To say things are hectic for the Sublette County Hospital District is an understatement. 

The district is just months out from opening a brand-new hospital in Pinedale, and the list of tasks is daunting, district board chair Tonia Hoffman said. For starters: ensure construction is complete, onboard doctors, move long-term-care residents, set up payment and billing systems, install furniture, hire nurses.

“We’re kind of deep in the throes of trying to get everything ready to go,” Hoffman said. 

Amid the myriad tasks involved in opening the county’s first hospital by July 1, it wasn’t exactly welcome news to discover a new state law will impose a significant cut in property taxes, she said. The district earns revenue from a mill levy, which pulls from those taxes. The mill levy equated to $12.4 million in 2022-2023 for the hospital district.

Senate File 69, “Homeowner property tax exemption,” will apply a 25% exemption on the first $1 million of a single-family home’s fair market value, which will translate into a smaller pool of funds for the Sublette County Hospital District to draw from. The district is far from alone. 

“It will have an unfortunate effect, I think, on every small rural hospital in the state,” Hoffman said. 

Wyoming’s 15 hospital districts, along with hundreds of other special districts and local governments that get revenue from a portion of property taxes, are now confronting funding cuts. These districts include services for cemeteries, housing authorities, irrigation, recreation, fire protection and rural health. 

Though exact numbers won’t be clear until properties are reassessed — an annual task typically finalized in June — districts expect some hard choices as they determine how to stretch shrinking funds. With rural health care providers already facing steep challenges, some say, the cuts could topple a precarious fiscal balancing act.

In Pinedale, Hoffman said, the hospital district is relatively insulated by its mix of funding sources. But in combination with other recent and potential changes aimed at taxes, she said, the overall effects are concerning.

“We’ve [already] been preparing for months on where we can cut, and where we can save,” she said. 

Taxpayer relief squeezes districts 

In response to sharply rising home values in several counties and correlated spikes in tax bills, Wyoming lawmakers passed five homeowner relief bills in 2024. Gov. Mark Gordon approved all but one. 

In 2025, lawmakers brought another round of property-tax relief measures to the Legislature, with many noting that property tax burden was the loudest voter concern they heard. Bills included Senate File 69, which originally proposed to apply a 50% exemption on the first $1 million of assessed value for single-family homes for the next two years.

Dozens of special district representatives, including first responders, urged lawmakers to reconsider given the drastic service cuts the measure would require due to millions of dollars in lost revenue. They argued that many taxpayers don’t realize property taxes don’t fund state government, but instead pay for local services like senior centers and law enforcement. 

Special districts do this through voter-approved mill levies, which are tax rates applied to the assessed value of a property. One mill is equal to one dollar per $1,000 of assessed value. Depending on the district, the aggregate of an assessment of 1 or 2 mills could generate enough funds to help support annual operations. 

Legislators tussled over Senate File 69 at great length, debating the level of cuts and whether the state should offer relief to communities by backfilling the lost revenues. In the end, they agreed to the 25% cut with no backfill. Gordon signed that bill into law March 4. 

“This act, coupled with the bills I signed last year, responds to the call for property tax relief,” Gordon said in a news release. “Now the practical impacts of this legislation will need to be navigated by our cities, counties, special districts and citizens.”

Rural health care fragility

Wyoming hospitals are already in precarious positions, Wyoming Hospital Association Vice President Josh Hannes said, due to the challenges of operating rural health care facilities. Low patient volumes, administrative burdens from insurance companies, high rates of uninsured patients, rising labor costs and increasing prescription drug prices create a difficult landscape for financial sustainability, he said. 

Senate File 69 further jeopardizes the state’s health care network, said Hannes, who lobbied against the bill during the session. While the measure may seem like a win for property owners, Hannes wrote in a February op-ed, “the reality is such an exemption would have devastating consequences for Wyoming communities.”

Mill levies fund critical services and facility upgrades for the state’s 15 special hospital districts, supporting not just hospitals but also senior living facilities, he noted. 

Cutting property taxes “could force many of these already vulnerable institutions to make painful cuts, potentially reducing essential healthcare services in rural areas where access is already limited,” Hannes wrote.

