Citizens grill RHCB
Crowd lauds Pinedale doctor and nurse
by Annie O’Brien

The Feb. 14 meeting of the Sublette County Rural Health Care Board, the first in over a month, had to be moved to the Sublette County District Courtroom because the county commissioners’ meeting room could not accommodate the large number of attendees.

The tone of the meeting was tense; a lengthy public comment period featured several angry criticisms of the board from local health care providers and citizens. Many attendees condemned the RHCB for what they perceived as its unfair treatment of Dr. Judy Boyle, of the Pinedale Medical Clinic, and Dr. Doug LaSuer, of the Marbleton-Big Piney clinic. Neither Boyle nor LaSuer, who have practiced medicine in the county for several years, currently have contracts with the Rural Health Care District.

Soon after the meeting began, the Board went into an executive session meeting with LaSuer’s attorney, Elizabeth Greenwood. When they returned, RHCB Chairman Bill Budd told the public no decision had been made. He then announced that, despite its reputation for discord and strife, the Board had “no ax to grind.”

“We were elected to provide the best health care we can for Sublette County,” Budd said. RHCB member Dave Racich motioned to accept a contract with Kip Boone, the future Clinic Administrator. Boone, who is scheduled to arrive on April 2, will oversee the operations of the district clinics, ensure both facilities are compliant with legal standards, and “administrate the business of medicine [and] the practice of medicine” within the RHCD, according to district director Randy Johnson.

Racich suggested Boone was aware of the challenges facing county health care. “He admits Sublette County health care is in dire straits. We’ve dug ourselves a hell of a hole,” Racich stated.

Racich also moved to allow the RHCB to negotiate with all active health care providers in Sublette County. The board would initially offera uniform two-year contract to all providers, but could, according to Budd, adjust the agreements to reward providers with more education, experience, or other qualifications.

The motion, which was unanimously approved, would allow the RHCB to offer a contract to Dr. David Burnett of the private Wyoming Range Medical. Burnett, a former employee of the Marbleton-Big Piney clinic, remains a controversial figure in county health care after his abrupt departure from the district in 2005, during which he failed to fulfill his 90-day severance obligation.

The public comment period of the meeting commenced when Marilyn Huffman, a nurse at the Pinedale clinic and co-organizer of an initiative to codify RHCD nursing policies, read aloud a letter signed by herself and her husband, Van Hufman, criticizing the board for failing to negotiate with Boyle and LaSuer. Before reading the letter, Huffman said, “We’re all working very hard at having good manners and I’m trying to do that too.” The letter specifically censured board members Budd, Jud Faler, and Garry Eiden, Sr. Huffman stated, “Jud, Mr. Budd and Mr. Eiden, you have done a great disservice to the people of this county. In our opinion the damage you three board members have done to the health care in our county is despicable . . . If she [Boyle] leaves the Pinedale Medical Clinic it will be because of your actions and your voting records as members of this board. That may not matter to you at all, but it will certainly have a huge impact on the health and well-being of her patients and ultimately, you three should be held accountable.”

When Huffman finished reading, the audience gave her a standing ovation. Huffman submitted a letter of resignation to the board, which it did not initial.

Other citizens spoke in support of Boyle, praising her compassion, as well as her medical abilities. Dr. David Kappenman, a recent addition to the Pinedale clinic staff, said she was a “very valuable resource” to her colleagues as well as her patients. “Hold onto what you have,” he advised the board.

When the public pressed the board about its alleged animosity toward Boyle, the members responded they planned to offer her a contract. Several citizens also expressed their concerns over the district’s financial uncertainty. Racich spoke against a request made by EMT Andy McGinnis for the board to fund gym memberships to Proactive Rehabilitation, claiming the board could not, in the interest of financial responsibility, assume such a cost. He said the RHCB was unsure about the precise details of its finances, and expenses like gym memberships should be considered after the clinics are fully staffed with doctors and can provide around-the-clock medical care.

RHCB members and Lorraine Gatzke, district CFO, said the district’s financial cloudiness was due to transition between the outgoing board and the new one. The departure of Juana McGinnis, the RHCD clerk who oversaw many aspects of the district’s administration, also made fiscal clarity difficult to achieve, she said. One audience member demanded a “bench mark” date for the end of the transitional period. Racich assured the audience that by the time it submits a budget, in June of 2007, the board’s rocky inaugural period would be over. In response, attendee Mike Harker suggested the district could lose staff members whose contracts are still “up in the air” by waiting until June.

Former board member Mary Lynn Worl challenged the current RHCB on its executive session protocols. The RHCB’s agenda for the Feb. 14 meeting indicated the board would discuss patient charges behind closed doors. Wyoming statute 16.4.405 states that public governing bodies may go into executive session to discuss matters including salaries, hiring, dismissals, disciplinary action, the purchase of property or real estate, security threats and matters concerning litigation.

Johnson responded that some of the items scheduled for discussion in executive session could be tied to potential litigation and would not comment further.

One woman asked the Board why it would consider contracting with Dr. Burnett after he had twice left the district and owned a private medical practice. Racich replied that contracting rather than competing with Burnett “makes sense” for the financial health of the district. The question of “minimum standards,” which would require all district doctors to maintain board certification in their area of expertise by passing an exam administered by the American Board of Medical Specialties, was also resurrected. Last December, in a 3-2 vote, the RHCB rejected the certification requirement proposal brought by a county health care providers’ consulting group.

While all doctors currently employed by the district are board certified in their fields, Dr. Burnett, a family practitioner, is not. At the Feb. 14 meeting, Budd insisted his opposition to the proposal had been misconstrued by the public and local media.

“I have never said ‘I do not want to have board certified doctors,” Budd stated. He added that he voted against the minimum standards proposal after speaking with a representative from the Wyoming Board of Medicine, who told him that about half the doctors in Wyoming, a state that does not require board certification for medical licensing, do not possess certification. Requiring certification, Budd said, would “tie the hands of this board,” eliminating many physicians from the district’s hiring pool.

Key spoke again, demanding to know how what had previously been, to his understanding a successful private medical practice under Dr. Boyle could have disintegrated into financial and political wreckage.

Racich responded that the RHCD had been embattled for years, suffering from rifts between the north and south ends of the county and from “egos” involved in health care. Key demanded to know when the infighting and fiscal confusion would end.

Racich replied, “I don’t have that crystal ball. I don’t know if I’ll wake up in the morning.” An audience member shouted out, “Call Dr. Boyle.”