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COVID future or COVID past? $1.25 billion may help Wyoming hospital construction costs

Two C-130 transport aircraft from the Wyoming Air National Guard’s 153rd Airlift Wing fly over the Wyoming Medical Center on Friday, May 15, 2020, in Casper. The Wyoming Air National Guard flew the aircraft over hospitals across Wyoming on Friday as a tribute to healthcare workers. (Dan Cepeda, Oil City)

CASPER, Wyo. — COVID-19 is so-named because the particular strain of the coronavirus behind the global pandemic was first detected in humans in Wuhan, China in December 2019, as National Public Radio reports.

While Wyoming has started to re-open businesses after restrictions to slow the spread of the virus began to go into place in mid-March, it is unclear how the virus could impact the state moving forward.

As the Wyoming House of Representatives debated how hospitals in the state will be able to benefit from $1.25 billion in federal Coronavirus, Aid, Relief and Economic Security (CARES) Act qualifying funding received by the state as the first day of the special session stretched into the night on Friday, May 8, representatives tended to aim their perspectives in one of two directions: toward the future or toward the past.

Majority Whip Tyler Lindholm introduced an amendment to House Bill 1001 which would explicitly allow some of the $1.25 billion to go toward hospital capital construction costs:

“Members, what you are looking at here is an amendment that hospitals can use these funds for construction projects to increase their capacity to deal with an outbreak of COVID-19,” Lindholm began. “Using these funds to increase our hospital capacity to deal with a second wave of COVID-19 is absolutely critical.”

Lindholm said the amendment would allow for projects such as:

  • building negative pressure rooms
  • increasing ICU capacity
  • building projects in communities with minimal or nonexistent healthcare options

“Specifically, members, what we are looking at here is there are several rural outfits out there that have no capacity at this time,” he continued. “Even though they are a hospital, if someone has something like COVID-19 and has to be hospitalized, what you are looking at is they are going to have to be transferred to a major facility.”

“The reason why I am bringing this forward is if they have to get transferred to one of those facilities, chances are if the rural communities are seeing hospitalizations, then the larger communities are also. So this provides the opportunity for those organizations to come forward in this situation and explain the need on why a negative pressure room, or something like that, or an ICU aspect would be needed.”

While Lindholm and other representatives talked about preparing for possible future waves of COVID-19, others like House District 31 Representative Scott Clem turned a critical eye to the recent outbreak in the state.

“I’m looking back on what we just went through,” Clem said. “Let’s go back. Why did we go through all the trouble to flatten the curve? It was so we wouldn’t overwhelm or overburden our medical system. Not only did we not overburden it, but we ran it into the ground.”

“My community in Gillette, they were laying people off. They were cutting back on people’s hours. They were burning through cash. And so I struggle to see the need of this because, you know, I have no idea how many COVID-19 patients are actually in Wyoming hospitals, maybe there is not even one.”

Wyofile reported that there were ten hospitalizations across the state as of Tuesday, down from a peak of 23 hospitalizations from April 20-21. 71.5% of the overall 541 laboratory confirmed cases reported in Wyoming have not required hospitalization, according to the Wyoming Department of Health, who don’t provide daily hospitalization updates on their website.

“But even at the peak, what we saw here this last time, we have plenty of capacity,” Clem said. “What I don’t want to do is take this $1.25 billion and to turn it into, for back of a better term, a slush fund for something.”

“I think it really does need to go to businesses, to those who have been affected. The real casualty of COVID-19, that’s not the right word, the most damage that we have done with COVID-19 has been to our economy, and that’s where the money really needs to go. And so, at this point I’m a no on this. Unless, do we have some data to show us that this is really a needful item?”

Some members from Wyoming’s hardest hit area, Fremont County, said there is a desperate need to fund hospital capital construction.

“I think the members of the legislature know full well the damage this has done to Fremont County,” House District 34 Representative Tim Salazar said. “And in my town of Riverton, we need capacity. We need healthcare. We are under-served. Our statistics on life-flights will show you how desperately Riverton needs this help. We need a new hospital.”

“We don’t have healthcare in Riverton. And the numbers and the statistics and those who have been affected by this COVID virus proves it.”

Fremont has seen 197 confirmed COVID-19 cases, almost 160 more than the 40 confirmed cases in Natrona County, the home of Wyoming Medical Center where many people from Fremont come for treatment of COVID and other medical conditions.

“I don’t know if anyone has looked at the governor’s mailout this morning on the COVID-19 situation,” House District 55 Representative David Miller, also of Fremont County, said. “Almost two-thirds of the cases have come out of Fremont County. Four of the seven deaths have come out of Fremont County and helicopter flights to Casper and other hospitals have gone up 600% over the last few years.”

“We need to look at this option.”

House District 36 Representative Art Washut said that he liked the concept of the amendment but added that hospital capacity is not the only issue.