Wyoming has eight hospitals “at risk of closing,” according to a recent Center for Healthcare Quality and Payment Reform report. 

Hannes was not sure how the report qualified “at risk” but said every one of Wyoming’s 19 “Critical Access Hospitals” — small, rural hospitals with 25 or fewer beds located at least 35 miles from another hospital — operated at a loss in 2023. 

“I think it’s fair to say all of our hospitals are at risk,” he told WyoFile. 

Of Wyoming’s 15 hospital districts, Hannes said, 12 districts operate those “Critical Access Hospitals.”

“When you take 25% of the residential tax revenue away from those, that’s going to be an issue,” he said. The challenge will be widespread. 

“Every other governmental entity that receives that revenue is going to have to make some pretty tough decisions about what portions of their services could they maintain,” Hannes said. 

Austerity planning? 

Reserves and other financial streams will factor into how hospital districts will deal with cuts.

The Teton County Hospital District was established in 1976 to oversee St. John’s Health in Jackson. The district is authorized to levy up to 6 mills annually but has levied 3 since the district’s creation. That equated to roughly $12.3 million in 2024, according to county records. 

Like Hoffman, St. John’s Chief Communications Officer Karen Connelly noted the convergence of national, local and state headwinds “challenging the sustainability” of Wyoming medical centers like St. John’s. 

“Senate File 69 is one,” Connelly told WyoFile in an email. Others, she said, include pressure on workforce wages due to the high cost of living in Teton County and the shift in payer mix toward Medicare due to an aging population, which affects reimbursement rates. 

“For context, the annual mill levy support has roughly equaled the cost of unreimbursed care we provided our patients,” Connelly continued. “A reduction in that support, along with the other challenges I’ve noted, will require us to reduce costs where we can and evaluate our services and programs in order to remain sustainable.” 

The hospital district is just beginning to develop its budget for the next fiscal year, which begins July 1. “The budget we develop … will account for an expected reduction in mill levy funds as well as the other challenges I described,” Connelly wrote. 

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Albany County Hospital District operates Ivinson Memorial Hospital in Laramie, which has served the community for nearly a century. The district levies 3 mills on county voters, which amounted to $2.2 million during the last fiscal year, Ivinson Memorial Hospital CEO Doug Faus said. The amount has been growing steadily for about a decade, he added. Because the hospital has produced a profit in recent years and has employed careful fiscal management, he said, “we’ve been able to put money in the bank and save it, you know, for things like this.”

The hospital uses the mill levy funds for charity care, he added. “So any citizen in our county who doesn’t have the ability to pay, that’s what that money is used for.”

And while Faus doesn’t see the property tax cuts forcing any major service cuts at Ivinson, he is also keeping a close eye on the swirl of health care changes on the horizon, including federal efforts to cut Medicaid and Medicare. 

“We save money for a rainy day because we know the rainy day is coming — and it looks like the clouds are forming,” Faus said. 

Budgeting surprises

In Pinedale, where the hospital district has worked for years to reach the construction stage, the path has already been littered with challenges.

The Sublette County Hospital District operates clinics in Pinedale and the Big Piney/Marbleton area, but the county is the only one in Wyoming without a hospital. The district in 2020 asked voters to increase the mill levy with the express intent to create a new district to build a hospital, and the measure passed by a large margin. That levy was $4.8 million in 2021/22, and jumped more than 150% to over $12 million the following year, according to the district’s annual report. 

The vision is a 10-bed, 40,000-square-foot hospital, with a similarly sized attached long-term care facility. It’s an ambitious project, however, and has relied on the levy along with private donations and other county contributions. 

Hoffman, too, cited other recent changes, such as a 2022 deferred repayment plan that allows mineral companies more time to repay taxes. That means the district based early feasibility studies on funds that aren’t immediately available.

“I think that across the entire state, all of the hospitals are in the same situation, and we’re all going, ‘OK, how do we pivot and figure out how to work against this, or how to maintain our revenues when this is going to be a really challenging time,” she said.

