Sublette County commissioners and leaders of the Sublette County Hospital District are locked in a dispute over the county’s withholding of $2.7 million that had been pledged to help build a new long-term care facility, a component of a larger project to give the rural county a hospital.
The Sublette County Commission says its withholding of money is temporary and meant to secure “adequate assurances” that the hospital district will hold up its end of the two entities’ agreements.
The hospital district, however, says it didn’t breach any agreements — and the county government’s move, even if it’s temporary — could have a “catastrophic” effect on health care services in the county.
Both sides are expected to meet Wednesday at 5 p.m. at the Marbleton Town Hall to discuss a resolution.
The dispute centers on the timeframe it will take for the hospital district to build or renovate a new home for the county’s public health department, a project that at least one county official believes is taking too long.
Sublette County voters in 2020 approved the formation of the Sublette County Hospital District with 60% of voters in favor of its creation. The district launched a plan to build a new long-term care facility, Heritage Home, and a hospital on the same campus.
The county currently has two clinics but no hospital, making it the only county in Wyoming without a hospital.
The county commission in a 2022 agreement pledged $20 million toward the nearly $80-million project. The county agreed to add another $5.4 million to that grant in February 2023, according to its meeting minutes.
As of May 20, the commission had nearly $2.7 million left to pay of its total obligation, but it has chosen to withhold it.
Price Tags
Some Sublette County Commission members during a commission meeting this week accused the hospital district of not living up to its duties under the 2022 contract.
Sublette County Hospital District leaders, however, denied any such breach.
Hospital officials also warned that the blocked money could delay the hospital from opening on schedule, jeopardize health care countywide and spook staff members away by forcing the district to pull construction funds from the payroll and other critical funds.
“We’ve already paid that ($2.7 million) bill and we’re asking for reimbursement,” Sublette County Hospital Board Chair Tonia Hoffman said during her Tuesday presentation to the commission.
The total project costs nearly $78.8 million, which includes about $29.2 million in a USDA loan, a $5 million contribution by the district itself, $12.9 million from the state and from federal COVID money, $3.25 million in tax revenues, a $2 million donation, another $1 million donation from billionaire Joe Ricketts, and the county’s commitment of $25.4 million, according to one of Hoffman’s presentation slides.
Having to front payments that are reimbursed by county grant funds and state-administered COVID-19 money “has at times put us in significant financial hardship,” Hoffman added.
She said the shortfall has the potential to lead to a domino of other money problems that could threaten health care in the county.
“Because everything is linked. Openings are tied to inspections; inspections are tied to licensures, licensure is tied to survey… and that survey is tied to our ability to bill for services,” said Hoffman. “At a time when our finances are very, very fragile, we have to meet all those deadlines to be able to bill for services and that’s critical for us right now. Any delays can cause us some serious problems.”
A financial dent in the district could ripple through the county’s health care system and hurt the hospital’s chance of powering through its rough startup phase to attain “critical access” hospital status with the Centers for Medicare and Medicaid System (CMS), said interim hospital CEO Greg Brickner.
The critical access hospital program allows extra federal reimbursement for qualifying rural hospitals, with strings attached – such as a requirement to furnish 24-hour emergency care seven days a week, according to CMS’s website.
Lindsey Bond, Hospital District Chief Operating Officer, said the district has worked hard to attract medical personnel – but it doesn’t want to risk losing those workers by suffering an unexpected financial shock.
What We Want
In response to an interview request, Sublette County Commission Chair Lynn Bernard sent Cowboy State Daily the board’s statement on the blocked payment.
“The county has fulfilled all required payments to the Hospital District,” wrote Bernard in the statement, adding that the withholding of the grant payment is temporary, and is meant “to ensure that facility requirements for Sublette County Public Health are met so that Sublette County can meet its obligations to the community and the state of Wyoming.”
The county “fully intends” to make that last grant payment “once adequate assurances are shown by the hospital, hopefully sooner than later.”
Trouble Is ...
The district in its 2022 agreement pledged to provide a free, suitable office space for Sublette County Public Health, and to provide for the agency’s other facility needs such as utilities.
The county and district pledged to decide where they’d put the public health agency no later than the hospital’s completion date – which was slated for July 1 and is now scheduled for Aug. 4.
And the district promised to have that site built or remodeled within 180 days of the hospital’s completion.
If the hospital were to open this summer as hoped, that would put the deadline to construct or remodel the public health nurse’s facility into early 2026, under the contract.
Sublette County Commissioner Dave Stephens during the Tuesday meeting called that timeframe unacceptable.
“I don’t really believe the first quarter of 2026 is acceptable, and I can’t believe you all would think that,” said Stephens. “A lot of people here have used the public health; it is used an awful lot more than people think.”
