What happens when a rural Wyoming town loses its only source of health care?

BAGGS-This town of 400 residents on the banks of the Little Snake River in south-central Wyoming has a school, a grocery store, a post office and a hotel with a restaurant and bar. Sometimes there's a food truck.

But when it comes to health care, residents now have two options: calling 911 or driving at least 40 miles to the nearest town with a clinic or hospital. That's because, as of last month, Baggs' only clinic closed its doors, leaving residents without any local options if they have a fever, sore throat or need some stitches.

The closure was due in large part to an inability to find a permanent health care provider - like a physician assistant - to take over after the last one retired, opting for a new career at The Cowboy Inn across town.

Baggs is emblematic of a rural problem: scant health care resources that amount to a house of cards. One person leaves and the whole thing can fall apart.

The clinic

Baggs is the kind of rural that even in 45 minutes of driving, the largest nearby town still has fewer than 10,000 people, and it's in another state. It hosts an ag-heavy economy with plenty of ranches, which come with their own health care risks.

As of the 2020 census, the population of the entire encompassing area of Carbon County was only 14,500, including its largest town: Rawlins.

Until recently, Baggs was home to the Little Snake River Clinic, where people could receive primary care from the local physician assistant or come in as needed for non-emergent care like a fever, sore throat or bad scrapes. A physician would schedule appointments there once or twice a month, too.

It was managed and paid for by UCHealth, a $6 billion Colorado-based health care provider, and the Little Snake River Health District. That levy-funded district was formed to help fund local health care needs like the clinic's budget and equipment when the scant patients weren't enough to keep the lights on.

Most of Wyoming, including Carbon County, is a designated primary health professional shortage area. The last time that information was updated for the area was in 2021, long before the Baggs' clinic closed its doors.

The collapse

While patient numbers were dwindling, UCHealth and the health care district's amicable decision to close the clinic came because neither could find a new physician assistant to take over.

"The Little Snake River Rural Health Care District was notified on the above date by UC Health that as of September 20, 2024, they will no longer be operating the clinic in Baggs, WY," said an Aug. 12 notice from the health district. "They have struggled to find a permanent provider."

Ryan Mikesell, president of the health care district board, said there were no hard feelings, it's just been difficult to find someone willing to take the job.

"Finding someone not only willing to run the clinic for you, but to move here and stay here is a challenging thing," he said.

The Baggs clinic had partnered with UCHealth's Yampa Valley Medical Center in Steamboat Springs, Colorado, about 80 miles away. The center's Director of Clinic Operations Ryan Larson said staff had been looking for someone to lead the clinic since February. Even part-time doctors wouldn't move to what Larson acknowledged was likely the most rural facility in the entire UCHealth system of more than 200 clinics.

"We have one, two lined up, and then one, two rescinded thereafter," he said. "We had somebody looking from Sheridan, Wyoming, then decided that she just wasn't willing to relocate from Sheridan to Baggs."

By late September, residents of Baggs and nearby towns had already started signing up for primary care in Craig, Colorado, according to UCHealth.

On a clear day, it's about a 40-minute drive from Baggs, but slightly longer from Dixon, Savery or outlying ranches. While residents say the road almost never closes, it can still become icy or drifted in during the winter, especially after plow drivers park their vehicles for the night.

Some residents already had a doctor in Craig, but for those who didn't or needed more immediate medical help, the trip to see a health care professional for an open wound, burn or fever would likely be costly both in terms of hours and gas money. That's excluding seniors whose ailments can be treated weekly if they're able to hop on a free bus for trips to Craig and Steamboat Springs, Colorado, which is mainly funded with public money.

For emergency medical services, though, the loss of the clinic could mean more critical patients. Sue Lee has seen it before, when the clinic closed back in 2012. She's been an EMT in town for more than 20 years.

"When the clinic had closed before, we got a whole lot busier," she said.

The previous closure lasted until 2014, according to former health district board member - and unofficial town historian - Linda Fleming, and was likely spurred by reimbursement issues with Medicaid and other government programs. After a short stint of being run by a Craig doctor, UCHealth stepped in.

