Letter to the editor

In response to the opinion letter published in the Ekalaka Eagle on January 22, 2021 signed by Ryan Tooke, CEO of Dahl Memorial Hospital; Dale Diede, PA; Carla Dowdy PA; Alexandra Loudermilk, NP; and Darryl Espeland, DO, the Board of Carter County Commissioners submit the following facts:

First, the community needs to know that the Carter County Commissioners intend to continue to work with the Hospital Board to provide ongoing public health services to the citizens of Carter County.

Second, this letter is a response to the coercive nature of the resignations, the letter, and the untimely refusal to provide Covid vaccinations to the public that were meant to force the Commissioners into spending hundreds of thousands of dollars of additional taxpayer money to develop a state-of-the art public health care system that is utilized by Missoula County for a population that is nearly 100 times the size of Carter County and a county budget that is in excess of $150 million. That coercion was an act of gamesmanship that threatens the health and safety of the residents of this County.

Third, at the beginning of the Covid pandemic in Carter County, Carter County public health officials consisted of a county-paid full-time County Health Nurse who was receiving a salary and benefits in excess of $90,000/year and a County Health Officer, Diede, who received $1,500/month retroactive pay to March 2020 in addition to the salary that he was already receiving from Dahl Memorial. The nurse and officer positions were two County positions created by Montana law and paid for by the County.

Fourth, the County Health Nurse resigned from her position in July, 2020, prior to Covid reaching Carter County, and the County immediately began to advertise to fill that position at a time when every health care facility in the nation was suffering from a shortage of nurses.

Fifth, the County Commissioners and County Board of Health repeatedly inquired of Diede what additional assistance he needed to perform his duties as County Health Officer. When he requested additional assistance to conduct Covid contract tracing in early November, 2020, the County began contracting those services to independent contractors. Short of throwing our citizens in jail for violating isolation and quarantine orders and closing the schools, the County Board of Health regularly followed the recommendations of the Public Health Officer.

Sixth, on December 17, 2020 Diede resigned from his County-paid position as County Public Health Officer for which he served for about the last 20 years when public health primarily concerned sanitation, rabies, and an occasional case of an STD. Dowdy and Loudermilk, also removed themselves from any public health duties although they were never given duties by the County, but, apparently, worked to assist Diede. Dahl Memorial was reimbursed for Dowdy’s and Loudermilk’s time with Covid money sent to Carter County’s Health Department from the State.

Seventh, Diede, Loudermilk, and Dowdy, with the apparent support of the hospital CEO, provided the County with two weeks’ notice of their intent to stop providing public health services to Carter County residents, including but not limited to Covid testing and Covid vaccinations beyond the 1A stage. To be clear, AFTER the onslaught of Covid testing, isolation orders, quarantine orders, and contact tracing, and immediately PRIOR to the general public receiving Covid shots, Diede, Loudermilk, Dowdy, and Tooke notified Carter County of their intention to stop providing public health services to citizens of Carter County. Later, Tooke provided the County with notice of their intention to cease providing public vaccinations via the VFC program.

Eighth, prior to her resignation, it is true that the County Health Nurse was housed “under the roof of Dahl Memorial” as claimed in the letter - a roof which is OWNED BY THE RESIDENTS OF Carter County and is rented to the non-profit corporation of Dahl Memorial Healthcare for $1/year. This is pursuant to a lease signed in 2017 that requires Dahl Memorial Healthcare to provide space in the county-owned hospital for a public health office. In the past, prior county health nurses, some of whom were active nurses and some of whom were retired, were hired by the county and paid by the county. They were also housed in the county-owned hospital facility. After Diede’s resignation in December, 2020, Dahl Memorial Healthcare, without notice or approval of the County Commissioners and contrary to the lease, converted the County Health Office into a visitation center.

To be clear, the citizens of Carter County own the old hospital building, they own the new $16.5 plus million hospital, they own the ambulance used to transport patients in Carter County and the building it is housed in, and they own the residence that is occupied by travelling nurses, all of which were provided to Dahl Memorial Healthcare for free (or for a couple of dollars) with the belief that Dahl Memorial Healthcare was and continues to be a community partner with the County in providing health care services to all the people of Carter County, not just those with insurance.

Ninth, with the support of the Carter County Commissioners, the citizens of this County passed a mill levy that generates $260,000 / year to support Dahl Memorial Health, a non-profit corporation. Over the years, the County has provided tens of thousands of dollars-worth of additional grants, gifts, and loan waivers to Dahl Memorial Healthcare in support of its mission which, if you believe the letter’s authors, no longer feels a desire to remain a community partner in providing those same residents with public health services. The Commissioners believe that position may be the position of the signers but is not the position of the Hospital Board.

