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Gillette Hospital Continues To Lose Millions, But CEO Optimistic

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By Ellen Fike, Cowboy State Daily

Despite the Campbell County Hospital continuing to lose money, months after officials declared it was on a path to “financial insolvency,” its CEO is optimistic about the future, he told Cowboy State Daily on Thursday.

According to the hospital’s most recent revenue report, it lost around $34 million over the last fiscal year. The new one begins on July 1.

This is significantly higher than the projected $10 million in losses the hospital was expecting when spokeswoman Karen Clarke spoke with Cowboy State Daily in April.

Hospital CEO Matt Shahan told Cowboy State Daily that rural hospitals in Wyoming and across the country have been struggling and Campbell County Health is no exception.

“We continue to work with staff, providers, and subject matter experts to implement innovative solutions to control costs and maximize revenue-generating opportunities,” he said.

The hospital’s board of trustees will approve the organization’s latest budget on July 21, but all of the departments submitted their preliminary capital and operating budgets in April.

In May, the hospital’s CFO, Mary Lou Tate, “separated employment” from the organization. Her replacement has not yet been announced, but an interim CFO has been working to assist and finalize the budget process, Shahan said.

In March, hospital officials announced that financial projections showed that without decisive action, the hospital could be bankrupt by 2026, leaving thousands of people without emergency health care in Campbell County.

Hospital officials said at the time that the issue of financial troubles is one many rural health care facilities are facing across the country. The situation was exacerbated by the pandemic, which caused hospitals across the country to lose “hundreds of millions of dollars.”

Hospital officials said the issue of financial troubles is one many rural health care facilities are facing across the country and one that was exacerbated by the pandemic, which caused hospitals across the country to lose “hundreds of millions of dollars.”

Nineteen rural hospitals in the United States closed in 2020, and more followed in 2021, according to the University of North Carolina, which has tracked the number of rural hospitals in the nation since 2005.

The 19 closures in 2020 was the biggest loss of rural hospitals in a year since UNC began tracking those records.

In April, Clarke told Cowboy State Daily there were some misconceptions about the way the hospital was funded.

“One of the biggest misconceptions about CCH is that we are fully taxpayer-funded,” Clarke said at the time. “County and state funds account for approximately 5% of our revenue. So while Campbell County residents see $10 million going to CCH, that is only 3% of our operating revenue.”

Medicare, Medicaid and medical insurance make up most of the hospital’s revenues, Clarke said, but Medicare reimburses the hospital at a lower rate than medical insurance.

“Our aging population means there are going to be more and more Medicare patients, and those patients tend to be sicker,” she said. “Medicare reimburses at (87 cents per $1 spent) as opposed to $1.45 for commercial insurance  As more competitors come into the market, they are going after commercially insured patients because they do not have to accept all patients.”

While the hospital accepts all patients, regardless of their ability to pay, administrators have to figure out what services the hospital can provide at a loss and which services need to be expanded through partnerships, business development and marketing.

Clarke pointed out that Wyoming has a higher rate of Medicare and uninsured patients compared to the national rate, with 16.2% of Wyoming’s patients being on Medicare compared to 14.2% nationally and 12.3% having no insurance, compared to 9.2% nationally.

Clarke said that the hospital is taking several steps to attempt to resolve the budget issues, such as affiliating with health care system UCHealth and collaborating with a company to resolve billing issues.

Reps. Eric Barlow, Bill Fortner, John Bear and Chris Knapp, all R-Gillette, all did not return Cowboy State Daily’s request for comment on the situation by press time.

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Monkeypox Hits U.S., Wyo State Health Officer Can’t Predict Whether It Will Spread To Wyoming

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By Ellen Fike, Cowboy State Daily

A virus similar to smallpox has been detected in the United States, but there is no way to predict whether the illness will spread to Wyoming, according to the state’s public health officer.

Health officer and epidemiologist Dr. Alexia Harrist told Cowboy State Daily on Wednesday that it was difficult to say whether the spread of monkeypox was a cause for major concern as of yet.

“It’s too early to say at this point,” she said. “It will probably be a rapid learning process with this, but I think we’ll discover more in the coming days.”

According to the World Health Organization, the United States has from one to five confirmed cases of monkeypox, which typically occurs in central and west Africa.

Harrist explained that the virus typically causes symptoms such as a headache, fever and muscle aches, but also is accompanied by a distinct rash. According to the Centers for Disease Control and Prevention, the symptoms are similar to, but milder than, smallpox.

Harrist said the illness has been traditionally associated with people who have traveled to Africa and caught it. However, the newest outbreak has seen symptoms popping up among gay and bisexual men.

“In the United States, it has been reported some individuals in these clusters have self-reported as men who have sex with men, but this is not all of the cases,” she said. “It’s not something easily spread as COVID. The main way it spreads is through skin-to-skin contact.”

Harrist said typically, people who have caught the virus will develop symptoms within a week or two, but she said the time can also range anywhere from five to 21 days.

She added that a monkeypox risk to the general public at this time was relatively low in the United States, but recommended that anyone who has recently traveled out of the country or had contact with someone diagnosed with monkeypox should speak with their health care provider.

Monkeypox can kill as many as 1 in 10 people who contract the disease, based on observations in Africa, according to the CDC.

According to WHO officials, the vaccine used to prevent smallpox appears to be about 85% effective in guarding against monkeypox, based on observational research in Africa.

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Vomiting, Diarrhea (And Both Concurrently) Increasing In Wyoming; Caution Urged

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By staff reports

If you are experiencing bouts of vomiting and diarrhea (or both concurrently), you aren’t alone. Stomach-related illnesses are on the increase in Wyoming, the Department of Health announced on Friday.

The Wyoming Department of Health put out a notice on Friday letting citizens know of the uptick but had no explanation for it.

The department did note that areas in the northern part of the state, including the town of Sheridan and Park County, and the southern part of the state including Laramie County, seemed to be hit the hardest.

If there’s any good news, there’s no mask mandate that comes with it, the words “explosive” or “projectile” are not included in the notice, and it’s relatively easy to prevent by the washing of hands.

But the department is recommending not attending graduation parties or weddings while vomiting or experiencing diarrhea.

In fact, if vomiting or experiencing diarrhea — or both for that matter concurrently — one should wait 48 hours before attending events.

That’s because it’s so easy to spread.

“We’re usually talking about extremely tiny amounts of poop or vomit we can’t see,” Department of Health surveillance epidemiologist Matt Peterson said.

Although it may be difficult to cancel a wedding or graduation ceremonies, it should be attempted rather than attending either and vomiting on other patrons — or worse.

The best way not to spread it or get sick yourself to wash your hands.

“Gastroenteritis illnesses can be prevented,” Peterson said. “It sounds too simple, but, truly, good hand washing is critical.”

However, if exposed it can take between 12 to 48 hours before experiencing sickness. Hopefully symptoms will alleviate quickly but vomiting and diarrhea — or both — could last for up to10 days.

Commonly described as “stomach flu” or “food poisoning,” gastroenteritis can spread easily when people eat or drink contaminated food and beverages, touch contaminated surfaces or through close contact with someone already sick.

 Recommended steps to help prevent illness include:

·         Frequently wash hands, especially after using the restroom or changing diapers, and before eating or preparing food.

·         If ill, stay home from work and school, especially if employed in food-handling, healthcare or child care.

·         Thoroughly clean and disinfect contaminated surfaces immediately after an episode of vomiting or diarrhea with a solution of 1 cup household bleach per 1 gallon of water and letting the solution sit for one minute.  Always follow manufacturers’ safety precautions.

·         Immediately remove and wash contaminated clothing or linens after an episode of illness (use hot water and soap).

·         Flush or discard any vomit and/or poop in the toilet and keep the surrounding area clean.

·         Ill persons should take extra care to avoid spreading the virus by minimizing contact with other persons while ill and practicing good hygiene.

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Mysterious Hepatitis Outbreak In Children Skips Wyoming So Far

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By Clair McFarland, Cowboy State Daily

Although three neighboring states have seen the mysterious hepatitis cases in children now being reported nationally, the phenomenon hasn’t hit Wyoming.   

In a May 6 press conference Dr. Jay Butler, deputy director of the Centers for Disease Control and Prevention, listed 25 U.S. states and territories in which acute hepatitis has been diagnosed in children. The cause is not yet known.

Among those states are Wyoming neighbors Idaho, Nebraska, and Colorado. Children in nearby North Dakota have also been diagnosed with the illness.

Of 109 cases currently being investigated by CDC, five children have died of acute hepatitis, but Butler would not say which states the fatalities occurred in because he was concerned about preserving patient privacy with “such a small number” of fatalities.  

Of the infected children, 90% have been hospitalized and 14% have received liver transplants. Hepatitis can cause liver failure. 

Hepatitis can be caused by known hepatitis viruses such as Hepatitis A, B, C, D, or E, but in these pediatric cases affecting children roughly 2 years of age, the cause is unknown.  

Most of the children being investigated also have a particular strain of adenovirus – adenovirus 41 – that usually only causes hepatitis in immunocompromised people.  

But Butler said the infected children were healthy before their livers started shutting down.  

There has been no sign of the illness in Wyoming, according to the state Department of Health.

“Wyoming has had no reported pediatric cases of the hepatitis of current interest,” Kim Deti, a department spokeswoman, told Cowboy State Daily.

Deti said WDH issued a document to health care providers last month to watch out for hepatitis symptoms and informed the department of “testing recommendations.”  

The document urged clinicians watch patients for loss of appetite, fever, fatigue, nausea, vomiting, abdominal pain, dark urine, light-colored stools, joint pain and jaundice, or yellowish coloration. All are hepatitis symptoms.  

Adenovirus symptoms also are included in the notice. While many adenoviruses cause respiratory symptoms, the strain identified in the majority of the 109 child hepatitis sufferers cause stomach issues, such as vomiting and diarrhea. It can be accompanied by respiratory symptoms as well.  

Wyoming clinicians have been advised to test for adenovirus in children with hepatitis of unknown cause, to inform WDH of any children under 10 with a high enzyme count indicating liver damage and to “save samples” from hepatitis-suffering children under medical care.  

Clinicians also were told to report prior cases dating back to October of last year.  

Causes Investigated 

Butler told reporters May 6 that the CDC and clinicians are investigating many potential causes of the hepatitis.  

He emphasized that the first nine children diagnosed with the illness in the country, in Alabama, were not vaccinated for COVID-19. They also had no known history of COVID-19.  

The median age of the 109 infected children is 2, Butler said, so most would not be eligible for the COVID-19 vaccination.  

According to news reports, the United Kingdom identified cases of pediatric hepatitis on April 5, about two weeks before the first cases were identified in the United States.

Many of the UK children had access to dogs, but Butler would not attribute the illness to the presence of dogs or any other environmental factor. He added environmental factors are among the many causes being considered.  

Butler said the number of acute hepatitis cases in children is not above the baseline, or unusually high compared to years past. But he said officials are taking notice because of the apparent link between hepatitis and adenovirus, which spreads easily.

The WDH said in its notice to Wyoming doctors last moth that adenovirus spreads by close personal contact, respiratory droplets, and “fomites,” or carriers of infection.  

“There is no specific treatment for adenovirus infections,” the notice reads.  

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Rawlins Hospital Stopping Labor And Delivery Services, Will Save $2M

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By Ellen Fike, Cowboy State Daily

A second hospital in Wyoming has announced it will stop providing labor and delivery services in the near future.

The Memorial Hospital of Carbon County in Rawlins will soon discontinue obstetrics services, hospital spokeswoman Stephanie Hinkle told Cowboy State Daily on Monday.

“An exact closure date has yet to be determined,” she said. “We are working through a number of these topics this week, as the decision was just made last Thursday.”

The hospital’s board of trustees made the decision Thursday after an “extensive” executive session during its regular meeting.

Hinkle told Cowboy State Daily that by eliminating the services, the hospital will save an estimated $2 million.

“This was an incredibly difficult and emotional decision for the Board. The cost of traveling nurses has played a significant role in the eroding cash position of the organization,” board Chair Rod Waeckerlin said Friday.

“Labor and Delivery is a unique service line that requires intensive staffing. Unfortunately, as a result of the pandemic, MHCC has lost a number of nursing staff, forcing a reliance on traveling nurses and creating a financial imbalance operationally,” he said.

The hospital currently has three traveling nurses in the obstetrics department, Hinkle said.

It was unclear how many patients would be affected by the end of the services, but Hinkle said more information would be provided during a news conference later this week.

In March, the South Lincoln Medical Center in Kemmerer announced it would also end labor and delivery services beginning June 1 due to staffing issues.

Hospitals in Wyoming and nationally have been facing financial and staffing issues, partially due to the COVID-19 pandemic.

Gillette’s hospital, Campbell County Health, is projecting $10 million in losses this year. Its officials estimate the hospital could be bankrupt by 2026 without major changes, some of which are already being implemented.

Nineteen rural hospitals in the United States closed in 2020 and more than 180 have closed since 2005, according to the University of North Carolina, which tracks the number of rural hospitals in the nation.

The 19 closures in 2020 was the biggest loss of rural hospitals in one year since UNC began tracking those records.

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Sleep Experts Say Quit Changing Time On Clocks; Pick One And Leave It Alone

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By Wendy Corr, Cowboy State Daily

It’s an idea whose “time” has come.

That’s how the American Academy of Sleep Medicine welcomed the U.S. Senate’s passage of a bill that would do away with the twice annual change between Standard and Daylight Savings Time.

For those in Wyoming who study sleep patterns and the effect on people’s overall health, it’s about time.

Fatigue, sleepiness, irritability and insomnia are common symptoms associated with the semi-annual time change reported to the Wyoming Sleep Disorder Center in Cheyenne, according to Jerry Crawford, the center’s director.

“Because we’ve confused the body,” he said. “It had adjusted to a certain amount of light at a certain time, and things getting dark at a certain time. And then we flip that, and it takes a little bit of time to readjust.”

Crawford’s organization conducts testing to help evaluate various types of sleep disorders. The center also has a sleep specialist who sees patients and a sleep clinic for therapy, follow-up and general consultation for any type of sleep disorders. 

Crawford told Cowboy State Daily that the center does see an increase in patients right around the twice-annual time change.

“Initially we can see an increase in patients, people complaining about fatigue, just feeling tired and a little bit off, right around that change from Standard Time to Daylight Savings Time, and from Daylight Savings Time to Standard Time in the fall,” he said.

Crawford said for those already experiencing health issues, the change in sleep patterns can exacerbate their conditions, although he said it’s usually just a temporary development.

“If we see any exacerbation or aggravation of previous medical conditions, typically we can expect that to resolve within a couple of weeks,” he explained.

Standard Or Daylight Savings?

Crawford said any permanent change, whether to Standard Time or Daylight Savings Time, would have its benefits.

“I think they both have their pros and cons,” he said. “There are valid reasons to argue both sides of that coin, there are pros to Daylight Savings Time, there are pros to Standard Time.”

Although the time change bill passed unanimously by the U.S. Senate in March would set clocks permanently in the Daylight Savings Time mode, Crawford said the human body would probably react better to staying on Standard Time.

“When we’re looking at the physiology and the biology of humans, Standard Time is probably going to be a little bit better for us,” he said. “Especially for our kids – we’re getting them up early in the morning, it’s still dark outside, it’s taking them a little longer to wake up. They’re having problems in the first period of school, things along those lines.”

To illustrate the difference, if on Dec. 20, the shortest day of the year, the sun rises at 7:45 a.m. during Standard Time, a switch to full-time Daylight Savings would see the sun rise at 8:45 a.m. 

“But with Daylight Savings Time, there are some societal pros,” Crawford added, because of the later hours of daylight. 

The American Academy of Sleep Medicine, on its website, heartily endorsed the end to the twice-annual clock change. However, the academy noted that the human body – and public health – would benefit by staying at Standard Time year-round.

The U.S. House of Representatives has yet to review the bill that supports permanently moving the nation’s clocks ahead an hour. If it passes the House, the change would not take place until November of 2023.

The change in times most Americans abide by was made official in 1966 with congressional approval of the Uniform Time Act, which set the time changes to happen on the first Sunday and April and the last Sunday in October. 

In 2005, Congress extended Daylight Savings Time by an additional three weeks, to begin the second Sunday in March and end the first Sunday in November.

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Fremont County Gets $37 Million For New Hospital

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By Clair McFarland, Cowboy State Daily

The largest U.S. Department of Agriculture loan ever made in Wyoming has moved Fremont County $37 million closer to a new hospital.  

The Riverton Medical District, a nonprofit group formed in 2019 by community members, announced Monday that the USDA has awarded a $37 million low-interest loan toward the building of a new hospital north of Riverton. 

The loan, which leaves the project just $10 million short of full funding, is the largest USDA loan ever provided in Wyoming, said Corte McGuffey, an RMD board member.

The new hospital will compete with SageWest Health Care in Riverton, an idea conceived in 2018.  

“In a few months it will be four years since my former freshman P.E. teacher Janis Bradley came up with the crazy idea to do something about our hospital situation,” McGuffey said during a news conference Monday. “She called the meeting with a group of local leaders.”  

Initially, the activists wanted to remedy what they saw as the failings of SageWest, including a high rate of patients being flown out of Riverton for treatment, the 2016 closure of the Riverton obstetrics ward, the lack of ability to respond to burns and other issues.  

The obstetrics ward remains closed. Lander SageWest Health Care retained its obstetrics ward.  

“Back then the goal was not to build a new hospital,” said McGuffey. “It was to save our hospital. But meeting after meeting – in those early days – it became evident that our health care situation would not improve unless a different course was taken. 

“That’s when our cowboy ethic took over,” he continued. “We drew the line, and the mission changed to ‘Let’s build a new hospital.’”  

Riverton City Council Member Kristy Salisbury said in a later phone call that the RMD has identified other possible sources for the remaining $10 million. 

SageWest Health Care countered in an email Monday to Cowboy State Daily that the existing hospital is “committed to ensuring that the residents of Fremont County have access to high-quality, full-service hospital care close to home,” and that SageWest is “proud of our dedicated teams and all that they do to meet the healthcare needs of Fremont County at both our Riverton and Lander campuses.”

Tribal Parcel 

Plans call for the new hospital to be built on 12 acres of land, four of which were donated by the Eastern Shoshone Tribe on its 300-acre parcel north of Riverton known as the Shoshone Business Park.  

The acreage when pledged was worth about $1 million and comprised a significant portion of the equity required to secure the USDA loan.  