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Less than four months after Evanston Regional Hospital discontinued its labor and delivery services, a Utah medical network has stepped in to patch the maternity care gap in southwestern Wyoming. 

Intermountain Health is now offering pre-pregnancy, prenatal and postpartum maternal health services in Evanston through a program called Maternal Health Connections. 

The program offers a combination of in-person, virtual and home visits, as well as remote patient monitoring, for pregnant people and new mothers. The program can help Evanston-area patients get prenatal and postpartum care without having to risk traveling long distances on Wyoming highways, particularly in dangerous weather conditions. 

“Pregnancy can be a difficult time in a woman’s life, and current economic and geographic challenges do not make it simpler,” Ibrahim Hammad, MD, a maternal fetal medicine physician at Intermountain Health, said in a press release. Hammad oversees the new program. “It’s part of our responsibility as healthcare professionals, to not only provide care and treatment in clinics and hospitals, but also to reach out to our patients in an effort to ease their burden. This program is designed to bring maternal care to the patient.”

The news is a bright spot in a health landscape that has seen services erode in recent history. Along with facility closures, hospitals have struggled to attract and retain sufficient staff and diminishing care puts pregnant people and their babies at risk as they travel longer distances to find services. The trend also poses existential threats to communities, as adequate health care is crucial to attracting young families to rural towns, state leaders say. 

When Evanston’s maternity ward closed in late 2024, it marked the fourth Wyoming facility since 2014 to shutter its labor and delivery unit and expanded a service gap in the southwestern corner of the state. The hospital cited declining demand.  

How it works 

Maternal Health Connections provides access to virtual visits from Intermountain OB-GYN physicians and other providers based in Utah, according to Intermountain Health. For in-person care and assistance, an Intermountain Health registered nurse will staff a Maternal Health Connections clinic in the Uinta Medical Building in Evanston. Clinic appointments are available two days per week.

Video conference equipment in the clinic will allow an OB-GYN physician or midwife based in Utah to consult with a Wyoming patient through telehealth, assisted by the on-site nurse. The program also offers remote patient monitoring devices for participating pregnant moms to take home beginning at 28 weeks. 

“Our mission is to improve maternal and neonatal outcomes in Uinta County and surrounding communities.” Krystal Richards, the grants project director for Maternal Health Connections at Intermountain Health, said in release. “We’re excited to bring a local maternity care option to these Wyoming families.”

Program patients can deliver babies at Intermountain Health hospitals in Park City or Ogden, Utah, and receive postpartum care through the Evanston-based nurse, including home visits.  

A federal Health Resources and Services Administration grant of $3.9 million helped launch the program, according to Intermountain Health. 

Interim work

Wyoming’s maternal care gaps have grown drastic enough to capture the attention of lawmakers, the governor and healthcare representatives.  

Solutions have been elusive. Complicating the issue are provider challenges like low birth volume in rural areas, high costs of medical malpractice insurance, financial viability struggles for hospitals, the impact of new abortion laws on doctors, liability concerns and regulatory barriers to midwives delivering in hospitals.  

Health care advocates have called on the state to expand Medicaid, promote midwifery and build partnerships that could expand care. 

The Legislature’s Joint Labor Committee made Wyoming’s maternity care and child care shortages its No. 1 priority between the 2024 and 2025 legislative session. No bill explicitly aimed at alleviating the care gaps emerged from the committee, however. Attempts to increase funding for maternity care programs failed in budget talks, meanwhile. 

The OB Subcommittee of Gov. Mark Gordon’s Health Task Force also worked to explore solutions. That group narrowed its focus last summer to three areas: how to better use midwives, doulas and family physicians alongside obstetricians in delivery care; exploring creating OB medical fellowships to bolster care in Wyoming and regionalizing the state’s maternity care.

The Legislature’s Management Council voted last week to give committee chairs the discretion to choose off-season priority topics for their panels. The Joint Labor Committee had again proposed maternity care as a No. 1 topic for 2025.

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Four Wyoming birthing facilities have closed over the last dozen years — ending options for mothers to deliver babies in Riverton, Kemmerer, Rawlins and Evanston. With 11 of the state’s 23 counties lacking a practicing OB-GYN as of last year, even accessing prenatal care can be difficult. 

