Clinic management changes hands

By Joshua Wood

Employees of Saratoga Care Center, Platte Valley Medical Clinic, residents of Saratoga and even Dr. Bryan Kaiser himself were in attendance at a packed Saratoga Town Council meeting on the night of Tuesday, Aug. 7 at the Saratoga Town Hall. With the fate of Kaiser’s lease with the Town of Saratoga in question and with repeated executive sessions over the last few months, it was suspected that the council would announce the fate of Kaiser’s future with Platte Valley Medical Clinic.

Those suspicions were confirmed as Mayor Ed Glode read a letter addressed to Kaiser in which the municipal government stated that they had no intention of renewing their lease with the recently arrived provider as was reported by the Saratoga Sun late Tuesday night (www.saratogasun.com, “HMS to takeover clinic”).

Following the reading of the letter, council member Will Faust, who serves as a representative on the Platte Valley Medical Board, stressed his struggle with helping the Town of Saratoga come to its decision.

“I’ve spent the last eight months researching, digging into rural healthcare systems and models. I’ve interviewed numerous healthcare professionals and have come to the realization that our provider and our clinic, at least in our situation, is an unsustainable model given the complexities in today’s healthcare,” said Faust.

Faust would add later in the meeting, as the public comment quickly filled with concerns, that he believed that the current healthcare model had lead to repeated cases of burnout with doctors in the Valley and that the model needed to change.

Council member Richard Raymer brought up his own personal experience with members of his family working as medical providers in the Valley and the difficulties that arose.

“Hopefully, we’ll be moving in a better direction as far as people being able to actually provide the care that they need to and worry a little less about the administration side,” said Raymer.

Following council comments, and before public comments, the town council gave Rude, president and owner of Health Management Services, (HMS) LLC., the floor to introduce himself and his idea for healthcare in the Valley. The announcement and discussion surrounding the future of Kaiser and the tentative assumption of management by HMS dominated the majority of the town council meeting.

“It isn’t about any individual providers, but it is about making sure there is a unified plan, that the unified plan moves together and that that movement together is towards the future of healthcare,” said Rude. “With respect to that, the nursing home has struggled and has recovered from those struggles. The clinic has historically struggled and will recover from those struggles and what we’ve started talking about in the last, probably, six months is why we have systems in place that aren’t a reflection of the most contemporary models for healthcare and how it is we can start to make those steps forward.”

Following Rude’s introduction, members of the public expressed their concerns about the future of the clinic, lack of transparency, the future of Kaiser and the solvency of Saratoga Care Center, whis is operated by HMS.

“Would you mind commenting about your more recent financial problems with the nursing home?” Nancy Jansa asked of Rude.

“There are some portions of it that are private employment matters, but at the end of our private employment arrangement with past leadership there were things that we had to handle because there was financial damage being done implicitly to our institution and those things are under investigation by criminal law enforcement,” answered Rude. “The lack of attention being paid to the management of the facility at that time also meant that our census was incredibly low. So, we have recovered from the low census, we have sought out financial backing from private sources here in town to ensure that we had cash flow to survive the period of time that we needed to get through and then we worked with the State of Wyoming to discuss what our Medicaid rate was and have that repaired to a point that it’s going to be sustainable.”

Jansa asked Rude several questions concerning the care center, including the number of beds the facility was rated for. Rude replied to Jansa that the original rating was a “harbinger of days gone by” and that HMS was trying to purchase the building from the current owners but, barring that, would be looking at building a new skilled nursing facility. Before Jansa sat down, she once again stressed her desire for transparency.

“My last comment is: transparency is really important to the people that live here. A lot of us remember helping to feed people from the nursing people when the last critical situation occurred,” Jansa said.

“We will continue that level of transparency. One of the things that I do have to say, that I have personally been navigating, is that relationship with our building’s owner and it has been very difficult and because of the way we are looking at making some of these dramatic changes, for our side, we’ve had to be very private. What we do there as a non-government entity is the business of a private business, but I will say this as I move forward to do things in the future: I would be a fool to build a hospital and not consult with anybody. I need your input. I’ll bring that to you. I’ll ask for it, I will show you how this is possible and then we will go together to build the right institution for the future,” Rude said.

Cindy Bloomquist also shared her concerns, asking Rude if there would be a medical doctor in the clinic on Oct. 1, the tentative date set for HMS to assume management of the clinic. The president of HMS informed Bloomquist that, at that time, there would not be a full time doctor available but that he would have a medical doctor from Crook County Medical Services District in Sundance providing aid to the clinic.

“That’s not the same,” said Bloomquist.

“It is not the same and I’m trying to be transparent about that,” Rude replied.

“So how long will that last?” Bloomquist asked.

“It will last until I find the right doctor to be the next permanent replacement. I’m not going to sit here and blow smoke to you, Cindy. It’s not the same,” answered Rude.

“It’s critical for many of us,” replied Bloomquist.

“I understand that, but we have medical professionals at the mid-level with our Family Nurse Practitioner (FNP) and Nurse Practitioner (NP),” Rude said.

“And many of them are great, but it’s simply not the same,” stated Bloomquist.

Rude then told Bloomquist that HMS would work to schedule a medical doctor for those patients that demanded one with Bloomquist asking Rude if he meant that the clinic would not have a full time doctor starting out.

“I am telling you that on day one I will not have a full time doctor in the clinic,” answered Rude.

Concern from other residents continued along the same line of thought with some upset that there would not be a full time medical doctor available following the transition to HMS managing the facility. Others continued to stress their concern over the lack of transparency and asked if there had been a chance for public comment. Sue Jones, county commissioner, stood up and addressed the audience.

“First off,” said Jones, “those people are bound legally and there’s a very fine, fine line between them and their lease on that clinic and these two gentlemen’s private business. So there was no public comment. There should never have been a public comment period about it and they still are more than entitled to go into private session for legal advice to fine line that lease. They will continue to do that because I was one of the authors of that lease. It is a sorry unit, personally. We should have done a better job. They will have to rewrite a new lease for that clinic, though, but, otherwise, the transparency and the talking about the doctor’s private business, Mr. Rude’s private business is just that. It is private business.”

Following Jones’ explanation of the clinic lease, questions and concerns aimed at both the town council and Rude appeared to begin to taper off. Bloomquist, again, stressed her concern about the future of Kaiser, the lack of transparency with the lease decision and the announcement of a critical access hospital.

“A hospital’s a big thing and yet you started with this and that makes no sense to me and it seems there’s spite involved, in my opinion, there might be. I don’t get it. I mean, that just doesn’t seem right for our community. Get the whole plan laid out, the funding behind it and then choose to do what you want with the lease. You can make short leases, you can do all sorts of things, but to have to have us all get used to something new, again, and maybe not somebody with the skills is very difficult and I think it’s unfair to our seniors and Janet and me and lots of people like us. I just really dislike the way you went about it,” said Bloomquist.

With the decision to sign the letter informing Kaiser that the lease would not be renewed unanimous, the council moved on to other business which took very little time compared to the issue of medical services and access within the Valley.

The next Saratoga Town Council meeting will be held at 6 p.m. on Aug. 21 at the Saratoga Town Hall.