Riverton Medical District is purchasing the other 8 acres from the tribe for $2 million.

Competition The ‘American Way’ 

The new hospital could improve services and prices by competing with the existing facility, according to John St. Clair, chairman of the Eastern Shoshone Tribe.  

“It’s going to provide much-needed medical services, for not only Riverton, but the entire community,” he said. “But beyond that, it will provide a level of competition to the  services that currently exist. 

“Competition,” St. Clair continued, “will hopefully result in better prices for our people to pay for those services. We know that competition is the basis for our economy – and more than that, it’s the American way.” 

Many Eastern Shoshone Tribal members live near Riverton on the Wind River Indian Reservation, along with members of the Northern Arapaho Tribe.  

Billings Medical Clinic 

RMD last year signed a letter of intent to affiliate with the Billings Medical Clinic.  

Dr. Scott Ellner, Billings Medical Clinic CEO, told the crowd Monday that his organization emphasizes locally-controlled healthcare, and intends to keep medical decision-making in local hands.  

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Lander Hospital Says It Shouldn’t Pay Medical Bills For Woman Whose Eye Was Gouged Out

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By Clair McFarland, Cowboy State Daily

The family of a Fort Washakie woman who died after her eye was gouged out by a fellow patient at a Lander hospital should not receive compensation for the resulting medical bills, according to the hospital.

SageWest Health Care in Lander, in a new motion in the lawsuit filed against it by the family of Elaine Tillman, said the $500,000 in medical payments sought by Tillman’s family are not allowed under Wyoming wrongful death laws.

Tillman died in Utah nearly two weeks after her eye was gouged out by Dubois man Patrick Lee Rose on Thanksgiving Day 2020 in the hospital’s emergency room. Both were being held as mental health patients in emergency custody, according to SageWest filings.  

After the incident, in June 2021, Rose was released from custody in the Wyoming State Hospital due to limitations on Wyoming’s mental health confinement laws.  

Hospital Bills 

Tillman’s daughters June Louise Tillman and Cathy Ann Lucas sued SageWest Health Care in July 2021, about a month after Rose’s release. They claimed that Rose had a known violent history and was not properly supervised or restrained by the hospital.  

Tillman’s daughters asked the court to order the hospital to pay damages for loss of companionship, emotional support and services Tillman may have provided them had she lived. Plaintiffs also asked for “hedonic” or compensation for the loss of joy of Tillman’s life.  

Tillman’s family has also made claims for nearly $500,000 in hospital bills tied to the incident, according to a March 30 filing by SageWest.  

But the hospital asked the judge to dismiss that claim, saying the bills, some of which are attributed to Tillman’s brief stay at the University of Utah Medical Center after her injury aren’t covered in wrongful death suits under Wyoming law.  

“The evidence is uncontroverted that (Tillman’s daughters) have never seen, nor paid, any of the decedent’s medical bills,” reads the filing, adding that even SageWest hasn’t seen these outside bills itself, “just an itemization.” 

“Therefore,” the motion said, “if the (daughters) were to recover for Mrs. Tillman’s last medical bills, it would be a complete windfall, which is not the purpose of awarding damages.”  

SageWest also has asked the court to block the family’s request for “hedonic” reimbursement, which it says also isn’t covered under wrongful death suits in Wyoming.  

Comparative Fault 

SageWest argued further in its March 30 motion that Rose should be added as a defendant in the lawsuit, saying the Tillman family only sued the hospital “as a tactical and strategical move.” 

SageWest claimed that the Tillman family lawyers do “not want (U.S. District) Judge (Nancy) Freudenthal to put Patrick Rose on the verdict as a non-party ‘actor’ for the jury to allocate and assess comparative fault to Mr. Rose,” reads the SageWest motion. “But, under Wyoming law, the Court must put Mr. Rose on the verdict,” to ascribe possible fault to him in a jury trial.  

The Tillmans have not yet responded to the filing.  

Violent History? 

Patrick Lee Rose

Another key argument in the lawsuit is whether Rose had known violent tendencies the hospital should have anticipated.  

The Tillman family alleged that the hospital should have known of Rose’s propensity for violence and overseen him better while he was at the hospital.  

SageWest argued that Rose’s gouging attack on Tillman was “unexpected and unforeseeable.” To advance this point, the hospital asked on Feb. 4 for psychiatric history documents for Rose dating back to 2007.  

Rose’s attorney had provided documents covering a 37-day window surrounding the event, but the hospital said that was not enough evidence to argue the case.  

U.S. Magistrate Judge Kelly Rankin on March 8 granted the hospital’s request for Rose’s longer case history.  

Home to Dubois 

According to court documents, Rose escaped his own room in the hospital, entered Tillman’s, jumped on the woman and gouged out one of her eyes with his thumb. He was attempting to gouge out her other eye when hospital personnel restrained him and called police.  

Charged with second-degree murder, Rose was released in June of 2021 to live with his wife in Dubois because of provisions in Wyoming’s criminal and mental health confinement laws.  

A Wyoming defendant cannot give a plea at a criminal arraignment until he is determined to be of sound mind. If he’s not sound of mind, he can be held under the state’s emergency mental health laws – but only until he no longer constitutes a threat to himself or others.  

Rose has suffered for about two decades from an acquired brain injury caused by heavy metal toxicity, according to court documents. 

Last June, a physician for the Wyoming State Hospital testified in Lander Circuit Court that Rose was no longer a threat under the law, but he could not be made sane enough to enter a plea.  

The court released him into his wife’s custody.  

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Gillette Hospital Projecting At Least $10M In Losses, Officials Hopeful For Future

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By Ellen Fike, Cowboy State Daily

Although the Campbell County hospital is projecting losses of at least $10 million, officials are hopeful that recent changes will prevent the possible bankruptcy Campbell County Health is facing.

Hospital officials announced this week that recent financial projections showed that without decisive action, the hospital could be bankrupt by 2026, leaving thousands of people without emergency health care in Campbell County.

Hospital spokeswoman Karen Clarke said that officials released the information in order to help the community better understand the situation.

“One of the biggest misconceptions about CCH is that we are fully taxpayer-funded,” Clarke told Cowboy State Daily on Friday. “County and state funds account for approximately 5% of our revenue. So while Campbell County residents see $10 million going to CCH, that is only 3% of our operating revenue.”

Medicare, Medicaid and medical insurance make up most of the hospital’s revenues, Clarke said, but Medicare reimburses the hospital at a lower rate than medical insurance.

“Our aging population means there are going to be more and more Medicare patients, and those patients tend to be sicker,” she said. “Medicare reimburses at (87 cents per $1 spent) as opposed to $1.45 for commercial insurance  As more competitors come into the market, they are going after commercially insured patients because they do not have to accept all patients.”

While the hospital accepts all patients, regardless of their ability to pay, administrators have to figure out what services the hospital can provide at a loss and which services need to be expanded through partnerships, business development and marketing.

Clarke pointed out that Wyoming has a higher rate of Medicare and uninsured patients compared to the national rate, with 16.2% of Wyoming’s patients being on Medicare compared to 14.2% nationally and 12.3% having no insurance, compared to 9.2% nationally.

While hospital officials have been aware of the situation in recent years, Clarke said that the COVID pandemic dramatically affected the health care industry, including CCH.

The pandemic and its related surges of infections repeatedly shut down some services at CCH, such as elective surgeries. Additionally, during the surges, the hospital was hit with a large number of “very sick” patients, limited staff and shortages of personal protective equipment.

“We diverted staff from elective surgeries and other departments to staff our ICU, Medical Surgical unit, Emergency Department, and our primary care facilities,” Clarke said. “While many people in Wyoming think of the pandemic as a windfall for hospital systems, it was devastating financially.

“As recently as January, when the most recent COVID-19 wave hit, we had to once again shut down our surgical unit to all but emergency surgeries,” she continued. “Prior to that, the last shutdown, which consisted of limiting the number of elective surgeries based on available hospital beds and staffing, lasted from September to the end of November.”

Clarke noted that hospital officials have been projecting losses of at least $10 million since last fall.

Clarke said that the hospital is taking several steps to attempt to resolve the budget issues, such as affiliating with health care system UCHealth.

“Being part of the group purchasing program alone saved us over $750,000 in the first quarter of 2022,” Clarke said. “Having the ability to cross-train nurses as scrub techs by sending them to UCHealth has helped us bring back our surgery procedures to a more pre-pandemic schedule.”

Hospital officials must also think about finding efficiencies across all services lines and developing partnerships with local and regional health care providers, she said.

The hospital is also collaborating with a company to resolve billing issues, which Clarke said has helped reduce total unbilled accounts by 62% since August.

“This is significant because patients are no longer waiting months for a bill and we are realizing that revenue more quickly,” Clarke said. “We have been able to reduce the time to process requests for copies of medical records from over 90 days at one point to an average of 11 days.”

Finally, the appointment of interim CEO Jerry Klein has been especially helpful in recent months, Clarke said.

“He has been working closely with both finance and leadership to start tackling these issues,” she said. “Klein has worked with CCH leadership, directors, managers and supervisors since Jan. 1 to collaboratively understand and identify potential areas of improvement.”

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Gillette Hospital Facing ‘Financial Insolvency’ By 2026

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By Ellen Fike, Cowboy State Daily

Campbell County’s hospital is facing such massive budget shortfalls that it could be facing “financial insolvency” in just a few years, its leadership announced this week.

Campbell County Health officials did not return Cowboy State Daily’s repeated requests for comment on Wednesday and Thursday.

Hospital officials announced this week that recent financial projections showed that without decisive action, the hospital could be bankrupt by 2026, leaving thousands of people without emergency health care in Campbell County.

Hospital officials said the issue of financial troubles is one many rural health care facilities are facing across the country and one that was exacerbated by the pandemic, which caused hospitals across the country to lose “hundreds of millions of dollars.”

“More broadly, our community population is aging, our population is sicker, we have a higher number of people who are uninsured or underinsured, and our outdated technology has hampered our ability to quickly pivot and respond to financial losses,” hospital officials said this week.

Nineteen rural hospitals in the United States closed in 2020, and more followed in 2021, according to the University of North Carolina, which has tracked the number of rural hospitals in the nation since 2005.

The 19 closures in 2020 was the biggest loss of rural hospitals in a year since UNC began tracking those records.

Campbell County Health officials said they are addressing the situation “head-on” and are “on track to strengthen both the quality of healthcare and the financial viability of CCH for generations to come,” but did not respond to a question from Cowboy State Daily about the hospital’s strategies.

The announcement said hospital leadership and the board of trustees have been taking measures to move toward financial stability, such as affiliating with health care system UCHealth, working with a company to address billing issues, implementing a new health care software system and selecting a new CEO.

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Flu Tracking In Wyo Back After Two Years, Infections Slightly Above Projections

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By Clair McFarland, Cowboy State Daily

After a hiatus of nearly two years, the Wyoming Department of Health is tracking influenza infections once again.  

The latest available data on flu infection showed an influenza infection rate above what the state Health Department had predicted through most of the current flu season.

The figures showed that flu rates between late October and early March exceeded the projected seasonal average of 2% of those visiting health care providers except during a four-week period in November and December and a one-week period in March.

The highest percentage of flu infections occurred in late January, at just less than 6%.  

Flu activity was “high” in January but waned to “moderate” in late February and now is listed as “minimal”  — in a curve typical of flu seasons historically, according to Department of Health data.     

In a similar report from 2018, flu infection percentages started the flu season lower but peaked at a higher infection rate, topping out at 7% in February.


The Health Department stopped tracking the flu in the spring of 2020, soon after implementing its rigorous COVID-19 tracking platforms.  

“Flu activity dropped to a very low level in spring 2020 when COVID took over,” WDH spokeswoman Kim Deti wrote Monday in an email to Cowboy State Daily. 

She attributed the drop to “precautions” taken by the state’s residents to slow the spread of COVID.  

Wyoming Gov. Mark Gordon in March of 2020 instigated a state of emergency which allowed the state to put limits on gatherings, mandate business closures and put other restrictions in place. Those mandates have eased, and Gordon announced Feb. 28 that he plans to end the state of emergency on March 14.  


WDH has posted flu tallies, along with influenza and pneumonia death tallies from October and November 2021 to its website,

However, those numbers were not publicly available during those months. According to Deti, they were not posted until Dec. 31. 

“Influenza is tracked by season, not by calendar year,” she wrote, adding that “reported numbers do not show a total picture with flu and never have.”  

Deti explained the delay in posting was the result of burdens on department staff created by COVID.

“Our staff in this area has been carrying a heavy load due to the COVID-19 pandemic,” she said.  

WDH staff, Deti said, now are uploading flu data on a weekly basis.  

Deaths Published

Although the bar graphs logging flu and pneumonia deaths were not accessible via weekly reports during the tracking hiatus, those numbers now have been added into the flu tracking reports.  

The winter of 2020-21 showed generally fewer pneumonia and flu deaths than in the five years prior with between six and nine per month. April and May of 2021 had six and five pneumonia/flu deaths respectively, which was closer to the five-year averages of roughly eight and four.  

The current season from November to February has had generally fewer pneumonia/flu deaths than the six years prior, except for an October 2021 spike to 12 deaths.  

Contributing Causes 

Deti said in the 2020-21 flu season, only one flu death also was listed as a COVID death.  

“This was actually the only reported influenza-related death for the 2020-21 season,” she said, indicating that the other 49 deaths on the mortality graphs are attributable to pneumonia instead.  

So far this season, added Deti, “we have not seen” death certificates listing both COVID and the flu as causes.  

The department’s Records Department declined to provide a tally of ages and underlying death causes in COVID victims in late 2020, saying “listing a decedent’s age and the cause of death… may easily be linked or mapped back to an obituary and the identity of the party.” 

“The WDH will not disclose this death data to the public,” the agency wrote at the time.   

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Flu Cases Remain Low Compared to Prior Seasons in Wyoming

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By Jennifer Kocher, Cowboy State Daily

Wyoming’s influenza season appears to be off to a mild start, with cases up just slightly this year over last year but markedly lower than prior flu seasons.

According to the weekly influenza report from Wyoming Department of Health, the number of flu cases reported in the state fell from 200 during the first week in January to just over 100 at the last reporting on Jan. 14.

By comparision, during the same period in 2019, a little less than 600 influenza cases were reported. That year, case numbers spiked at more than 1,400 cases by the end of February. 

Flu season runs from October through May.

Influenza case numbers were not posted for the 2020-21 season, according to Kim Deti, public information officer for WDH, because the state did not experience significant flu activity last season. 

This year, WDH has reported seeing cases of both Influenza A and B virus circulating, with the dominant strand being Flu A (H3N2). Cases have been reported in 21 of Wyoming’s 23 counties.

Deti cautioned against putting too much stock in these numbers, however, given the fact that some medical providers do not consistently report influenza cases to WDH and few patients get tested for the illness.

“The numbers do not show a total picture. With flu, they never have,” she said, noting that comparing reported cases of influenza from season to season or week to week may not be valid given the many factors influencing both testing and reporting.

 However, it is certain that Wyoming is currently experiencing low levels of influenza activity this season compared to previous years, Deti said. 

Deti said that the decrease in flu activity last season in Wyoming mirrored a decline in flu cases seen nationally. Many experts attributed the decline in 2020-21 to COVID-19 related precautions such as traveling less, attending fewer public events and other public health precautions.  

 “For the 2019-20 flu season, activity was running at high levels until the pandemic began and people started taking the precautions we all remember,” she said in an email to Cowboy State Daily. “Then it dropped.”

WDH can’t predict what the rest of the flu season will look like, Deti added, because it’s relatively early in the season.  

Since the beginning of this year’s flu season, 22 Wyoming residents have died of pneumonia and influenza-related illnesses. 

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Wyoming Mental Health Official Expresses Concern About Health Care ‘Crisis’

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Published on December 9, 2021December 9, 2021  in News/Crime

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By Ellen Fike, Cowboy State Daily

Wyoming mental health care officials are asking residents to contact their legislators to urge them to action in addressing the state’s mental health care system, which they said is currently in “crisis.”

Heath Steele, president of the Wyoming Association of Mental Health and Substance Abuse Centers, said his group is very concerned about the status of mental health care and services in the state.

“Mental healthcare in our state is in crisis. Wyoming is the worst ranked state, at 29.8 deaths due to intentional self-harm per 100,000 population, twice the national average,” said Steele, who is also executive vice president of operations for Volunteers of America of the Northern Rockies. “The system is stressed with more than 28,000 Wyoming citizens accessing state funded mental healthcare last year. That is in addition to those Wyoming citizens who used insurance or were able to private pay for services.”

Steele said the problems in mental health care in Wyoming can be tracked to a lack of funding and staff to provide services.

“This crisis was not caused by the Coronavirus pandemic, but it has certainly been exacerbated by COVID-19,” Steele said. “Perpetually underfunded and understaffed, mental healthcare providers in all 23 counties of Wyoming are finding it harder than ever to provide adequate care for the increased rates of substance abuse, mental health disorders, and other behavioral health issues.”

Steele noted that while Volunteers of America was “blessed” to have staff members who are passionate, motivated and dedicated to serving those in need, they were also exhausted due to working long hours for little pay.

“Federal funding has been provided through the CARES Act, but it was restricted in a way that created more work for programs and staff,” Steele said. “By adding beds with leased quarantine units, programs were able to respond to the crisis created by the pandemic. But this type of response, one that creates more work for front-line staff, results in COVID fatigue and is unsustainable in the long term, doing nothing to reform a broken system.”

He added a state investment into system-wide reform, rather than further cuts in mental health care spending, are needed on the part of legislators.

He said the state cannot afford to put its mental health care systems on the “back burner” any longer.

“We need to invest in system-wide reform, instead of further cutting the budget,” he said. “We need to educate and retain Wyoming youth who are interested in becoming mental health experts. We need to understand that providing Wyoming citizens with much-needed mental health services will decrease Title 25 holds, incarceration and even the state’s suicide rates.”

He encouraged Wyoming residents to reach out to their legislators and let them know mental health care needed to be one of their top priorities in the next legislative session.

WAMHSAC will be advocating for several issues during the next session, including supporting using funds from the general fund budget to support people in various degrees of crisis and to have a suicide hotline that operates 24 hours a day, seven days a week.

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Former Campbell County CEO Receives $675,000 Severance Pay

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By Ryan Lewallen, County 17

Campbell County Health has agreed to pay Colleen Heeter, it’s former chief executive officer, $675,000 as part of her contract-obligated severance package, the organization announced Friday.

