Legal issues, complaints aired to RHCD

by Cat Urbigkit

The Sublette County Rural Health District met in Pinedale Monday evening with the full board in attendance.

John Mortenson of Mortenson Stevens presented the board with the annual audit report.

The district's balance sheet shows cash availability less liability at end of fiscal year was $2.95 million, "a pretty strong financial position," Mortenson said.

For management issues, Mortenson noted that all checks are prepared by District Clerk Jauna McGinnis and she also has access to the board members' facsimile signatures. He noted that internal controls are meant to protect both the board and the clerk, and suggested that it may be wise to have a board member in control of facsimile signatures.

Mortenson and the board discussed several other internal controls that could be implemented, should the board so choose. The board decided to put the audit recommendations on the agenda for the board's next regular business meeting.

Cathy Summerall of Pinedale spoke with the board of a problem she encountered with administration in the Pinedale Medical Clinic. Summerall noted that in March, her husband went to the clinic for a physical with Dr. Sherman. During that physical, Sherman asked if Jim Summerall was having any problems, to which he noted he sometimes had heartburn at night, so Sherman gave him a prescription for the problem.

In August, the Summeralls received notice from their insurance company that it would not cover $65 of the clinic bill. The Summeralls then learned that the clinic had charged for two office visits for that day.

Cathy Summerall described the process she went through in working her way through the Pinedale clinic personnel, each one explaining that because Jim Summerall's appointment was for a physical, and he was written a prescription for heartburn, a certified coder determined that it was proper for the clinic to charge for two office visits.

"To me, nobody was using any common sense here," Summerall said.

Summerall noted that once she worked her way up to Dr. Judy Boyle, Boyle agreed to take the charge off the bill because Summerall was so upset about it, "not because it was the wrong thing to do.

"I wanted them to take it off because it wasn't fair to start with," Boyle said.

Board Chairman Walt Bousman said that since there is a certified coder and insurance companies involved, it's probably a national issue. Summerall disagreed, noting that when she gets a physical in an out-of-town clinic, she isn't billed for two visits.

"I just don't think that it's kosher," Summerall said.

Board Member Jerry Jensen noted that the clinics are operated under contract, so "we have no say-so on how they run their business in there."

Lesta Winer of the Pinedale Medical Clinic spoke, arguing that there is a specific definition of what a physical exam entails, and it doesn't include the "oh by the way, while we're in here ..." that many patients apparently try to include. Winer said there is a modifier that allows billing for two office visits per day for a person who comes in and is seen for two totally separate things.

Winer said the Summeralls' bill was reduced not just because she was upset, but also because Dr. Sherman wasn't there anymore for the clinic to consult with about the situation.

Board Member Bill Barney questioned whether it was a legitimate billable item, why the clinic didn't intervene with the insurance company on the client's behalf.

"That's not our problem ... you need to know what your policy covers," Winer explained. She defended the charge, noting that doctors doing a physical can't address numerous other items as well without an additional charge.

But Summerall noted that Sherman asked during the physical if Jim was having any problems: "It's almost entrapment."

The board thanked Summerall for visiting with them about her concerns.

The board held a short question-and-answer session with legal counselor Ed Wood. This appeared to be in response to questions raised by the Examiner about the propriety of the board enacting a policy at a board meeting, only to have the board members, outside the meeting, develop a consensus to reverse that action. The board chairman then put the policy on hold, with all action and deliberation taken outside the board meeting.

Jensen asked Wood what constitutes day-to-day operations in which the board chairman can take action on outside of board meetings. Wood said there is not a lot of statutory guidance on that issue.

"Those are very limited," Wood said. "You can't take any action. Any action has to be done by the board ... No action can be taken by any board member alone."

Jensen posed a scenario in which the board members call each other to see about "coming up with a consensus" about an issue and asked Wood if such action were legal. Wood told the board that they could talk to each other, but cautioned that they should tread carefully.

"You can't use that to bypass an open meeting," Wood said.

Jensen asked if board members met each other in the coffee shop and discussed board issues at that time, if that were allowable. Wood said that the intent determines the answer. If the intent was to meet to discuss the issues, that is a meeting that should be granted public notice.

When the Examiner questioned Wood whether board members did meet up and began deliberating public business, even without an intention to do so, if that would be an improper meeting.

Wood questioned if such an incident could be termed a meeting under the law, but did confirm: "Those types of deliberations should not take place."

Wood said, "It's not what you call it, it's what you do."

Jensen made a motion that the application procedure be modified to include the medical director's signature for sponsoring the EMT applying for the position, to which board member Garry Eiden seconded. The motion passed on a unanimous vote.

The board also voted to hire two new ambulance drivers: Bill Krieger in Big Piney and Steven Wight of Pinedale.

McGinnis gave the board an update on the Marbleton EMT who had been injured a few months ago and, because of the ensuing financial difficulty, asked the board to pay her portion of her district-sponsored medical insurance premium until she was back on her feet. The board had agreed to do so on a month-to-month basis. McGinnis reported the EMT is now going back to work and will be able to pay her premiums, plus an additional $50 per month to pay back the balance due, for eventual payoff.

"Well good," Jensen responded. "I'm glad we could help her."

In other business, the board agreed to hire Davis Partnership to engage a feasibility study on countywide medical facility needs. The study, estimated to cost $45,000, is expected to address at least three issues: expansion of the Pinedale clinic to meet future needs, expansion or replacement of Marbleton clinic, and the need for a hospital in the county.

Jim Washam, a commissioner of the Wyoming Veterans Association, said there are 8,500 veterans in a five-county area of western Wyoming. Currently those veterans have their needs filled in Salt Lake City. He said the Salt Lake hospital is looking at contracting with the Pinedale clinic to handle veteran care, pulling patients in from five counties. Washam said this items needs to be considered in the planning process and the feasibility study.

The board held its election of officers, with a renewal of the existing officer slate.

The board agreed to hold a policy and procedure meeting on Tuesday, Nov. 4, in Big Piney at 7 p.m. to address EMT paid-personnel policies and pay scale. The next regular board meeting is scheduled for Monday, Nov. 10, at 7:30 p.m., also in Big Piney.