After months of standstill over the future of inpatient hospice services at Close to Home Hospice Hospitality House, both sides may have taken a litigious step forward.
Earlier this month, the Northeast Wyoming Community Health Foundation sent a demand letter claiming that Campbell County Health is in breach of contract regarding operating hospice services in Close to Home Hospice Hospitality House and also another service agreement. The foundation formerly was called the Campbell County Healthcare Foundation.
At last week’s hospital board meeting, Chairman Adrian Gerrits addressed the letter, which formally notified CCH that it “unilaterally” terminated the “Foundation Services Agreement,” while also implying CCH is in violation of its “Hospice Hospitality House Agreement.”
“When I saw the letter, I immediately thought to myself, ‘Oh no,’ because I didn’t think this was the right direction for our relationship to move forward,” Gerrits said.
He added that he was hesitant to bring the letter forward to the board because “once legal professionals are engaged, it takes the contention to a new level.”
Last September, inpatient services were quietly suspended in the community-built, CCH-run Close to Home. In October, CCH and the foundation announced that it would remain closed for three to six months while both parties worked together on a long-term solution.
Close to Home continues to house CCH outpatient hospice services. Inpatient hospice services continue to be provided at the Legacy Living and Rehabilitation Center. But there have been no inpatients in the Hospice House since it was first closed almost one year ago.
The Aug. 9 letter said that CCH unilaterally terminated the services agreement by stating that it would no longer comply with its terms and failed to make its scheduled annual payment earlier this summer. The contract is a five-year deal which includes CCH paying the foundation $22,500 annually for a series of services.
It also stated that CCH is in violation of the hospice agreement for not operating inpatient services inside of the building.
Gerrits said CCH decided to cancel the services agreement because “there was a lot of stuff in there that we were not being compliant in following, and there was a lot of stuff that was not getting done on their end and our end.”
The formal termination had not occurred yet, he said. But the conversations had taken place.
“We are still in the agreement for the hospice services,” Gerrits said. “The services agreement, we have not sent a formal letter to terminate this agreement because we got their letter preemptively.”
With legalese now further clouding communication between CCH and the foundation, trustees discussed what the letter really meant and what its required response would be.
“I see the letter and like many things that are written by lawyers, it’s confusing,” said trustee Sara Hartsaw. “Are they suing us or not? The way it’s written is really threatening to us.”
Line by line
Alison Ochs Gee, an attorney for the hospital board, said CCH is not required to respond to the letter, but the board is still able to respond if it chooses.
“At this point, the foundation has not filed a lawsuit so there’s no formal legal action, although it appears one may be threatened by this letter,” Ochs Gee said.
While not a formal legal response to the letter, the board went on to lead a 90-minute conversation about Close to Home at its meeting.
The hospital board walked through nine line items from the services agreement with Ochs Gee and hospital board attorney Tom Lubnau, discussing whether a violation may have occurred.
In parsing the contract, they drew questions over the foundation’s compliance in regard to the foundation’s obligations to account for its donations for CCH, provide financial statements to CCH, assist with fundraising for CCH, maintain an electronic database of donors, writing grants for CCH and other matters outlined in the agreement.
Lubnau said the foundation has $172,336 in restricted funds for the hospice committee and another $771,728 in funds for the hospitality house. Close to Home has three components: The hospitality wing for families, the inpatient wing for hospice patients, and the basement, where outpatient services are operated.
“We don’t know how they got those donations,” Lubnau said. “How those funds got earmarked, where they came from. That, as far as we know, hasn’t been accounted for.”
Another issue, Ochs Gee said, was that Heeter’s voice on the board has been removed, “which has further complicated the ability of CCH to represent itself.”
They also discussed issues regarding insurance provided to Foundation Executive Director Nachelle McGrath through CCH.
“This has evolved as (the foundation has) gotten more and more financially self-sufficient,” Lubnau said. “They’ve moved out from under your wings. Some of these things in this contract are just remnants of us trying to give them a boost. It’s the old story of ‘a luxury once sampled becomes a necessity.’ And you’ve got a demand letter now for the necessity, or what their perceived necessity is.”
