Has Banner lived up to the quality it promised with Casper hospital? Third-party monitor will decide.

In Casper, critics and defenders of the state’s largest hospital have been pushing contrasting narratives about its owner for more than a year. 

One story goes that since Banner Health purchased Wyoming Medical Center in 2020, management has allowed unacceptable slips in the quality of care for patients. The other contends that Banner has provided crucial resources to sustain care through the pandemic and beyond. 

Now, an arbiter will provide what many hope is a clear answer to the question of how well Banner is managing Wyoming Medical Center. Natrona Collective Health Trust — which has oversight of Banner’s contractual compliance — recently retained a third-party consultant to independently monitor Banner Health to determine if it is indeed fulfilling its commitments.

“We applaud the hiring of an outside monitor, this holds promise for the future,” longtime Casper doctor James Anderson told Natrona County Commissioners during a meeting on Banner in early March. Anderson is a member of the group that’s been raising alarms over the hospital’s operation.

The local Banner administration, Anderson added, “finally seems to understand what is needed to provide quality health care in Casper and Wyoming.”

Banner Health executives, who have defended their management, also support the hiring of the health care management consulting firm, PYA. It can clarify in an impartial way a matter that’s been much disputed, CEO Lance Porter told the commission. 

“There’s a lot of opinion on, are we in compliance with post-closing agreements or are we not,” Porter said. “Really what’s lacking is the subject matter expertise. So I really support what’s being done … to find an outside monitor, a subject matter expert.”

“And if we have things we need to improve on, then I am committed to doing that,” Porter said. 

The discussion signified a degree of pacification in a conversation that has been contentious, with critics claiming that while Banner has driven out doctors and created questionable conditions for patients, the bodies tasked with oversight haven’t held its feet to the fire.

New owner, contract stipulations

Banner Health purchased Wyoming Medical Center for roughly $200 million in August 2020. The nonprofit hospital previously operated under a lease agreement with Natrona County, which owned the facility. Banner Health, headquartered in Phoenix, folded the hospital into its network of 33 nonprofit hospitals in six states. 

The Natrona County Commission approved the arrangement, touted by supporters as a way to take advantage of Banner’s resources to create a preeminent facility and reduce the amount of care that leaves the state. Today, Banner Wyoming Medical Center operates two campuses and 14 care clinics.

In the transaction, Banner agreed to comply with contractual stipulations, including providing 24/7 emergency room care and retaining levels of service related to maternity care, trauma care and other essential care. 

But not long after Banner took over, stories began to percolate in the community about service declines, doctors quitting, long waits and poor care. Those experiences spurred a group of concerned citizens to launch a campaign aimed at bringing the level of care back to what they said the community deserves. 

The concerned citizens group formed in 2023 out of a response to stories shared at dinner parties, coffee dates and everyday conversations, said Casper resident Tom Swanson, one of its members. “We learned that the hospital was failing in a number of ways.”

They heard about long wait times, prescriptions not being filled, understaffed departments and an exodus of doctors disrupting continuity of care, he said, along with other troubling incidents. The group worried eroding services would send residents elsewhere, degrading hometown quality and compounding health care challenges.

“A male patient presented in our ER with a ruptured, previously repaired, aortic aneurism the day after Thanksgiving 2023,” the group wrote in an early letter to Banner Wyoming executives and others. “He was sent to Greeley Banner because Banner Health Casper did not have the vascular expertise available here at home. A female patient with a recent oblation procedure at Anschutz, Denver, called to request an appointment with her primary care doctor; she was told the first available appointment was in three months. It wasn’t that way before.”

The citizens brought their concerns to Banner and the Health Trust. Both were slow to respond, they said. They also reached out to the county commission pleading for action. Both the Trust and commission have oversight over whether Banner complies with the 2020 transaction contract stipulations.

Banner administrators defend the facility’s operations under its ownership. Banner’s aim is to be the best hospital in the state and Wyoming’s trusted destination for referrals, CEO Lance Porter told WyoFile in a November interview. 