The state’s maternal care gaps have grown impossible to ignore. Yet, a year after lawmakers identified the issue as a matter of top concern, little has been done to address policy or funding concerns.

To be clear, experts say the challenges facing rural maternal care are numerous and complicated — and not something that can be solved with a single solution. Still, attempts to tackle the problem through raising Medicaid reimbursement rates or creating grants to support labor and delivery programs failed in the recent Wyoming Legislature. 

Now, lawmakers appear likely to take the issue up anew. The Joint Labor, Health and Social Services Committee proposed as its top interim study topic “Maternal Medical Care in Wyoming and Maternity Care Deserts.” 

Wyoming Women’s Action Network founder Jen Simon, an advocate for better maternal health services, hopes a second round of lawmaker study will yield action. Legislative debate on the topic, particularly in the Wyoming Senate, illustrated that lawmakers are concerned and thoughtful about the issue, she said. 

“I’m hopeful that that is the tenor and the energy that comes into the interim around this topic, because it’s immensely important in every conceivable way for the future of our state,” Simon said. 

The Legislature’s Management Council meets April 8 to finalize interim topics. 

Where we are 

WyoFile’s 2023 Delivery Desert series revealed significant gaps in maternal care, with families going to extraordinary lengths to deliver babies, doctors spread thin or on the brink of burnout and hospitals juggling the complicated cost formulas in thinking about maintaining labor wards. 

Places like Fremont County have seen annual births plunge following facility closures, while anecdotes of families temporarily relocating to towns like Billings and Salt Lake City at great cost and inconvenience to deliver their babies have increased. A Wyoming Health Department assessment found that nearly half of the state’s counties lacked a practicing OB-GYN in 2024. The State Scorecard on Women’s Health and Reproductive Care ranked Wyoming 42nd that same year. The state placed behind all of its neighbors. 

Solutions have been elusive. Complicating the issue are provider challenges like low birth volume in rural areas, high costs of medical malpractice insurance, financial viability struggles for hospitals, abortion legislation’s impacts on doctors, liability concerns and barriers for midwives to deliver in hospitals.  

However, health care advocates have called on the state to expand Medicaid, promote midwifery and build partnerships that could expand care. 

The Joint Labor Committee made Wyoming’s maternity care shortage its No. 1 interim priority in 2024, along with childcare. However, no bill explicitly aimed at alleviating the care gaps emerged from the committee.

The OB Subcommittee of Gov. Mark Gordon’s Health Task Force also worked to explore solutions. That group narrowed its focus last summer to three areas: how to better utilize midwives, doulas and family physicians alongside obstetricians in delivery care; the possibility of creating OB medical fellowships to bolster care in Wyoming and regionalizing the state’s maternity care.

Meanwhile, care has eroded further. Evanston Regional Hospital discontinued labor and delivery services on Dec. 30, citing declining demand.

Debates and attempts

Maternity care did come up during this year’s legislative session budget talks. 

Gordon included a raise to the Medicaid reimbursement rate for maternity care in his supplemental budget. 

“This is a complicated issue that we continue to evaluate and develop recommendations to address,” Gordon wrote in his budget recommendation. “One thing that we can do today is increase Medicaid rates for our providers to ensure we can help retain the services in Wyoming, as Medicaid births account for approximately one-third of the deliveries in Wyoming.”

As such, Gordon requested about $2.4 million to be added to the Department of Health’s budget — split evenly between state and federal dollars. 

The House Appropriations Committee stripped those funds, the Senate Appropriations Committee restored them, but the supplemental budget wasn’t passed, rendering those actions moot. 

The Senate also debated allocating $18 million to the Health Department to provide grants to support delivery and maternity care.

The current gaps are “unacceptable,” Sen. Chris Rothfuss, D-Laramie, said when introducing his funding amendment. “We don’t have any solutions on the horizon. I was personally hoping there’d be some good opportunities and options through this legislative session, but we just haven’t seen it.”

Given that, Rothfuss said, the grant program would be “effectively a stopgap measure” to prop up the fragile maternity care system until better solutions are reached. 

