Letter to the editor

This letter comes from the need for us to speak the truth about the issues surrounding public health in Carter County and the impact this has on our community.

Historically, Dahl Memorial Healthcare Association has been synonymous with public health. The public health nurse has been under the roof of Dahl Memorial for decades and often the job has been taken on by a Dahl Memorial employed nurse contracting with the county to carry out public health duties. But let us be clear; Carter County Public Health is, and has always been, the responsibility of the county.

The public health department in this county has been defined by reduced cost or free vaccines for children. That is as far as the public health department has been developed. However, this is by no means what a public health department should be providing its community members, even in rural Montana. There has been a lack of education and initiative from the county to establish a robust public health department. A department should be its own entity, but be able to work side by side with the local medical providers to provide the unique services that the county’s residents need. This issue has been brought to the county commissioner’s attention on several different occasions prior to the COVID-19 pandemic and no action was taken to allocate more funds or resources to increase the public health department’s reach into the community.

We, along with just about every other rural public health department, were vastly underprepared for the pandemic that struck our nation one year ago, and more specifically our community 4 months ago. With the public health nurse having resigned, we had one person with a paid title in the public health arena. Dale Diede PA-C was tasked with handling the entire situation by himself. He was in charge of developing protocols and procedures for how the county should handle the COVID-19 outbreak. This included establishing free testing, contact tracing, quarantine and isolation guidelines, and enforcement of those guidelines. This is not a one-person job! Even in counties smaller than ours, they have 3-4 people working together to handle those tasks and those people certainly aren’t the medical providers. When he asked for support for his decisions from law enforcement and the county commissioners, he did not receive it. Quite the opposite actually. The two other medical providers at Dahl Memorial stepped in to help because one person simply cannot keep up with the amount of time and energy it takes to do the public health job under normal circumstances. During a pandemic, it’s impossible.

One month into the pandemic hitting our community, Dahl Memorial discussed with the county commissioners and the public health board its concerns that the current model of Dahl Memorial assuming all of the duties of public health including testing, sending tests to the state, arranging transportation for the samples, contact tracing, follow up phone calls, etc. was not sustainable. We asked, at the October 2020 meeting, for the county to attempt to create a public health department and to separate Dahl Memorial’s responsibility from that department. No action was taken. At the November 2020 meeting, all the medical providers attended the public health board meeting and once again expressed concern that our medical practices were significantly struggling based on our inability to keep up with both the medical practice and the public health obligations that had been put on our shoulders. We were tasked with creating a solution.

Two weeks later, the county commissioners and the public health board were given options in the form of a qualified individual that has vast amount of experience in the field of public health. This same individual had already researched Carter County and developed a proposal on how to start and evolve an adequate public health department that focused on this community’s unique needs; including, but not exclusively, COVID-19 guidelines.

There was no action by the public health board or commissioners. In fact, it was tabled until January 2021. It was at this time that Dale Diede PA-C chose to resign as the public health officer with the full support of the other medical providers so that medical care to the community could be our primary focus. Dahl Memorial Healthcare established that it would no longer assume the responsibilities of public health in any capacity. The commissioners and Carter County Public Health board were given two weeks’ notice and we provided services until the end of 2020. This was one month from the time we initially presented them with options to alleviate the problem. As of December 31, 2020, Dahl Memorial and its medical providers chose to separate completely from the county run public health department due to a lack of support, effort, and education on behalf of those elected to do this job. This simply is not the responsibility of Dahl Memorial to provide quality medical care AND to assume all the duties of public health.

While we completely understand that this pandemic has thrust the need for public health into the spotlight and that those elected to serve this county were given the job of securing an efficient and qualified public health department during uncertain times, they were not alone in discussions or in attempting to remedy the situation. Dahl Memorial staff took on the entire burden of public health during this pandemic without so much as a small effort toward assisting with the tasks or coming up with a solution by those whose elected positions mandates that they run the public health department. Instead, we were told that it was our responsibility to find a solution and when we did, they failed to take any definitive action.

Please understand that Dahl Memorial did not make the decision to resign lightly. This greatly affects the community, and we are aware of this hardship. However, our job is to serve the community at the medical facility and we simply cannot assume the full-time job of public health without compromising our primary duties. Please place your concerns where they belong; with the elected officials that you voted into office. They took an oath to serve you and it is their job to do so.

As always, we are here to serve the community for your medical needs.

Dahl Memorial will be offering COVID-19 rapid testing as part of a clinic visit if it is deemed necessary. This is not a free test and will be billed through your insurance.

We will be doing routine vaccinations for children and adults, but not as a part of public health through the state. This means that the vaccines will be billed through insurance but may not be covered. Please contact your insurance company for questions on this issue. You may also contact Fallon County Public Health (406) 778-2824 and inquire about their reduced cost or free vaccine program.

If you did not receive your first COVID-19 vaccine, we will not be administering further COVID-19 vaccinations unless arranged by Fallon County Public Health (406) 778-2824. Please contact them with further questions or concerns.

If you did get the first vaccine, you will be contacted to receive the second at Dahl Memorial.

Sincerely,

Dale Diede PA-C

Carla Dowdy PA-C

Alexandra Loudermilk, NP

Darryl Espeland, DO Medical Director Dahl Memorial Healthcare Association

Ryan Tooke, CEO Dahl Memorial Healthcare Association