Because of Banner Health, he said, Wyoming Medical Center has been able to bring on specialized cardiovascular and prostate procedures, invest in new equipment, bulk up its trauma care capabilities and gain approval for a renovation that will entail a new behavioral health unit.

The hospital would not have survived COVID without Banner Health, he said, which provided the crucial staffing resources to handle the load. There was an initial period of transition and rebuilding, he said, and “change is hard.”

Doctors have left, Porter acknowledged. Some didn’t meld well with the integrated health system, others were managed out because Banner didn’t feel they were the best fit. Recruiting has been a challenge, he said, but that is always the case in a rural hospital. At its height, Banner Wyoming had a dozen traveling doctors, or locums, working in the hospital, he said, but that number has since fallen significantly. The hospital has meanwhile continued to garner medical acknowledgements and announce new hires.

There have been mistakes and events that should not have happened, Porter and other executives acknowledged, such as when a patient died in the hospital’s emergency department in view of others in the hospital. They are working to ensure those kinds of incidents don’t repeat.

While the hospital is aware of the concerned citizens’ testimonials and complaints, Porter said, “unfortunately, a lot of this is anecdotal,” rather than backed by data.

The result of the two sides’ arguments was a disagreement over the state of things. Then last month — a little over a year after the group launched its campaign — the Health Trust hired the independent monitor. It’s a move both sides approve of.

“We are not here as a group to destroy the hospital,” Swanson of the concerned citizens said. “We want to make it better. We just want to make it safe and effective for the citizens of Casper and our families.”

Oversight criticism

The Natrona Collective Health Trust is a private health foundation tasked with overseeing the cash and investments of Wyoming Medical Center among other funds. It belongs to a category of organization formed when a nonprofit health system purchases standalone nonprofit hospitals. The trust’s work involves both philanthropy and policy, but it also has oversight over Banner’s contractual obligations.  

As Banner has been hit with criticism, skeptics also have argued the trust needs to do better. The nine-person board lacks health expertise needed to complete its duties, the concerned citizens group said. 

The county commission appointed Jennifer True to one of its two seats on the board in March 2024. When she was called up to address the board during the recent meeting on Banner, she gave her formal resignation — offering deep misgivings about the body’s spending patterns.

“When I accepted this role, I did so with hope for the transformative change the trust could bring to Natrona County,” she read from her resignation letter. “Instead, it has become clear that the organization has strayed from its founding mission. Rather than prioritizing community impact, collaboration and responsible stewardship, the trust has developed a culture of spending — marked by extravagant expenditures, self-promotion and a troubling lack of fiscal accountability.”

Trust CEO Beth Worthen defended the body when reached after the meeting, saying its expenditures are in line with, if not below, comparative boards around the country. She also said the board’s recent hiring of consultant PYA is intended to support its oversight duties.  

“We take our responsibilities related to monitoring the contractual commitments very seriously,” Worthen said, “and as a part of that, we felt like additional expertise was needed.” 

PYA began work in January. It has been examining the contracts, toured the facility and started combing through Banner’s annual reports. It will report its findings to the county commission in July, Worthen said. 

In a press release announcing PYA’s engagement, the trust called it “a collaborative effort to ensure transparency and accountability in the implementation of Banner Health’s commitments.”

Natrona County Commission Chair Dave North said he looks forward to PYA’s finding. During the March meeting, he commended Banner for making recent good-faith improvements.

“I know you’ve had some hiccups,” he told CEO Porter at the meeting. “There’s still a few that I would like to sit down and talk to you about.”

The citizens group hopes the county keeps a close eye on the matter, it says. 

“We all know the stories that have appeared … the horror stories that we’ve had at Banner,” Swanson said. “Not to say that the [Wyoming] Medical Center didn’t have some of those horror stories, but we’ve had quite a few. We’ve had too many for the citizens of Natrona County.”

CORRECTION: A previous version of this story listed an incorrect vocation for Tom Swanson. -Ed.