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UPDATE, FRIDAY, MAY 7: We've added additional comments to this story.
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Wednesday, May 5, 2010 - Original story:

On Tuesday, Sublette County voters delivered a strong message to the Sublette County Rural Health Care District (SCRHCD) by soundly defeating their mill levy increase request. The SCRHCD wanted to increase the county mill levy from the current two mills to four mills "to provide additional funding to support emergency medical services (EMS) and other healthcare services of the District."

Health Care District officials told Sublette County citizens the District could be broke in two years if the levy increase was not passed and they would likely not be able to support the community’s health care needs without significant cutbacks in services (Letter to voters from Rob Harding, CEO, SCRHCD). With that thought overshadowing the topic, it appears quite surprising voters still nixed the tax increase. Because this was held as a special election, not in conjunction with a regular county election, the SCRHCD had to absorb the cost of putting on the election, estimated to be between $8,000-$9,000. With that kind of cost to Sublette County taxpayers, we have to believe the Rural Health Care District must have felt they had a pretty good chance of their request passing to make it worthwhile to even ask and put this to a vote. How did they get this one so wrong?

Rural Health Mill Levy Election results (PDF)

We were curious to know our viewer's thoughts as to why they voted against the Rural Health mill levy increase request. Because this is a sensitive subject, we understood why people might be reluctant to speak out openly to voice their honest comments. In order to take the fear of negative repercussions off the table, we offered for our readers to send in their comments and we would post them anonymously so the thoughts could stand by themselves. Below are the comments we received. If anyone would like to add additional anonymous constructive comments to this thread why they voted against the mill levy increase proposal (subject to editorial review and discretion), please e-mail to: dawn@pinedaleonline.com
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Monday, May 10, 2010: "After a lot of consideration I decided to vote NO for the mill levy for several reasons and at the top of the list would be the admin and manager salaries.

In looking at the wages that have been published over the last couple months I wonder why admin wages are so high. As a few quick examples, I think it’s ludicrous that a lab manager makes $125,000+/- per year, a CFO makes $160,000+/- per year compared to County officials that are capped at $75,000+/- (for handling a much larger budget than the RHCD CFO) and a CEO makes $170,000+/- per year plus housing and does he also get paid mileage for driving to and from Idaho? I think it’s time to cut the fat at the top which brings another thought to mind, who allowed those wages to become so overinflated? Did the RHCD board approve it, did the previous CEO or board allow it or did the CFO have the authority to set those wages including her own? Who could we do without? My vote would be the overpaid admin staff, not the doctors, nurses, EMT’s or any other individuals that provide medical care. Was there ever a set of checks and balances to monitor district finances moreover admin salaries or were they given free rein to give themselves whatever they wanted? What was the hiring process for the admin staff, were they hired based on qualifications or friendships?

The term "transparency" has been used extensively lately however it’s a shame that it took so long to divulge the info the Commissioners were requesting but now I can see why, I’m sure there were some employees that didn’t want their wages public and for a good reason, they knew themselves that they were overpaid!!!

I think it’s a contradiction for people to be turned away from the clinic if they have difficulty paying their debt to the district especially since the RHCD hasn’t paid their debt to the County, in fact have they made even a single payment? How is that different? Double Standard?

I don’t understand how the RHCD can approve negative budgets as they have in the past…..shouldn’t the high priced CFO have dealt with that issue before presenting it to the board?

It’s time for the RHCD to tighten their belts and do the right thing but I guess only time will tell if there will be cuts and if so, where the cuts will come from, will it be the overpaid admin staff or will it be the EMS level where there should be no cuts as we need those folks who work diligently to care for us when necessary as opposed to those sitting behind a desk collecting huge paychecks. I considered voting yes ONLY to maintain the level of EMS care but the admin salary cons outweighed the pros."
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Friday, May 7, 2010: "Hello, just wanted to voice my opinion on why it did not pass, the administration is paid way to much. The organization is entirely to top heavy. The EMT's are underpaid and underappreciated, in an emergency, is it the administration that shows up? No, it is the underpaid EMT's. If the mil levy would have helped the EMT's and not the admin, the vote would have been different.