When the clinic reopened, the critical calls to the town's EMT service slowed again, Lee said.

"It's a rapport that they build," she said, talking about the clinicians with the community. "I have already started getting phone calls about, 'What do you think? Do you think I need stitches? There's nobody here. What should I do?' And I'm like, I'm sorry, you're gonna have to go to Craig."

Many locals used the clinic like an emergency room, Lee and fellow EMT Alex Foster explained. Without it, they may wait too long to call for help.

"I think that'll be one of our biggest hurdles, is that they won't call us until it's too late," Foster said. "They don't want to make us come out, and even though we're all willing to come out at all hours, they just don't want to bother us. Because that's the first thing they say to us, 'I'm sorry I had to call you out.'"

The building

Beyond the staffing challenges, there were funding issues with the clinic building itself.

It was set to be a major town asset with plans to house both the clinic and local seniors so they didn't have to leave town for assisted living care. But that didn't work out.

Paul Prestrud works with the school in Baggs, and took a break from maintaining the football field to talk.

Beyond working for the school, he was pastor for 25 years, served previously on the health care clinic's board and is now on the Assisted Care Facility Board, which worked to get the clinic into a new office before it was forced to close.

Originally, Prestrud said, Crowheart Energy donated its buildings to the assisted care board when it moved operations out of the area. But the facilities needed a lot of work to become a self-sustaining business that could house both the clinic and older residents.

A financier had promised to inject $4 million into the project, but told the Assisted Care Facility Board it would also need to borrow $1 million to prove its intention. A deal was struck, but the backer came up short, leaving the group $650,000 in debt to the bank, Prestrud said.

The CEO of the company that promised the financing, Carlos Manuel da Silva Santos of Portugal, was charged with fraud and arrested last November.

Prestrud said the group is still $400,000 in the hole even after paying down the debt. Prestrud sets his sights high, though, hoping someone like a generous Denver Broncos football player will enter the picture. Locals could take the pro-athlete fishing or elk hunting, and maybe the local group could start moving forward again, working to help the town's aging population.

Why did this happen?

Recruiting providers in rural areas is challenging all across the U.S., according to Mark Deutchman, director of the University of Colorado School of Medicine's Rural Program. While it's a "very complex" problem, he said, there are several well-known reasons providers don't want to go into rural medicine.

"They don't want to live in a smaller community, they want to live in a bigger town," he said. "And sometimes they're worried about amenities, sometimes they're worried about the school system, sometimes they're worried about the workload, that they're going to be the only one there, or only one of a few there. Sometimes their spouse or partner won't go, even if they want to go."

Beyond that, he said training programs often do a "rotten job" of supporting students who want to practice in rural areas. Of about 160 U.S. medical schools, he said only 30 or 40 have programs specific for those seeking out rural jobs, providing them experience working in rural offices. And at least for his program, that means more doctors actually choosing to stay in rural areas - about 40% of his medical graduates in the last 19 years.

But when it comes to a place as rural as Baggs, it can be even tougher. If young doctors want to specialize, or even make contacts, it's hard to do that in a town without a hospital, he said.

"If you're a physician, and you look at your skill package and your knowledge and say, 'Well, I want to be able to take care of people who are hospitalized, I want to deliver babies ...' you can't do that if there's no hospital," he said.

Communities can make a difference though by getting creative, he said. That includes finding and providing housing, offering student loan forgiveness or even helping fund the education of someone from the area in exchange for them returning home to work.

Local health care professionals like Lee and Foster helped host medical students aiming to work in rural areas year after year, but not a single one came back to work in the community.

"A big fat zero," Lee said.

Jim Zimmerman, the retired physician assistant from the clinic, has a personal understanding of why it's so hard to both recruit and retain health care workers. Originally from Craig, he's worked in Baggs a few times, adding up to about 14 years, he said.

Housing is one key impediment, Zimmerman said.

"If the community wants to have another provider come in and work here and stay here, they're gonna have to figure out some housing things, which means they're gonna have to find somebody that is going to sell a little bit of land," he said.

