From the pages of
Sublette Examiner
Volume 9, Number 3 - April 9, 2009
brought to you online by Pinedale Online

RHCD continues to work on budget cuts

by Tiffany Turner

With a possible multi-million dollar budget deficit facing the Sublette County Rural Health Care District (RHCD), department heads worked diligently to decrease their budgets 20 percent based on last year’s numbers.

The board requested a budget session to discuss these cuts with the department heads. The budget session was held last Wednesday in Pinedale.

More than 65 people, including members of the public, showed at the meeting to hear what the board had to say and voice their opinions toward the cutbacks and services the district provides. According to CFO and acting CEO Lorraine Gatzke, the budget deficit is between $1.2 and $2.6 million, depending on the different budget cuts made.

Current budgets also reflect no growth for the district, due to the budget crunch.

“We’re not bringing in anything new, not with the budget the way it is,” Gatzke said. “We need to grow, but we can’t right now.”

The situation

Since a large number of the public and district employees came to the RHCD’s budget meeting, Chairman Bill Budd decided it wise to explain where the budget deficit came from and how the board’s operation and funding works.

Budd said the board is elected by the same constituents as the county commissioners and operates very similarly.

“They only have one thing we don’t have and that is any way to raise money,” Budd added.

The board operates on a two-mill levy each year, Budd said, while hospital districts can tax up to six mills and a cemetery district receives three mills. This is why the new mill levy raise passed by the Legislature this spring is so important, he added. The ability to increase the mill levy to four would cover the budget deficit the district is facing.

“However, at the urging of the commissioners, we have to go to a vote of the people,” Budd said.

Due to date restrictions for the election and the legislation not effective until July 1, the soonest the board can ask for a vote would be May 2010.

“It is very frustrating from our viewpoint,” Budd said. “We are not in the same time and place we were 15-20 years ago in this county or anywhere else. Times have changed.”

The difficulty facing the board now, Budd said, is needs versus funds.

“You are not here tonight because we as a board want to cut you back,” he said. “We are telling you how it is and what we have to work with.”


Dr. James Quirk, department head for the medical staff, asked the board to not consider cutting back on services as an option.

“It is a pleasure and a honor (to work here),” Quirk said. “We are proud of the progress we made last year.”

Quirk responded negatively to “trimmed” hours of operation or specific services to decrease his department’s budget needs.

“You asked us for sustainable quality 24 hour health care,” said Dr. Tom Jones. “Some things can’t be cut to keep the services currently available.”

The board shared the sentiment.

“Obviously, you are very passionate about your jobs and the care you provide, and that is fantastic,” said board member Cindy Van. “I support that.”

Van said she did not want to see closing either clinic for extended hours or lowering standards and types of care as an option, either. Right now, she said, options are just being considered to possibly alleviate the difficulties.


EMS department head Wil Gay presented a new, $980,000 lighter totaling $3.9-million, EMS budget to the board that cuts three positions and purchase of a new ambulance, although this would make repair and maintenance costs higher.

Gay said there might be additional places where the actual will come out lower than the budgeted number, but he saw those as necessary.

“You cannot predict when it is going to be a busy time again,” he said. “You leave yourself a little room to play so that if it does get busy, you can staff it.”

Members of the EMS department present spoke against lowering the budget for new ambulances, which accounts for about $200,000 of the budget cut.

“I’d like you to remember there are crews and patients that depend on those (ambulances),” said EMT Chris Bachelor.

Bachelor said she and many other EMTs have been stuck in various places in Sublette County and out of the county on trips to hospitals, due to equipment breakdown.

“It is an incredibly frustrating situation, keep that in mind as you make a decision,” she added.

Options discussed included speaking with industry leaders about support for the program. Gay said they had not been approached, as the original agreement for the Sand Draw ambulance barn was that the county and industry would build it and supply the ambulance and EMS would staff it. Gay added $100,000 was left from the facility’s construction and he believed it was still earmarked by the county for that project. He said it might be an option to use that account until more funds can bee found.

The other option was asking the county to take over the EMS department, although concerns were expressed about controlling the care provided if the county took over.

Should EMS no longer be under the RHCD, the budget deficit would no longer exist. State statute does not require that a health care district provide an EMS department.

“I’d hate to see that put under the county and not have any say in how our people are trained. … They would become not part of the health organization,” said board member Dave Racich.


The department stated they were doing better than in years past for payment collection; however, department head Kelli Lovell said, if all outstanding bills were paid a significant amount of the deficit would no longer exist.

Lovell said there are currently $1.4 million in collections, not including $1.4 million in bills still in-house.

“We have a really high self-pay base,” she said.

According to Gatzke, 32 percent of the district’s client-base is self-pay and they cannot turn anyone away for services, even if bills are not being paid.

This leaves us between a rock and a hard place when it comes to trying to collect,” Gatzke said. “Especially with the current economy.”


Andy McGinnis presented a new budget with an 18-percent decrease from the prior year, although his department would add maintenance costs for the new clinic and ambulance barn in Big Piney/Marbleton.

“Please understand that I am pretty barebones where I am at,” McGinnis said.

From the public

“The fact that you are having this meeting and trying to squeeze everything out of every penny is encouraging,” said one citizen, adding the clinics are currently running better than they have in years.

He continued to say, however, expectations of trying to recover to the point of almost turning a profit was ridiculous as the same is not asked of every county department, such as the Sheriff’s Office.

“It would be ridiculous to ask them that and it would be equally ridiculous to ask you. … I think they are barking up the wrong tree,” he added.

Many in the room agreed.

“I know I am preaching to the choir here; this is more of a plea for everyone to contact the county commissioners. … I want to tell the board how I’m so proud of them for creating … one of the most excellent medical centers I have ever seen, and I am proud to be a part of it,” said Physician’s Assistant Kris Roork. “(I would like to see) the commissioners support us fully and financially until we get our mill levy.”

The board determined it would behoove them to hold budget workshops and meet with each department head personally to go over individual budgets over the next two months to understand each department’s needs and costs.

Gatzke is working to schedule these meetings.

The board plans to create finalized numbers and approach the county commissioners to cover the deficit amount to keep services running at the current level.

“We are not in an emergency situation. … We just need to get our money in order,” Budd said. “You are all doing a wonderful job and I hope you are looking at us doing the same on this end.”

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