The RHCD must be more forthcoming with financial information. Even though they are not required to do so by law, when tax dollars are being spent, it is wise as well as ethical to tell the taxpayers how their money is being spent. I think the entire budget should be an open book; we are entitled to know the amounts of the salaries, operations, maintenance etc.

Also, it doesn't make sense that a tax subsidized clinic should cost so much for a routine office visit. It is about the same as going to a specialist in Salt Lake."
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Friday, May 7, 2010: "One more thing that people are angry about is that some Sublette County residents are not allowed to use the services of the clinic because their bills have gotten beyond a certain level, even though they are making monthly payments and trying to catch up. The RHCD CEO/Board should have found out if the voters would support paying more taxes before they made so many financial committments, instead of the other way around."
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Thursday, May 6, 2010: "Although I voted for the mil levy. I have read other peoples comments, and will not try to repeat what has already been noted. I feel the following are additonal things that influenced the attitude towards the Rural Health Care District:

Scare tactics are never a good way to approach a problem.
The public has not been kept informed on a continuing basis, no minutes in the papers or libraries.

Involving the public would have fostered better understanding. Most people do not realize the expenses associated with recruiting a physician and the common incentives that are used to bring doctors to rural communites. Nor do most people understand that emergency care is not going to be cost effective.

Spending large sums of money without the revenue in place.

The 2006-2008 budget passed with a 6 million dollar deficet price tag.

The County paid for the constuction of the Pinedale Clinic, yet what happened to the millions of dollars that were in reserve to build the Pinedale Clinic?

Lack of continuity from one Board to another: A lot of money was wasted because the leadership of the current Board would not sit down and listen to what the previous Board had in place as well as the strategy for building the new clinics. Why did the Marbleton Clinic need to be as big as the Pinedale Clinic? Why were land options allowed to expire and then the same properties purchased at a greater price? These questions are also for the County Commissioners.

Some people think that the District should go back to the "contract for service model" where a physician is contracted to run the clinic. This would be a major mistake. Since the District has taken over the clinics the number of physicians available has greatly increased as well as the certifications of the clinics and labs.
People do not like the fact that the CEO of the District does not make Sublette County his permanent home.

Most people are not opposed to family practice doctors, but many individuals in Sublette County go elswhere because they want to go to an internal medicine doctor or take their child to a peditrician. So why pay more taxes when the services they want are not offered at their local clinic.

The District should run like a school board with policy making, decision making and oversight being the responsibility of the board."
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Thursday, May 6, 2010: "I am just so tired of our government, from countys, to states and federal not realizing that we ALL have to live within a budget and when the economy is in a decline, it is time to cut back and save for a rainy day. It seems that people have forgotten where the moneys used in government decisions is gotten from, OUR tax dollars, it is NOT free money.
I am happy to see some resistance starting to show to the above mentioned problem."
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Wednesday, May 5, 2010: "In my opinion the RHCD request was denied because people expect a tax supported entity to be completely transparent, and their choice not to disclose was not a good one. What I am wondering about is are they audited by the same standards other county agencies are? From the Rec Board to The County Clerk, we all are audited once a year, and let me tell you I better have my documents ready when the auditors pull into town. Remember every county employees name and position and salary are posted in the paper twice a year! It's tax money, and people want to know where it goes. And where it comes from. I feel bad that the correction in the RHCD budget deficit will be made from the bottom up and not the top down. It will be the front line people who get chopped maybe the voter got someones attention, we are not uninformed and we do care."
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Wednesday, May 5, 2010: "The top salaries are too high. Not enough transparency regarding spending. "Forgot" that they were supposed to repay the county for the clinics. When EMS was voluntary a few years ago, they wanted to "try" two paid employees. Now look at it."
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Wednesday, May 5, 2010: "They are taxing the people who pay their bills and have insurance in order to cover cost not covered by people either not paying their bill or not having insurance. They need to do like everyone else and have a little spending restraint before getting more money. I have to tell my children all the time that they need to be responsible and accountable for what they have in order to ever get more. This same thing should apply to the RHCD. This should also tell them that maybe they should listen to other people instead of attacking everyone who says anything negative about them or their policies."
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Wednesday, May 5, 2010:
"My wife and I voted against to mill levy because;

1. Lack of transparency regarding finances.

2. Huge increases in costs of administrative function.

3. Overkill in costs and numbers of people in all areas, including EMT services.

4. We need some fiscal responsibility - not higher taxes!"
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Wednesday, May 5, 2010:
"I was just wishing last night that the voting ballots themselves had included a short spot at the bottom for WHY or WHY NOT? So that we would know what our community is thinking. I am horribly disappointed that only 31% of the people showed up to vote on these important issues. The community's apathy is appalling.

