Hospital board split over Hulett clinic plans

Questions were raised over the viability of plans to build a new clinic in Hulett at last week’s meeting of the Crook County Medical Services District Board of Trustees. Split opinions caused disagreements on the need for a new clinic and the board’s relationship with the Crook County Hospital Foundation.

As the meeting began, Judy Hutchinson, on behalf of the foundation, handed out up-to-date copies of the proposal for the clinic, which is planned at around 8000 square feet. When asked about projected cost, Hutchinson said, “don’t know yet,” and explained the project has not yet reached that point.

Trustee Mark Erickson asked how much money the foundation has raised for the clinic to date. Hutchinson stated that around $500,000 is already earmarked and the foundation will be “going after grants” with the help of a grant writer.

Hutchinson said the foundation is in contact with potential donors who are waiting until the project reaches a certain point to make their contributions. The goal, she said, is $2 million, which is more than the original estimate.

Karl Rude, President of Health Management Services, explained there are impacts on the district’s cost report based on how space in the clinic is occupied. The next step, he said, will be for an independent third party expert to analyze the plans based on who will occupy the space.

Viability

Not all board members were pleased with the plans. Trustee Joey Kanode raised issues with the viability of such a large new clinic; the patient numbers simply do not support the need to expand, he said.

“How can we justify a project like this with only five visits a day?” he asked, noting that the new building would be three or four times the size of the current one.

Kanode suggested that it might be a better idea to build the district’s business in Hulett before embarking on such a large project, such as by introducing a pharmacy. He explained his worry that half the building won’t be utilized because the district has not been proactively building business in Hulett.

Trustee Connie Lindmier disagreed: the district will never have anything new if you wait until you’ve already built things up, she said. Chairman Sandy Neiman added that it took a while to build up business in Moorcroft once the new clinic was built – visitation numbers in Moorcroft were no better before that point, she said, but improved over time.

Kanode, however, argued that the Moorcroft clinic is not completely utilized either.

Cost Concerns

Erickson suggested that the price tag for the new building seems unrealistic. There’s no way an 8000 square foot building can be constructed for $2 million, he said: “It’s going to be twice that.”

He stated that he would like to know what the rent will be to occupy the building, a question he feels is important for taxpayers to have answered. This is “not the field of dreams where if you build it they will come,” he said, and if the rent is too high then the building will sit empty and unused.

When told that this information is not yet available, Erickson warned, “You’d better know the depth of the water before you jump in”.

Rude interjected that, while $250 per square foot might seem low, in medicine the cheapest thing to build is new clinics. The proposed size is just below a threshold over which regulations would demand more expensive items be added to the plans, he said.

Rude further explained that the point of the third party expert examining the plans is to play with the design and make it feasible. The expert will help obtain the best price point and also the best arrangement for the district, after which the foundation and board will need to make decisions.

Priorities

Kanode questioned whether a new clinic is really the best use of the foundation’s fundraising power when there are other areas of the county’s healthcare system that could do with some attention.

Erickson agreed, commenting that there is an “immediate need” for new ambulances. Not all of them are in good shape, he said, while the district is receiving more calls than ever before.

Hutchinson explained that the money raised to date for the Hulett clinic was earmarked specifically for that purpose. It cannot be used for any other project, she said, but the foundation is more than willing to fundraise for other needs if asked.

Hutchinson asked if the board had ever come to the foundation and asked for help with the ambulances. No, said Erickson, but he also didn’t ask them for a new clinic.

The clinic is not the only pot of money the foundation has available, said Hutchinson. If the nursing home needs paint and lights, for example, this can be implemented as a separate fundraising goal.

Lindmier commented that there are many projects the district should and can be looking at completing in the near future. Working on the clinic, she said, does not mean that the board has to stop moving forward with other things, such as thinking about replacing the current hospital building.

Lindmier asked why the board would look a gift horse in the mouth. Half a million dollars exists for a new clinic, she said – what would be the point in not making use of it?

Relationship

The root of the issue was reached when Kanode questioned the board’s working relationship with the foundation. “One concern I have is that I’m not too sure how this arrangement is going to work,” he said.

Kanode explained he had grown concerned when the board had trouble obtaining the numbers needed from the foundation for the district’s annual audit. Perhaps the two entities shouldn’t work together if it’s going to be that difficult, he said.

This was disputed strongly by Hutchinson and Sandy Kellogg of the foundation, who were adamant that the delay was only caused by having to wait for their accountant to obtain the numbers.

However, this was not Kanode’s only issue with the relationship. He described a conversation with a previous board member who had warned him that the foundation is only willing to raise money for Hulett, where the providers don’t even want a new clinic.

This, too, was disputed, with CCMSD Chairman Sandy Neiman commenting that the providers do now want a clinic. As to the point of the foundation, Neiman listed some of the help it has offered since she has been a board member, including a new range in the kitchen, replacement of almost all the hospital windows, a donation of $100,000 to help the board operate when it was broke, lab equipment, flooring and the bathroom in the long term care unit.

“Those are a few of the things I can remember,” she said, later noting that the benefit of the foundation is its willingness to do anything – to get grants and raise money – and the board only has to ask.

“It’s a win-win for us, we just need to keep each other more informed,” said Neiman.

She also commented on the progress that has been made in the years since management company Westworld left the district with little money or equipment. She praised the foundation, saying, “We’ve come a long way. I’m proud of where we’re going and I’m proud of what we’ve done to get here”.

CEO Nathan Hough stated his experience that foundations seem to work best when a board brings them a list of needs and priorities and asks them to choose which goal would capture the imagination of donors (though Hutchinson expressed that it would be preferable for the board to select the most important goals). This, said Hough, puts everyone on the same page and sets a future direction for everyone to travel together.

Though the debate over the clinic’s viability was left at an impasse, it was agreed that foundation members would aim to attend more board meetings and keep the board up to date on its actions.