Gerrits said his “olive branch” idea was to commit to provide the money owed through the services agreement for this year and next year, to their fundraising events, without a services agreement, to pay off the contract.
Lubnau said that for legal purposes, CCH can not just give the foundation money, unless a service is received in exchange, hence the services agreement.
“I think the discussion that we had as a board was this agreement hasn’t ever really been complied with (or) upheld by either side,” Gerrits said.
The foundation responds
McGrath did not attend last week’s meeting in person, but said she watched remotely and listened to what became a four-hour board meeting.
“It is unfortunate that Campbell County Health chose to take the path of disrespect at their meeting,” McGrath said. “We would like to resolve our contract with professionalism while focusing on the community’s best interests and their investments. There are obviously differing opinions, but we would still welcome an opportunity to sit down and collaborate.”
Efforts toward collaboration between CCH and the foundation have happened at various points since Close to Home closed last September. During the hospital board’s spring retreat in Deadwood, South Dakota in March, McGrath approached the board for what became an extended airing of grievances between both sides.
At the time, the joint Close to Home Task Force was created for members of each faction to collaborate on a feasible business model to potentially reopen the Hospice House. Those meetings culminated in the foundation offering $100,000 a year to CCH to bring back inpatient services as they once were.
CCH Chief Financial Officer Mary Lou Tate estimated that CCH lost between $329,000 and $801,000 by operating Close to Home each year since 2016.
A hospice consultant was commissioned to evaluate Hospice House and provided a report that suggested Close to Home could run on an altered business model and cut its operating losses to $170,00 per year. Tate expected that number would be closer to $300,000, under the consultant’s plan.
The plan was effectively nixed when the $100,000 offer went on the table.
During an emotional hospital board meeting in June, where members from the public advocated for Close to Home’s importance to the community, Gerrits apologized for how the situation had unfolded, said the board had no “appetite” for closing the facility and that both sides needed to continue working on a long-term solution.
McGrath said last week that she met with Heeter and Gerrits “several months ago” to discuss the services agreement, where they went through each of the contract’s line items. She said she made multiple attempts to meet again to discuss the services agreement until CCH ultimately told the foundation it was stepping away from the deal.
“They unilaterally stopped providing that service and we felt that we had no other choice,” McGrath said of the letter.
Sending the letter is not the foundation suing CCH, McGrath said, adding “it’s the last thing anybody wants.”
On Thursday, McGrath is joining CCH Chief Operating Officer Jerry Klein, Home Health Hospice Director Ashley Montague, trustee Lisa Harry and Tate in Cheyenne for a meeting with representatives from the Davis Hospice Center and Cheyenne Regional Medical Center.
During that trip, both sides are expected to compare Close to Home operations to the Davis Hospice Center and learn from a functional hospice house if a sustainable and feasible long-term business model for Close to Home can be reached.
“As far as Close to Home goes, we’re now into 10 months, 11 months from the closure date and nothing has happened,” McGrath said. “We feel that it’s very important to respect what the community wanted and they invested their money in and there needs to be some accountability.”
Not about finances, but …
The second half of the Hospice House conversation centered around Montague, who rehashed the story of the circumstances that led to inpatient hospice services halting.
Amid dwindling inpatient census at Close to Home, the facility was unable to offer full-time work for all of its staff. At first, they had to either use vacation time or be repurposed in different departments when not needed at Close to Home.
But eventually, it became a financial issue for the employees, who were considering leaving CCH, she said. That led to the “pause” in inpatient services that Montague said was an attempt at retaining staff long-term.
“I think there’s a huge perception that the Hospice House closed due to finances and the story that I just told, which is the true story, shows that it actually had zero to do with finances,” Montague said. “What the closure of the hospice house has done has allowed us to look deeper into the financial situation of the hospice house, which has exposed some things that have become a bigger concern but that was not a part of the original closure.”
Since suspending its operations, CCH has explained that its former inpatient hospice model could not continue on due to staffing issues, even if the hefty yearly losses were more palatable.
