'Off to a good start'

A little over a year after Castle Rock Hospital District took over a unified ambulance service for Sweetwater County, leaders from Castle Rock had a positive report for the Sweetwater County Board of County Commissioners. 

Castle Rock CEO Bailie Dockter, CFO Todd Toolson, and new Ambulance Director Kim White gave a quarterly update on the ambulance service during Tuesday's commissioner meeting. 

"So far for the ambulance service things have been going about as expected," Dockter said.

She explained that one of the current areas of focus is controlling expenses, especially since ambulance service revenue can be somewhat random and unpredictable. The ambulance is also focusing on recruiting, with Dockter admitting that the service is shorthanded but "always looking for good help" and working on creative ways to recruit. 

Castle Rock is also working on furthering the training of current employees. Three staff members were recently promoted after getting their intermediate licenses, according to Dockter. She explained that they will work with other intermediates to transfer into the role, but will ultimately be able to provide more advanced care. 

A change in staff at Castle Rock came with the start of new Ambulance Service Director Kim White at the end of October. Dockter explained that White previously served as the Director for Emergency Services and Behavioral Health at Memorial Hospital of Sweetwater County and was the Incident Command Coordinator at the hospital during the COVID-19 pandemic. 

"We're really happy that she's come on with us," Dockter said. 

White also expressed her excitement over joining the Castle Rock team. She explained that she's been a nurse for 28 years, has served in a variety of leadership positions, and grew up in Green River and has lots of family in town. White said she has learned since joining the ambulance team at Castle Rock that "they're all very dedicated to the community and patient care." 

Some of the things White wants to continue working on include having more training and education and making sure that the service has needed supplies and "enough staff to take care of the community." She's also looking forward to working with the trauma coordinator at the hospital and using her past experience of working with the county and local leaders and organizations to make sure that everyone is working on the same page. 

Castle Rock CFO Todd Toolson also spoke to the commissioners to give an update on the financial side of the ambulance service. 

"I'm pleased to report that we're off to a good start this fiscal year," he said. "We're on pace to be profitable, with the help of the county subsidy, somewhere between $50,000 to $300,000 this fiscal year." 

He acknowledged that the estimate is a wide range, but noted that there's still "a long ways to go," and in the future Castle Rock will be able to adjust the contract with the county and decrease their subsidy once they see profit amounts. 

"Revenue-wise we're doing better than expected," Toolson said. 

The ambulance service has been busier than expected with both 911 calls and transfers, according to Toolson. While this leads to increased revenue, the downside is it has also led to increased hours and some struggles with overtime. Due to this the ambulance service is doing somewhat worse than expected with wages, Toolson said, and the biggest financial concern comes with managing staff. However, he noted that substantial overtime has dissipated somewhat, and that finances have already improved since White came on board as director. 

"We're confident in what we're doing, and we think financially it's going to be a successful year for us and for the county together," Toolson said. 

Commissioner Taylor Jones asked Toolson for clarification on certain budget items for the quarter, including  $6,800 spent on employee relations, $68,000 spent on contract services, and the category of overhead expenses. 

Toolson explained that the employee relations category includes things like meals and parties for employees, and noted that the expenses were over budget for one month but under budget when putting all the months together. He said that the contract services expenses were almost all legal expenses from the period when employees discussed unionizing and Castle Rock worked with legal representatives from around the nation to show that the district is "statutorily exempt." The overhead expenses category, according to Toolson, is a "big bucket" that includes expenses connected to finances, payroll, HR, marketing, administration, housekeeping, maintenance, and more. 

Commission Chairman Keaton West also asked for more details on contract adjustments, and Toolson explained that many of those come from ambulance service write-offs for expenses not covered by patients' insurances. Commissioner Robb Slaughter questioned why the contract adjustments were 220% more than what Castle Rock initially anticipated. Toolson explained that Castle Rock based their estimates on trends in Green River, and later realized the differences with Rock Springs, such as an increase in the amount of "self pay" patients who don't have insurance and typically do not pay the ambulance for service. He said he believes the percentages will "settle down" as the service continues and there is more data to use to make estimates. 

Commissioner Mary Thoman asked about a regionalization grant that Castle Rock is applying for. Dockter said they've been working with the state budget committee and submitting more information to get the grant, which can't be used for building a facility or ambulance bay but could be used for purchasing and replacing ambulances.

She explained that Castle Rock has three staffed ambulances and seven physical vehicles, and that they would expect to use the grant to replace some vehicles and "remount" some, which is a cheaper option that involves putting the "box" of the ambulance on a new vehicle base. 

When it comes to the ongoing discussion of building a new facility or ambulance bay in Rock Springs, Dockter noted that a piece of land next to Sweetwater Memorial that had previously been considered is now being looked at for a different purpose by the hospital. She added that the Castle Rock Board is considering other options, including the possibility of purchasing land to build on. 

Another issue that had previously been discussed was Castle Rock's mutual aid agreement with Daggett County, which Commissioner Island Richards asked for an update on. Dockter explained that Castle Rock visited with the state about designating a mile marker closer to McKinnon for the Daggett County ambulance to cover, but found that it can be complicated to designate different service areas, especially between different states. The current system in place involves dispatch calling both Castle Rock and Daggett County and Castle Rock giving approval for Daggett County to respond to calls, with the understanding that Castle Rock can meet them halfway to transfer a patient if necessary. Dockter added that she has confidence patients are being responded to quickly. 

On the subject of response time, Commissioner Richards also brought up a letter the county received complaining that an ambulance never showed up to a 911 call. White explained that in that particular instance, one ambulance was taking a transport to Utah, another ambulance was transporting a patient for AirMed, and the third ambulance was on another 911 call. White received a call from a supervisor asking if she could respond, which she planned to do, but she was in Green River and the call was in Rock Springs. By the time she was ready to go, the 911 call had been canceled, she said. 

Richards asked how common it is for ambulances to be out of service for 911 calls because they are being used for transports. Dockter acknowledged that the three staffed ambulances are used for transports, which would take an ambulance out of 911 service when it's being used for a transport. Dockter also said they are very aware that they don't want to delay 911 calls, and wouldn't make choices that the data wasn't supporting. 

"Based off of all the data that we're seeing coming from our number of responses, three ambulances is enough," Dockter said. "Not to say that there aren't exceptions, and we would need to call in a fourth," she added.  

Commissioner Thoman, Commissioner Slaughter, and Chairman West also requested that Castle Rock give more comprehensive quarterly reports in the future, including giving more details on ambulance service statistics. 

Chairman West acknowledged that the commissioners had previously said they didn't feel it was their place to micromanage Castle Rock, and that they felt issues like complaints should be directed to Castle Rock's board and staff. However, he added that the county has a vested interest in the ambulance service.

"I don't want to feel like we're just the checkbook," West said. "The more information we have, I think, would be better for us to understand what you're doing and what improvements have been made so that we can be a good partner."