The Nov. 5 announcement comes just over three weeks after the sudden termination of Heeter’s employment at the direction of the CCH Board of Trustees during a special meeting on Oct. 14, according to the Gillette News-Record.

Heeter had been employed by CCH for three years, beginning her role with the organization in 2018 as interim director of the powder river surgery center before accepting a position as CCH’s chief operating officer in January 2019.

In 2020, she accepted a position as CCH’s top executive officer at the start of the COVID-19 pandemic and oversaw the organization’s affiliation with UCHealth, with whom she was employed until her termination as part of a management services agreement, per CCH.

In a Nov. 5 release, CCH thanked Heeter for her time and commitment.

The process for finding a suitable replacement for Heeter has begun, CCH said in the release, adding that the organization feels it is essential to attract and retain the very best leaders.

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Poll: Majority Of Wyoming Voters Support Medicaid Expansion

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By Ellen Fike, Cowboy State Daily

A majority of Wyoming voters questioned in a recent survey support the expansion of Medicaid to provide health insurance coverage for more people, a new poll released by the American Cancer Society Cancer Action Network showed.

The poll also found many Wyoming residents are concerned about their health care situation. More than one in four said they are worried that they will lose health insurance, and many have lacked health insurance in the past three years.

Wyoming is one of 12 states that has not expanded Medicaid. If it did, around 24,000 additional state residents could have access to health insurance through the federal program.

The poll of 500 registered voters, which was conducted by New Bridge Strategy, showed that 66% of Wyoming residents polled supported expanding Medicaid.

Support for expansion spanned political party lines, although it was not uniform. According to the survey, which had a margin of error of plus or minus 4.38%, 58% of Wyoming Republicans and 64% of Wyoming Independents questioned supported expansion, while 98% of Wyoming Democrats supported it.

“The latest Wyoming Department of Health numbers suggest an estimated 29% of new enrollees in Wyoming would be between the ages of 50 and 64. These are our neighbors and co-workers and when they thrive, so do we. We know that access to care makes it easier to work, find a new job, pay for basic needs and succeed in today’s economy,” said Sam Shumway, AARP Wyoming state director.

Additionally, nearly two-thirds of Wyoming voters polled said they know someone who would benefit from Medicaid expansion and more than one in four (27%) said they are worried that they or someone in their household will be without health insurance in the next year.

“Our neighbors in Montana, Nebraska, Utah and Idaho are all benefiting from extending health coverage to low-income residents – it’s time for Wyoming to join them,” said R.J. Ours, ACS CAN Wyoming government relations director. “These results show people’s very real concerns about cost of care and access to it for themselves and their families. They’re picturing loved ones who may be struggling to see doctors, pay for medications and get the care they need.”

Additional findings from the poll included:

  • 65% of residents said they want their state legislator to support Medicaid expansion;
  • More than half of voters say the health care system is not meeting the needs of working, lower-income residents, and
  • Nearly one in three of those surveyed say health care costs and access to care are the most important issues in Wyoming.

“Regardless of political party or region of the state, Wyoming residents want our family, friends and neighbors to have health care,” said Richard Garrett, American Heart Association of Wyoming government relations director. “It’s great to see this level of support across the state, and we will be working hard with lawmakers to make sure that we increase access to health care for those who need it most.”

During their 2021 general session, Wyoming legislators considered a proposal to increase access to care by expanding Medicaid to roughly 24,000 residents. The bill passed the House, but fell short by one vote of winning needed approval from a Senate committee.

Sen. Ogden Driskill, R-Devils Tower, recently penned an opinion piece that took a stance against Medicaid expansion in Wyoming.

“If Wyoming expands Medicaid, our hospitals will lose over $16 million in annual revenues, meaning fewer hospital jobs and fewer beds available,” Driskill wrote. “And if we ever do expand, I believe a new hospital tax will be needed to cover Wyoming’s share of extra costs.”

Speaker of the Wyoming House of Representatives Eric Barlow, R-Gillette, a supporter of the Legislature’s most recent Medicaid expansion bill, did not immediately respond to Cowboy State Daily’s request for comment.

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Wyoming Dept Of Health Reports Rare Human Case of Pneumonic Plague

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By Jimmy Orr, Cowboy State Daily

The Wyoming Department of Health on Wednesday announced the detection of a rare but serious case of pneumonic plague in a northern Fremont County resident.

The department was tight-lipped about other details except that the individual who contracted the ailment had contact with sick cats.

Dr. Alexia Harrist, state health officer, said while the risk for humans to contract plague is very low in Wyoming, the disease has been documented throughout the state in domestic and wild animals.

“It’s safe to assume that the risk for plague exists all around our state,” Harrist said. “While the disease is rare in humans, it is important for people to take precautions to reduce exposure and to seek prompt medical care if symptoms consistent with plague develop.”

An outbreak of pneumonic plague was reported earlier this month in Madagascar. Seven individuals are reported dead and another 22 are hospitalized.

The last large outbreak of pneumonic plague in the country occurred in 2017 and infected more than 2,400 people and killed more than 200.

Plague is a bacterial infection that can be deadly to humans and other mammals, including pets, if not treated promptly with antibiotics. This disease can be transmitted to humans from sick animals or by fleas coming from infected animals.

Pneumonic plague is the most serious form and is the only form that can be spread from person to person. Pneumonic plague can develop from inhaling infectious droplets or may develop from untreated bubonic or septicemic plague.

Plague can also be transmitted from person to person through close contact with someone who has pneumonic plague. Individuals with a known exposure to plague require post-exposure treatment with antibiotics to help prevent illness. 

This human plague case is the seventh thought to be acquired in Wyoming since 1978. Other recorded Wyoming cases include a 1978 out-of-state case acquired in Washakie County, a 1982 Laramie County case, a 1992 Sheridan County case that resulted in death, a 2000 Washakie County case, a 2004 out-of-state case acquired in Goshen County, and a 2008 out-of-state case acquired in Teton County.

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Dept of Health Warns Public About Rocky Mountain Spotted Fever & Colorado Tick Fever

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By Wendy Corr, Cowboy State Daily

After a more than a year of doing everything we could to protect ourselves against microscopic bugs, as summer rolls around, we need to start watching out for actual insects.

It is well known that ticks, mosquitoes and other insects common to Wyoming often carry diseases that are a threat to both people and animals in the summer.

But according to Kim Deti with the Wyoming State Health Department, one of the most common diseases associated with ticks, Lyme disease, isn’t too much of a threat here.

“You’ll hear a lot nationally about Lyme disease,” she says, “but we do not have the kind of ticks in Wyoming that carry Lyme disease.”

But Deti noted that other tick-borne illnesses are definitely something to watch for, such as tularemia, Rocky Mountain spotted fever (RMSF) and Colorado tick fever (CTF). 

Tularemia symptoms include fever, swollen and painful lymph glands, inflamed eyes, sore throat, mouth sores, skin ulcers and diarrhea. 

If the bacteria are inhaled, symptoms can include sudden onset of fever, chills, headache, muscle aches, joint pain, dry cough and progressive weakness and pneumonia. 

Initial RMSF symptoms may include fever, nausea, vomiting, muscle pain, lack of appetite and severe headache. Later signs and symptoms may include rash, abdominal pain, joint pain and diarrhea. 

And CTF usually causes fever, headache, muscle and joint pain, and, occasionally, a rash.

But it’s not just tick bites that can spread those dangerous diseases.

“If a person handles an animal that’s infected with tularemia, like a rabbit or rodents, that can be a risk for the person for those tick-borne diseases,” Deti said.

One illness that made headlines for years has been on the decline in Wyoming recently, according to Deti.

“West Nile Virus has certainly been at a much lower level in Wyoming for the last several years,” she said, “but we do want people to prevent those mosquito bites.”

West Nile virus (WNV) is spread by mosquitoes when they feed on infected birds and then bite people, animals or other birds.

While most people infected with WNV don’t have symptoms, others can experience fever, headache, body aches, skin rash and swollen lymph nodes. 

A very small number develop West Nile neuroinvasive disease, with symptoms such as severe headache, fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions and paralysis.

But humans aren’t the only creatures who face danger from tiny threats. 

Jim Logan, the Wyoming State Veterinarian, said there are a number of insects that can transmit diseases to livestock and pets.

“In addition to mosquitoes and ticks, and certainly those are a big factor in disease transmission, there are also the deer flies and horse flies,” he said. “Those types of things can carry such diseases as vesicular stomatitis, which I hope we don’t see this year — but we’re entering the season when typically that is going to be a possibility.”

Logan says that particular disease is very similar to foot and mouth disease, which impacts the ability for animals to eat, walk or reproduce. 

“It’s indistinguishable from Foot and Mouth Disease, which always scares the state veterinarian because of the risks of the disease getting into this country and the effect that would have on the economy,” he points out. “And there is no vaccine for vesicular stomatitis.”

Logan added that Lyme disease, anaplasmosis, blue tongue and other diseases carried by tiny midges and other insects are a real danger to Wyoming livestock. 

“Insect control is really the major prevention,” he explained. “There are sprays, insecticides and repellants, but repellants need to be applied once or twice a day in order to be effective.”

Logan noted that while vaccines exist for mosquito-borne illnesses such as West Nile and Western Equine Encephalitis, the best defense is to reduce the risk of infection through prevention.

The same advice given by the Health Department to help humans keep safe from insect-borne illnesses can be followed to protect animals as well, Logan said.

The five “D’s” of insect prevention, for both people and animals, are:

1) DAWN and 2) DUSK – Mosquitos prefer to feed at dawn or dusk, so avoid spending time outside during these times.

3) DRESS – Wear shoes, socks, long pants and a long-sleeved shirt outdoors. Clothing should be light-colored and made of tightly woven materials.

4) DRAIN – Mosquitos breed in shallow, stagnant water. Reduce the amount of standing water by draining and/or removing.

5) DEET – Use an insect repellent containing DEET (N, N-diethyl-m-toluamide). When using DEET, be sure to read and follow label instructions. Picaridin (KBR 3023) or oil of lemon eucalyptus can also be effective.

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Niobrara County Tops in Wyoming For Smokers; Double National Average

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By Jim Angell, Cowboy State Daily

The percentage of smokers in Wyoming’s smallest county is almost twice the state average and is more than double the national average, according to a state report.

The report “Wyoming and County Profiles,” prepared by the state’s Economic Analysis Division by compiling results of various state studies, found that 34.1% of Niobrara’s 2,422 residents reported that they had smoked at least 100 cigarettes in their lifetimes and were currently smoking.

The percentage is the highest in the state and is far above Wyoming’s average of 18.4% residents who identify themselves as smokers.

However, Kim Deti, a spokeswoman for the state Department of Health, said the figure may be skewed by Niobrara County’s low population.

“I wouldn’t be surprised that Niobrara County numbers are affected by their low population and likely low number of participants in the survey that was the source of that information,” she told Cowboy State Daily.

Wyoming itself ranks 14th in the nation for the percentage of its population that smokes, according to the United Health Foundation.

The percentage of people nationally who identify themselves as smokers is 14%.

Deti said while it may be difficult to say with certainty why Wyoming has a percentage of smokers, several factors may be playing into the number.

“Potential factors include social and cultural attitudes and low perception of harm, low tobacco taxes and no statewide smoke-free policies,” she said. “Some of these factors have been linked to lower smoking rates in other states.”

Following Niobrara County for the highest percentage of smokers, according to the report, is Hot Springs County at 24.5% and Weston County at 24.3%.

At the other end of the spectrum is Teton County at 10.1%.

However, Jodie Pond, Teton County’s health director, said the county has a high percentage of people who use “vapes” rather than cigarettes.

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Teton County Has Lowest Percentage Of Obese People

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By Jim Angell, Cowboy State Daily

It could be the snow and all the fresh air.
It could be the outdoor fun that is there.
Or maybe the fact that they’re all fitness nuts
Or maybe nobody there likes doughnuts
But in the land where mountains rise like a steeple
Are the fewest of the few of Wyoming’s fat people.
(With apologies to Dr. Seuss)

Whatever the reason, Teton County is the slimmest county in the state, according to recently released state figures.

Figures released last week by the state Department of Administration and Information’s Economic Analysis Division showed only 12.2% of Teton County’s residents have a body mass index higher than 30, the lowest percentage in the state.

The figures were included in the Economic Analysis Division’s annual “Wyoming and County Profiles” publication, which provides information about demographics, health information, vehicle ownership and more on a county-by-county basis.

A body mass index or BMI is derived through a formula involving a person’s height and weight. According to the Centers for Disease Control and Prevention, a person with a BMI of 30 or higher is considered obese. 

Statewide, about 29.7% of Wyoming residents have a BMI of 30 or higher.

The highest percentage of obese people in the state, according to the report, was found in Goshen County, where 38.3% of the residents have a BMI of 30 or higher.

Health officials in Teton and Goshen counties were not immediately available to comment on the report.

Teton County residents appear to just be healthy overall, also boasting the smallest percentage of cigarette smokers in the state.

The report said only 10.1% of the county’s residents reported they had smoked at least 100 cigarettes in their lifetimes and were still smoking.

By contrast, in Niobrara County, 34.1% of the residents identified themselves as smokers.

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Riverton Medical District Signs Letter of Intent to Affiliate with Billings Clinic

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Staff reports

A group of Riverton business and community leaders on Wednesday announced plans to build a new hospital in Riverton. 

The Riverton Medical District announced that it signed a Letter of Intent to pursue affiliation and clinical partnership with Billings Clinic, cementing the group’s strong focus on local health care with a trusted partner. 

The partnership with Riverton adds to Billings Clinic’s relationships in numerous Wyoming communities including Basin, Lovell, Powell, and two clinics in Cody. 

Billings Clinic is an independent not for profit, physician-led and community governed organization that is affiliated with (not owned by) the Mayo Clinic as a member of the Mayo Clinic Care Network. 

Billings Clinic brings experience in rural health care, and the Riverton facility would join 16 other health care facilities across Montana and Wyoming in addition to the tertiary care center in Billings, as part of Billings Clinic’s growing health system. 

“This is not just a win, it is a mammoth victory to have signed a Letter of Intent with Billings Clinic to be our clinical and management partner. They are a nationally recognized health system with a laser focus on advancing care in local communities in Montana and Wyoming. They were our first choice as a partner, offering unique experience that will keep our hospital locally owned and governed,” said Corte McGuffey, Riverton Medical District. 

“We reached out to other communities that work with Billings Clinic and received excellent feedback, including Beartooth Billings Clinic in Red Lodge, Montana.”

“In 2002, Beartooth Billings Clinic was looking for a partner who shared the same values as our Board and community. Lutheran Health Systems (now Banner Health) had exited our community in 1991 and we were leery of establishing another relationship. Billings Clinic not only shared our values, they guided our effort to achieve our ultimate goal – a new hospital. 

Today, ten years later, our organization is growing and thriving,” said Kelley Evans, CEO, Beartooth Billings Clinic.  

“We feel very fortunate to have the opportunity to partner with the Riverton Medical District because their core values align with ours. The ability to connect Riverton with the other communities we serve will help increase clinical services and advance patient care in the community,” said Dr. Clint Seger, Regional Chief Medical Officer, Billings Clinic. “Sustaining and growing health care services locally is a top priority for Billings Clinic.”

The next step for moving this project forward is approval of a low-interest loan of more than $40 million from the United States Department of Agriculture (USDA). The Riverton Medical District has met with the USDA on several occasions and the application process is now fully underway. “Our community has been so supportive of our efforts, including our collaboration with the Eastern Shoshone Tribe to secure land,” said McGuffey. “We are grateful for this support and are excited to bring these plans to fruition.”

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Wyoming Ambulance Services Facing Funding Emergency

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By Elyse Kelly, The Center Square

Wyoming’s ambulance services have reached a state of emergency as funding in many counties dries up.

Fremont, Sweetwater, Weston counties will all lose Emergency Medical Services (EMS) on July 1 if funding cannot be found for the program. Sweetwater and Weston both have potential solutions, but in Fremont, Wyoming’s second-largest county by landmass, no one has stepped forward to fill the gap, according to Luke Sypherd, president of the Wyoming Emergency Medical Services Association.

Wyoming’s funding structure for EMS is unsustainable, Sypherd said, and the overhead for running an ambulance service is costly.

“There are only 11 states in the United States that require EMS to be provided by law,” Sypherd told The Center Square.

Wyoming isn’t one of them, which is resulting in funding for EMS hitting the chopping block before other required services.

Subsidized labor through volunteers has kept Wyoming’s EMS afloat in the past, but that base is shrinking because of an increase in calls and the technicality and costs of maintaining EMS training.

Unlike fire and police, ambulances aren’t reimbursed for calls unless they transport a patient to a hospital. In addition, Medicaid and Medicare only cover somewhere between one-third and one-sixth of the cost of an ambulance trip, leaving a huge funding gap. 

The COVID-19 crisis sped these issues to a breaking point, Sypherd said. Funding dropped out as lower tax revenues combined with fewer reimbursable ambulance trips as EMT’s were encouraged to treat patients at home rather than taking them to hospitals.

Sypherd said one way to reduce costs is by restructuring to make services regional rather than every town having an EMS. This would result in cost savings because many positions could be consolidated into one and infrastructure could be used to cover a wider range.

“You have economy of scale for purchasing power within hospitals, you having a deeper staffing pool,” Sypherd said.

Cody Regional Health hospital runs a regionalized EMS that serves all of western Park County.

Even restructured, EMS still needs funding. Sypherd said there has to be some local or state tax-based revenue to help cover the costs of EMS. He suggests a list of possibilities already in use in some places, like a license plate tax, special health districts within a county, or sales tax.

“Very unpopular—people don’t like to pay taxes, but again when a government health insurance plan isn’t covering the cost of health care then the money has to come from somewhere else,” Sypherd said.

Sypherd also insisted EMS must be made a mandated essential service.

“Law enforcement and fire certainly are essential services, but then some of the other things that counties and cities are required to provide by law, you can’t tell me those are as essential as emergency medical services like 911,” Sypherd said.

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Gillette Hospital Accidentally Breaches Personal Info of 900 Patients

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By Ellen Fike, Cowboy State Daily

A Gillette hospital accidentally released the personal health information of 900 patients earlier this month with an email attachment.

Someone from Campbell County Health sent an email to a single person with an unintended attachment that contained patient information including names, account numbers and types of insurance.