“The narrative or the perception that Colleen, our CEO, unilaterally made the decision to close the Hospice House is simply not true,” Montague said. “It was a team decision. I acknowledge that it was very quick and we’ve acknowledged that it wasn’t as well communicated as we would have hoped, but it was not made unilaterally and it was the best we could come up with at that time.”
Faced with the letter and, at the moment, no clear path reached to sustainably bring back inpatient hospice services at Close to Home, trustees discussed what the next steps should be, particularly in addressing its relationship and services agreement with the foundation.
“My thought would be, I don’t want to try and fit a square peg in a round hole or whatever the saying is,” Gerrits said. “This doesn’t fit with our current organization anymore. I don’t feel like our organizations are tied together enough for this to be an applicable document.”
Trustee Alan Stuber said he would go with whatever the board decided, but that he preferred a solution that kept CCH and the foundation aligned in some capacity.
“I have a 9- and a 5-year-old who play the blame game every single day,” said Stuber, a police officer. “I’m in an occupation where people blame people every single day.”
Ultimately, he would like the two entities to stick together in a manner that works for both, he said.
“There’s been many, many, many volunteers who have given many, many hours,” Stuber said. “A lot of donor money has gone through and I would hate to see it all end at the snap of a finger.”
Harry said that there is a lot of value in the foundation if it supports CCH. She wants to bridge the gap between the two.
“We also need to say we need something,” Harry said. “If we have something that needs to be funded. If we want something, we need to express to them so they know what our expectations are. I don’t think we’ve done a great job in telling them, asking them and expressing what our expectations might be.”
Trustee Tom Murphy, former Gillette mayor, said the finger pointing is not how the community got to where it is.
“I would like to see us start new,” Murphy said. “I would like to see us pay what we had to pay and erase everything that’s happened in the past and move forward.”
Gerrits said the board will have more clarity to decide whether running inpatient hospice services in Close to Home is viable after the contingent returns from Cheyenne.
He said their findings will be discussed at the next board meeting in September, which will be about one year from when this ongoing Hospice House saga first began.
When Jonathan Decker first stepped foot in Afghanistan in 2013, the status of the War on Terror was in a malaise between the purpose it began with and the debacle it is in now.
The conflict was still active and the U.S. military presence was high, but efforts to scale back would soon be set in motion.
A Gillette native and Westwood High School graduate, Decker, now 29, entered the U.S. Army in 2011, as many of his family members had done before him.
During his nine-month, mid-war infantry stint in Afghanistan, Decker said that even then it became clear that a withdrawal eventually would be in the cards.
He didn’t claim to know how or when to pull out the military presence. But now, on the eve of President Joe Biden’s Aug. 31 deadline to leave the country the U.S. has occupied for nearly 20 years, he knows one thing for sure.
Just not like this.
“It’s an absolute disaster,” he said. “An absolute disaster.”
With the clock ticking, U.S. and Afghan lives lost, the Taliban in control and the Kabul airport immersed in chaos, it is difficult to make sense of how 20 years of effort could dissipate in a matter of weeks, Decker said.
“It’s disgusting. It really is,” Decker said. “It was not supposed to happen like this.”
Falling apart overnight
Within a matter of months, as the U.S. decreased its presence in the country, the Taliban seized power.
“You don’t pull the troops out first,” Decker said. “They’re the last to go. It was just completely done backwards.”
The Taliban swept across the country, taking over provincial capital cities. And hundreds of thousands of Afghans fled their homes in fear of what awaits them under Taliban rule. The group last was in power from 1996 to 2001, when it ruled the country under a harsh interpretation of Islamic law.
“The jury is still out, but the likelihood there’s going to be the Taliban overrunning everything and owning the whole country is highly unlikely,” Biden said on July 8, the day that he said the U.S. would withdraw by Aug. 31.
The U.S. has been trying to get out of Afghanistan for several years.
American troops ousted the Taliban in a matter of months when they invaded to root out al-Qaida, which orchestrated the 9/11 attacks while being harbored by the Taliban.
