Presentation consternation

“I just feel unprepared to have meaningful questions because we didn’t know you were going to be here tonight. At least, I didn’t.”

This comment from council member Jon Nelson during the May 21 meeting of the Saratoga Town Council highlighted what appears to be a lack of communication within the Zeiger administration following an invitation several days earlier to representatives from Memorial Hospital of Carbon County (MHCC) to speak at the most recent town council meeting.

Council members Judy Welton and Bob Keel were informed two to three days before the meeting, but two council members, Nelson and Steve Wilcoxson, were not.

MHCC did not appear anywhere on the agenda for the meeting of the town council. The two minute time limit for public comment, which has appeared on agendas since being implemented by Zeiger at the March 5 meeting, had been removed for the May 21 meeting.

The proposal from MHCC came as a surprise not just for some of the council, but for Saratoga Care Center Administrator Mark Pesognelli as well, who, along with the council and Health Management Services (HMS) President Karl Rude, was informed via an email dated May 13 from Saratoga Town Clerk Suzie Cox that there would be no discussion of the medical lease at the second town council meeting.

“Good Morning,” the email read, “Mayor Zeiger asked that I let you know that Mr. (Tom) Thompson will be unable to attend the meeting on May 21 and therefore the Medical Clinic Lease will not be discussed until the meeting on June 4. If you have any questions, or concerns, please do not hesitate to contact me.”

As was reported previously (see “Saratoga ‘unbound’” on page 1 of the May 15 Saratoga Sun), Rude and Pesognelli were asked to attend the May 21 meeting for further discussion of the medical lease.

During the presentation by MHCC Interim Chief Executive Officer Bob Quist, who was joined by board chairman Sherrod France and board member Mark Kostovny, the council was informed that it would take time for the hospital to provide a physician to the clinic in Saratoga should the town enter into a contract with the hospital. Quist added that, should a physician be found, they would not be full-time in the Valley, but would split their time between Saratoga and the new clinic in Rawlins.

Nelson asked Quist if MHCC had any interest in the skilled nursing facility that is currently managed by Saratoga Care Center, a subsidiary of HMS. Quist stated that MHCC had not had any involvement in operating nursing homes, but would consider a partnership if the Town of Saratoga asked for help from the hospital. Quist added that the reason that the hospital had no interest in the skilled nursing facility was due to the slim margins of profit that traditionally come with such an operation.

Following Quist’s presentation, Pesognelli approached the council and was followed by Healthcare Sustainability Project Subcommittee (HSPS) member and former Saratoga Town Council member Will Faust.

“Couple things I will bring to your attention. First of all, we talked about the clinic and you’re probably hearing a familiar story; it’s going to take time to get a doctor. That’s the same story that we’ve put before you. Finding the right person’s not easy, so I would concur with you (Quist) wholeheartedly on that,” said Pesognelli. “I will also let you know that you will have to go through the same credentialing process if you start over, again, which, as you well know, is a lengthy time and is not easily done. They will have to credential the clinic, they will have to credential the providers for the clinic. So, you will find yourself right back in the same position that we are in the process of working ourselves through. So, I don’t see where that particularly solves the problems for you, either.”

The Sun reached out to Eric Boley, CEO of the Wyoming Hospital Association, who clarified that any medical professional currently working for MHCC would not have to be credentialed, though those new to the state would have to go through the same process that HMS has recently gone through.

As Pesognelli finished speaking to the council, he admonished Zeiger for what he called a lack of transparency.

“I was a little taken back myself because I didn’t know we were talking about this this evening, nor was it on any agenda I’ve seen. I would ask, in the future, in fairness, if we’re going to talk medical related topics it would certainly be nice to know that. Then I could come prepared and the council could be prepared,” said Pesognelli.

Zeiger responded to Pesognelli, stating that HMS was scheduled to give a presentation at the June 4 town council meeting.

“The last one wasn’t, with the lease. That discussion was not scheduled, nor was this. So, I would just ask, for the sake of transparency, for myself, for the town and for your council that in the future, perhaps, you let us all know what your intentions are,” Pesognelli said before leaving the podium.

