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The following was written and submitted by the Castle Rock Hospital District Board.
“The Trustees of the Castle Rock Hospital District Board, (CRHD), feel compelled to amplify on our Board’s position regarding the publication of salaries and “openness and transparency,” in general, which we attempted to convey at CRHD’s September 19, 2017 meeting with the Board of Sweetwater County Commissioners (BCC).
The CRHD Trustees recognize the importance of a favorable rapport with the BCC and wish to establish and maintain a positive relationship with the BCC – one that incorporates the level of mutual trust, respect, and sense of fair-play conducive to the cooperation that must exist among our various governmental entities.
The CRHD Trustees are committed to “openness and transparency” based on the extensive board experience, including County agency boards, on which a number of our Trustees have served. We are also well aware that CRHD’s records are public documents to be available upon request. Contrary to what was reported at the September 19th meeting, CRHD has never denied the County’s request for personnel salaries and positions. CRHD has always complied with any public records requests and have annually, through the BCC, published salaries in the local media. It is CRHD’s position that as a duly elected board of volunteers, it is our responsibility and prerogative for deciding the manner in which we disseminate information on the business matters of the District to comply with state law and other organizational interest.
When the CRHD Board discussed the language that the County added to this year’s ambulance contract, the consensus was that it was reasonable for the BCC to receive CRHD ambulance salaries to demonstrate that the subsidy the BCC committed to CRHD was being used to cover losses in providing actual ambulance services and not used for exorbitant salaries, benefits, or unnecessary, frivolous luxuries, directly or indirectly. Since the BCC doesn’t seem interested in seeking that same information from Sweetwater Medics, (Medics), we thought CRHD’s offer to supply its ambulance salaries was abundantly compliant and that CRHD’s Clinic salaries weren’t relevant to the County’s funding, because the BCC wasn’t helping fund CRHD’s Clinic. We didn’t seriously believe that the BCC wanted to preempt CRHD’s Board duties and prerogative regarding CRHD’s compliance with applicable legal requirements and sound judgment based on what CRHD’s Trustees perceive to be in the best interests of the taxpayers of the District. If the BCC insists on substituting its judgment (micromanaging) by usurping the duties and prerogative of the duly elected CRHD Trustees, then there is no need for CRHD Trustees to take time out of their lives to volunteer to serve as unpaid members of the CRHD Board.
So, why would CRHD object to submitting its Clinic salaries to the BCC for publication? The short answer is, we don’t – but we believe in the principle that the same standards should be applied to all recipients of the County’s public monies. We freely agreed to provide CRHD ambulance salaries, even though the BCC made no such demand of Medics. But, the BCC demanded CRHD’s Clinic salaries, which the BCC does not fund. The BCC repeatedly asked the CRHD Trustees, “What’s the big deal (about publishing CRHD’s Clinic salaries and positions)?” The BCC members were abrupt in their refusal to discuss CRHD’s rationale that as a recipient of public monies, Medics’ salaries should also be published. The BCC’s final word on the subject was that Medics does not have to publish its salaries, because it is a private company and the BCC has appointed an ad hoc board to govern the County’s contract with Medics. Of course, this ad hoc board is also a public entity subject to the same public record requirements as the BCC and CRHD.
The BCC’s smug refusal to provide transparency regarding Medics’ salaries was surprising given that in December 2015, Emergency Medical Service (EMS) experts SafeTech Solutions issued a community needs assessment of EMS in Sweetwater County, commissioned by the BCC. In the final report, it was noted that “Sweetwater Medics operates with part-time leadership, some of whom may have possible conflicts of interest because of other roles in the community. One owner works as director for AirMed operations in Rock Springs.” Given that air transports per capita in Sweetwater County are much higher than state and national averages, and that the cost of medical insurance and care in Sweetwater County is among the highest in the country, we believe the BCC should see this as further cause for transparency with Medics.
