Ten days after delivering a baby girl by cesarean section in April 2019, Sublette County resident Ashli Tatro was home nursing her newborn around midnight when she suddenly knew something was wrong.
Tatro was experiencing a uterine hemorrhage, and was bleeding profusely. She needed medical attention immediately. While her husband was on the phone with a doctor in Jackson, Tatro passed out, so her husband called 911. An ambulance came to Tatro’s residence with the plan to drive her 70 miles to Jackson, the closest hospital. But Tatro fainted twice more after she got in the ambulance, so she was rerouted to the Pinedale Medical Clinic where she would wait to be life-flighted to a hospital.
Sublette County, located in south-central Wyoming, is the state’s only county that does not have a hospital. That means medical professionals there cannot provide certain lifesaving treatments — in Tatro’s case, she needed blood. Patients in Sublette County who need higher-level care must be transported to hospitals outside their home communities.
A spring storm that night prevented helicopters from retrieving Tatro, so she was stabilized at the Pinedale clinic until a fixed-wing plane was finally found out of Riverton that could fly her to the University of Utah. Time was of the essence. Tatro, with her type O negative blood, could not have blood administered on the flight — she would have to wait until she was in the Utah hospital.
Finally, around 6 a.m., Tatro received the lifesaving treatment she needed. Doctors told her she was lucky. The experience changed her perspective on the health care system in the community she loves living in with her young family.
“Before having an experience like this, I never realized that they couldn’t give you blood (at the clinic) or how our remoteness from a hospital really affects us,” Tatro said. “For me, too, after having kids, you realize the importance of good medical care close by. Our clinic is really good for the little things we have experienced thus far, but big things do happen.”
In an aim to accommodate for those “big things,” Sublette County residents have taken on a yearslong effort to establish a hospital. The effort has cleared some hurdles and faces more challenges, but the community is nearing the point where shovels can hit dirt.
The vision: to build a new health care facility on a site where baseball fields and an irrigation ditch currently sit. Hopes are high that by 2023 the lot will be occupied by a 35,000-square-foot hospital with a 24/7 emergency room, as well as an attached 33,000-square-foot long-term care facility for older residents that will include a Memory Care Unit — a rarity in western Wyoming. A preliminary estimate prepared by accounting firm Eide Bailly puts the cost at $46 million, $28 million for the hospital and $18 million for the long-term care unit.
The facilities will be the new destination for emergency care, relieving clinics in Sublette County that currently provide what they can. They will also replace the beloved but aging Sublette Center Retirement Community. Both, advocates say, will represent a fundamental shift for the county.
Dawn Walker, Sublette Center administrator, recognizes that she’s part of making history, she said, by helping ushering in a project that will impact generations.
“(To) be a group of visionary people who are building a new project to help make Sublette County health care better, that’s not an opportunity that everybody gets,” Walker said. “I, for one, feel very blessed to be hired by the Sublette Center and working for this company at this time when we get to do something that’s beyond us.”
Making the case for local care
For around two decades, the Sublette County Rural Health Care District governed health care locally, overseeing a network of care in a sparsely populated county spanning nearly 5,000 square miles — an area larger than Connecticut.
Small towns like Pinedale dot the landscape, but no major population centers exist. And after 20 years, the health care system was overtaxed, with many of its facilities outdated.
One clinic in the Marbleton/Big Piney area in the south end of the county and another in Pinedale on the north end were providing a certain level of care, but couldn’t perform essential services such as blood transfusions, COPD exacerbation and chemotherapy. Patients would have to be transported by ambulance or life-flight to emergency rooms outside of Sublette County in trips that often took more than an hour.
David Doorn, Sublette County Rural Health Care District administrative director, said there’s a “golden hour” — a time window in which each minute is crucial to the patient’s outcome — that can be squandered due to a trip from a clinic to the emergency room. Though the clinics were providing emergency and trauma care with nurses and doctors on call, they were only being reimbursed by Medicaid at a clinic rate of 60%. (A critical care hospital would be reimbursed 100% for the same services.)
The clinics were also relying on declining revenues in the oil- and gas-dependent county. While that had been a sufficient funding model for years, a significant downturn in the fossil fuel sector in recent years left officials without the necessary funds to sustain operations.
“Being designated as a clinic, it just doesn’t work,” Doorn said. “It’s worked in the past, obviously we had the luxury of lots of tax revenue, but we know that’s all changing.”
There was also a level of mistrust among county officials, community members and the rural health care district’s board of directors, those involved said. Tonia Hoffman, who was elected to the board in 2018, said the past board did not have a “good history of being good stewards of monies that are incoming when we are in the middle of a boom.”