“It seems to me that this is a worthy idea,” Washut said. “My concern though is that capacity requires not just a bed and space, but also doctors and nurses that are respiratory therapists and those sorts of folks. And do we have that for each of our rural communities in Saratoga or up in the [majority] whip’s neighborhood?”

“I think that’s a bigger question than just having rooms.”

House District 40 Representative Richard Tass recalled debate in 2019 about whether a veterans’ skilled nursing facility should be constructed in Buffalo or Casper.

“I really agree with our policeman there from Casper,” Tass said. “His point is well taken. I’m sure we all remember the hand-wringing and tears that we shed about building a new facility for retired people here in my home town and all the talk that there was no CNAs, there was no staff available that we could get to bring into our new facility.”

“Just to start building buildings because it is a fun idea and we’ve got money we can go build things, then what do you do? You turn them over to the local counties and you say, ‘Ok, here’s your big beautiful building. Go fund it. Pay for repairs and all the other costs.’ The standing up a building turns in to being the smallest part of the cost of having some neat facilities.”

House Labor, Health & Social Services Chair Sue Wilson said that while the state could use funding under the CARES Act for hospital capital construction projects, she said legislators should keep in mind the long-term budget needs.

“There are many areas of our state that are under-served,” she said. “And so, constructing new facilities to provide care either for COVID situation or OGBYN, trauma, heart attack, those are great needs.”

“However, we should really consider what we have been considering in the Labor Committee and will probably for some years. One of the reasons we have high healthcare costs in the state is because we are spreading expenses for fixed facilities out over a very few number of patients.”

She said the state may have to think of new ways to provide long-term funding for rural healthcare.

“To expand our facilities, what we need to consider is, going on from now, in 2021, 2022, 2023, there are not going to be a lot of patients in those facilities,” Wilson said. “My co-chairman and I are really about at the point where we think we are going to perhaps need to follow some sort of utility regulation model to provide taxpayer money for facilities to just keep them stood up in rural areas.”

“The more facilities we build where there are not that many patients, the more likely it is in the future that we will want to use public dollars to keep them open. And I don’t necessarily think that’s a bad idea. I think that we can certainly argue that healthcare for trauma or for obstetrics or for diseases, is a public function. But just realize that standing up a building before December 30 is only the beginning.”

Some argued that COVID numbers seen in some parts of the state don’t justify such spending proposed in the amendment.

“I might add that a Campbell County hospital has had one COVID patient in there the entire season,” House District 32 Representative Tim Hallinan. “How many [hospital beds to treat COVID patients] would be needed in Sundance or Hulett? I don’t think there would be any need for them there.”

“So I think the expenses that are related to this really don’t make sense. “

But Speaker Pro Tempore Albert Sommers of Sublette County said that some rural areas would be better prepared if a second wave of the virus hits.

“We’re the only county in Wyoming that does not have a hospital, it does not have an ability to have an ICU room,” he said. “Right now maybe that hasn’t occurred, that need for more capacity hasn’t occurred. But If you think about how we might open up and as more people come toward Yellowstone National Park and [toward Jackson], which is where we rely on, almost 100 miles away for our large health care service.”

“What happens if something blows up there? And blows up likewise in my neighborhood? I think there is a need for more capacity out there. I worry about my community being able to handle if we do have an advanced COVID outbreak later on next year, for example, or onward. Where will my constituents go?”

Sommers said he thought that capital construction was within the purview of United States Department of Treasury guidance on how COVID-19 funding can be used.

“I think this is legitimate use of money,” he said. “Just to reflect back on what it says in the guidance. It says: ‘Expenses of establishing temporary medical facilities and other measures to increase COVID-19 treatment capacity, including related construction costs.'”

House District 09 Representative Landon Brown said that it wasn’t only rural hospitals which would be able to benefit from the funding.

“We have hospitals throughout the state that have had to push back major, major operational situations because of this COVID-19 outbreak,” he said. “My hospital here in Cheyenne for example, had planned on doing an ICU renovation. They have been burning through their cash.”

“They’ve been able to keep people afloat on their payroll instead of laying people off. But what that does is that burns through their ability to fund these project renovations.”

Brown noted that another section of House Bill 1001 would allow hospitals to use CARES funding for payroll costs.

“I think that was the original intent of this legislation was to allow hospitals to mitigate this if we have a second wave in the fall or even next year,” he added. “We want our hospitals to be ready. What better time, then, to use the federal funds that have been allocated to this state as opposed to the state having to come up with these funds to assist or these counties having to come up with these funds when we are already in an economic downfall?”

House District 30 Representative Mark Jennings asked what other support hospitals in the state have received from the $2.2 trillion COVID-19 stimulus package passed by the U.S. Congress.

“Out of the $2.2 trillion, I was under the impression that there was a package for hospitals,” he said. “Something like $330 billion, or something of that nature. Can you speak to that? I mean are we duplicating something that might be taken care of out of another package?”

Brown said that the Cheyenne Regional Medical Center has received $8 million, but that didn’t go very far.