“We take our role of safeguarding our patient’s personal information and using it in an appropriate manner very seriously,” said Colleen Heeter, CEO. “Campbell County Health apologizes for any concern this situation has caused our patients, is doing everything we can to rectify it, and ensure that it will not happen again.”

The breach was discovered within the hour and CCH officials immediately contacted the recipient, who was directed on how to permanently delete the attachment from email and all devices.

Hospital officials believe that any potential harm resulting from this breach has been mitigated and all affected individuals have been contacted.

The hospital has taken all appropriate steps to investigate the breach, including reporting to the Secretary of Health and Human Services and following internal policies and protocols, it said in a statement.

Process changes will be implemented in the organization based on the outcome of the investigation.

All CCH employees will be required to participate in additional education and training on best practices in protecting health information.

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SageWest: Please #MaskUp

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SageWest Health Care and LifePoint Health are proudly joining our community partners and hundreds of hospitals across the country in asking you to #MaskUp.

COVID-19 continues to sweep through our community, and we’re fighting hard to keep on providing quality care and keep our patients and employees safe and protected. But we need your help.

Wearing a mask is our best defense against the spread of COVID-19 until vaccines are available. If we all do our part and fight together, we’ll get through this. Together. #MaskUp 

To view the video, click HERE.

Good News: Wyoming is Not the Fattest State In the Nation

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Although Wyoming is surrounded by much more fit states, at least we find ourselves in the lowest half of the fattest states in America (lowest meaning good).

A new survey came out today which ranked the fattest states in America.

The fattest states?  No surprise.  All in the south. West Virginia, Mississippi, and Arkansas take top honors, according to Wallet Hub.

Wyoming, on the other hand, ranked 31st in the nation. If you are feeling cocky, don’t look at Utah or Colorado (49th or 51st respectively). Don’t look up either. Montana ranks 45th. Even Nebraska beats us (at 40th).

The reason for the survey is not to fat-shame, they say. They point to “health consequences” of fatness — mostly diabetes.

“Fat is becoming the new normal in America,” the report reads. “According to the most recent data from the Centers for Disease Control and Prevention, more than seven in 10 U.S. adults aged 20 and older are either overweight or obese.”

The U.S. spends nearly $200 billion in annual health care costs related to obesity, the report said.

The study, curiously, then lists the top 50 comfort foods for each state. Wyoming does very well in this respect.

Buffalo jerky is number one for our state — which comes in at 240 calories per serving.

That compares with fried cheese curds in Wisconsin (home of Chris Farley) — which has 1,190 calories per serving.

Nevada’s choice of comfort food calls seems logical.  “Hotel buffets” are listed as its residents’ top choice with 1,000 calories — although 5,000 calories seems more logical.

Maybe Wallet Hub should employ a fact-checker for that one. But definitely they need a spellchecker.  They list “pasties” as the top food item in Michigan.

Maybe but the pasties look more like “pastries” in the accompanying graphic. Or maybe they are just really weirdly shaped pasties.

CORRECTION: We’ve been told by many, many readers that pasties are not just things that strippers wear. They are actual food. We stand corrected.

Maybe there’s a reason that Utah comes in 51st with its choice of top comfort food. Something called “funeral potatoes” is the top choice. That, like Wyoming’s buffalo jerky, has a paltry 240 calories.

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Gordon Allocating CARES Funds To Help With Wyoming Insurance Enrollment

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By Ellen Fike, Cowboy State Daily

Gov. Mark Gordon announced Friday that he is directing federal CARES funds to assist Wyoming residents in signing up for health insurance this fall.

Gordon is allocating $600,000 to be used for the Enroll Wyoming program, which will be used to hire trained enrollment counselors to provide outreach, education and assistance. This will also ensure Wyomingites are made aware of the upcoming open enrollment period for insurance coverage (Nov. 1 – Dec. 15).

“Wyoming is facing increased numbers of uninsured residents as a result of the pandemic,” Gordon said. “This assistance is an important resource for those seeking health insurance during these challenging times.”

The enrollment counselors will work with community partners, such as libraries, community colleges, workforce centers, public health nursing offices and more, to identify individuals who need assistance enrolling in the federal insurance marketplace.

The Enroll Wyoming program is a collaborative effort between Cheyenne Regional Medical Center’s Institute for Population Health, the Wyoming Primary Care Association, which operates the statewide community health centers, and Wyoming 2-1-1.

According to the Kaiser Family Foundation, federal funding for the Enroll Wyoming program in Wyoming has been cut by 83%.

“We are thankful for the opportunity to help meet the increased need for health insurance during this pandemic by building on our efforts over the last seven years of providing enrollment services,” Amy Spieker, CRMC’s director of community health and analysis, said. “Enroll Wyoming is an excellent example of how Wyoming organizations come together to care for our neighbors during tough times.”

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New Surgical and Cardiovascular Center Opens in Lander

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The new Western Wyoming Medical Ambulatory Surgery Center will open Tuesday in Lander.  

The $10 million project brings state-of-the-art cardiovascular and surgical care to central Wyoming.  According to Alan Daugherty, manager of the facility, Doctor Claude Minor, Doctor Kevin Courville, Doctor Michael Crosby, and a staff of ten medical professionals will begin seeing patients immediately.

Dr Minor is a general surgeon who says his favorite thing in the world is saving limbs on his diabetic patients.  Dr Minor performed the first C02 angioplasty ever in Wyoming just a few months ago saving a patient’s leg.  The use of C02 instead of contrasting dye protects the patient’s kidneys from damage.

Dr Kevin Courville is an interventional cardiologist and will be specializing in cardiac rhythm management, coronary and peripheral interventions. Dr. Michael Crosby, an anesthesiologist, will provide anesthesia services.

Western Wyoming Medical has leading edge technology including the very latest heart catheterization unit in the United States.

Daugherty says he expects that patients from all over Wyoming and surrounding states will come to Lander for the specialized treatment at Western Wyoming Medical and that the patients traveling to the heart center will benefit local businesses while in town.

Paul and Carrie Guschewsky are the developers of the project. The couple has previously remodeled several commercial buildings in town and were instrumental in bringing Rocky Mountain Oncology to Lander. 

The facility will also be home to several expanding businesses in town.  Elevate Rehab is increasing its personnel and services.  Todd Wurth’s Farmers Insurance agency is looking forward to serving its growing clientele.  

Dr. Dunaway at Lander Women’s Care is pleased to expand his services in this new facility, as well.  Wind River Heart Clinic will also have its home in the new complex. 

The 23,000 sq ft facility is built for the future with complete fiber optic connectivity, high efficiency heating and cooling systems and LED lighting. 

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Wyoming “Off-Track” When It Comes To Road Safety, Mental Health

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By Ellen Fike, Cowboy State Daily

Wyoming is off-track when it comes to roadway safety and mental health services, a recent National Safety Council summary concluded.

In the NSC’s state of the response executive summary, the organization analyzed how well the 50 states protected their citizens during the ongoing coronavirus pandemic.

The report assessed state efforts in five key areas: employer guidelines, testing, contact tracing, mental health and substance use and roadway safety.

Wyoming was considered one of the 10 off-track states, which also included Florida, South Dakota, Montana, Kansas and Oklahoma.

Mississippi and South Dakota received the lowest overall rating.

Wyoming also was singled out as being off-track when it came to roadway safety (alongside Montana, both of the Dakotas and Massachusetts) and for addressing mental health issues (alongside other states such as South Dakota, Alabama, South Carolina and Kansas).

Only 12 states received an “on-track” rating, which included California, Oregon, Washington and Illinois. The other 29 states were considered “lagging.”

Although the pandemic has claimed more lives than accidental drug overdoses, motor vehicle collisions and falls combined, the state of response report uncovered “an inconsistent approach that has jeopardized safety due to the pandemic’s impact on issues such as addiction, traffic and workplace safety.

The NSC provided recommendations for states to improve their scores, such as ensuring access to medically-necessary treatments, including the availability of behavioral health services and substance use disorder treatment through telehealth and continuing focus on improving the safety of roads.

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Study: Wyoming Has 47th Lowest Vaccination Rate In Country

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By Ellen Fike, Cowboy State Daily

Wyoming has some of the lowest vaccination rates in the country, according to a recent study.

Personal finance website WalletHub recently ranked all of the states and the District of Columbia for their vaccination rates. The data ranged from the share of vaccinated children and the share of people without health insurance to the presence of reported measles outbreaks.

Wyoming was ranked 47th in the entire country for its overall vaccination rates, due to its low rates among both children and adults. Wyoming had the lowest flu vaccination rates among children under 17 in the entire nation.

The state also had one of the lowest shares of teenagers with an up-to-date HPV vaccination, coming in 49th of 51 states. It ranked the same when it came to teens getting the meningococcal ACWY vaccine.

Wyoming also had the 48th lowest flu vaccination coverage rate among adults.

Mississippi came in at 51st on the ranking. Massachusetts, Vermont and New Hampshire took the top three spots.

WalletHub did the study in light of more information being released regarding a possible coronavirus vaccine. According to a Gallup poll, 35% of Americans would not get a coronavirus vaccine, even if it were free.

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Budget Cuts Could Reduce Medicaid Providers, Wyoming Health Department Says

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By Jim Angell, Cowboy State Daily

Reductions in the amount of state money paid health care providers through Medicaid made as a way to tackle the state’s budget shortfall could result in providers leaving the program, according to the Wyoming Department of Health.

The department, in a report outlining the impacts of its $28 million reduction in benefits it pays for health care for some Wyoming residents, said the reductions will lead to limits on services in some cases.

“In some cases, some Medicaid providers may choose to leave the program entirely, which may create access issues in some more rural or frontier areas of the state,” the department said in a report on its recent budget cuts.

The Health Department was the hardest hit by budget cuts outlined by Gov. Mark Gordon recently to offset a $1.5 billion shortfall in revenues predicted to occur during the current two-year budget period.

Of almost $254.5 million in cuts in spending from the state’s “general fund,” its main bank account, the Department of Health saw the largest reduction, almost $89.1 million.

More than a quarter of that amount, almost $28.2 million, will come from cuts in reimbursements to health care providers from the state.

The cuts would be matched with a $28.2 million reduction in federal funds.

The Department of Health, in its report on the reduction, said the spending cuts would come from a 2.5% decrease in reimbursement rates for health care providers and through service reductions.

The cuts are likely to cause a decline in Medicaid involvement by health care providers, the department said.

“Various second-order effects are likely as well, including Wyoming Medicaid providers limiting services to Medicaid members or in some cases no longer accepting new Medicaid clients,” the report said.

Another spending reduction of almost $3.7 million will be seen in the state’s Children’s Health Insurance Program or “CHIP,” a program that provides low-cost health care for eligible children.

The program had been managed by a private company, but the state received no bids to continue the program during the most recent renewal period.

As a result, the program will now be run through the state, with claims processed through the Medicaid Management Information System, the Health Department said, with lower Medicaid reimbursement rates for health care providers.

The change will save the state $3.7 million without reducing benefits to covered individuals, the department said, although some patients may have to find new health care providers.

“A small number of clients may need to change providers if (the Health Department) cannot convince the providers to enroll due to lower rates,” the report said.

Federal funds to the state to help pay for the program will also be reduced by about $6.8 million, the report said.

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Wyoming Law Enforcement Receive 1,500 Defibrillators Thanks To Grant

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By Ellen Fike, Cowboy State Daily

Wyoming law enforcement and first responders will receive 1,500 automatic external defibrillators, thanks to a $4 million grant.

The Wyoming Department of Health’s Office of Emergency Medical Services announced the distribution on Thursday morning. The grant is from the Leona M. and Harry B. Helmsley Charitable Trust.

The grant includes funding to help build community CPR and telephone CPR programs in strategic areas, which is part of the Helmsley Charitable Trust’s ongoing commitment to improve Wyoming’s cardiac system of care, with the goal of increasing survival rates.

“Two things we know conclusively that save lives outside of the hospital are early defibrillation and early, high-quality CPR,” said Andy Gienapp, OEMS manager, in the news release. “Anything we as a state can do to make those two simple and effective treatments more available to the people of Wyoming is a win.”

About 356,000 Americans suffer from out-of-hospital cardiac arrest annually, with an overall survival rate of 10%.

Gienapp said a preliminary review of OEMS data showed EMS responded to 3,540 out-of-hospital cardiac arrests in Wyoming with an AED used in only 14% of those episodes over a three-year period.

“It may not be possible to get an AED to everyone in Wyoming,” said Gienapp, “but we can sure do better than 14%, and that means we can save lives.”

Studies conducted by the American Heart Association demonstrate a dramatically higher survival rate for cardiac arrest patients when law enforcement has equipment available and is trained to deploy it.

Studies have shown when the heart is first shocked by law enforcement the chances of survival are nearly 40%, compared to 28.6% survival for those who are first shocked by EMS.

“Seconds count during a cardiac arrest,” Walter Panzirer, a Helmsley Trustee, said in the release. “We know in Wyoming first responders often have great distances to cover. This funding will help ensure law enforcement officers who often get to a scene before EMS have the necessary equipment to give cardiac arrest victims a fighting chance for survival.”

Gienapp noted recognizing a cardiac event, calling 911, having dispatch-assisted CPR (as a minimum), having quick access to an AED and training the community in hands-only CPR greatly improve the survival rate of those suffering from a sudden cardiac arrest.

OEMS will oversee the project in Wyoming. The AEDs will be provided to more than 90 separate organizations over the next several months, including highway patrol, campus police, tribal law enforcement, county sheriff offices, local city police agencies, game wardens and state park officers.

They will also be provided to several national, state and county park visitor centers.

All those who receive an AED will receive both initial and ongoing training.

Wyoming is the third state to receive comprehensive funding to place AEDs among law enforcement agencies and other first responders.

The AEDs will ensure rescuers provide the fastest first shock when defibrillation is needed. The equipment features industry-leading analysis technology that reduces pauses during CPR, allowing for improved blood circulation and better odds of survival.

Using Wi-Fi connectivity, these self-monitoring devices can send near real-time event data, including a patient’s heart rhythm and shocks delivered, to incoming emergency services or receiving hospitals.

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Wyoming Lands In Middle Of Ranking For Best, Worst States For Health Care

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Doctor Shortage in Wyoming; “Almost Impossible to Recruit”

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By Ellen Fike, Cowboy State Daily

Wyoming landed right around the midpoint in a recent ranking of the best and worst states for health care in the nation by personal finance site WalletHub.

Wyoming was ranked 31st in the list, just between Indiana (30) and Oregon (32). It ranked lower due to a near last-place ranking for its number of doctors per capita (coming in at number 50, just above Idaho), and having some of the highest average monthly insurance premiums, tying at number 48 with Vermont, Iowa and West Virginia.

However, Wyoming did rank third when it came to having the most dentists per capita, just behind the District of Columbia and Vermont, respectively.

Massachusetts was considered the best state for health care, while Georgia was considered the worst.

To determine where Americans receive the best and worst health care, WalletHub compared the 50 states and the District of Columbia across 44 measures of cost, accessibility and outcome. According to the website, the average American spends more than $11,000 per year on personal health care.

According to a study by the Kaiser Family Foundation, the U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden, which measures longevity and quality of life. However, the U.S. has improved in providing healthcare access for people in poor health and healthcare cost growth has slowed somewhat.

“Most buyers of health insurance tend to focus on identifying health plans with the lowest price; and typically, are not concerned with the level of coverage,” Virginia Commonwealth University professor R. Timothy Stack told WalletHub. “My recommendation is to pay the extra premium for a health plan that offers a broad network coverage of providers. Consumers, especially younger ones, believe they would not experience a life-threatening medical condition during their life whereby accessing a medical expert is critical. This type of coverage could benefit them medically as well as financially. “

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One Unexpected (And Stupid) Result From the Coronavirus: More Smoking

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Perhaps the stupidest development to result from the coronavirus a smoking resurgence in the country.

Wednesday’s Wall Street Journal reports that although the national smoking rate hasn’t increased, the decrease in cigarette sales have slowed from a projected decline of 4% to 6% to a decline estimated at 2% to 3.5%.

The reason, according to the maker of Marlboro cigarettes, is a combination of fewer opportunities for people to congregate outside the home and the arrival of government stimulus checks.

“Fewer social engagements allow for more tobacco-use occasions,” said Altria Chief Executive Billy Gifford on an earnings call Tuesday.

More tobacco-use occasions cost money.  In Wyoming, smoking-caused health care costs $258 million per year and smoking-caused losses in productivity cost $202.4 million per year.

The news that some recipients of government stimulus checks are spending the money on cigarettes could be depressing for many reasons.

One, people would use stimulus checks for cigarettes. Two, smoking is bad for your health. Three, COVID-19 is a respiratory illness.

The University of Maryland Medical System reports that smoking not only increases your risk for complications if you get the virus, it can also make you more likely to contract the disease in the first place.

“The Centers for Disease Control categorizes smokers as “immunocompromised,” which means having a weakened immune system,” they write. 

“This puts smokers in the same group as those receiving cancer treatments or who have HIV. The CDC cautions that people who are immunocompromised are at risk to get more severe COVID-19 symptoms,” they said.

In 2017, 18.7% of adults in Wyoming smoked. Nationally, the rate was 17.1%.

In 2017, 5.7% of adults in Wyoming used e-cigarettes and 9.1% used smokeless tobacco.

In 2015 (the latest data available), 29.6% of high school students in Wyoming used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 24.1%.

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Wyoming Hospitals Offer Quicker Coronavirus Testing

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By Wendy Corr, Cowboy State Daily

Since the coronavirus emerged as a real threat to Wyoming residents in March, the only testing option for many counties was a process that involved sending swabs to the state health office.

But last week, it became possible for both Cody and Powell hospitals to run tests in their labs and produce results within a day, according to Doug McMillan, CEO of Cody Regional Health.

“At the state, the turnaround time is, I think, three to five days,” he said, “and the average can take longer. We’re working with Abbott, the company vendor that we work with, and they provided software to update four or five of our existing machines, and the state did provide us with one additional machine.”

Jeanine Brus, director of the lab at Cody Regional Health, said the accuracy of Park County tests have been corroborated at the state level.“We sent at least a hundred tests in tandem to the State,” she said, “and we got the exact same result that the State did.”

Brus said Cody Regional Health can can conduct up to 50 tests per day. The hospital is also conducting drive-through testing in its parking lot.

“It’s now open from 8 (a.m.) to 11 (a.m.) every day, and we’re testing asymptomatic patients (individuals who do not have symptoms),” he said. “Patients are getting calls that day, or no later than the next day, so we’re really excited about that.”

