Dr. Boyle Headed to Pinedale Clinic
Health Care Board wants to study Pinedale EMT contract proposal
by Rob Shaul

Monday night, the Sublette County Rural Health Care Board voted unanimously to accept Dr. Judy Boyle's offer to take over the medical directorship of the Pinedale Medical Clinic. Dr. Boyle currently works at the Marbleton/Big Piney Clinic.

In October, the Board terminated its contract with Dr. Ron Glas at the Pinedale clinic, and signed a 3-month interim contract with Dr. Tom Johnston.

Last year, Dr. Boyle was recruited to work as a second doctor at the Big Piney/Marbleton Medical Clinic. Her contract with Dr. David Burnett at the Marbleton Clinic expires January 15. In an interview last week, Dr. Boyle said she considered the open position at the Pinedale Clinic a professional opportunity, but indicated she would not take the contract unless she was able to continue seeing her patients at the Marbleton Clinic one to two days per week.

Dr. Burnett addressed the Board at the beginning of its discussion concerning Dr. Boyle's proposal. "Dr. Boyle is an excellent physician and an asset to this community," he began, adding that the two had a "good working relationship."

Dr. Burnett continued that if Dr. Boyle was given the Pinedale contract and wanted to keep office hours in the Marbleton Clinic, "the door is wide open to her." In the end, he strongly recommended that the Board accept Dr. Boyle's proposal and act on it that night.

Dr. Burnett said that if Dr. Boyle did go to Pinedale, she would need to be replaced. He encouraged the Board to begin the process to recruit a second doctor for Big Piney.

"I definitely want two doctors in both clinics," agreed Board member Gregg Anderson. Halfway's Jim Greenwood asked the Board's permission to set up a doctor recruiting committee in Big Piney.

Board member Garry Eiden of Marbleton asked Dr. Burnett if it was possible for Dr. Boyle to run the Pinedale Clinic and still have time to see patients in Big Piney. "It depends on her staff," replied the doctor. He noted that, for a time, he spent one day a week in Pinedale while operating the Marbleton Clinic.

Former Board member John Linn of Big Piney encouraged the board to be bold. "This is the best time the Board's ever had to work on other problems," he began. "The door is wide open to creative thinking." He urged the Board to consider offering one contract for both clinics, to be handled by cooperative doctors. "This would go a long way towards unifying the north-south conflict that's always in the corner," he said.

However, Jim Greenwood was more cautious. He said before going to one contract, the Board should give Dr. Boyle an opportunity to get her feet on the ground in Pinedale, and offer her an initial 6-month contract.

Dave Racich also wasn't ready to take the step to a single contract, noting that "there's a lot to work out," first.

In the end, the Board voted unanimously to offer Dr. Boyle a 6-month contract as Medical Director at the Pinedale Clinic and to authorize the Board's attorney to begin contract negotiations.

The 6-month contract will take Dr. Boyle through the remainder of this fiscal year. In July, the Board intends to offer 2-year contracts at both clinics.

Dr. Boyle was out of town and couldn't attend Monday's meeting. The Board intends to meet with her on December 19th, 7:30 p.m. in the Pinedale Library to discuss her proposal. The public is also nvited to the meeting.

Paid EMT Contract Proposal

Pinedale EMS director Gary Wilson presented a proposal for a paid EMT service to the Board.

Pinedale EMS proposes to guarantee 24/7 ambulance coverage in the north end of the county for first ambulance out of the ambulance barn. The EMS will not guarantee that a second ambulance will be available if there are multiple, simultaneous calls for servcie.

The contract amount is $195,000. This includes approximately $77,000 in revenues the service would generate.

The Pinedale EMS would cover the ambulance needs with three full-time paid EMTs and one half-time paid EMT, said Mr. Wilson. The paid EMTs would be backed up by volunteers, as is done in several other communities in western Wyoming.

John Linn told the Board he felt going to a contract for ambulance service would "open a real can of worms." He wondered about malpractice insurance and the Board's liability if something went wrong.

Mr. Wilson responded that the malpractice would be covered by the insurance carrier of the doctor who acted as medical director for the Pinedale EMS. The EMTs would cover their own liability insurance.

Dr. Burnett, medical director for the Big Piney EMS, verified that his malpractice insurance covered the Big Piney EMTs.

"I can never vote for this contract," Jim Greenwood told the EMTs. He explained that he felt the contract was the position of just a few of the Pinedale EMTs and not the entire service. Plus, once the Board goes to a contract, "there's no turning back," he warned.

Mr. Wilson replied that the Pinedale EMS has met several times concerning the contract proposal, and only two of the EMTs expressed reservations. However, both said they would support the majority.

"We can always go back," said Dave Racich in response to Mr. Greenwood's second concern.

"It's an upset volunteer system right now," said Mr. Greenwood. He's concerned that if a contract didn't work out, it would get even worse.

"What you have now is a bunch of volunteers on the verge of burnout," responded EMT Kris Hunt. "All of us are anxious and waiting for you to help us find a solution ... Having a contract just opens the door to possibilities, it doesn't close the door."

This fiscal year's budget for the Pinedale ambulance service is approximatley $135,000. This includes approximately $77,000 in revenues from the service. Thus, accepting the $195,000 Pinedale EMS contract proposal would increase Board spending by approximately $60,000.

Mr. Wilson said the proposed contract would not be a major change for the EMT volunteers. The full time paid EMTs would receive a salary of $1,600/month.

Mr. Greenwood told the EMTs he wanted more options. He noted that the EMTs first suggested a 3-paid EMT contract last summer, and he believes they are fixated only on this solution and no others.

John Linn said he felt any contract system needed to be implemented county-wide, to include the Big Piney service. "The south end has said they don't need it," replied Mr. Racich. "They don't want it ... It would be like giving medicine to someone who doesn't need it."

Mr. Greenwood suggested that sometime in the future, the Board should consider going to one countywide EMS. He added that he was concerned about the equality issue with both ends of the county.

At this point, the Board, Mr. Linn, Mr. Wilson and Leslie Rozier discussed several ideas to "equalize" the funding at both ends of the county. One suggestion was to give each service a "base" budget of something like $40,000 and allow each service to keep its revenue. Another suggestion was to determine a cost per run, and fund the ambulance services based on the number of runs they take each year. "I think we're getting somewhere now," said Mr. Greenwood.

Board Member and former EMT Walt Bousman also expressed concerns with the Pinedale EMS contract proposal. Mr. Bousman suggested that for accountability purposes, the paid EMTs should work out of the medical clinics at both ends of the county. Mr. Bousman said he was also concerned about decentralized billing.

Mr. Wilson replied that when Dr. Glas was at the Pinedale Clinic, he didn't want an EMT working up there. On the south end, Dr. Burnett is more open to the idea. He said the Pinedale EMS would do its own billing if a contract for services was agreed to.

After more back and forth discussion, Chairman Dave Racich said, somewhat in frustration, "We either try to hash something out now or go back to the drawing board and drag our feet for another 8 months."

A little while later, Daniel's Gregg Anderson also expressed some frustation. Addressing the other Board members he said, "All I'm hearing is, 'these guys can't handle it.' These guys are sticking their heads out and accepting the responsibility."

In the end, the Board decided to hold the contract and review it for further discussion at January's regular meeting. That meeting will begin at 7:30 p.m., January 8 in Marbleton. <