Thanks for attempting to compile the results while keeping my personal opinion confidential. It's still a bit confusing to me that people would rather TAX our family, friends and neighbors while visiting our wonderful community, but they won't ensure that 24 hr healthcare is available for those same people. Wow.

On a personal level, I voted FOR the mill levy, even though I sincerely believe the Administrators of the SCRHCD are overpaid, and some are grossly mismanaging their positions. That aside, I know that they (The Board) will cut the positions that are most critical to our community, the medics on our ambulance service. For some reason, they believe that administrators and office staff are more important than the front line delivery personnel for emergency services.

It is a fact that an ambulance can respond to an emergency, give critical treatment, and transport to a tertiary care facility. That facility can be one of our beautiful clinics, resplendent with fabulous artwork on the walls, fantastic photos, well-appointed furnishings, and custom wrough-iron work by local artisans, or we, the medics, can deliver our patients to St. John's Hospital or Sweetwater Memorial. Our ambulance faciltity has no artwork, except what we as individuals have brought from home or hung on the walls ourselves, no fancy shelves, nothing. But those things aren't necessary for us to deliver the quality healthcare that our community deserves and requires.

When they decide to cut even more positions from our EMS staff, in an effort to save their precious dollars, it will have an immediate and negative impact. I will be interested to see how they manage this financial situation.

I voted AGAINST the additional lodging tax. It's for non-critical services. In the grand scheme of things, I would rather not have ANY additional tax, but if I do have to pay more, I could justify paying for critical services. Our hotel fees in Pinedale are already outrageous. My out of state family and friends are already punished by the cost of fuel. Why would I punish them some more by increasing their lodging costs?

There has been a lot of waste, not only in the EMS, but also through out Sublette County. We feel that throwing more money at the problem is not a solution. Leadership needs to learn to tighten their belt like everyone else. No one wants to see the service cut back and we appreciate the hard work and dedication of our local EMTs, but we’re appalled at the recent revelation of gross irresponsibility. I am so glad that the people of Sublette County have decided to hold Rural Health Care accountable at the risk of a "socially unpopular" outcome."
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Wednesday, May 5, 2010:
"I've wanted to voice my opinion prior to the election, but unfortunately I am in the position of possibly losing my job if I speak up. (Thank you for the 'anonymous' outlet!) Even though as an employee of the district I face losing my job by not voting for the mill levy, I also felt as a citizen that the CEO (both current and previous) and district have not been forthcoming and honest enough with our community. They have not managed the funds they have been given adequately in the last several years, expanding our healthcare services exponentially without any thought into how they would support those services. What kind of businesses out there can actually function that way, spending money before they know where it's even going to come from?? Although many changes have been made, especially recently, I don't feel that they have done enough yet, and until they can learn to manage those funds responsibly, I don't feel they deserve any more of our tax money. Unfortunately, whenever their budget has had a shortfall they cut employees from the bottom of the organization while still paying exorbitant salaries to those on the top. It's time for them to find some balance in the organization and decide what is important, and to run the county's health care more efficiently than they have in the past. For me, it wasn't about how much it would ultimately cost me - if I know it is being spent well & going where it needs to go, I don't have a problem with the extra expense . . . unfortunately, I don't think the SCRHCD has proved that to the citizens of Sublette County. If they can't even gain the support of their own employees, how can they possible gain the support of everyone else on the outside of those walls? It's time to address the problems and be open with everyone, not 'throw more money at the problem'."
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Related Links:
2010 May 4 Election results May 4, 2010
Letters to the Editor April 29, 2010 (3rd letter, Care Corner from Rob Harding, CEO of the SCRHCD)
Sublette County Rural Health Care District financial information April 26, 2010
Health Care Corner Rob Harding, CEO SCRHCD, March 30, 2010
Health Care Corner Rob Harding, CEO SCRHCD, March 24, 2010
Sublette County Rural Health Care District receives Level V Trauma Receiving Facility Designation March 21, 2010