Hoffman was one of several board members elected in 2018 in what Doorn said was a voter referendum to go in a new direction. The rural health care district, the county commission and Sublette Center began conversations for how to solve the community’s health care problems, reaching a consensus after several years: a hospital should be built with a new Sublette Center facility attached.
In 2020, as advocates were preparing that tax measure, COVID-19 hit. As it did with so many other existing problems, the pandemic exacerbated Sublette County’s health care issues.
The two clinics shipped most patients to Jackson and Idaho Falls. But it was unclear what would happen if those hospitals filled up and were unable to accept Sublette County’s patients, underscoring the dangers of not having hospital-level capabilities.
“We were trying to make plans here for what we’re going to do with those people, because we don’t have the in-patient beds to take care of that if that’s what happened,” Doorn said.
The same problem faced the Sublette Center, where around eight of 34 total residents were transported to hospitals to be treated for COVID-19, Walker said. Whether the Sublette Center’s residents are being transported for COVID-19 or any other medical emergency, Walker said, traveling is a significant burden. At one point it even looked like patients could be sent as far away as Arizona, she said.
“Elderly people are fairly fragile and they don’t transport really well,” Walker said. “Transportation is very hard when you’re going long distances, and especially when you have conditions like dementia. It just increases that confusion.”
The ability to take residents directly to an attached hospital will be a game-changer, and is a favorite future feature of residents, Walker said.
With the pandemic creating new urgency for a solution, leaders decided to try to form a special hospital district. That formation would enable project leaders to access one additional mill levy, in addition to the two already in place — which organizers hoped would help fund and operate the new hospital and long-term care facilities. The issue was put to the Nov. 3, 2020, ballot.
Pinedale resident Kari DeWitt, who helped manage the campaign, said there was some significant opposition in the community. But in a general election that set a new turnout record, according to the Pinedale Roundup, the special hospital initiative passed by 961 votes — a “Sublette County landslide,” DeWitt said. The county has 9,897 residents.
July 1 will harken the official merger of the rural health care district and the special hospital district, dissolving the rural district and putting the Sublette County Hospital District in charge of the health care system. The Sublette Center is expected to merge shortly after.
Optimistically charging uphill
Meghan Isaacson has lived in Pinedale for three years, having moved there to be near her mom. But she has to live carefully, she said. Isaacson has a bleeding disorder and her blood doesn’t clot properly. Being an hour or more away from a hospital means she has to be vigilantly cautious.
“It’s really always like I’m in bubble wrap,” Isaacson said.
She’s feeling more optimistic today about her life in Pinedale with the hospital project advancing, she said.
But the project’s advocates know that while they’re on their way, there is more work to do.
The valuation of the mill levy dropped 26% from original estimates — due to a decline in oil- and gas-derived revenue — which will make it harder to get through the new health care system’s early vulnerable months, advocates say. But it is still enough to qualify for what is perhaps a crucial factor in the project’s journey, an application to the U.S. Department of Agriculture Community Facilities Direct Loan and Grant Program for $32 million.
The Sublette County Commission committed $20 million toward the long-term care facility, helping to free up financing for the hospital.
March 29 saw another critical piece of the puzzle come together as the new hospital district board chose Star Valley Health as its management partner, per USDA requirements. Star Valley has its own critical-access hospital, built in 2002, and has laid out a model that Sublette County’s health care system can follow, Star Valley Health Chief Operating Officer Mike Hunsaker told WyoFile.
“We’ve had really great success in helping people get their health care close to home rather than having to travel outside of town for everything,” Hunsaker said. “And I know that’s what the Sublette County community is looking for is sort of a blueprint that would help them avoid some of the pitfalls.”
The partnership will benefit both Star Valley Health and Sublette County, he said, as specialty physicians can work in both.
“It gives an opportunity both for us and Star Valley to improve our services,” Doorn said.
Once construction is complete, the Sublette County hospital, which is yet unnamed, will have to endure a year of general hospital status. That means it won’t receive the reimbursement rates a critical-hospital access does.
Proponents are hoping federal stimulus money is available from the American Rescue Plan Act that can help carry the new system over that hump.
DeWitt said the Sublette County health care project would be a more than worthy recipient of those funds.
“There are a lot of people clamoring for those monies, but I think it’s the strongest because we hit all three points,” DeWitt said. “We get access to health care, which is just a good human right. We had economic development, which is stabilizing the economy, and then we hit job creation.”
No matter what obstacles lie ahead, proponents are determined to see the new facilities built. The goal is worth all the work, Doorn said.
“This is really going to make a huge difference,” he said.