EMT raise rescinded
Extension on doctors’ contracts offered.
by Cat Urbigkit

Sublette County Rural Health Care District board members had a full state for its Monday night meeting in Marbleton.

Dr. Judy Boyle reported that an emergency room physician has agreed to help out at the Pinedale Medical Clinic later this year. Boyle said this person will cover the clinic three days a week and some weekends, starting July 1 and continuing through October.

But as far as getting another physician to work alongside Boyle in the clinic on a more permanent basis, Boyle said, "It’s hard to find a physician right now." The woman physician who visited the county last weekend to consider the job probably won’t be able to come to work here, Boyle said, because Sublette County has lost its ranking allowing a national health service corps scholar. Since the visiting doctor is one of these scholars, the likelihood she’ll agree to work in Pinedale is low.

Pinedale emergency medical technician Sandy Anderson read aloud a letter from Dr. Michael Kramer of Pinedale who is a practicing emergency physician working in Henderson, Nev., 10 to 12 days a month, according to the letter. Kramer’s letter expressed continued support for EMTs and physicians in the county, noting, "How they treat us, the patient, may in a small part depend on how you have treated them." The board’s stated intent to rescind the one-percent raise for the EMTs was subject to contention from Kramer, who suggested the pay should be adjusted for inflation. He called the one-percent "an insult."

Board member Walt Bousman said he believes the board is providing adequate pay for the EMTs, but disagreed with the one-percent increase. Board member Jim Greenwood said he was "strongly against" the increase as well, stating that raises should be entirely at the discretion of the board and not automatic. Greenwood made a motion to rescind the one-percent pay increase policy. The board approved Greenwood’s motion with no objections.

Bousman’s comments critical of an increase in the physicians’ contracts were the subject of discussion as well. Bousman said the example he used in last week’s Examiner article was merely a hypothetical example, and that he picked on the Marbleton clinic because it has "the least amount of patient contact."

Bousman said he doesn’t feel he has enough information to support a $500,000 subsidy. The district currently pays each of the county’s two contracting physicians $18,500 per month to operate two clinics. Burnett has proposed that amount be increased another $2,000 per month, leading to a $492,000 total per year to operate the district’s clinics.

Bousman said that since he doesn’t have enough information, he would like to have the contracting physicians provide the board with patient counts sorted as to the type of patient contact (whether telephone, blood drive, office visit) and whether the patient was a local or a tourist, infant or adult. Bousman said, "We don’t know what it costs to operate a clinic," so he would like to see this sort of information provided to the board in a quarterly written report. Bousman said the information would help him make a more educated determination about what the "subsidy" amount should be.

RBCD board chairman Dave Racich said the he isn’t sure whether the board has any legal basis to ask a contractor for such information about their business.

Bousman’s repeated use of the word "subsidy" drew a response from Burnett, who clarified the amount paid by the board is the fee for the contract for services and not a subsidy. Burnett noted that since the board uses a contract for services it is "somewhat banned" from obtaining financial information about the clinic business.

"I’m not willing at this time to go along with any proposal," Burnett said. "As far as patient visits, I see no basis in that. Our position has been to comply with the board requests in accordance with our contracts. To my knowledge, that’s exactly what we’ve done."

Boyle said she believes the information requested by Bousman would be useful demographics that the board could utilize in future planning effort, such as examining increases in older patients.

Burnett said Boyle may be right in that aspect, but the board needs to consider what it would hope to learn from the requested information.

"My underlying feeling is that the board is trying to use these patient numbers to try to justify the amount that you are spending for the contract," Burnett said, for which it has no bearing. "The bottom line is we still have to provide the services."

Greenwood said when he first came on the board he viewed the payment as a subsidy as well, but has changed his view.

The money is "to guarantee coverage 24 hours a day," Greenwood said. "That guarantees every citizen of Sublette County and the people who come through it, that they are going to be able to be helped by a physician or a physician’s assistant 24 hours a day. Now if that means we have to raise it because of costs, I don’t have a problem with it."

Board member Garry Eiden Sr. said, "I look at it as an insurance policy – a Sublette County insurance policy."

Racich said, "We’ll have to make that determination of how much we want to pay for that insurance policy" by the time the board finalizes the budget. The issue is expected to be discussed at the second reading of the budget, scheduled for next month.

At Greenwood’s suggestion, the board also passed a motion offering an automatic one-year extension on the physician’s contracts, which are set up on two-year terms.

Pinedale Emergency Medical Service President Wil Gay broached other EMT business. He presented the board with a $234 reimbursement check from Kris Bacheller as a resolution to a compensation dispute with the board.

Gay also noted that a critical incident class was going to be taught at the ambulance barn in Pinedale and that former PEMS EMT Gary Wilson had signed up for the class. Gay said he felt he should have the board’s permission for Wilson’s presence at the building, since when the board fired Wilson it also restricted him from the building.

Although it appeared Racich was supportive of allowing Wilson to attend the class, the rest of the board disagreed about allowing him in the facility.

Eiden said, "I don’t want him in there," as did Greenwood.

Bousman said, "I’m going to side with Greenwood and Eiden," so Wilson is not allowed to attend the class at the district’s facility. RHCD board member Bob Dew was not in attendance at the meeting.