And McMillan said the same-day testing option is drawing people from beyond the Big Horn Basin.

“A family member was driving from Bozeman to come to Cody to get their test, because they’d been told it’s going to take 10 to 14 days to get the results back in Bozeman, Montana,” he said.

McMillan added that with the increase in tourism – and in the number of cases – as the summer goes on, this type of service is invaluable to locals and to visitors alike. 

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Wyoming Department Of Health Not Implementing Meningitis Vaccine Requirement (Yet)

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By Ellen Fike, Cowboy State Daily

Due to the coronavirus pandemic, the Wyoming Department of Health is withdrawing a proposed addition to the state’s list of required vaccinations.

In 2019, the department proposed changes to require the meningococcal vaccination for students to enroll in school as one of several recommended updates to the state’s vaccination policies. Other changes included clarifying other school vaccination requirements and clarifying provider agreement requirements for the immunization information system.

The department determined a portion of the rule changes could have presented a challenge to its school partners at this time. However, in a news release, the department said it expects to implement the new rules at some time in the future.

Two vaccines are recommended to prevent the meningococcal disease, any type of illness caused by the neisseria meningitidis bactera.

Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. While a bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling, injuries, cancer, certain drugs and other types of infection also can cause meningitis.

Meningococcal disease can include meningitis and bloodstream infections.

The Centers for Disease Control and Prevention recommends all 11 to 12-year-olds get the meningococcal conjugate vaccine, with a booster dose at 16. Teens and young adults (people 16 to 23) may get a serogroup B meningococcal vaccine.

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Wyoming Department Of Health Now Allowing Visits To Long-Term Care Residents

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By Ellen Fike, Cowboy State Daily

The Wyoming Department of Health has issued new guidelines to allow in-person visits to long-care facilities, three months after all such facilities barred in-person visits due to the coronavirus pandemic.

But the visits will have to be outdoors and under strict guidance. Visits can happen in a designated outdoor space and no more than two people can visit a resident at a time.

Visitors will also have to undergo a health screening before every visit. A facility staff member trained in patient safety and infection control measures must remain with the resident at all times during the visit.

Staff and residents must wear surgical face masks and visitors are required to wear face coverings.

“We recognize how challenging this pandemic has been for Wyoming’s aging population and their families,” Gov. Mark Gordon said in a news release. “Isolation can be debilitating for our seniors. I’m glad we are able to take this step to make in-person visits possible in a safe manner.”

The decision to allow visitation rests with individual facilities, which are encouraged to consider local conditions when making visitation determinations.

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Harrist Believes Early Action Stopped Significant Coronavirus Spread

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By Ellen Fike, Cowboy State Daily

Dr. Alexia Harrist can remember the morning she checked one of the infectious diseases websites she regularly follows.

It showed a strange outbreak of pneumonia in Wuhan, China, a city Harrist had never even heard of.

As a trained epidemiologist (someone who studies and analyzes the distribution, patterns and determinants of health and disease conditions in defined populations), it was fascinating to see this pop up, but she didn’t think much about it.

Just a few months later, that strain of pneumonia turned out to be the coronavirus, a newly discovered virus that would cause a pandemic.

As Wyoming’s state health officer, Harrist has been thrust into the spotlight over the last three months, regularly providing updates to the state about the coronavirus and health orders stemming from it.

She loves her job, but admitted she never expected to become such a public figure when she took over the role as health officer.

“I know my role is to protect public health,” she said. “Dealing with a pandemic like this is something I never imagined would have to be done. I’ve been a part of making decisions I never expected. But thankfully, I’m not alone and I have a ton of support from my team at the Department of Health.”

Harrist has been the state epidemiologist with the Wyoming Department of Health since March 2017 and officially became the state health officer in late 2018. She’d been filling the role as the interim officer since the summer of 2017 when Dr. Wendy Braund left the position.

Originally, Harrist is from the Boston area, growing up there and attending college in the region. She went to Philadelphia for graduate and medical school, but fell in love with Wyoming when she spent two years at WDH for a medical fellowship.

“I’m an outdoors person, so I just loved the mountains, the skiing, mountain biking, all of it,” Harrist said. “I also loved being at the Department of Health, so when I got the chance to come back as state epidemiologist, I took it.”

As the state epidemiologist, Harris’t job is to oversee disease control and surveillance. She and her team track diseases that have public health significance and prevent further transmission.

In her role as state health officer, Harrist is more involved in health policies surrounding disease prevention and control. She also advises and provides input for numerous activities taking place in WDH regarding disease prevention.

While Harrist didn’t expect to take on the role of state health officer when she joined WDH in 2017, she found that she enjoyed working through policies and a broader variety of activities.

But since March, she and basically every other county health officer and health care provider across the state have been inundated with the coronavirus.

“We’ve all been working long hours, because the virus doesn’t care what day it is or what time it is,” she said. “I already knew my team was great, but to see them come together and step up to this challenge, it’s been incredible.”

Harrist touted her team’s work doing contact tracing, where they find a person infected with the virus and find everyone that person has recently been in contact with. She also praised the state’s Public Health Laboratory, which has been kicked into high gear to get test results out quickly and efficiently.

While she is saddened by the 17 deaths Wyoming has seen due to the virus, Harrist feels that by taking early action with health orders, the state was able to prevent many more coronavirus cases and deaths.

However, she doesn’t believe the state, country or world is anywhere near to being out of the woods when looking at the virus. She urged caution moving forward, noting that wearing face coverings and continuing to social distance will likely be a part of everyone’s lives for the foreseeable future, at least until a vaccine or treatment for the virus is created.

“The pandemic isn’t over,” she said. “We expect to see more cases and more deaths. But I do think we’ve had success in slowing the transmission and we’ve prevented more people from dying.”

In the last few months, Harrist has learned that tough decisions have to be made when it comes to people’s safety, something not everyone appreciates.

She knows there have been detractors, those who don’t like the orders she issued with Gov. Mark Gordon that closed some businesses and restricted some activities, such as large gatherings of people.

But she praised Wyoming citizens for their vigilance, saying that they’re the real reason the coronavirus didn’t spread throughout the state as originally expected.

“I’ve learned that if you make a right decision for public health, there are people who will support those decisions,” she said. “In terms of public health, these are absolutely some of the hardest decisions we have had to make. You have to look at the possibility of deaths, the severe illnesses we’ve seen and the knowledge that people’s livelihoods would be affected. I think we did the right things, but time will tell.”

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Wyoming Department Of Health Sees ‘Alarming’ Vaccine Decline

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By Ellen Fike, Cowboy State Daily

The Wyoming Department of Health has seen an “alarming” decline in the number of administered immunizations since the start of the coronavirus pandemic.

In a news released issued Tuesday, the WDH pointed to a decline in immunizations given by providers enrolled in the department’s Immunization Unit’s Vaccines for Children and Wyoming Vaccinates Important People programs.

The Wyoming Immunization Registry showed state providers administered 42% fewer vaccines in April compared to April 2019. The total number of vaccine doses ordered by these providers has dropped about 25% compared to April 2019.

“It appears the pandemic’s uncertainty and challenges have resulted in the postponement of routine well-child visits, which typically include immunizations,” Jude Alden, Immunization Unit manager with WDH, said in the release. “While we recognize the reasons for the decrease, we also want to encourage families to stay on track and to schedule appointments to make up any immunizations that may have been missed.”

The Centers for Disease Control and Prevention (CDC) published data earlier this month that confirmed the trend of lower vaccinations during the pandemic is being experienced nationwide and not just in Wyoming.

Alexia Harrist, state health officer and state epidemiologist with WDH, is concerned postponing routine visits and immunizations could put Wyoming families at a higher risk of contracting vaccine-preventable diseases, including measles and whooping cough.

“It is critical for infants, young children, pregnant women and people with chronic illnesses to continue maintaining routine immunizations during the pandemic to help prevent further outbreaks,” she said in the release. “We definitely do not want outbreaks of other dangerous diseases to unexpectedly grow in Wyoming while we are still dealing with the coronavirus pandemic.”

Alden said clinics across Wyoming are using strategies to help ensure safe access to their patients for routine visits, such as:

  • Designating specific entrances, hours and exam rooms;
  • Checking in patients outside of the clinic and allowing them to wait in the parking lot until appointment times;
  • Allowing one caregiver to accompany a child to the clinic;
  • Cleaning and disinfecting exam rooms between patients; and
  • Encouraging all patients to wear cloth face coverings as they come into the clinic.

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Cheyenne Hospital Likely to Lose $10M for April Due to Coronavirus

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The Cheyenne Regional Medical Center will likely see a loss of close to $10 million for the month of April, its CEO said in a statement Friday.

Hospitals across Wyoming have taken major financial hits during the coronavirus pandemic, due to the increased social distancing practices calling for fewer people to be in the building at one time and the cancellation or postponement of elective surgeries and other procedures.

CMMC CEO Tim Thornell said the hospital lost $1 million in March and is projecting an operating loss of close to $10 million for April.

“Cheyenne Regional Medical Center, like every other hospital in Wyoming, is certainly feeling the negative financial impact that COVID-19 is having,” Thornell said in a statement. “We are seeing about a 30% reduction in inpatient care and an upwards of 50% reduction in outpatient care.”

The hospital system is managing the situation, but Thornell noted that these losses aren’t sustainable in the long term. To address funding shortfalls, CRMC is using financial reserves to supplement current operations, which means major capital projects have been placed on hold to divert funds to daily operations.

There is also a hiring freeze in place at the hospital and overtime is being limited. Reduced hours have been implemented for select non-urgent service lines.

“Our volumes are down in all areas,” Thornell said. “We have a strong and dedicated staff that continues to provide the best possible care to our community during these challenging times.”

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Wyoming Hospitals Take Extra Precautions to Prevent Coronavirus Spread

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By Ellen Fike, Cowboy State Daily

Hospitals across Wyoming have taken numerous precautions to limit the possible spread of the coronavirus in their establishments and in their communities. 

Since the patients and staff are at such high risk for transmission, hospital managers are putting new rules in place for the interim to keep everyone safe, patients, staff and visitors alike. 

Here is a look at what rules hospitals in Wyoming have implemented regarding the virus: 

Albany County

Ivinson Hospital: If anyone in the county is experiencing flu-like symptoms, including a fever of at least 100.4 degrees, a cough or shortness of breath, they should call the nurse triage line at 307-755-4750 between 8 a.m. and 5 p.m. Monday through Friday. 

Certain entrances are limited to patients and the public, which can be found here. 

Visitor restrictions have been implemented, now limited to 8 a.m.-8 p.m. daily. Patients can’t have more than one visitor in a 24-hour span. No one under the age of 16 can visit the hospital except for treatment. Visitors with cold or flu symptoms are asked to refrain from visiting a patient. 

Certain services have been reduced or postponed at the hospital These include elective surgeries, which are suspended until further notice. The hospital is reducing non-emergency outpatient services, as is the Meredith and Jeannie Ray Cancer Center. The gift shop operation hours will be from 8 a.m. to 3 p.m. Monday through Friday. 

Big Horn County

North Big Horn Hospital District: Sick visitors are restricted from visiting, as are children under 18 in most areas of the hospital. 

All staff, patients and visitors are screened for the virus prior to entering the facility. If someone believes they’re experiencing symptoms of the virus, they’re asked to call the hospital ahead of time so staff can prepare for the patient’s arrival. 

Certain entrances are limited to patients and the public. 

New Horizons Care Center isn’t allowing visitors at this time. 

Campbell County

Campbell County Memorial Hospital: The hospital is currently closed to all visitors except one parent of pediatric patients and one support person for anyone giving birth. All patients are required to undergo a respiratory health screening with a temperature check. No visitors under 18 are allowed in the hospital. 

The hospital has also closed certain departments, including cardiac and pulmonary rehabilitation, outpatient respiratory therapy and surgery. The only surgeries that will be done are emergency cases and those deemed medically necessary. One support person will be allowed in the hospital for those having surgery, following a health screening.

Access to certain entrances is limited to patients and the public. The Heptner Cancer Center is open for regular business hours for dialysis and oncology patients only. The pediatric clinic is canceling all non-essential appointments. 

The Close to Home Hospice and Hospitality House will require all visitors to be screened for respiratory symptoms. The Powder River Surgery Center is closed. No visitors are allowed at the Legacy Living and Rehabilitation Center. All employees and select volunteers will be screened for respiratory symptoms. Powder River Orthopedics and Spine is open and seeing limited patients. 

The wellness daily community blood draws, lab tests and health and wellness screenings have been discontinued until further notice. 

Carbon County

Memorial Hospital of Carbon County: The hospital is screening all patients, staff and visitors when they enter the facility, including asking a series of questions and conducting a temperature check. 

Only patients in critical condition and women in active labor will be allowed a visitor. No children under the age of 18 will be allowed in the hospital except for medical care. No visitors are allowed in the common areas, such as the waiting rooms and lounges. 

The hospital can only be entered through the main lobby or the emergency room. All non-urgent or elective surgeries are postponed. 

Converse County

Memorial Hospital of Converse County: Elective surgeries are postponed until further notice. Primary care providers are canceling or rescheduling all non-urgent appointments, however all of the clinics are still open. Patients will be asked a series of questions before being allowed into the buildings. 

The main entrance of the hospital will be monitored from 7 a.m. to 5 p.m. Monday through Friday. Exterior hospital doors will be locked after hours. The Arbor Cafe and Mocha Molly’s are closed to the public. 

No visitors or guests will be allowed in the hospital. 

Fremont County

SageWest Health Care: Patients in the emergency department, inpatient units and outpatient clinics are screened for the virus. Staff treating a potential case of the virus are provided with appropriate protective equipment to help prevent exposure. Patients with symptoms of the virus are immediately provided masks to prevent exposure. 

Only pediatric, OB, outpatient surgical patients and those receiving end-of-life care will be allowed visitors. These groups may only have one healthy adult (a person over 16) as a visitor and everyone must be screened upon entering the facility. 

Goshen County

Banner Health Community Hospital: Pediatric patients can have one adult visitor with them and laboring mothers may have one support person, but all other guests are barred from teh hospital. Deliveries of gifts, care packages, flowers or anything else will not be accepted at this time. 

Banner Health has canceled elective surgeries in two other states, but not Wyoming as of press time. The hospital won’t give “fit-for-work” clearances or test for the virus for an employer. 

The main entrance and emergency room entrance remain open to the public. 

Laramie County

Cheyenne Regional Medical Center: The hospital’s visiting hours are limited from 7 a.m. to 7 p.m. daily and patients may only have one visitor during the entirety of their stay. However, patients who are admitted and screened or test positive for the coronavirus won’t be allowed visitors.

Cancer Center patients are also only allowed one visitor. Visiting hours are the same as the hospital’s. 

The Davis Hospice Center is locked at all times, but visitors will be allowed in special circumstances, such as an end-of-life event or when the visitor is essential for the patient’s well-being. This will be assessed on a case-by-case basis. 

Natrona County

Wyoming Medical Center: Medically necessary surgeries will be conducted on a case-by-case basis. The schedule is checked daily for appropriateness in order to conserve resources. 

Medically necessary exams such as echocardiograms, pulmonary function tests and stress tests are still being scheduled. All procedures are being evaluated on a case-by-case basis. The Sleep Lab is closed. 

The NERD Health and Wellness Center’s health coaching, acupuncture and massage appointments are canceled. Pulmonary rehabilitation is canceled until further notice. The childbirth education and breastfeeding classes are canceled, as well as in-person lactation consultations. 

Visiting hours are now from 7 a.m. to 8 p.m. daily. A patient will be allowed one visitor per day, but exceptions will be made for comfort care or terminally ill patients. Pediatric parents and babies in the nursery can have both parents visit, but only one at a time. Visitors will go through a health screening before being allowed to enter.

Park County

Cody Regional Health: Pediatric patients admitted to the ER or inpatient services will be allowed one legal caregiver with them for the entirety of their stay. Maternity patients will have the same rules applied to them. Visitors aren’t allowed in the hospital otherwise. 

Health Fair lab draws have be canceled at all of CRH’s location. The orthopedics department is reduced to essential appointments only, including fractures, post-operation appointments and traumatic injuries. 

All elective procedures for radiology and cardiac catheterization procedures are canceled, except for critical diagnostic/testing procedures. Cedar Mountain Center rehab services are canceled. 

Pediatric clinic visits are reduced to only visits for newborns up to four months old. 

Certain medical practices, like internal medicine and cardiology, are reducing their hours for the time being. 

Platte County

Platte County Memorial Hospital: See entry for Banner Health Community Hospital in Goshen County. 

Sheridan County

Sheridan Memorial Hospital: Visitors aren’t allowed for most patients. Exceptions include OB patients, those coming in for surgery or an outpatient procedure, patients at the end of their life and pediatric patients, all of whom are allowed one support person. They will all be screened for illness symptoms before their visit. Patients and staff are also screened when they enter the building. 

Sweetwater County

Memorial Hospital of Sweetwater County: Anyone with a fever or cough is asked to wait to go to the emergency room before contacting the nurse triage line. 

Visitors are restricted except for OB and pediatric patients, as well as those at the end of their lives. They must be the same person for the OB and pediatric patients. No children are allowed as visitors. Everyone entering the hospital will be subjected to a temperature scan. 

Teton County

St. John’s Health: Patients can have only one designated visitor per day, but both parents can visit if the patient is a child. No one under 18 or displaying flu-like symptoms is allowed to visit. Everyone entering the hospital must wash their hands or use a sanitizer with a 60% alcohol base before entering. 

Emergency department patients can’t have visitors except one parent for a child or one caregiver for a patient who needs help communicating. 

The St. John’s Living Center is restricting all visitors except in the case of an end of life situation. It’s canceling all communal dining and group activities, both internally and externally. All staff are screened for fever and respiratory symptoms at the beginning of their shift. Residents are also being screened. 

The hospital can’t currently clear anyone to return to work after an illness. 

Uinta County

Evanston Regional Hospital: The ER is the only accessible door to patients at this time. Patients are allowed one to two visitors, but no one under 18 or displaying sickly symptoms. Everyone entering the facility will do a health screening. 

Weston County

Weston County Health Services: Visitors aren’t allowed at this time. People experiencing coronavirus symptoms are asked to call the center before arriving. 

Wyoming’s First Coronavirus Disease 2019 Case Reported

in News/Health care

Lab testing at the Wyoming Public Health Laboratory has identified the first known case of a state resident with coronavirus disease 2019 (COVID-19), according to the Wyoming Department of Health (WDH).