The public health nurse has tolerated size constraints, poorly-working doors and windows – and a sewage backup in her current facility, he said.
“She can’t continue like that, OK?” said Stephens. “And they do an awful lot for this county.”
Stephens’ claims about the public health facility ignited dispute.
“I’d like to say publicly, there has been no breach (of contract) on the part of the hospital,” said Hoffman, adding that the district has 180 days’ grace to provide for the public health nursing facilities, under the contract language itself.
“There’s been the term ‘anticipated breach’ thrown around and I don’t think such a thing exists,” she said. “I’m not an attorney but I think you either breach a contract or you don’t breach a contract.”
The hospital district can’t address public health’s new facility needs right now due to financial woes, she noted, but has “in the interim provided them with a comfortable and inviting space for public health.” Hoffman also presented a plan with four different options on how to better house the public health nurse.
The interim space is smaller than the agreed-upon goal for the facility, she acknowledged.
But the hospital district has “a whole packet” of work orders showing responses to windows, sewage, and other maintenance problems all handled within 24 hours, except in the case of a problem requiring a parts order, she said.
Sublette County Public Health Nurse Janna Lee, whose listed office phone number was not working Wednesday, did not respond by publication time to an email request for comment.
Stephens did not respond by publication time to a voicemail request for comment.
Contract, Contract, Contract
Commissioner Doug Vickrey indicated at the meeting that in his view, the hospital district hasn’t “abided” by its part of the agreement. He pronounced the definition of the word “contract” aloud.
He also bemoaned a number of what he characterized as rude emails from community members, and claimed there was a culture of censorship among the construction workers on the hospital site.
“The county has lived up to their side of that agreement,” said Vickrey. “But the contract has to be abided by both sides. It’s not a one-way deal.”
Vickrey, in a Wednesday interview with Cowboy State Daily, declined to elaborate on how the hospital district allegedly violated the contract.
“It will come out,” he said. Growing reticent, he added, “I’m not going to get into it.”
Vickrey pointed to county budget concerns, saying he anticipates a 40 to 45% shortfall in county tax revenues for the coming year.
The county has nearly $179.3 million in its reserve accounts – some of which are earmarked for specific causes. The county also is required to keep $10 million in cash reserves, Sublette County Clerk Chief Deputy Jerun Kerbach told Cowboy State Daily on Wednesday.
But the $2.7 million pledged to the hospital district isn’t relying on those reserves, Kerbach added: “That’s already put away for them.”
How It Went Down
Commissioners decided not to pay the remaining pledge at their May 20 meeting.
They met in executive session, shielded from the public, and when they emerged, Chairman Bernard “removed the Hospital District Voucher” from the accounts payable without a vote, the meeting minutes say.
The vote that happened wasn’t on whether to pay the hospital, but on whether to pay the county’s other, regular stack of bills.
Commissioner Mack Bradley alone voted not to approve the regular bill payouts.
In his own interview, Bradley indicated he believed he was voting against the withholding, rather than against approving the normal bills.
Commissioner Sam White did not vote on the motion either way, according to his later interview and to the recollection of County Clerk Carrie Long, who said she didn’t hear him say anything during the vote.
White, who also seemed to believe the vote was about the hospital, told the outlet it was already clear the three-person majority was for withholding its payout.
This episode “was a little confusing,” said Long, since no one actually voted on what to do with the hospital’s money.
As to whether a lack of a vote invalidates the withholding, Long directed Cowboy State Daily to ask Sublette County Attorney Clayton Melinkovich.
“I thought it would,” said Long, “but I’m not the attorney.”
Melinkovich did not respond by publication time to a Wednesday voicemail request for comment.
A Little History
Hospital District public relations director Kari DeWitt told Cowboy State Daily on Wednesday that the county’s additional $5.4 million commitment in 2023 was a reaction to inflation and post-COVID supply chain issues harming the hospital project.
The Wyoming Legislature complicated the hospital’s plight further, hospital district leaders said, by passing a law in 2021 letting energy companies stretch their ad valorem tax payments from that time period over the 13 years to follow in smaller monthly payments based on estimates but reckoned annually.
This put the hospital district about $8 million behind in its expected tax revenues from its mill levies, DeWitt said.
Jonah Energy and PureWest both decided to participate in the deferral scheme, Sublette County Treasurer Emily Paravicini told Cowboy State Daily. The state offered a loan program to the counties to backfill and make up for the temporary shortfall, but Sublette County didn’t take those loans when the deferrals first started because it “ended up having a really good year or two, during that time with minerals,” said Paravicini.
“It wasn’t until this last year that we really felt like we were short,” she added, as smaller-than-anticipated revenues trickled in.
Clair McFarland can be reached at clair@cowboystatedaily.com.