More than 160 people, including 13 U.S. troops, were killed in an attack carried out by the Islamic State at the Kabul airport Thursday.
Among those deaths was Rylee McCollum, a 20-year-old expectant father from Jackson.
“It’s tragic nonetheless,” Decker said about losing a Wyomingite in the airport bombing. “It hits a little closer to home, having lost someone from Wyoming. It doesn’t make it any more tragic. The whole situation is just horrible.”
More than 100,000 people have been evacuated so far, but thousands more remain trapped.
“It makes us look like a laughing stock right now,” Decker said. “We were there for 20-plus years. For what? All of it just fell apart pretty much overnight.”
Blood, sacrifice and frustration
Denton Knapp, a Campbell County High School graduate and a U.S. Army veteran, served three combat tours, including one in Afghanistan in 2012-2013, where he commanded NATO’s Regional Support Command-East.
He ran the training sites for the Afghan police and army along the country’s eastern border with Pakistan, helping with recruiting and basic training, as well as teaching them the logistics of operations and working with the U.S. government.
Even then, the U.S. had begun scaling back its presence in Afghanistan, he said.
Knapp, who retired from the Army in 2017 as a colonel, said the current situation in Afghanistan is unbelievable.
“Watching this is very frustrating,” Knapp said. “It really makes me angry, knowing the blood and sacrifice that were given not only by us but by our allies.”
In his July 8 speech, Biden said the U.S. “did not go to Afghanistan to nation-build. And it’s the right and the responsibility of the Afghan people alone to decide their future and how they want to run their country.”
Two decades of work has now gone down the drain, Knapp said.
“We spent 20 years of blood and treasure trying to help Afghanistan reestablish its government,” he said. “Our commander in chief has given that all up in weeks.”
And it’s not just that. All of the billions of dollars in vehicles and equipment that the U.S. had given to the Afghan government is now in the possession of the Taliban.
“It’s just unreal that we just outfitted a terrorist organization in Afghanistan,” Knapp said.
This whole situation is a blow to America’s reputation among its allies, Knapp added, and trust has been lost.
“Around the state and across the country, people are angry and it’s nonpartisan anger,” he said. “It starts with the commander in chief, and it goes down from there.”
Donald Trump had a plan to withdraw troops from Afghanistan in a phased approach, rather than all at once, Knapp said, and he also had a plan to bring back interpreters and other contractors on the Afghan side.
Biden has stuck by the deadline of Tuesday to completely withdraw from Afghanistan.
“We’ll never have our people out by then,” Knapp said. “If we’re leaving it up to the Taliban to dictate what we’re going to do with our Americans overseas, it’s a lost cause.”
He has friends in Afghanistan who can’t get out, including an Afghan general that he went to college with for a year.
“He’s trapped over there right now,” Knapp said. “He’s gone to five U.S. military schools in his career. That will be held against him (by the Taliban).”
He said he’s been getting calls from friends who are in hiding because they can’t evacuate, and there’s thousands more that are in the same situation.
“They stood by us and fought for years and years, and we’ve now abandoned them. It’s just unbelievable,” he said.
The U.S. has been in Afghanistan for 20 years, which might seem like a long time, but it’s actually quite short in the grand scheme of things, Knapp said.
“If you think about it, 20 years is one generation,” he said. “We’re talking about cultural change, which has to cover multiple generations.”
If the U.S. chose to do so, it could go in and take over, Knapp said, but “we just made it a lot harder to start over again.”
Making sense of it
Despite the chaotic “s---show” of an ending to the last two decades in Afghanistan, Decker said the helter-skelter finale has not changed how he views his service, or the service of countless others.
While the boots on the ground, so to speak, followed orders, he said it was those at the highest levels who created the mess that crescendoed this month.
Not just the current administration, but the administrations before. Four presidents presided over the war in Afghanistan and each one had their hand in the muck, to some extent.
“We did our job,” Decker said. “We did what we were asked to do. They didn’t. They completely failed the situation.”