“That propped the hospital up here for the month of April,” he said. “But it will not continue into May. There is nothing in Wyoming that actually qualifies as rural healthcare. We classify as ‘frontier.”

House District 44 Representative Sara Burlingame said she had some concern about the need to spend the CARES Act funding by December 30.

“I’m not sure about the date of completion, when those monies would have to be used by,” she said.

Burlingame added that she thought is was important the legislature keep in mind that those with COVID-19 are the ones who have really suffered.

“When we talk about the real casualties of the crisis, [it is important] that our legislature is always mindful of folks who have lost their family members, like the three who are lost in one family in [Fremont County] and that our work is to balance the needs of the economy with the actual casualties who are lost in this. I just wanted to make that note.”

House District 29 Representative Mark Kinner of Sheridan County said that hospitals could use more help, though they have received funding.

“Just showing an example of how those [funds] are being used in our community; they are being used to help keep the hospital alive while they’ve cancelled all their elective surgeries and so on,” he said. “But they’ve cancelled all their income. As I understand it, most of those dollars have been used just to keep the hospitals going.”

“I think this [proposal] does help, in our case, with a remodel that would add surge beds for [a second wave] possibly happening in the fall. But also mental health beds that we don’t have in our area. I think we would all agree that we are probably going to have need for more mental health beds going forward with this.”

House District 06 Representative Aaron Clausen aslo spoke in favor of the amendment.

“Part of this billion dollar windfall from the federal government, I think it is almost our duty to help bring healthcare to some of these under-served areas and improve some of the areas that we have that could use a little help,” he said. “I’m on and for the amendment. Great idea.”

House District 39 Representative Stan Blake said the amendment could help more than just hospitals.

“Everyone is talking about hospitals,” he said. “But I think we have a lot more than hospitals. We have hospital districts, we have rural healthcare facilities that could use this money. So don’t just think hospitals. In Farson, we have a rural healtcare facility. Green River, we have a hospital district. So it’s not just hospitals, it could be a variety of different facilities.”

While some Fremont representatives spoke in favor of the amendment, House District 54 Representative Lloyd Larsen said that his county being a hotspot relative to other parts of Wyoming could be misleading.

“I think it is really important as you look at statistics around the state. Fremont County has 121 confirmed cases,” he said. “But does that mean that hospitalization has increased? It does not. Currently, the Lander hospital has one COVID patient and Riverton hospital has one COVID patient, neither one is on a ventilator.”

“And that number has gone down since the outbreak of COVID. Our numbers have gone up because we have been testing significantly more people than the rest of the state. And what we’re learning from that is that probably, there’s more people out there that have COVID that aren’t requiring hospitalization than data initially would have outlined. I think we have to be careful and make sure that we are stating accurate information.”

The WDH reports there have been 197 confirmed cases in Fremont. Larsen said he got his numbers from hospital adminstrators on Thursday.

“Just because they are big numbers doesn’t necessarily equate into a need,” he said. “I met with the hospital administrators here to get those numbers yesterday. Don’t get your shorts in a knot because the numbers have increased too much.”

His colleague from Fremont County, House District 33 Representative Andi Clifford, took a different view.

“There are over 150 tribal members who are positive,” she said. “And I’m going to push back on the previous speaker. I don’t have shorts and my shorts are not in a knot, but when we talk about healthcare and the healthcare disparities, this is serious and we need healthcare.”

Washut said that increasing hospital capacity could possibly prevent business and school closures if the state does see another COVID-19 wave.

“I think capacity may equal a decreased need to close,” he said. “If the hospitals have capacity, then the fear that we need to close down all sorts of businesses and schools and so forth from being overrun goes away. I’m a little mixed on this one. But if we can talk about the doctors and nurses to staff these, I’ll probably vote for it.”

Salazar said the legislature should not lose sight of either the past or what could be to come.

“Think about last two months,” he said. “I don’t believe that COVID-19 is dead. I think it could easily reappear. We could be facing the same thing we faced the last two months. No healthcare [in Fremont]. That is not satisfactory.”

Lindholm said that the State Loan and Investments Board would have to approve any capital construction projects before they would get access to CARES funding.

“I’m not proposing that we build buildings just for the sake of building buildings,” hes said. “Just because I’ve added 8 words doesn’t mean these hospitals are going to crop up right off the bat.”

The House adopted Lindholm’s amendment on a vote of 31-26. They also adopted several other amendments to House Bill 1001 before passing the bill on third reading.

House Bill 1001 and Senate File 1001 are mirror bills which have both been passed on three readings in their respective chamber of origin. The legislature will reconvene at 9 am Saturday when they will resume consideration of the special session legislation.

The mirror bills will move to the second chamber for possoble amendments and a third reading vote. The bills would then be assigned to a Joint Conference Committee to reconcile differences.

Only one of the two mirror bills can ultimately become law.

The Wyoming Department of Health provides COVID-19 case, variant, death, testing, hospital and vaccine data online. The department also shares information about how the data can be interpreted. COVID-19 safety recommendations are available from the CDC.