Furthermore, the study notes that “Sweetwater Medics exhibits poor accounting practices. Within expenses, in some years, partner compensation is broken out, but in other years, it is not reported at all, leaving questions about how partners were compensated and whether the ‘salaries and wages’ line item included or excluded partner compensation. These inconsistencies fail to provide the transparency that Sweetwater Medics needs as good stewards of public funds.” Regarding the subsidy ($308,035 at the time), the study notes that “it is not clear if this subsidy is fully needed.”
So, here is CRHD’s rationale on this: Publishing salaries of recipients of public funds is either about “openness and transparency”, or it is not. CRHD believes that the intent of publishing salaries of its ambulance employees is to demonstrate that those public funds are being used to cover losses in providing actual services If this is the case, then Medics’ salaries should also be published as a condition of its receipt of $328,436 of taxpayer funds. CRHD finds that Medics’ status as a “private business” is a textbook example of one of the “logical fallacies”, specifically, “a distinction without a difference”, since Medics is also receiving public monies.
Additionally, the citizens of Sweetwater County are entitled to know under what provisions the ad hoc emergency services board was formed, its rules of governance, and its scope of authority and responsibilities. Further, the emergency services board and the BCC should explain how the subsidy for Medics is determined. What information does the ad hoc board review to evaluate the validity of the requested subsidy? What auditing is performed of Medics’ compliance with its BCC contract? What percentage of Medics’ losses does the BCC fund – all of it? And, what percentage of Medics’ total budget does that subsidy represent? Is Medics truly a private business when it is receiving $328,436 in Sweetwater County taxpayer monies from the BCC?
When the CRHD Trustees noted to the BCC that the CRHD Ambulance Service (Ambulance) was losing $29,000 per month ($348,000/year), the BCC cavalierly quipped that maybe CRHD should “revisit its ambulance funding and perhaps privatize it.” CRHD finds this to be an ironic, if not outright cynical proposition. If privatization were a viable option, the BCC would not be subsidizing Medics to the tune of $328,436/year (and growing)., and we would not be having this discussion.
The BCC seems committed to assuring that Medics’ losses are covered by the County taxpayers. Currently, Medics receives the majority, if not all of the fully insured patient transfers to Salt Lake City, which are profitable trips. Conversely, CRHD is offered uninsured transfers, which, of course, Medics wants no part of, because uninsured transports are big money losers. When CRHD requested a more equitable share of insured transports, the BCC stated that transfer assignments were the responsibility of the County Hospital (MHSC) and that any insured transport offered to CRHD instead of Medics would mean that the BCC would have to make up that loss to Medics. When CRHD repeatedly requested statistics from MHSC regarding ground transports, they were never provided.
The BCC has repeatedly decided that Green River’s CRHD taxpayers should absorb CRHD’s ambulance losses, while the BCC assures that Medics is kept whole for its losses with subsidies out of the County-wide 12-mill levy paid by every property owner in the County. As we see it, our valued friends and neighbors in Rock Springs receive ambulance service from Medics, robustly subsidized by the BCC out of the 12-mill County levy. On the other hand, Green River taxpayers fund their own ambulance service out of the additional 3-mills they pay for CRHD. Of that additional 3 mills, $348,000 annually goes to cover losses for Green River’s CRHD ambulance service. CRHD receives a modest $81,000 (and declining) subsidy from the BCC out of the County’s 12-mill levy. Because Green River pays both CRHD and County taxes for ambulance service, it seems that Green River taxpayers are being “double dipped” for that service.
Try to imagine what health care in the County would look like and how it would be funded if the taxpayers of Green River had not voted to tax themselves an additional 3 mills to meet needs that apparently weren’t being satisfied by the County as they are in Rock Springs. What would the BCC do to assure that Green River had equal access to an appropriately scaled, proportional level of medical and ambulance services as are available in Rock Springs through the County Hospital (MHSC) and a “private” ambulance service heavily subsidized by the BCC? And, how much would that cost the BCC to provide?
Attached you will find a current listing of salaries by position for CRHD personnel which has been published every year.
To the Board of County Commissioners, please recognize that “openness and transparency” is more than token lip-service to an abstract buzz phrase.”
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