CCMSD contemplates new bid to fund hospital building

A clearing of the air at last week’s meeting led to the board of trustees agreeing to examine the possibility of once again seeking to fund a new hospital building for Crook County Medical Services District (CCMSD).

As the board convened for its monthly meeting, Sandy Neiman addressed new trustee Brent Fowler with the stated intention of getting to the bottom of a rumor before the board begins working together in the new year.

“When you were elected and even afterwards, you said the reason we don’t have a new hospital is my fault,” she said to Fowler.

“I was wondering why you felt that way and let’s get it cleared up.”

Fowler responded, “I guess I’d have to figure out where you got that from,” to which Neiman explained that she had heard it from “several people” and wanted to resolve potential conflict.

Fowler responded that his concern is not personal, but rather that the board has not taken its chance to get COVID-19 funding for a new hospital building, despite it still being available. He said he has spoken with many people, including state and national elected officials, and believes, “We still have a golden opportunity.”

“If you want to take it personally, take it personally, I don’t care, but nothing has been done to get a new hospital. We did not go forward with the opportunity and I actually had one board member tell me that we don’t need a new hospital because we have one in Spearfish,” he said.

Fowler questioned why someone would even be on the board if they felt that way. In response to a query from board chairman Mark Erickson, he confirmed that the person he was referring to is no longer on the board.

However, as discussions continued, the board was able to provide clarification that, while CCMSD did not ultimately apply for the first round of COVID-19 funding known as the CARES Act because it was not available for capital construction, the district has not given up and has since attempted to secure American Rescue Act (ARPA) funds.

New Hospitals

Beginning his argument that the district should pursue funding, Fowler brought up the fact that Pinedale recently constructed a hospital for $21 million in funding, which is much less than the $50 million CCMSD believes is needed. Saratoga and Riverton are also getting new hospitals, he said.

“All of them put in for those funds. They got their funds. We didn’t put in for them,” he said.

“…We’ve got a 1960s building that, every time we tear into it, we come up with reasons why we have to delay, because we still have asbestos. Why would we want to keep something like that?”

Fowler told his fellow board members repeatedly that he ran for the board for a reason and is here to do what people elected him for.

“I think most of us are,” responded Erickson, stepping in to clarify Fowler’s understanding of how the COVID-19 funding worked at the point in time he was referring to when he stated that CCMSD did not apply.

CARES Act money was for emergency COVID-19-related needs and federal guidelines did not allow for capital construction, Erickson said. It was federal money rather than state so, even if the state had created rules that allowed this use, he said, they would not have superseded the federal guidelines.

Neiman added that the district would also not have been able to meet the federal requirements for that funding, in particular the extremely tight deadlines.

“We were told through legal counsel…that it did not fit us,” she said. She noted that the district also did not have land for construction at that time.

Evidently someone did manage to get hold of the money to buy a new hospital, Fowler retorted, or Pinedale wouldn’t have its building.

“That was a different fund,” Erickson explained.

Original Bid

When complaining that CCMSD failed to apply for funding, Fowler was referring to discussions that began in 2020, when CARES Act funding was released in response to the COVID-19 crisis.

According to Sundance Times coverage at that time, after hearing a pitch from Senator Ogden Driskill and then-Representative Tyler Lindholm, and despite reservations over the timing and feasibility, board members decided to support the duo’s efforts to secure the funding.

However, it was far from clear in those early days whether CARES Act funding could be used for capital construction and the board was concerned by the extremely tight deadlines it would need to adhere to, as the funding needed to be obligated by the end of the year.

In August, 2020, board attorney Kara Ellsbury shared the results of a conversation with the Attorney General’s Office, which she said had shed light on whether the district should put in an application for a new hospital facility.

“They have said that the CARES Act funding that the State Lands and Investments Board is administrating is very clear that it does not apply for new construction, [and that even] if it could apply for new construction it…truly has to be spent by year’s end,” Ellsbury said at the time.

ARPA Funds

American Rescue Plan Act (ARPA) funding came later, said Erickson at last week’s meeting, and the district did put in an application for a new hospital building. The board recently heard that its application was not successful.

Fowler confirmed he was aware of this, but said he didn’t think CCMSD did enough to secure the money.

“I know why we didn’t get it,” said Fowler. “The presentation wasn’t good enough to get it.”

CCMSD needs to hire a grant writer, he said, and needs to increase the mill levy to convince the state to approve grant funding.

Neiman retorted that, while the board has in fact been doing whatever is in its power to chase funding, a mill levy increase is unlikely to pass muster with voters.

“In the past, there have been three requests for a mill levy increase, and those have been turned down,” she said.

Fowler reiterated that the reason he is on the board is to do everything possible for the medical services district and he believes from his research that, if everything is done right, the money can be secured.

“What I’m asking for from all you people is to give me a list of what we need to do,” he said. “…We can have a pissing session over it, or we can go after it.”

It isn’t as simple as that, said Neiman.

“There isn’t one of us that wouldn’t go after a new hospital if we knew how it could be paid for, if we had the land. We do not have the land right now, and you have to have that first,” she said.

Erickson asked Fowler to confirm that he advocates for raising the mill levy.

“I think that, to go to the state and ask for funds for any kind of grant to allow us to improve our facilities without taking this step to get there first is not a good sign,” Fowler said.

Legislative Help

Also in attendance at the meeting was Senator Ogden Driskill, who said he would still like to see Crook County get a new hospital. If there’s one thing he would like to leave behind as a legacy, he said, it’s that.

Another round of ARPA grant funding is pending, Driskill said, but he would like to know that the board is “all in” before he commits to providing assistance.

“I’m here to help you do what you want. My only deal is, and I’m pretty hardcore on it, that you have to stand behind what I’m doing, because that deal last time was really hard,” he said, referring to the failed efforts of 2020.

Erickson noted that things were different back when the idea was first posed – there had been no discussion of a new building at the time, whereas the district has since commissioned a study to look at possible options. In 2020, there were no plans available except a set of outdated blueprints based on another hospital constructed CCMSD’s former management firm.

What happened two years ago is “water behind”, said Driskill, and it’s time to move forward. He estimated that he may be able to help the district secure between $3 and $10 million for a new hospital building – potentially enough, he said, for the engineering portion.

This would, of course, leave the district tens of millions short of the total needed for construction, but Driskill suggested that, with full plans in hand, the district could then pursue loans as well as additional grants through, for example, the United States Department of Agriculture.

Doubts still remained as discussion continued. Erickson noted, for instance, that the other districts which have successfully built new hospitals have much more available money – Pinedale, he said, has $165 million in the bank, and their mill levy is about ten times Crook County’s.

This is why the mill levy needs to be raised, said Fowler. Three more mills would raise approximately $700,000 per year, which, according to Driskill, would “basically cover a loan up to $20 million.”

Neiman pointed out that the district cannot simply make such a decision – it needs to ask the people, and they may not feel supportive of additional taxes.

“Then we have to explain to the people why we want to do it so that you get buy-in,” said Fowler. “That’s part of our job, to me, as a board, to try to get the people behind what is needed.”

The board and Driskill held lengthy discussion on the various questions that will need to be answered before completing a funding application, such as what exactly the hospital needs, what additional funding can be obtained, what kind of loans the district should or could afford, how land can be secured and whether to raise the mill levy.

As the conversation came to a close, the board agreed to continue discussions and, if feasible, pursue opportunities for funding as and when they come available.