RHCD board transition and budget considered

by Cat Urbigkit

Sublette County Rural Health Care District board members spent time at their Monday night meeting in Pinedale discussing how to ease the board through a transitional period when current board members step off the board and are replaced with three new members.

Chairman Dave Racich and board members Jim Greenwood and Bob Dew have decided not to seek re-election to the board, and there will be eight candidates appearing on August election ballots vying for their chance at the three seats. None of the candidates were in attendance at Monday's session and board member Garry Eiden Sr. was absent as well.

The board agreed once the budget is finalized, but prior to the August election, it will hold a special meeting to update a RHCD policy and procedures manual, which Racich said "might save (the new board) some headaches" in the future.

Vern Cox, the director of the Sublette/Lincoln Community Counseling Services met with the board. The board had requested a representative of the agency attend a meeting to discuss the reorganized service, which receives $10,000 annually from the RHCD.

Cox explained that he is the new director of the program, which was recently incorporated into a two-county counseling service from its prior identity as Sublette Community Counseling Services (SCCS).

SCCS was plagued with problems, including allegations against its former director, who resigned and left the county after denying the allegations last fall. These problems are believed to have led to a decrease in client services, which Cox said now appears to be on the increase.

Cox said state officials were no longer going to fund SCCS unless the problems here were resolved, and asked Cox to step in. Incorporating the two county programs made sense, Cox said, because it's "more beneficial to join forces" than to have two small county programs.

Cox said there are now two part-time therapists working with his agency, and said he is looking for another full-time therapist. Cox said his top priority will be building a more substantial substance abuse program.

Funding for the agency's $100,000 annual budget includes $37,500 from Lincoln County and $10,000 from the RHCD.

Cox said about one-third of the people seen by his agency are substance-abuse cases, while the remaining majority involve other emotional issues.

"We never turn anyone away for inability to pay," Cox said, noting that payment is on a sliding scale, with the average fee being $20. While the base fee is $70, Cox said "very, very few people have a salary range" requiring that fee. Cox added that the $70 is what is billed to insurance companies, but only about half of that amount is actually received.

Driving while under the influence evaluations ordered by a judge are another matter.

"We do not do DUI evaluations without cash up front," Cox said, noting that these evaluations take about four hours to complete and cost about $125.

The board thanked Cox for attending the meeting to answer their questions and said the $10,000 budget request will be granted consideration as budget preparation proceeds. Cox reminded the board that his agency is very willing to host in-services for county employees, law enforcement officers, dispatchers and emergency medical technicians who deal with critical incidents.

The board also met with Dave Bell of Tegeler and Associates Insurance to discuss whether to continue with purchasing an insurance plan from the company or to switch to the local government insurance pool currently being used by about 300 other agencies and governmental entities. After hearing Bell's presentation and discussing the issue further once Bell had left the meeting, the board decided to continue its current insurance policy through Tegeler. Board members expressed serious concern with joining a pool that includes a $500,000 deductible while relying on claims of governmental immunity to protect it from liability.

Greenwood said, "I don't think (the pool) is a good deal."

Board member Walt Bousman concurred, "I'd just as soon stay with what we have."

The board vote was unanimous.

Dr. Judy Boyle of the Pinedale Medical Clinic told the board that while there was one physician interested in joining Boyle's practice in Pinedale, she wanted malpractice insurance paid. Boyle said that would be an estimated cost of $150,000 up front, which she said she is not willing to fund.

"I can't afford to pay that much out of the clinic budget," Boyle said, noting that the skyrocketing cost of malpractice insurance has become a huge issue for physicians and is now a hiring and recruitment issue.

The board agreed to hold a special workshop and meeting to discuss the budget and a host of other items. The meeting will be held on Monday, June 24, at 7:30 p.m. in the Daniel Fire Hall. It's at this meeting that the board is expected to debate any fee increase or pay proposals for the contracting physicians and the EMTs.

Another budget issue was raised when board members pointed out that since the board went to the salaried and paid EMT service program in April 2001, there has been a $100,000 loss between the two services. That means that the revenue received by the two ambulance services wasn't enough to pay the EMT compensation. The Pinedale service fell $32,500 short, according to Greenwood, while the Big Piney service was $73,800 short.

Racich noted the district has a collection rate of less than 50 percent. When discussion turned to increasing the ambulance service rates to generate more revenue, Dew questioned whether more revenue would actually be raised or if the collection rate would drop even lower.

Greenwood noted that the ambulance rates charged within Sublette County are "the cheapest in the state."