The Aug. 31 deadline is approaching, but that does not mean the war is over. Watching it unfold in real time is surreal. To call it a fluid situation is to overestimate the ability of liquid. Each second is a splitting matrix of possibilities, many of which spell doom.
“In a blink of an eye, it’s almost like we were never there,” Decker said.
But they were. Decker, Knapp, McCollum and thousands more were all there. Some still are and some will never return. The U.S. tried to change Afghanistan and did. Just not as intended.
It took 20 years and thousands of lost lives to figure that out.
“It was way higher than us who failed,” Decker said. “It wasn’t us who did this.”
For those seeking the additional protection against COVID-19 through a third-shot booster, your time may be coming soon.
Campbell County Public Health, along with the state and nation, is awaiting the third shots of the Moderna and Pfizer COVID-19 vaccines to be approved for the general public and could begin giving them early this fall.
The U.S. Food and Drug Administration and the Advisory Committee on Immunization Practices have to sign off on the booster before it becomes publicly available, but a third COVID-19 shot can be received for some of those who qualify as moderately or severely immunocompromised. It is already being offered by Public Health.
The Centers for Disease Control and Prevention clarified that the third shot currently offered to some is not the same as a booster shot. A booster shot helps improve the immune response when the vaccine’s effectiveness naturally wanes over time. The third shot currently offered is to build up the immune response in people whose immune systems may not have built as high levels of immunity because of their conditions.
Those who are immunocompromised can get their third shot from Public Health now.
“The boosters won’t be offered until the ACIP makes their final recommendations for approval on that,” said Ivy McGowan, Public Health response coordinator. “What is currently approved and is currently being offered is the additional shot for those people who qualify under that immunocompromised description.”
Last week, the U.S. Food and Drug Administration approved Pfizer’s COVID-19 vaccine, now marketed as Comirnaty, for people 16 and older. The Pfizer vaccine continues to have emergency approval for those ages 12 through 15. The third-dose booster shot has also gained emergency approval for certain immunocompromised people and can be received by those who qualify at Public Health.
The general public has not been cleared yet for the booster shot, but plans for the third jab have been outlined
The FDA is still in the approval process for the third dose of the mRNA vaccines from Pfizer and Moderna. President Joe Biden’s administration has announced plans for the booster shot to be made available to the public this fall, likely to be received eight months after the person received their second dose — or even sooner — pending FDA approval and an OK from the ACIP.
Those shots could roll out nationally as soon as the week of Sept. 20. That timeline would make eligible many of those who were among the first to receive vaccines when they began rolling out last December. McGowan said that Public Health is still unsure what the logistics will be and does not have a timeline in place for when those shots could become available in Campbell County.
As for the other vaccines available in the U.S., Moderna already requested full approval from the FDA and Johnson & Johnson has shared plans to apply for full approval later this year.
In recent weeks, McGowan has filled vaccination appointments for a combination of people either feeling more comfortable receiving the shot now that it’s fully approved or those who are seeking extra protection with the increase in community cases and hospitalizations lately.
“My sense is that it’s a blend between the two,” she said.
Although the logistical plan for receiving booster shots remains unclear, McGowan said Public Health has not had an issue receiving additional vaccine when needed.
“As far as supplies go, there aren’t any concerns in the supply chain for vaccines right now,” she said.
Ordering and managing the right vaccine supply is both “art and science” she added, in regard to gauging public demand while also not over doing it to either waste or sit on unneeded vaccine.
“I would reiterate that the research is really clear,” McGowan said. “The vaccines, they are safe and they’re effective at reducing transmission and reducing complications of the disease if the person were to become infected even after being vaccinated.”
Public Health encourages anyone with questions about the vaccine to call its office at 307-682-7275. Appointments are available in its office on Mondays, Tuesdays and Fridays.
With the recent surge in cases, Public Health has been busy with its drive-thru testing appointments and expects that to continue. Campbell County remains one of the least vaccinated counties in one of the least vaccinated states.
“As the weather starts to cool and people start gathering indoors, if we still have low vaccination rates and high community transmission rates, it is well within the realm of possibility that we will see another fall like we did in 2020,” McGowan said.