So, in light of the new $16.5 plus million-dollar hospital, the $260,000 a year public mill levy, $100,000 in grants and taxes to pay for a County Health Nurse, tens of thousands of dollars-worth of County taxpayer loans historically written off for Dahl Memorial Healthcare, the free ambulance and maintenance for the ambulance, and Covid money passed through to Dahl Memorial Healthcare, the County Commissioners are unsure how this community could bear the burden of “allocating more funds or resources to increase the public health department’s reach into the community” as demanded in the letter. The County Commissioners and all the citizens of Carter County have given generously of their money, time, and effort to sustain our local hospital over these many years. That is what community partners do. They help one another in times of crisis for the protection of the community.

Tenth, during this Covid epidemic, Dahl Memorial received some $1.6 million in Covid Funding, a million of which, the County was informed, was deposited in a hospital foundation and $500,000 of which was deposited in the Bank of Baker. The County remains curious if the $1.6 million in Covid funding received by Dahl Memorial Hospital may have been spent in a manner to assist in providing better Covid-related services to the citizens of the County, instead.

Eleventh, Dale Diede served as this County’s Public Health Officer for somewhere around twenty years and was responsible for developing services, protocols, and procedures relating to public health. With the assistance of the prior County Health Nurse, the County updated and passed hundreds of pages of “Annexes” which govern the County’s isolation and quarantine protocols; isolation and quarantine response plans; specimen handling, packaging, and transport plans; non-pharmaceutical interventions; pandemic influenza plans; pandemic flu plans; foodborne illness outbreak investigation operating procedures; protocols governing handling of food-borne or water-borne illnesses; and multiple continuity of operations plans. Most of these plans and protocols were created in 2010 and were periodically updated through 2020, and all of these plans were submitted for review and passage by the Commissioners. In addition to developing the above-noted Annexes, the County Health Nurses engaged in education programs for the schools, in DES planning for emergencies, and in-home patient services. For this, the County Health Nurse position was supplemented by multiple state and private grants as well as public taxpayer money which were entirely independent from Dahl Memorial Healthcare. To say that the Carter County was prepared for Covid any less than any other community in Montana is ridiculous. To say that the public health department was defined by vaccines for children is simply not accurate.

Twelfth, the letter submitted to the Eagle was but one more coercive act to force the Carter County Commissioners and Health Board to create an upscale state-of-the art public health program designed after Missoula’s system that involves the County hiring and funding an infectious disease expert as a Public Health Director/Health Officer, a support staffer, a full-time county health nurse, and other associated expenses at a possible cost of in excess of $300,000 to the people of this County. The resignation and published letter came after the County properly advertised the positions and allowed for sufficient time to interview and vet applicants. So, in response to the citizens of Carter County and the Carter County Commissioners’ historical efforts to support, prop-up, assist, and work with Dahl Memorial Healthcare, the CEO and co-signatories are now refusing to provide any additional public health services even in conjunction with Carter County. It’s one thing to stop providing necessary medical care to your fellow citizens in the middle of a pandemic. It’s another thing, entirely, to then attempt to force a hold up those same citizens for even more taxpayer money to pay for medical services in the County. We understand this position is not the position of the Hospital Board.

Thirteenth, the County Commissioners have made every attempt to hire a County Health Nurse since July 2020 at a time when just about every county and every facility is trying to hire a nurse. As of January 22, 2021, Carter County hired Patricia Loughlin who grew up in Carter County and who has served regional hospitals as a registered nurse for 29 years as our new Carter County Health Nurse. We are excited to have Trish as our County Health Nurse, and we are looking forward to working with her to provide county health services to the citizens of the County, including services that have not been provided in the past.

In addition, we wish to publicly thank the Fallon County Commissioners and Mindi Murnion, the Public Health Specialist, and the staff at Fallon County Public Health, for agreeing to provide 1B Covid vaccinations to Carter County Citizens who can travel to Baker. We will work to provide additional Covid vaccinations to Carter County Citizens within the County in the future.

Finally, the County Commissioners are looking forward to developing a County health program and support the staff of that program with the resources that are available within the bounds of what is financially reasonable and practical for the citizens of this County. We believe these services will be put into place soon, and we believe these services should be available to all citizens of Carter County regardless of whether they carry private insurance or not.

Signed this 25 day of January, 2021

/S/ Steve Rosencranz, Carter County Commissioner

/S/ Rod Tauck, Carter County Commissioner

/S/ Mike Watkins, Carter County Commissioner