board? Or who decided for the board?

Mr. Budd stated that he was aware of the decision because Mr. Boone informed him.

Dick Noble asked Mr. Budd: would you rise to a point of order to state that they were out of order in doing this without the board voting on it?

Mr. Budd stated that if that was the necessary action for this situation then he would be willing to call a point of order.

Mr. Noble asked when Mr. Boone’s job description would be ready.

Mr. Johnson reported that he and Mr. Boone have been working on dividing the labor for the district and that currently Mr. Boone will be responsible for the business of the district: money, clinics and staffing and Mr. Johnson will be the liaison for the EMS and responsible for district PR as well as legal and Federal requirements. The remainder of the details of the job descriptions will be hammered out in a couple of weeks.

Mr. Bousman expressed his concern regarding bringing in a new person (Mr. Boone) and he has not been authorized with specific tasks (job description).

Mr. Schertz requested that before the west side of lot 18 is purchased that a vote be taken. Also emphasized that the clinic is not owned by the district but by the county so before a decision is made to demolish the old clinic and build the new they must get permission from the county.

Bill Krieger referred to the earlier comment that Mr. Boone was directed to focus on pursuing Doctors and Nurses for the clinic and asked that the board also mention the Big Piney clinic and not just the Pinedale clinic.

Mr. Racich clarified that in speaking of getting nurses and doctors for the county he was referring to Sublette County as a whole and not just Pinedale. Dr. Czarnik can attest to the fact that the board members have made every effort to ensure coverage for Big Piney when there were providers available at Pinedale to cover.

Dr. Czarnik expressed his appreciation for the EMS for stepping up in the last few months to help wherever they are needed. Publicly commended the EMS for their hard work and dedication.

Tom Davenport addressed the board, explaining that he was concerned about quality health care in the district and voted for the board members because he believed they could bring change and strong leadership to the district. In the last few weeks we have lost a good doctor and a couple of good nurses. He saw the accident this weekend and wondered what would happen since there was no doctor on call, just a PA, no nurse and no lab technician to do an x-ray. This is not what anyone wants for healthcare in Sublette county. Recommended that the board direct Mr. Boone to negotiate with Dr. Boyle and get a contract signed within two weeks. The county needs Dr. Boyle because she is well-certified, patients have faith in her and certified professionals have stated they would go to see Dr. Boyle. In order to build trust in the community he recommended working on communicating as much as possible as soon as possible. Also recommended working on deciding exactly what Mr. Boone’s responsibilities will be and give him the authority to do them and backing him up. Mr. Davenport expressed his thanks to the board for their hard work and willingness to try and make things better.

Lab Issues
Mr. Johnson read a letter from Ms. Overgaag regarding a new point of care in a blood chemistry analyzer. This equipment is easy to use and training for staff is quick and easy. Ms. Overgaag suggests the purchase of this analyzer for the clinic as it will allow for more providers to use it and it eliminates a lot of need for lab testing so would help out a great deal at the clinic. The cost for analyzing is high but it would be used mainly as a backup and they would continue to use the current machine.

Mr. Racich expressed his belief that the purchase of such equipment should wait for the arrival of Mr. Boone as administrator or Dr. Quirk as the Medical Director. Suggested tabling the proposal until the next meeting.

Mr. Bousman commented that he has faith in Ms. Overgaag’s suggestions and does not have a problem purchasing one now and holding off on additional units until after the arrival of Dr. Quirk. Motions to purchase one lab analyzer, seconded by Mr. Racich who asked for discussion.

Mr. Racich asks whether one unit would be put in the Pinedale Clinic or the Marbleton Clinic.

Mr. Johnson explained that it would be for the Pinedale Clinic because there is not a machine in Marbleton that requires that level of testing while Pinedale does need it.

Dr. Czarnik commented that he has just completed his CMEs and signed the paperwork to become the new lab director for Big Piney/Marbleton Clinic.

Mr. Budd called the motion to purchase the lab analyzer – Bousman, aye; Racich, nay; Budd, nay. Motion failed.

Cindy Van commented that she appreciates the meeting being moved to the larger room and gave a recommendation that the board also write a letter of thanks to Dr. Czarnik for doing such good work as the only provider in Marbleton.

Board directs Mr. Johnson to write a letter of thanks to Dr. Czarnik.

Financial Statement:
Mr. Racich made motion to approve payments as presented, seconded by Mr. Bousman and carried unanimously authorizing vouchers for payroll and vendors numbered 8909 through 9085 and DD 032307-10 to DD 032307-77 totaling $379,038.40.

Adjournment:
With no further business Mr. Bousman motioned to adjourn the meeting, carried unanimously.
Adjourned at: 10:03