Dr. Alexia Harrist, state health officer and state epidemiologist with WDH, said the patient is an adult female from Sheridan County with some recent domestic travel history.

WDH is following up to learn more details about the person’s exposure risk and to identify and communicate with anyone who may have been in close contact with the patient. Known contacts will be monitored for symptoms and tested if needed. As is currently standard, the test result is considered to be a “presumptive positive” and the Centers for Disease Control and Prevention (CDC) will conduct further testing for confirmation.

Harrist noted the current risk of transmission in Wyoming remains low for most residents. “We expected to identify a case in Wyoming at some point because the reach of the disease is clearly growing. Travelers to certain affected locations and close contacts of ill people are still overall at the highest risk of becoming ill,” she said.

“Our state has been planning for this situation for weeks and we will continue our coordinated efforts to address this threat,” Governor Mark Gordon said. “I pledge to work closely with our state agencies, federal partners and local officials to ensure we are implementing all the necessary steps to protect public health.”

Harrist said symptoms reported with this disease are familiar: fever, cough and shortness of breath. There are many different coronaviruses, some of which cause the common cold in people and others that circulate among animals.

Experts believe COVID-19 spreads mostly between people who are in close contact and through respiratory droplets when an infected person coughs or sneezes. People are thought to be most contagious when they are most ill with obvious symptoms. A person may also get COVID-19 by touching a surface that has the virus on it and then touching their own mouth, nose or eyes.

Recommended steps that can help avoid the spread of COVID-19 or similar illness include:

· Avoid close contact with sick people.

· While sick, limit contact with others as much as possible.

· Stay home if sick.

· Cover nose and mouth when coughing or sneezing. Avoid touching eyes, nose and mouth. Germs spread this way.

· Clean and disinfect surfaces and objects that may be contaminated with germs.

· Wash hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand rub with at least 60 percent alcohol.

“Travel recommendations and restrictions are also important,” Harrist said. The CDC currently recommends no nonessential travel to China, Iran, South Korea and Italy and no travel on cruise ships.

The CDC also says older adults and travelers with underlying health issues should consider avoiding situations with increased risk for transmission because they are at higher risk of severe COVID-19 illness. Examples include avoiding non-essential travel such as long plane trips and avoiding crowded places.

For more information about coronavirus disease 2019 and Wyoming, visit:

For more details about the disease from the CDC, visit:

Coronavirus Likely In Wyoming, State Preparing, Gordon Says

in News/Health care
Mark Gordon file photo

Posted by Governor Mark Gordon on Tuesday, March 3, 2020

It appears likely that the Coronavirus will reach Wyoming eventually, so officials are making sure that the state is ready for that eventuality, Gov. Mark Gordon said Tuesday.

Gordon, in a news conference called to discuss the illness, said although no cases of Coronavirus — also called COVID-19 — have been reported in the state, officials have been working for weeks to prepare for its arrival.

“There are no reported cases in Wyoming at this time and the risk to our residents from the disease remains low,” he said. “It is becoming increasingly likely that COVID-19 will eventually spread to the state. The Department of Health and the Office of Homeland Security are coordinating state resources and planning efforts to ensure vital resources are protected should events cause a disruption.”

Gordon said officials with the state Department of Health and Office of Homeland Security have been working with their counterparts at the local level, along with private entities, to make sure all are ready should the illness surface.

“These planning efforts have been underway for weeks and will continue as the situation evolves,” he said.

Department of Health officials have been working with local hospitals to provide guidance in areas such as testing and determining risk factors for the illness. The department has also been involved in conducting assessments of hospitals around the state, he said.

The Wyoming Public Health Laboratory has also been working to be able to conduct tests for Coronavirus, Gordon said, and Dr. Alexia Harrist, the state’s health officer, said testing could take place within a week.

Harrist and Gordon both noted that since little is known about the illness, it is hard to predict how it might affect the state.

“Right now, I could only say we’re not sure exactly what is going to happen with this virus,” Harrist said. “With this virus, it is very difficult to predict the extent of the transmission that will occur and how long that transmission will occur. We need to prepare for widespread community transmission, but … efforts in the U.S. and Wyoming are underway to try to prevent that as much as possible right now.”

Superintendent of Public Instruction Jillian Balow said the state has also been working local schools to advise principals, school nurses and custodians on how to prevent the spread of the illness and deal with an outbreak should one occur.

Coronavirus can cause respiratory problems, fever, cough and breathing difficulties. Since being first reported in China, it has spread quickly. More than 100 cases have been reported in 15 states, including Nebraska.

To prevent the spread of the illness in Wyoming, Gordon recommended residents follow the same advice given by the state Department of Health to prevent the spread of the flu: avoid contact with sick people, stay at home when sick, cover the nose and mouth when coughing and wash hands often and carefully. 

More recommendations can be obtained from the Department of Health website at Health.Wyo.Gov.

Gordon closed by saying there is no reason for panic.

“I want to assure the people of Wyoming that we are taking steps to be prepared,” he said. “There is no immediate cause to be alarmed.

Bob Geha: 48-Hour Waiting Period for Abortions Approved in House

in News/Health care/politics

By Bob Geha, Cowboy State Daily

A measure that would impose a 48-hour waiting period on women seeking an abortion won final approval from the House on Friday.

HB 197 was approved on the House floor on its third and final reading by a vote of 39-17.

The bill was amended to reduce a proposed sentence of 10 years for doctors who do not observe the waiting period to one year, a $1,000 fine or both.

The change was supported by Rep. Tyler Lindholm, R-Sundance, who said the penalty originally proposed in the bill was too strict.

“To apply a 10-year felony provision to that when we don’t apply the same standard to a rapist is absurd,” he said.

However, other amendments that would have reimbursed women for temporary housing, meals and other expenses while waiting the 48 hours was rejected.

Rep. Sara Burlingame, D-Cheyenne, said the amendment would have provided much needed support for women who are poor.

“I am trusting this body to say if we’re gonig to ask women to do this, we will set aside the money,” she said. “Not for all women. If you have means and you can go to Jackson, you’re on your own. But if you’re poor, then the state acknowledges your right to medical care … “

The vote sends the bill to the Senate for its review.

Medicaid Expansion in Wyoming: Supporters, Opponents Debate

in Government spending/News/Health care

By Bob Geha, Cowboy State Daily

A plan to expand Medicaid to provide more Wyoming residents with health insurance coverage might help keep people in Wyoming, but the cost might be too much for the state to handle, speakers at a panel discussion on the idea said Thursday.

Opponents and supporters of a bill proposed by the Legislature’s Revenue Committee debated the idea during a panel discussion hosted by the Wyoming Liberty Group.

The Revenue Committee’s bill is headed to the full Legislature for its consideration during its budget session, which begins Feb. 10. Estimates indicate that the bill would allow another 19,000 Wyoming residents to qualify for coverage under Medicaid at a cost of $9 million a year to the state.

Jan Cartright, executive director of the Wyoming Primary Care Association, said the benefits would outweigh the risks of adopting the expansion plan similar to programs in place in 37 other states.

“I think this is about people’s lives and I think I will work very hard with legislators to provide common sense arguments that are based on fact that would show this is a gamble Wyoming should take,” she said.

Several legislators, however, expressed concern over the cost of the program. The total cost is estimated at $154 million every two years, with the federal government paying about $136 million of the cost, leaving the state to pay the remaining $18 million.

“Ten percent of a large number is still a large number,” said Sen. Bo Biteman, R-Sheridan. “And we don’t have that money. We are scrambling, scratching and clawing, looking under the mattress for quarters. We’re not in any position to grow our state government at all. We need to be cutting our government.”

However, Rep. Dan Zwonitzer, R-Cheyenne, said the expansion might help keep residents in the state in the face of declining jobs in the mineral industry.

“In the next five years alone, we’re projected to lose 1,000 more jobs,” he said. “They equate that to about 4,000 people in the state that won’t have employment. They’re probably going to be forced to move somewhere else.

“The nice thing about Medicaid expansion in that respect, they’re part of the community, they want to hold on,” he continued. “If they can have access to part-time jobs to get them through until they can find other full-time employment in the state and we can keep them here, that’s great. Once they leave, we’re not getting them back.”

But the added burden of $18 million every two years for the state Health Department could result in cuts to existing department programs, said Rep. Sue Wilson, R-Cheyenne.

“I am very concerned, if our revenue picture’s the same, that we would expand Medicaid and then tell the department to find that money, $20 million a biennium, roughly, inside your agency,” she said.

However, Josh Hannes, vice president of the Wyoming Hospital Association, said the expansion would give officials in the state and the health industry to work together to develop a plan that would fit the state.

“We have an opportunity, I think, to work with our policy makers, our Department of Health, Department of Insurance, our folks at (the Centers for Medicare and Medicaid Services) to create a plan that works for Wyoming,” he said.

Naomi Lopez of the Goldwater Institute warned attendees that an extra influx of federal money will not necessarily lead to improved health care.

“There are a lot of areas where you can actually improve the delivery of care at a lower cost and really break away from this idea that government spending is going to be some kind of silver bullet to what ails your health care system,” she said. “It is not. What is actually going to fix the health care system is focusing on patient-centric solutions and I think that is not what Medicaid expansion is going to provide.”

Legislative committee approves Medicaid expansion plan

in News/Health care/Taxes

CHEYENNE — A plan to expand Medicaid coverage to about 19,000 Wyoming residents won approval from a legislative committee on Tuesday.

The Legislature’s Revenue Committee voted 8-5 to send to the full Legislature a bill that would expand Medicaid coverage at a cost of about $154 million for two years. Federal funds would cover about $136 million of the cost, with the state picking up the remaining $18 million.

Supporters argued that given declines in the state’s mineral industry, residents will need the extra assistance provided by expanded Medicaid coverage.

“I think the coal bankruptcies up in the northeast have made people sit back and think a little bit differently about our economy,” said committee member Rep. Cathy Connolly, D-Laramie. “We know that people are going to lose their jobs. We know it. Every bit of information points to it.”

Marcie Kindred, a Cheyenne Democrat who plans to run for the state House of Representatives, said the state owes it to its residents to provide assistance.

“I’m really lucky that I have a network of support of people to help me get out of that cycle of poverty,” said Kincaid, a mother of four who has relied on Medicaid coverage. “But what about the people that don’t have that network of support, that don’t have that health (coverage)? We, as citizens of Wyoming, have to care for our own. We have to be that support and turn back and pull them out.”

Opponents of the measure argued that the state will have to pick up a larger share of the expense should the federal government reduce its level of support.

“The federal government does not have the money for this,” said Karl Allred, a former state representative from Evanston. “Eventually, that’s going to go away. And once you’re into it, you can’t get out really effectively. Are you going to tell people all of a sudden now that you’ve been giving them health care and now you’re going to take it away?”

Bob Wharff, a lobbyist from Evanston, agreed.

“If we become dependent and reliant upon the government to fulfill that and it falls apart, there’s no other safety net there,” he said.

The measure will be forwarded to the full Legislature for its consideration during its upcoming budget session in 2020.

Flu season open in Wyoming — get your shot!

in News/Health care

It’s fall in Wyoming and that means the Wyoming Health Department is issuing its annual reminder to residents to get their flu vaccine to protect themselves against the kind of severe flu season seen last year.

According to the Health Department, 23 people died from the flu during the 2018-19 flu season and hundreds were hospitalized.

Although the department isn’t predicting what kind of flu season may be in store for Wyoming in 2019-2020, it is urging everyone to get vaccinated.

“There are a lot of things about the flu we do know,” said Kim Deti, the department’s spokeswoman. “We know it’s coming every year. We know every year we’re going to see deaths, hospitalizations and illnesses. We want you to get that shot.”

Autumn is the best time of year to get a flu shot, Deti said, because it coincides with the beginning of the typical flu season, which generally runs from October through May.

“We don’t necessarily have a time frame,” she said. “But this is a great time of year to get it. We don’t want people to wait until folks around them are ill. That’s not going to help you very much.”

The vaccine takes about two weeks to become fully effective, Deti said, meaning if someone waits until people around them are ill, they may have waited too long.

“If you wait until people around you are sick, you may still get exposed,” she said.

In addition to preventing the flu, the vaccination can reduce the severity of influenza if someone who has received the shot gets sick anyway, Deti said.

“We’re not going to promise it’s 100 percent ironclad protection,” she said. “But it’s the best weapon we have to fight influenza.”

Being vaccinated also helps prevent the spread of flu to others, she added.

“You might be able to bounce back from the flu, but you don’t want to pass the disease on to someone else who is more vulnerable than you are,” she said. “It’s about protecting other people who have more struggles with the flu.”

The Health Department identifies people who may be particularly susceptible to the flu as young children, pregnant women, people with chronic health conditions such as asthma or diabetes and those over the age of 65.

In addition to getting the vaccine, the Health Department urges people to take precautions against spreading the flu, such as washing their hands often.

“Hand washing is extremely important, particularly with the flu and how it’s spread,” Deti said.

Health officials: Vaping no safe alternative to smoking

in News/Health care

By Cowboy State Daily

As the number of people with reported respiratory ailments linked to vaping rises, Wyoming’s health officials are warning residents that vaping is not a safe alternative to cigarettes.

“Vaping is not safe for adolescents, for young adults, for pregnant women or for anybody who is not a current smoker,” said Dr. Alexia Harrist, the state’s health officer and epidemiologist.

National reports indicate more than 1,100 people are suffering from lung illnesses related to vaping, with 23 deaths reported. In Wyoming, Harrist said two cases of vaping-related illnesses have been reported.

Officials are unsure what is causing people to become sick, Harrist said.

“What we’re seeing now is an outbreak of severe pulmonary disease related to vaping,” she said. “And we’re still trying to figure out what the specific substance or device is that is causing this illness.”

Most of the people reporting the illness appear to be young adults, Harrist said.

“This certainly does seem to be something new and something different,” she said. “Because these are young, healthy people being admitted to the hospital with respiratory problems and sometimes even respiratory failure.”

Cheyenne resident Kathleen Jaure said she began vaping last year to stop smoking cigarettes. She theorized that the rise in lung ailments may be related to the rise in use of the electronic smoking devices.

“Maybe the potency is going up, that makes it more problematic,” she said. “Also, more people are doing it and so you’re going to see problems. And usually with something, it doesn’t happen overnight that there’s a problem. So I think as it goes on, then we’re starting to recognize the effects of vaping.”

Health officials report that lung ailments related to vaping display symptoms similar to those seen with the flu or pneumonia.

Ransomware attack still affecting Campbell County Health

in News/Health care
Ransomware attack

By Tim Mandese, Cowboy State Daily

A ransomware virus attack on Campbell County Health continued to plague its computer network, causing disruptions in service to Campbell County Hospital and connected systems on Monday. 

According to Kelly Ruiz, public information officer with the Department of Homeland Security in Cheyenne, two other institutions, both connected to Campbell County Health, were also affected by the attack. 

One was the Legacy Living and Rehabilitation Center in Gillette, a long-term care and short-term rehabilitation facility, Ruiz said. The other, according to Dane Joslyn, CCH public information officer, was Wright Clinic and Occupational Health, part of the Campbell County Medical Group.

Ruiz advised the public to follow common computer safeguards to defend against such virus attacks.

“There are some basic things that everyone whether it’s private industry or individuals can do … use strong passwords, don’t click on links, don’t open unknown email attachments,” she said. “Also use cyber security software, a good antivirus.”

It is unknown how the ransomware was transmitted to the CCH network. 

“It is still under investigation.” said Ruiz. “We are currently coordinating but we don’t yet know.”

Due to the ongoing criminal investigation, officials are not disclosing the nature of the ransom being demanded by the virus’ attacker. Most ransomware attacks direct the infected user to send an electronic payment through a given link before the system will be released. 

During a press conference at CCH Monday afternoon, hospital officials, affected department heads and investigators fielded questions about the attack and the investigation. 

“Our goal here is to bring in people that can help identify and go after the perpetrators,” said Leland Christensen, deputy director of the Department of Homeland Security.

Ian Swift, chair of the CCH board of directors, said work continues at the CCH despite the disruption.

“There is a sense of calm in CCH right now,” he said.

There is no estimate as to when the situation might be resolved, said Matt Sabus, information technologies director for CCH.

According to the CCH website, the county’s Emergency Medical Services, CCMH Emergency Department, Maternal Child (OB) and the CCMG Walk-in Clinic are open to assess patients and treat or transfer patients to area hospitals as appropriate.

Ransomware attack shuts down computer network at Campbell County Health

in News/Technology/Health care
Randomware virus

By Tim Mandese, Cowboy State Daily

Gillette — A “ransomware” virus shut down the Campbell County Health computer system on Friday, forcing the Campbell County Memorial Hospital to direct incoming emergency patients to other facilities, according to the health system’s website.

According to the CCH website, “All CCH computer systems have been affected, which impacts the organization’s ability to provide patient care.”

“We have processes in place to continue to treat inpatients appropriately and safely,” Colleen Heeter, Chief Operating Officer, said in the statement. “We will continue to update this information as it becomes available.” 

CCH first became aware of the ransomware attack about 3 a.m. Friday morning. As of Friday night, there was no information as to when computer systems would be restored. 

Services disrupted at at CCH include:

  • No outpatient lab, respiratory therapy and radiology exams or procedures;
  • No new inpatient admissions;
  • Some surgery cancellations;
  • Patients coming to the emergency department and walk-in clinic will be triaged and transferred to an appropriate care facility if needed.

Patients are urged that before coming to appointments, to contact their clinic or department to see if they still scheduled. Phone systems remain operational.

According to Dame Joslyn, CCH Public Information Spokesperson, current patients are being treated as normal, but new patients are being diverted to hospitals in Casper, Sheridan and Rapid City, South Dakota. 

“We have transferred six patients since 11:30 Friday morning.” “We (CCH) have enlisted numerous local, state and federal officials,” added Joslyn.

As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

in News/Health care
As Wyoming tries to control supply of opioids, patient, prescriber complications emerge

By Laura Hancock, Cowboy State Daily

Through decades of numerous, unpredictable illnesses, pain has become a constant for Cody resident Dawn Scott.

But with the opioid epidemic raging in Wyoming and throughout the U.S., obtaining painkillers has become as unpredictable as epithelioid hemangioendothelioma, the rare cancer she fought in the late 1990s. 

