Parity and Controversy

by Cat Urbigkit

Monday evening's Rural Health Care District board meeting in Marbleton had tempers flaring and the board being grilled on its policies, actions and priorities by Marbleton/Big Piney Clinic contracting physician Dr. David Burnett.

Burnett, who has not attended RHCD meetings in recent months due to his dissatisfaction with the board's handling of editorializing in its meeting minutes, attended Monday's meeting to discuss the budget, which was due for adoption at a public hearing Tuesday night.

Burnett began by asking board members about their philosophy regarding parity between the north and south ends of the county.

Board Member Mary Lynn Worl said, "When I ran for this board, I ran to represent this county." While the board strives to be equitable, Worl said, "that doesn't mean dollar-for-dollar or item-for-item."

Board Member Bill Barney said: "I think parity is an important issue ... But it's not the only issue."

Board Member Jerry Jensen said the board may "try to keep it equal ... but the needs on each end of the county are different."

Board Chairman Walt Bousman said the board tries to keep the funding as close as possible while meeting the needs.

Board Member Garry Eiden was not in attendance at the meeting, nor was Dr. Judy Boyle of the Pinedale Medical Clinic.

Burnett took issue with the draft budget figures granting the Pinedale Medical Clinic about $29,000 more than the Marbleton clinic. Burnett said when one considers that $19,000 in the Marbleton clinic's budget was rolled over from last year's budget, the difference is even more substantial at about $50,000.

Burnett questioned the board's inclination to deny the $1,900 heater for the ambulance bay in Marbleton while agreeing to provide $8,500 for a decontamination room for the Pinedale ambulance service.

"How do you make these choices?" Burnett asked, pointing out that his request for $4,500 for a blanket warmer to treat hypothermia was denied, while the board budgeted $8,700 for cervical colposcopy instruments for the Pinedale clinic, "which has no application in emergency medicine."

The board explained that Burnett needs to attend the budget meetings to understand how the decisions are arrived at, with Barney noting that part of the process involves advocacy for budget items.

Burnett responded, "I don't think I would have asked for something that wasn't needed."

Burnett continued: "There is not a single item on that list ... for either clinic, that is absolutely necessary for the emergency operations of either clinic ... There are items on there that improve our ability to service the patients of this county."

Bousman told Burnett that he needs to attend the meetings to answer questions the board members may have about his budget requests, and suggested Burnett attend Tuesday night's meeting in Pinedale to discuss his budget requests. Burnett said he would not be attending the meeting and would address any questions from the board at Monday's session, but few were asked.

Burnett said he wasn't interested in "a verbal match" with the board. He said the board was using the budget process "to chastise the clinic" because Burnett had questioned the board about editorializing in its meeting minutes and declared he wouldn't be participating in their meetings until the issue was resolved.

Burnett said he had already submitted a list of reasonable items for funding. "You can either take them or leave them," Burnett said. "I don't need to come whining and crying to you tomorrow night."

Barney said it's not a matter of whining and crying, but a matter of being in attendance to explain to the board the technical or medical needs for different pieces of equipment.

"It's unreasonable to expect the majority of the board members here to be conversive in the technical equipment that you use," Barney said.

Burnett said the board doesn't really understand some of these items even when they are explained. He noted that the board had approved the Pinedale clinic's request for $50,000 for a chemistry analyzer but the board couldn't explain what difference that would actually make in the clinic.

Burnett said that in the past the board has relied on Burnett's professional expertise, judgment and discretion rather than on a requirement that he attend numerous meetings to answer budget questions.

Worl said it should be noted that the Pinedale clinic budget also had items that were rejected by the board or voluntarily withdrawn.

Bousman told Burnett that his budget requests would be up for discussion the next night, "so we can continue this conversation tomorrow night."

Burnett responded, "I hope you enjoy the discussion amongst yourselves."

The board also discussed Dr. Judy Boyle's reimbursement for expenses related to her attendance at a Texas conference to have the Pinedale Medical Clinic receive a rural health clinic designation. At the March meeting, the possibility of reimbursing Boyle was discussed, but was to be tabled until the next meeting when the board had a firmer idea of the cost, which was estimated at $1,600.

Although Marbleton's Dr. Darcy Turner had asked the board if the reimbursement had been made and was told that it hadn't been, in fact the check had been signed in April with the regular stack of bills the board signs at every meeting. That means that rather than the board taking authorizing action, the expenditure was given blanket approval with the rest of the checks.

Worl noted, "There was no intent not to make this public," but Barney said concerns about the issue are legitimate and the board should investigate its procedures to examine how the check went through without specific approval.

Jensen said when presented with vouchers from physicians, the board has been "rubber stamping them and not finding out what they're for."

"We're not looking at what we're signing, and that's our fault," Jensen said.

The board tabled the issue for now.

Finally, the board discussed the preliminary findings of a study being conducted by a visiting architect from Denver. Apparently the architect inspected the district's facilities and found several code violations in the Big Piney clinic. Construction of a new facility is estimated to cost about $1.5 million and appears to be called for, according to several board members.

In other business, William Belveal of Pinedale asked the board to consider building a hospital in Sublette County, noting that the population is growing and "The cost of a hospital will never get any cheaper."

The board noted that it is going through a facilities master plan process and the result will help determine the need and type of medical facilities appropriate for the county.