In cash-strapped Wyoming, a community votes for a new hospital

As the state cuts funding for public services, cities and counties are figuring out how to go it alone.


A "Support the Hospital" patch on Laboratory Technician Vicki Haffey’s lab coat at the Pinedale Medical Clinic. Right, a patient room at the clinic. The county just passed a ballot measure that will bring a hospital to the county.

Kari DeWitt of Pinedale, Wyoming, needed a blood transfusion. It was 2014, and her placenta had partially ruptured; she and her unborn son were in critical condition. But Pinedale has no local hospital, only a town clinic, so she couldn’t get the help she required there.

DeWitt, a theater producer who leads the Pinedale Fine Arts Council, had to wait 45 minutes for a medi-flight plane to transfer her to a hospital in Idaho Falls, over 100 miles away. Within three minutes of her arrival, she gave birth — and received the blood she needed.

When she needed a blood transfusion, Kari DeWitt had to wait for a medi-flight plane to transfer her to a hospital over 100 miles away.
This year, DeWitt successfully campaigned to pass a ballot measure that will bring a hospital to Pinedale, in Sublette County. Now, nobody in her community will face the excruciating uncertainty she experienced when her son was born. “I know we’re in the ‘Wild West,’ ” DeWitt said. “But it’s not the 1800s.”

More than a dozen Wyoming communities, including Sublette County, raised or renewed local taxes in November 2020. In addition to the new hospital, the taxes will fund water system repairs, road and bridge maintenance, and a new museum. At the same time, Wyoming is facing major budget deficits as the primary source of state revenue — the fossil fuel economy — contracts. Now Wyoming communities have to figure out how to get by with shrinking state support. 

Even as Wyoming voters raised local taxes, they elected staunch anti-tax conservatives to the state Legislature. That may seem like a strange juxtaposition, but leaving new taxes up to municipalities and counties rather than the state aligns with the Libertarian-minded ideal of limited government embraced by many in Wyoming, said Rob Godby, an economist at University of Wyoming. 

 “I know we’re in the ‘Wild West,’ but it’s not the 1800s.”

Meanwhile, state budget cuts are underway. In response to energy revenue and coronavirus-related shortfalls, Gov. Mark Gordon, R, slashed spending by 10% in July. He’s since proposed further measures that reduce state funding by a half billion dollars, including a $135 million drop for the Wyoming Department of Health. In addition, direct distributions from the state to local governments have decreased by more than $50 million since 2015 — a 35% drop. “We are going to have to abandon some of our towns because we will not be able to afford upkeep on our roads and sewers,” Gordon told a state appropriations committee in July

The cutbacks will hit rural communities hardest. Godby likened small-county finances to the board game Battleship: Bigger cities and counties, like the big ships in the game, can withstand several hits and stay afloat, while smaller communities can be sunk by just a couple shots. “We’re getting closer and closer to the threshold, where cities and towns can’t function,” he said.

The Sublette County Rural Health Care District purchased 7 acres of town ball fields adjacent to the current Pinedale Medical Clinic. The fields will be the site of the future hospital.

SUBLETTE COUNTY RESIDENTS have been talking about the need for a local hospital for more than a century. In 1915, a newspaper headline announced one was going to be built in Marbleton. It wasn’t. In 1961, Pinedale and Big Piney feuded over which town would get a hospital — but neither did.

The latest effort, the 2020 ballot measure, passed by a healthy 20% margin. Unlike other recent failed attempts, the current plan got more support because it included the local senior care center and had financial backing from the county, said Emily Ray, the communications coordinator for the Sublette County Rural Health Care District. This fall, when nearby hospitals filled up with COVID-19 patients, Sublette County was forced to reckon with its dependence on other communities’ medical facilities.

“We’re getting closer and closer to the threshold, where cities and towns can’t function.”

The “yes” vote raises property taxes by $1 for every $10,000 in value and relies on local and federal funding: a $20 million commitment from the county and an anticipated $24-$25 million loan from the U.S. Department of Agriculture. The district plans to build a new wing onto the existing Pinedale clinic; officials expect construction to wrap up in late 2022 or early 2023. The expansion will add eight hospital rooms, clinical and surgical facilities, and 46 beds for long-term care — nearly doubling the existing capacity in Sublette, Sweetwater and Teton counties.

The new facility will be a “critical access hospital,” a federal designation created to financially support rural hospitals. This will allow it to receive higher payment rates from insurers, including Medicare and Medicaid, than the clinics could charge. That will help the health district, which has been operating with thin financial margins. Having a local hospital will also reduce expensive ambulance rides out of the county by more than 20%, according to clinic data.

For DeWitt, the approval of the new hospital district was a sign that the community recognized the need for better health care and takes pride in its ability to care for its residents. It’s also a reminder that some things are worth paying for: “I’m not sure there’s anything besides a hospital that can raise taxes here,” DeWitt said. “But at a basic level, you know you need a hospital.”

Vicki Haffey, a 27-year veteran of the Pinedale Medical Clinic, works inside the clinic's lab.

Carl Segerstrom is an assistant editor at High Country News, covering Alaska, the Pacific Northwest and the Northern Rockies from Spokane, Washington. Email him at [email protected] or submit a letter to the editor

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