Faust followed Pesognelli, beginning with updates from HSPS in terms of the feasibility study from BKD and the results from the community healthcare survey. Following those updates, the former council member accused Zeiger of misrepresenting the former council’s approach to the clinic. In recent meetings, Zeiger has stated that the previous council and former mayor Ed Glode had not allowed Jason Campbell, a MHCC board member, to speak during the Aug. 7, 2018 meeting when the Town of Saratoga announced it would not be renewing or renegotiating the lease with Dr. Bryan Kaiser.

“I think, Mr. Mayor, and I don’t want to pick on you, but that’s disingenuous to say that they didn’t have a chance to speak,” said Faust. “The reality is, Jason Campbell came to the meeting. He stood up and said ‘Well, I guess I don’t have anything to say’ and walked out. There was nobody at that meeting that said ‘You don’t have the floor’ and I want to make it clear: at that point in time, it was a business deal between two private entities that had come to an agreement and that’s the fact of the matter. The other fact of the matter is: we met with former (MHCC) CEO Dana in March 2018 asking for help. We met with them before we met with HMS, before we met with Ivinson Memorial (Hospital) and that board did not get back to us until Jason Campbell walked into this building.”

Recording from the Aug. 7, 2018 Saratoga Town Council meeting show that Campbell’s exact statement was “Mr. Mayor, council members. My name’s Jason Campbell, I’m the secretary of the Board of Trustees of Memorial Hospital of Carbon County and we were, I was, to come here and offer a proposal for clinical care, but you have just voted on something else. So, thank you for your time and I think I’m going to go home and make my kids dinner.”

Following the exchange between Faust and Zeiger, Keel, who had been facilitating the discussion between Quist and Zeiger during the meeting, asked Zeiger if the council had discussed canceling the medical lease with HMS. Zeiger stated that the attendance of MHCC at the meeting was an informational one.

“I think it’s important for everybody here to understand that it’s not the intention of the mayor and the rest of this council to make a change and it was solely the mayor’s intention to give another hospital entity the opportunity to tell us what’s available,” said Keel. “So, I don’t want the word to go out that we’re actively trying to make any changes or anything like that.”

An email sent to Cox at 11:26 a.m. on the day of the council meeting, however, contradicts Keel’s statement. The email, which was made available to the Sun, included language provided by Tom Thompson, the legal counsel for the Town of Saratoga, that would allow Zeiger to present a motion to notify HMS of the town’s intent to terminate the lease should it not begin to fulfill its base obligations.

The text of the motion reads:

“At the last meeting, our town attorney, Tom Thompson, gave us a report on the medical clinic lease and some of the issues with it. I have been hearing from citizens of the town concerning the lack of services that we are supposed to be getting under the terms of the lease. We need to give the Platte Valley Clinic/HMS notice that they aren’t performing and the chance to fix this.

“If they do, fine—the town and its citizens will be getting what it is we are supposed to get. But, if they can’t/won’t do what they promised the town they would do, then the town will have to move forward to terminate lease and explore all options available. But, the first thing to do is for the town to do what the lease says—which is give them notice of intent to terminate the lease due to failure to provide specific base obligations and the opportunity to cure those defaults within the time the lease provides.

“I would entertain a motion that the Town of Saratoga give notice to Platte Valley Clinic, LLC and Health Management Services of the notice of intent to terminate the lease for cause, with an opportunity to cure those defaults, all in the manner as provided in the lease agreement, due to it not performing the required base obligations 1) of ensuring the availability of 24/7 on-call services provided by or at the direction of a doctor of medicine or osteopathy, to include the appropriate utilization of telemedicine services, administered by qualified clinic staff; 2) of maintaining a staff of at least two full time midlevel practitioners, and medical oversight doctor of medicine or osteopathy, and assign those employees to work at the Corbett Medical Building or on call in the Town of Saratoga; and, 3) of providing the following telemedicine services: after hours availability and a network of appropriate specialist care, and direct our town attorney to prepare such notice of intent to terminate the lease for cause, with opportunity to cure, for the Mayor’s signature.”

Despite the email from Cox stating that no discussion of the medical lease would take place until June 4, and Zeiger stating during the May 21 meeting that he just wanted to see what options the Town of Saratoga had, the wording of the email to Cox indicates there was intent to begin the process of terminating the lease between the Town of Saratoga and HMS.

The next meeting of the Saratoga Town Council will be at 6 p.m. on June 4 at Saratoga Town Hall.