The guarantee of a doctor prescribing opioids can be as uncertain as her thoracic outlet syndrome, the illness that resulted in 21 surgeries between 2014 and 2016, which left her with most of her collarbone removed and muscles that had been attached to the clavicle reattached to other parts of her body. 

“Once I tell them the amount of opioids I’m going to need to get relief — which is significant after 21 years of surgeries — I’m almost instantly labeled a seeker,” she said. “Unless it’s an ER doctor who knows me and knows my history. Newer doctors or loaner doctors don’t offer any form of pain control.”

As state leaders try to control the flow of opioids in Wyoming, complications have emerged. Chronic pain patients have had trouble getting the medicine they need to be comfortable and live productive lives. Physicians and other prescribers – already under watch by private insurers and government health care programs – have new laws to consider in their practice. 

But state leaders, concerned about addiction and its effects on families and communities in Wyoming, felt it necessary to change the law and make it harder to dispense and obtain opioids.

Last month, the Cowboy State Daily reported more than 100 million painkillers were shipped to Wyoming pharmacies between 2006 and 2012. The state, local governments and Indian tribes have sued drug makers and distributors, saying they aggressively marketed the medicines and downplayed their addictive tendencies. 

In February, the Wyoming Legislature passed Senate File 46 and Senate File 47 – its own response to the opioid epidemic. 

S.F. 46 prohibits prescribing and dispensing more than a 7-day supply of opioids in a 7-day period to an acute pain patient, with the Wyoming State Board of Pharmacy to establish “reasonable exceptions” for chronic pain, cancer treatment, palliative care and other clinical exceptions.  The pharmacy board is working on rules

The 7-day law is similar to restrictions in about 15 other states

S.F. 47 requires licensed health care professionals to take continuing education courses in the responsible prescribing of controlled substances, which includes opioids. 

The law also requires prescribers to upload controlled substance prescriptions electronically to the Wyoming Online Prescription Database by Jan. 1, 2021, so that doctors, pharmacists and other professionals can review what drugs a patient is on — and prevent abuse or adverse side effects.

The federal government has touted state-level prescription drug monitoring programs as a way to spot and close down “pill mills,” and reduce addiction and overdose deaths. Wyoming physicians — who feel they don’t have a problem with over-prescribing, save for a few extreme examples – say the new state laws are heaping on more regulations on top of various insurance and government health care programs, said Sheila Bush, the Wyoming Medical Society’s executive director.

For instance, Medicare encourages physicians to check the prescription drug monitoring program when writing opioid scripts. One private insurer may prohibit opioids for patients under a certain age, another may limit patients to three days of opioids. There are federal laws, and now state laws, she said. 

“Separate from all of this, you still have good clinical knowledge – the ability for a physician to look at a patient and know the history and say, ‘This is the best care for you today,’” Bush said.  “They’re inundated. There’s no consistency.”

The Medical Society was supportive of the Wyoming legislation because it knew the public had asked for changes in the law. The organization felt that having a seat at the table and providing doctors’ expertise could make the measures better, she said. 

But Wyoming patients with serious medical issues may suffer as a result of these policies. 

Scott, the Cody chronic pain patient, had a miscarriage in a 2016. She asked the physician for painkillers for her cramping. She received just one pill – two milligrams of the opioid Dilaudid. 

“My normal dosage to give me maximum relief is between 12-16 milligrams of Dilaudid,” she said, describing the following days as agonizing. 

Scott has since found a pain specialist in Billings, Montana, who has reduced her trips to the emergency room when migraines, cluster headaches and other pain flares up. 

Scott, who as an attorney has represented people with chronic pain, believes opioids aren’t addictive for everyone. Some patients use them responsibly to relieve pain, she said. Scott said she’s gone through periods in which she didn’t have to take any painkillers. 

“It’s sad, and I’ve watched addiction first-hand, not with opioids – but my dad died of alcoholism,” she said. “I understand the power of addiction. I understand there needs to be control. But there also needs to be a case-by-case basis, not just a blanket decision that, ‘I’m not going to ever offer over 2 milligrams of Dilaudid.’ They feel like their discretion is being scrutinized because of regulations. Some doctors want to help people and they’re limited.”

More than 100 million prescription painkillers ended up in Wyoming in six years

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More than 100 million prescription painkillers ended up in Wyoming in six years

By Laura Hancock, Cowboy State Daily

Drug makers distributed nearly 126.7 million painkillers in Wyoming between 2006 to 2012, according to a federal prescription database recently made public.

That includes hydrocodone, which goes under the name brands of Vicodin and Lortab, and oxycodone, which goes under the name brand of OxyContin

The U.S. Drug Enforcement Administration database is being used in litigation by more than 2,000 entities such as state governments, local governments, tribes, labor unions and hospital systems – including several in Wyoming – in a federal courtroom in Cleveland. The litigation alleges drug manufacturers and distributors aggressively marketed the medicines, downplayed their addictive tendencies and created an opioid scourge that’s become a national epidemic. 

The Washington Post and the Charleston Gazette-Mail in West Virginia successfully fought to make the information public, and the Post created a searchable database — from which the Wyoming data was pulled.

The following describes prescription opioids sent to each Wyoming county between 2006 and 2012:

Albany4.5 million pills18 pills per person each year.
Big Horn3.7 million pills45 pills per person each year.
Campbell10.6 million pills35 pills per person each year.
Carbon3.1 million pills28 pills per person each year.
Converse2.9 million pills31 pills per person each year. 
Crook250,100 pills5 pills per person each year. 
Fremont7.8 million pills28 pills per person each year. 
Goshen2.2 million pills25 pills per person each year. 
Hot Springs1.8 million pills53 pills per person each year. 
Johnson1.2 million pills21 pills per person each year. 
Laramie20 million pills32 pills per person each year. 
Lincoln3.9 million pills32 pills per person each year. 
Natrona20.4 million pills39 pills per person each year. 
Niobrara421,800 pills25 pills per person each year. 
Park10.3 million pills53 pills per person each year. 
Platte2.2 million pills35 pills per person each year. 
Sheridan7.1 million pills35 pills per person each year. 
Sublette1.5 million pills23 pills per person each year. 
Sweetwater9 million pills30 pills per person each year. 
Teton3.3 million pills22 pills per person each year. 
Uinta5.8 million pills40 pills per person each year. 
Washakie3.1 million pills54 pills per person each year. 
Weston1.6 million pills32 pills per person each year. 

Several Wyoming governments are involved in separate litigation over opioids, including the state, Carbon County, Rock Springs, Green River, Casper, Cheyenne, and the Eastern Shoshone and Northern Arapaho tribes. Lawsuits have been filed in state and federal court

The plaintiffs in all of the lawsuits argue that drug treatment has cost them millions of dollars through Medicaid and community treatment facilities. Many people, hooked on prescription opioids, have turned to street drugs – including fentanyl-laced heroin. Some have overdosed and some have died— including nearly 50,000 across the U.S. in just 2017 alone

State Rep. Charles Pelkey, D-Laramie, said he was pleased to see the state taking action in the face of large distribution numbers.

“Much of the responsibility lies with the pharmaceutical companies who marketed aggressively, unaware or intentionally ignorant of the consequences,” he said in an email. “We can some things legislatively, but I am pleased to see that the state is pursuing the matter in the courts as well. If legislation doesn’t achieve the desired goal, maybe hitting them in the pocket, where it counts, will.”

Wyoming’s case is pending in district court in Laramie County, where OxyContin maker Perdue Pharma wants it dismissed. The state is opposing the motion.

Michael Pearlman, spokesman for Gov. Mark Gordon, said this week that the Wyoming Attorney General’s Office is waiting for the district court to rule on dismissal. 

“In the meantime, the court entered a scheduling order, including among other things, discovery deadlines which the AGs office is following,” he said in an email.

According to filings, the case is expected to continue at least through 2020.
The lawsuits filed by Wyoming cities and tribes are in federal court, all consolidated in U.S. District Judge Dan Polster’s Ohio courtroom. Bloomberg reported Tuesday that McKesson Corp., Cardinal Health and other drug distribution companies have offered a $10 billion settlement in lawsuits filed by the various states. A group representing some plaintiffs countered with $45 billion. 

Drug makers haven’t yet begun settlements with the plaintiffs in federal court in Ohio, but the judge is pushing for the parties to settle soon to end all the suits and help set aside money for drug treatment and prevention. Perdue Pharma separately settled with Oklahoma for $270 million.

Pearlman, Gordon’s spokesman, said opioids aren’t just an addict’s problem. Their families and communities are affected too. 

“It causes extra burdens on our law enforcement agencies and first responders,” he said. 

Public health officials continue to eye Wyoming’s immunization rates

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Graph of Wyoming vaccination rates

By Laura Hancock, Cowboy State Daily

At a time when all-but-eradicated diseases are making a comeback, immunization rates among young children in Wyoming tend to closely mimic national trends, according to an analysis of federal data. 

Some years, Wyoming’s rate is lower than the national average. Other years it’s higher. 

However, looking at data for four common vaccines tracked by the National Immunization Survey, Wyoming’s rates increase and decrease by more percentage points than the national average. 

That could be the result of the margin of error that comes from polling the country’s smallest population state, said Alexia Harrist, the Wyoming state health officer and epidemiologist. 

Although signs are good that Wyoming hasn’t significantly deviated from the national norm, that doesn’t necessarily mean Wyoming has escaped the “anti-vax” movement, which inaccurately pushes the belief that vaccines are harmful. Research shows that vaccine reactions are rare and the one study linking vaccinations to autism contained falsified information

“We are seeing some increases in the amount of waivers (for vaccination) that we’re getting,” Harrist said. “That is concerning that we may be seeing fewer children getting vaccinations.”

Wyoming is one of 45 states and Washington, D.C. where parents can seek waivers from required vaccinations for their children due to religious beliefs. 

Dr. Mark Dowell, the Natrona County health officer, remembers the days when he could override a family’s desire to waive their children’s vaccines. 

“I made sure that they had good reasons to prove to me there was a medical contraindication to the vaccine,” he said. “(Otherwise) I’d deny it. That’s how I’ve always felt, and I’ll continue to preach that.”

In 2001, the Wyoming Supreme Court ruled that public health officers exceeded their authority by denying immunization exemptions. Since then, Dowell and others stopped intervening. 

Public health officers stress the concept of “herd” immunity or “community” immunity, in which most people get vaccinated so that the few who cannot – those with cancer or immune deficiencies that prevent them from developing immunity with vaccines – are safe from smallpox, polio and other diseases once thought to be in the Western world’s past, Harrist said. 

That Wyoming hasn’t seen a measles outbreak could be luck. Or it could be the result of the Cowboy State’s vast spaces and few people. 

“The majority of the time I’m not running into major problems in this county,” Dowell said about Natrona County. “But almost all of the counties in Wyoming are very rural. They don’t have a lot of infectious disease.”

News of outbreaks outside of Wyoming may actually boost immunization rates. 

The phone starts ringing at Sheridan County Public Health whenever there is an outbreak. People want the health department to check their records to ensure they’re up-to-date on all their shots, said Debra Harr, the county nurse manager. 

“We’ve seen quite a bit more people calling to see if they are current on their measles,” she said. 

Doctor Shortage in Wyoming; “Almost Impossible to Recruit”

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Doctor Shortage in Wyoming; “Almost Impossible to Recruit”
Wyo Hospital Assoc. President: Federal changes makes it almost impossible for us to be competitive and for us to recruit especially family practice physicians in these rural areas where they’re needed the most.

By James Chilton, Cowboy State Daily

CHEYENNE – When it comes to sheer numbers, Wyoming’s doctor shortage isn’t all that bad, on paper at least.  Just two dozen additional full-time outpatient physicians would be enough to meet the primary care needs of the nearly 188,000 Wyomingites living in federally-designated Health Professional Shortage Areas, or HPSAs.

“The population of designated HPSAs in Wyoming for primary care is 187,903, and only 53.81 percent of that population’s need is met,” said Keri Wagner, of the Wyoming Health Department’s Office of Rural Health. “The practitioners needed to remove that designation is 24 for the entire state.”

While it might not sound like much, getting those 24 full-time doctors into the state, getting them to the communities where they’re needed most, and offering them the compensation and quality of life needed to keep them here have proven uniquely difficult in the Cowboy State. Federal and state programs have made some headway in the effort to bring more doctors, dentists and psychiatrists to all corners of Wyoming. But while the state’s reputation for wide-open natural splendor brings in the tourists and outdoorsmen, it’s not necessarily what most doctors are seeking when looking to relocate.

“It really takes a specific type of person, someone who grew up in these frontier communities that really wants to get back to practicing someplace where they’re relatively isolated. If they’re outdoorsmen or like cross-country skiing or hunting, sure; but there are long distances to get to any other type of entertainment,” Wagner said. “We’re surrounded by states with larger population centers, more enrichment opportunities and educational opportunities, so it can be a really tough sell for some communities that don’t even have a supermarket.”

The HPSA designation seeks to help with this by grading facilities, geographic regions and specific populations on criteria like patient-to-provider ratio, percentage of the population living below the federal poverty level and travel time to the nearest source of care. From this, hospitals, clinics and geographic areas are scored, with higher scores getting the most attention from the U.S. Health Resources and Services Administration.

“If they have the HPSA designation for any of the three disciplines (primary care, dental or mental health services) it opens up the opportunity to participate in the National Health Service Corps,” Wagner said. “We have roughly 30 corps participants every year.”

The National Health Service Corps tries to get practitioners to where the need is by offering scholarships and loan repayment programs to fledgling doctors in exchange for an agreement to work in a designated HPSA for at least two years. Physicians working in geographic HPSAs can also obtain additional bonus quarterly payments from the Centers for Medicare and Medicaid Services.

For HPSA designation and related support, practitioners must submit reports updating the state on statistics such as doctor-to-patient ratios.

“It’s important enough they’ll return their surveys if they’re afraid they’ll lose their designation,” Wagner said. “I’ve seen people where they receive the bonus payment, but there was some cutoff or something wrong with the timing, where the HPSA designation goes away and they have to return it. I think one of the big things that’s happened is the population is so small that just the loss of a quarter of an FTE (full-time equivalent, i.e. 40 hours of work per week) can make or break a designation.”

That’s been a continuing cause for concern for Eric Boley, president of the Wyoming Hospital Association. Boley agreed with Wagner’s assessment that, for whatever reason, the HPSA system seems weighted to apply to more densely-populated areas, where small changes in population don’t move the needle as much.

“The feds have changed the way the HPSA scoring is calculated based on service areas, so areas I and my members would designate as shortage areas no longer meet their criteria,” Boley said. “For example, south Lincoln County used to easily qualify for HPSA funding, where northern Lincoln County, the Star Valley area, didn’t have some of the challenges. But now because of criteria changes, the whole area is lumped into one.”

As a result, Boley said some of the state’s most vulnerable rural communities are left with few resources to attract medical talent from larger hospital systems, and even those that do have the resources have to make steep offers to even stand a chance.

“My facilities are having to pay, in some cases, the 95th percentile for salaries, with sign-on bonuses and really lucrative living expense packages,” Boley said. “It makes it almost impossible for us to be competitive and for us to recruit especially family practice physicians in these rural areas where they’re needed the most.”

Wagner noted the state has led its own effort to try to provide a little more financial leverage to small communities through the Wyoming Provider Recruitment Grant Program, which provides up to $50,000 to a hospital, clinic or community organization attempting to recruit a healthcare provider. Initially funded for the 2009-10 biennium, the program doesn’t level the playing field, Wagner said, but it has helped to recruit more than a dozen physicians, psychiatrists and, following a 2015 legislative change, other health professionals like registered nurses or occupational therapists.

Like most programs, Wyoming’s provider recruitment program has some strings attached that have kept it from being fully utilized. One big problem is that the grants are meant for reimbursement, meaning whoever’s doing the hiring needs to have the money up front and has to have someone recruited within one year for the payments to come through. 

“If they don’t recruit within that one year, they don’t get any money. If they do recruit, the provider has to start within six months of the date they sign them,” Wagner said. “So, is this entity able to fund all of this up front and wait for the reimbursement? Our neediest have applied, but they couldn’t go anywhere without money to front it.”

As such, Wagner said applications made through the program dropped from 45 in the 2009-10 biennium to just nine in the following biennium, and they have remained low ever since. But for those hospitals able to navigate the process and pay for the initial recruitment process, the program has proven a useful tool.

“I think it’s successful in that it provides funding to help recruitment at safety-net facilities. These are organizations that don’t have a ton of funding; they have a hard time competing with larger hospital systems in surrounding states,” she said. “So when a provider is contacted and they’re mulling over whether they should go to a rural health clinic in Colorado that’s offering an $80,000 loan repayment on top of a $40,000 sign-on bonus, versus this hospital in Wyoming … this program improves Wyoming’s negotiating position. It provides them with a little bit more clout.”

VA to implement Mission Act, cutting wait times, enhancing healthcare programs

in Health care/military
File photo

By Ike Fredregill, Cowboy State Daily

A congressional act going into effect June 6 could make it easier for Wyoming veterans to access the health care providers of their choice. The Mission Act will replace the Choice Act of 2014, which was adopted as the congressional response to extreme wait times experienced by veterans seeking medical care through the Department of Veterans Affairs.

“The Choice Act was a three-year law, which was intended solely for the purposes of pulling the VA into a newer era of community care,” said Sam House, a Cheyenne VA Medical Center spokesperson. “Then, President (Donald) Trump extended it for a year. The Mission Act, however, does not have a sunset, so it will be in place until Congress decides to remove it.”

With the Choice Act, veterans could seek primary and mental health care services from a local health care provider rather than from a VA facility if they lived outside a 40-mile radius of a VA medical center or could not schedule an appointment with their primary care provider at the VA within 30 days.

The Mission Act reduces those standards to a wait time of 20 or more days or a drive time of more than 30 minutes.

“They are not using specific matrix to look at drive times, but rather looking at the average drive time and taking into account heavy traffic periods,” House explained. “A guy living in Denver could live 5 miles from the VA, but it might take him 45 minutes to get there.”

For specialized care, the new act reduces the veterans’ wait time to be eligible for services at non-VA facilities from 30 days to 28 and changes the 60-mile radius requirement to a 60-minute radius.

“Congress is focusing on ensuring our vets are getting the best possible care as quickly as they need it,” House said.

Enhancing programs

In addition to easing access requirements, the Mission Act seeks to improve services already in place such as tele-health options, caregiver programs and VA infrastructure.