But beyond that, living in a town where the nearest Walmart is 40 miles away is a hard sell.

Once you work at a rural clinic for a while, Zimmerman said, the challenges can cause burnout. For him, the biggest issue was insurance and having to jump through hoops like preauthorizations.

"The pressures of the job, dealing with the insurance companies and dealing with all the demands that come with that are just too much anymore," he said.

He liked the work otherwise, which he said was different every day. But he said the clinic is effectively the community's ER, since the real ER is so far away.

"We have people that walked in with heart attacks," he said. "UCHealth would just say, 'Call the ambulance.' Well, in a small town like this, the ambulance might be 20 minutes from getting here."

Zimmerman often needed more equipment to treat these critical patients, he said, but it could be hard to obtain.

Larson at the Yampa Valley Medical Center acknowledged the challenges, saying that the Baggs facility was the only UCHealth clinic stocked with advanced life support medications or a defibrillator, with that piece of equipment purchased by the health care district.

Still, Zimmerman felt it often wasn't enough.

Hiring for general practitioners or even certain specialists can be difficult across Wyoming because there are health care jobs that pay a lot more.

That's especially true for specialties like pediatrics and OB-GYNs, which WyoFile found are in short supply across much of the state and nation.

Next moves

The Little Snake River Rural Health Care District isn't done fighting for the local clinic.

"We have RFPs, request for proposals, out to major entities in Wyoming, northern Colorado, pretty much anybody that'll take one," Mikesell, the board president, said. "Hopefully we hear back from somebody and can open the clinic back up."

There are also other resources clinics like the one in Baggs can use, like the staffing agency Wyoming Health Resources Network. On Caroline Hickerson's last day leading that organization in late September, she was audibly frustrated about the Little Snake River Clinic's closure.

"I'm just sad because I didn't know, and I wish that I had been able to help them, because I think I have providers right now who are looking for rural, underserved locations in Wyoming," she said.

The agency has ties to providers and educational programs that bring health care workers to Wyoming or require them to work here for a time, she said.

Hickerson left the agency at the end of September, but she said the network had a contract with UCHealth. She speculated that high turnover in UCHealth's recruiting office resulted in new staff who were unaware of the agreement or the Wyoming Health Resources Network's services.

"It results in people not knowing about contracts that have already existed and being able to use all the connections," she said. "I've worked with UCHealth and the leadership there knows I exist, but because they have so much turnover with their recruiters, and that's unfortunate, but that's an example of poor leadership in that organization."

When asked about the claims of high turnover and poor communication regarding the Wyoming staffing agency, UCHealth spokesperson Lindsey Reznicek reiterated in an email that the organization provided health care services in Baggs for a decade, posted an opening for an advanced practice provider in March and wasn't able to find a replacement.

"We were not comfortable continuing the clinic without a consistent provider presence to care for patients," she said.

Hickerson said there are also taxpayer-funded resources to help in situations like this, including 3RNET, the National Rural Recruitment and Retention Network, a partially federally funded online database for health care workers and jobs in rural or underserved areas.

"It's been in existence for a long time, but because it's publicly funded, it doesn't quite have the same breadth and reach and marketing capacity that the for-profit groups do," she said.

Looking to the future

In the meantime, the people of Baggs will likely remain tough and self-sufficient, opting to make the long drive if need be. They'd done it the last time the clinic closed, and they may have to do it again.

"We know where we live, you know?" said Lee, the first responder. "We chose to live here, so that's what makes [the community] tough. I mean, that's why we are who we are."

Zimmerman has even thought about opening a cash-only clinic where he could offer stitches and diagnosis without having to deal with insurance.

And many, like Kathleen Chase, remain optimistic. She's the site manager of the senior center in Dixon, next door to Baggs. Chase recognizes that the clinic closure will be a big deal to some in the area, but she also believes that the health district and community will learn how to make do.

"They're going to make it happen," she said. "This is such a great community. Everyone looks out for everyone."

WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.