“The Mission Act streamlines and improves community care,” House said. “It establishes a new urgent care benefit for our veterans, and it expands caregiver eligibility.”

When the Choice Act was implemented, veterans were given the opportunity to seek healthcare providers outside VA facilities, which is referred to as community care, he said.

The VA’s internal software, however, did not communicate with the myriad programs used by health care providers outside its facilities. Simple tasks such as transferring medical records and authorizing payments required mountains of paperwork as well as numerous case-worker hours, House explained. The Mission Act seeks to streamline the process through installing new software, HealthShare Referral Manager (HSRM).

“HSRM is an end-to-end healthcare referral system,” said Josh Benavente, Cheyenne VA Community Care supervisor. “That’s where the VA will build our authorizations for payments and providers can submit medical records.”

The new system goes live in June.

“The biggest problem it’s fixing is previously we were relying on too many outdated programs to get information to and from community providers,” Benavente said. “It allows the VA to communicate with community providers faster and easier.”

Eligibility for the VA’s caregiver program is also slated to expand to include veterans from all eras of service. The expansion is scheduled to roll out during the next two years, starting with veterans who were injured on or before May 7, 1975.

On the tele-health front, the act could facilitate community partnerships in rural areas to increase long-range, video and phone healthcare-conferencing accessibility, House said.  

“What the Mission Act will do is strengthen our ability and reason for going into communities to establish a centralized tele-health port,” he explained. “We have a number of veterans that don’t have internet capability, but they want to stay with the VA and can’t make the trip to the Cheyenne VA every time.”

One such program could soon provide veterans living near Saratoga an opportunity to use equipment at the Saratoga Care Center to access Cheyenne VA tele-health programs, House added.


As June 6 rounds the corner, House said the VA is racing to ensure the transition is smooth. 

“It’s been a mad rush for all of the VA to be trained by June 6,” he said. “There are so many pieces and parts to the act.”

Despite more programs and enhanced services, House said the act will not likely lead to an increase of staffing at the Cheyenne VA.

Cowboy State Daily talked to several veterans who were unaware of the changes coming to the VA, but most said they would like the Mission Act to make it easier for veterans living in rural Wyoming to enter the community care program.

“The Choice Program didn’t work too well because of all the bureaucracy,” said John Hursh, a Laramie resident and former captain in the U.S. Marine Corps Reserve. “So, I’m hoping the Mission Act can fix some of that.”

Cheyenne VA services remain intact a year after administrative downgrade

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Cheyenne VA services remain intact a year after administrative downgrade

By Ike Fredregill, Cowboy State Daily

Services at the Cheyenne Veterans Affairs Medical Center remain largely intact a year after the Department of Veteran Affairs downgraded an administrative ranking for the facility, a VA spokesperson said.

“Our lower complexity level has not affected the quality or services we provide,” said Sam House, the Cheyenne VA public affairs officer. “It didn’t affect our funding. The only thing it did was should we get a new director, they would be hired at a lower pay rate.”

According to the department, VA facilities are categorized by “complexity levels,” which are determined by characteristics of the patient population, clinical services offered, educational and research initiatives and administrative complexity. 

“It’s a system of looking at hospitals, and what they are capable of doing,” House explained. “They assign numbers to them, and they base the hospital director’s pay off that number. That’s all the complexity level means.”

The complexity system consists of three levels with level one and its subcategories being the highest and level three being the lowest. The Cheyenne VA, with a budget of $185 million in 2018, was downgraded from level two to level three early in 2018, which House said signifies no research is being conducted at the facility.

“We don’t have a focus on research,” he added. “Our focus is on mental health, primary care and geriatric care.”

House said one service was changed by the downgrade — orthopedic repairs. While the facility still provides othorpedic surgery, its staff no longer repairs orthopedic implants.

Wyoming Veterans Commission Director Steve Kravitsky said he was initially alarmed when he heard about the downgrade, but his fears were allayed after talking to Cheyenne VA Director Paul Roberts.

“(Roberts) assured me not only were they not going to decrease any services, but they were still bringing more services online,” Kravitsky said. “As director of the veterans commission and a veteran myself, I receive care at the VA, and I haven’t seen anything to the contrary.”

Built in 1934, the Cheyenne VA originally employed 100 staff members and provided 100 beds for primary care.

Nowadays, the facility’s area of service, also known as a “catchment” area, stretches from Rawlins to Sydney, Nebraska, and from Douglas down to north of Denver.

About 79,000 eligible veterans live in the catchment area, House said, but only 29,000 used the facility’s services in 2018, a 3 percent reduction from 2017.

House explained that the VA is made up of three entitles to administer three areas: Healthcare, benefits and the national cemetery.

Most of the services offered at the Cheyenne VA are centered around primary healthcare, but all three divisions of the department have offices on the grounds. 

“Recently, we’ve expanded our nursing home and hospice care facility,” House said. “The average age of Cheyenne VA users is 61. Our youngest user is 19, and our oldest is 102.”

A large portion of the facility is dedicated to offering primary care, including physical therapy, orthopedic surgery, cardiopulmonary lab work, audiology and otorhinolaryngology, or ear, nose and throat care.

The Cheyenne VA also provides some emergency services through its emergency room.

“Our ER is open and staffed 24/7, 365,” House said. “But we’re not a trauma center.”

Because of this, ambulances do not deliver patients to the Cheyenne VA, but rather, veterans are transported to Cheyenne Regional Medical Center, and the VA reimburses the medical center for the care provided.

“Because we have CRMC, we don’t have a trauma care unit in our ER,” he added. “We are in partnership with our community, not competition.”

Additionally, the facility offers limited dental care and was the first in the region to install a women’s clinic.

“The need for women-specific care is something I think the VA has really realized in the last nine to 10 years,” House said.

Laramie County is home to the largest concentration of veterans in Wyoming, and as such, the Cheyenne VA is well-placed to provide them with vital services, Kravitsky said.

“There are 12,085 vets living in Laramie County, according to the VA,” he said, “which is about 25 percent of the 47,472 living throughout Wyoming.”

Without the Cheyenne VA, veterans would need to travel to Denver or Sheridan for veterans services, Kravitsky added.

“With 20 veterans committing suicide every day, quality care close to home is essential to potentially reducing that number,” he said.

The veterans commission files veteran claims with the VA benefits division and is occasionally charged with reviewing inquiries into the VA’s quality or frequency of care. 

“Those inquiries are infrequent,” Kravitsky said. “We don’t get a lot of negative feedback about the Cheyenne VA.”

Wyoming measles-free, but officials urge preventive action

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Wyoming measles-free, but officials urge preventive action

By James Chilton, Cowboy State Daily

CHEYENNE – Wyoming has not yet been affected by what has become the largest United States measles outbreak in 25 years. 

But local healthcare officials are echoing federal calls for parents to keep their children current on vaccinations and to trust the experts when they warn how serious – and how contagious – the disease can be.

While still common in the developing world, measles was declared effectively eliminated in the U.S. in 2000. The measles vaccine, licensed just 36 years earlier, was credited with bringing annual U.S. measles diagnoses down from more than 440,000 cases in the early 1960s to just 43 cases in 2007. 

But measles diagnoses have been jumping sharply in recent years, and so far in 2019 more than 700 cases of the disease have been reported in 22 states, with 500 of those cases contracted by unvaccinated patients, according to the Centers for Disease Control and Prevention.

It’s an alarming trend that healthcare specialists say is based in part on a long-discredited 1998 British research study that suggested the measles, mumps and rubella vaccine was associated with higher rates of autism in patients who received the vaccine in childhood. 

The author was later banned from practicing medicine and the study was ultimately retracted from the prestigious medical journal that originally published it, but decades later, the seeds planted by that erroneous study are still bearing fruit, as this latest outbreak shows.

“I think social media has really aggravated it, and I just don’t think people know how to judge their sources.” said Dr. Robert Prentice, a pediatrician with Cheyenne Children’s Clinic. “There’s misinformation, there’s distrust, and for some people it’s almost like a religion. I think it’s an attempt to gain control over things that can’t be controlled.”

The reality, Prentice said, is that measles should not be dismissed as a harmless childhood disease one can bounce back from easily. The virus can remain contagious in airborne droplets for up to two hours after an infected person sneezes or coughs, and more than 90 percent of unvaccinated people who come into contact with the virus will contract it.

 “If you can prevent something, especially something like measles, which I had as a kid— my wife’s mother had it and thought she was going to die. It was a terrible disease,” Prentice said. “Yeah, most people survived it. But on the other hand lots of people died due to complications or the result of complications.”

He added that, in the past, isolated families were able to get by without vaccinating their children due to “herd immunity” – so many people were already immune to measles that it couldn’t spread to those who are not. But as more parents opt to skip the vaccine, herd immunity starts to break down, which poses problems not just for the unvaccinated children, but also for infants who are too young to safely receive the measles vaccine and adults whose immune systems may be compromised by other conditions.

“We can’t vaccinate children under a year of age; in an epidemic situation we can immunize after six months old, but at that point babies still have maternal blocking antibodies, so they don’t take viral vaccines very efficiently,” Prentice said. “Sometimes if kids are sick enough they have to be admitted to the hospital, and then I have to think about the other children there, the nurses there.”

Laramie County School District No. 1 Head Nurse Janet Farmer said all the district’s students must have documentation showing they’ve received two doses of the measles-mumps-rubella vaccine as recommended by the CDC and the Wyoming Department of Health. But there are ways some parents can get around that requirement by obtaining a medical or religious exemption.

She said it’s rare to see parents seeking a medical exemption from the measles vaccine, and even then they’re required to provide documentation explaining their why the exemption is medically necessary. 

“With the religious exemption, they just have to say they have a religious reason they don’t want the vaccine, and they don’t need to elaborate; and we’ve been told we cannot ask what their religion is or why they want it,” Farmer said. “(The exemption) still has to be approved by the Wyoming Department of Health, but they don’t have any recourse to say no.”

While such exemptions are still uncommon, Farmer agreed with Prentice’s impression that anti-vaccine sentiment is growing stronger lately, and the misinformation can be hard to correct.

“I don’t begrudge parents wanting to do what’s best for their child. But a lot of times people will believe what they read and see, and if they feel like the source is credible, they’ll believe it without doing research to see what’s behind that information,” she said. “So it’s hard to backtrack to convince people who’ve made up their minds.”

That said, Farmer noted that if a measles outbreak were to be confirmed within a district school, unvaccinated students would have to be sent home for safety’s sake.

Department of Health spokeswoman Kim Deti said that while Wyoming remains measles-free for now –the last confirmed case was reported in 2010 – the best way to keep that streak going will be for parents to trust that their pediatrician has their child’s best interest at heart.

“What we want people to do is follow the vaccine schedules as recommended,” Deti said. “That was the reason measles was eliminated before.”

‘Rugged individualism’ may contribute to high Mountain West suicide rates, says expert

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A sense of “rugged individualism” may contribute to the fact that the Mountain West states have some of the highest suicide rates in the nation, according to an expert in Cheyenne.

By Cowboy State Daily

A sense of “rugged individualism” may contribute to the fact that the Mountain West states have some of the highest suicide rates in the nation, according to an expert in Cheyenne.

Linda Goodman, the chief clinical officer at Peak Wellness Center in Cheyenne, said people suffering from depression or other issues in Wyoming and other rural states resist seeking assistance from counselors.

“The rugged individuality is a big piece of it,” she said. “The mentality that ‘I just need to cowboy up and be tough.’ That rugged individualism says ‘I need to be able to handle my problems by myself.”

In 2017, the Centers for Disease Control set Wyoming’s suicide rate at 26.9 per 100,000 people, the third highest ranking in the country. Wyoming joined Montana, Utah, Idaho and Colorado among the states with the 10 highest suicide rates in the nation.

Nationally, suicides have contributed to what was reported in a Detroit newspaper as a reduction in the life expectancy of Americans.

Author Mitch Albom wrote that death rates are rising among working class people who are middle aged and older, largely from what he described as “deaths of despair,” suicides and complications that arise from alcohol and drug abuse among people who believe they cannot achieve the “American dream.”

Goodman said she believes such feelings are often seen among the children of families who survived the Great Depression and World War II and vowed to give their children everything they needed to live the American dream.

“And for some of us, that is looking less and less like the American dream we had envisioned,” she said. “For some Americans today, it means having to let that dream go and if you don’t have the resilience to have another dream that emerges, then you are left with despair.”

Many people found themselves homeless or broke with the turbulent economies of recent years,” Goodman said.

“For people that had the ability to say ‘I’m going to drop back … I’m going to get back on my feet,’ that was fine,” she said. “But for people who did not have that, they turned to ways to avoid having to deal with those problems. That can be through the use of alcohol, it can be through the use of drugs, it can be through depression …”

Goodman said one thing that can help someone suffering from despair is for those people to help others who are less fortunate.

“There’s nothing that will help you more to feel like you have meaning in your life than to help someone else,” she said.

This story has been updated. A previous version of this story misstated the suicide rate.

Dangerous flu strain reported in Colorado could spread north

in News/Health care
Health Department warns flu

By Ike Fredregill, Cowboy State Daily

A virulent strain of influenza sweeping through Colorado could jump into Wyoming before flu season is finished, a Wyoming Department of Health spokesperson.

While she did not refer specifically to the variation of flu diagnosed in Colorado, Kim Deti, the public information officer for the Wyoming Department of Health, said it is not unusual for different strains of flu to spread.

“Strains move around,” she said. “In flu season, sometimes you will see more than one strain be dominant. That’s not unusual.”

While Influenza A (H1N1) is currently the predominant strain in Wyoming, Influenza A (H3N2), is spreading quickly through Colorado’s population.

“Over the last three weeks, we’ve started to see H3N2 circulating in Colorado,” said Nisha Alden, Colorado Department of Health respiratory disease program manager. “It’s somewhat of a second peak in our flu season. First, we were seeing a lot of H1N1, but in the last two weeks, we’ve seen more H3N2 than H1N1.”

Alden said H3N2 can be resistant to the flu vaccine and tends to affect people older than 65 more severely than H1N1.

“We see more (H3N2) outbreaks in long-term care facilities,” she said. “We see a higher number of hospitalizations. And sometimes, we see a higher number of deaths as well.”

Flu season typically runs from October-May, and during the 2018-2019 season, Alden said several flu-related deaths were recorded, including two fatalities among children.

Deti said Wyoming has also experienced several flu-related deaths in the current season, but none in children.

“Flu season is definitely continuing,” she said. “That’s not necessarily surprising, considering the season can run until late spring. But, we are one of the 30 states that are seeing a higher number of cases in the nation.”

The H3N2 flu strain has not cropped in many places around Wyoming this season, Deti said. But both strains can be combatted with a few simple steps.

“We always recommend the people get the vaccine,” Deti said. “People need to know the vaccine takes two weeks to do any good, so if you wait until everyone around you is sick it might not prevent you from getting the flu for that go around.”

Flu vaccines aren’t perfect, and though H3N2 can be resistant, the vaccine is still the most effective preventative measure, she said.

“Also, frequently wash your hands,” Deti added. “It sounds so simple, but it’s very effective.”

Anyone can contract the flu, but infants, pregnant women, people older than 65 and people with chronic health conditions such as asthma could be at a higher risk for severe complications including death, she said.

“We know flu season is coming every year, but we can’t predict when it will peak, and we don’t always know which strains are going to be circulating,” Deti said. “One our biggest concerns is that because flu is so common, it’s not always taken as seriously as it should be.”

In 2018, 27 people died in Wyoming of flu-related illnesses. Go to for up-to-date information about influenza strains and other illnesses prevalent in Wyoming.

Health Department urges care in handling baby poultry

in News/Health care/Agriculture
springtime Easter baby chicks

By Cowboy State Daily

With springtime and Easter just around the corner, Wyoming’s Department of Health is warning people who buy baby poultry to use care in handling the birds to avoid the illness Salmonella.

Tiffany Greenlee, surveillance epidemiologist with the department, said in a news release that Wyoming regularly sees cases of Salmonella as a result of the improper handling of poultry.

“Because poultry chicks are soft and cute, many people want to touch, hold or even snuggle them, but this behavior can be risky because the birds can have germs on their body and in their droppings,” Greenlee said.

Salmonella can cause diarrhea, fever, stomach cramps and other symptoms, which can be especially severe in young children, the elderly, pregnant women and those with weakened immune systems.Infections generally occur after someone puts their hands in or near their mouth after handling birds or touching areas where they live, Greenlee said.

Tips for the safe handling live birds include:

  • Children younger than 5 years of age, elderly persons or people with weak immune systems shouldn’t handle or touch chicks or other live poultry.
  • After touching live poultry or anything in the area where they are found, wash hands thoroughly with soap and water. If soap and water aren’t available, use hand sanitizer.
  • Don’t eat or drink around live poultry, touch with the mouth or hold closely to the face.
  • Don’t let live poultry inside the house, in bathrooms or in areas where food or drink is prepared, served or stored.
  • Clean equipment or materials used in caring for live poultry outside the house, such as cages or feed or water containers.

Wyoming’s 65th Legislature: General Session Review

in News/Health care/Taxes/Education/Agriculture/Criminal justice

It’s all over for this year. Check out our bitesized rundown of what passed and what failed in the 65th Wyoming Legislature’s General Session. Stay tuned this weekend for more analysis on the session highs and lows with our Robert Geha.

Thanks for watching and be sure to follow Cowboy State Daily for our expanded statewide coverage of Wyoming news coming to your feed in the days ahead.

Medicaid work requirement bill an effort to make people self-reliant, says senator

in News/Health care

By Cowboy State Daily

A failed bill that would have required people receiving Medicaid to work, attend school or take part in volunteer activities would have been a way to get people off of a cycle of dependence, according to a state senator.

Sen. Scott Clem, R-Gillette, said SF 144 would have encouraged a small number of people receiving benefits to rely more on themselves.

“The whole idea behind this is to not be so dependent upon the government, have a little bit of self-reliance,” Clem said. “And that’s good for people.”

The bill was killed on a vote of 39-20 in the House on Wednesday. It would have contained exemptions for people with serious medical conditions or disabilities, pregnant women and people in substance abuse programs.

Opponents of the bill argued throughout the session that the majority of people receiving benefits already face difficult times because of the illness or disability that forced them to rely on assistance to begin with.

“If you really want to help people, taking away their health care or threatening to take away their health care is not the way to do it,” said Chris Merrill of the Equality State Policy Center.

The bill was one of three killed in the first items of House business Wednesday as representatives tried to get through their last eight bills on third and final reading.