Sen. Charlie Scott, R-Casper, said that while not in favor of large expenditures, he supported this one.

“You want to destroy a community’s ability to attract new businesses and keep existing businesses that might be mobile?” Scott asked. “Take away their delivery care. Take away their obstetric care. It really puts them behind the eight ball.”

Sen. Gary Crum, R-Laramie, also supported the amendment, pointing out that without a facility in Rawlins, many Carbon County women have to drive 100 miles to Laramie and over Elk Mountain, a notoriously dangerous stretch of Interstate 80. 

“Let me remind you, some of us in this body have given birth,” Cheyenne Republican Sen. Evie Brennan said. “I can tell you 100 miles on one of those [deliveries], I may not have made it to the hospital.”

Brennan noted that while $18 million is significant, “we’re talking about access

for women who are carrying our most valuable resource: our children … Let’s not fight on this one. Let’s put our money where our mouth is and let’s say, ‘these are our most valuable resources.’”

Critics, however, balked at the program’s expense and vagueness. 

“It’s a real issue out there, but it takes a little more contemplation to stand up a program and just throw one-time money at it,” Sen Larry Hicks, R-Baggs, said. “I appreciate the sentiment … but without more details, I can’t support an $18 million appropriation when I don’t know what it does.”

Evanston’s closure is a cautionary tale, Rothfuss said, of the dominoes that can continue to fall while Wyoming lawmakers continue to study the issue. 

He failed to sway the body’s majority, however. The Senate voted it down 11-20.

Political newcomers

The Wyoming Legislature was filled with freshman lawmakers in 2025, noted Micah Richardson, associate director of policy at the Wyoming Women’s Foundation. Getting up to speed on the legislative process is difficult, she said, and could have created a drag on the conversation about maternal health care. 

She lamented the failure of a couple of smaller bills that could have helped move the needle on the issue. House Bill 231, “Medical education funding,” for example, would have expanded medical training and education at the University of Wyoming through a partnership with the University of Utah — potentially boosting provider numbers.  

Richardson also believes that to enact change, Wyoming will likely have to expend funds. 

“There can be some creative solutions or pieces of the puzzle to kind of get us there, but it is also going to take an investment,” Richardson said. “Not just, you know, ‘we say this is important,’ but it’s going to take some money to make sure that these things are given the support they need to be successful.”

Simon of Wyoming Women’s Action Network is encouraged by the Senate debate, hoping it will carry momentum into future lawmaker work.

“At least the senators can say, ‘It’s a priority from our perspective, for our hospitals, our residents, our families, our economy and our future,’” she said.

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Nearly five weeks ago, lawyers representing Wyoming’s abortion providers sought an emergency court hearing to temporarily halt new restrictions that have effectively shut down Wyoming’s only abortion clinic.

That hearing has finally been set for next week. And when it happens, a new judge will oversee matters — the third jurist assigned to the case since it was first filed Feb. 28.

Documents filed last week in Natrona County District Court show the case is now assigned to a judge who retired from the bench last year: Thomas T.C. Campbell. The documents do not indicate a reason for the change, beyond stating that “good cause exists to assign [the case] to another judge to preside over all further proceedings.”

Before his retirement, Campbell had served as a district court judge in Laramie County. He will take over a case that was twice assigned to Natrona County District Judge Dan Forgey and once to Teton County District Judge Melissa Owens.

Opponents of Wyoming’s two recently passed abortion laws filed suit at the end of February in Natrona County District Court. They asked Forgey to pause enforcement of both laws — one instituted more regulations on clinics and the second mandated ultrasounds and a 48-hour waiting period — while the lawsuit proceeds.

Plaintiffs sought an emergency hearing and temporary restraining order, saying the more onerous regulations that came with requiring abortion clinics to be licensed as ambulatory surgical centers forced the state’s lone facility — Wellspring Health Access in Casper — to stop offering services. In the first five business days after the law went into effect, the clinic said it referred 56 patients to other facilities for abortion-related care.

The plaintiffs say Forgey did not respond to their emergency request in a timely manner, prompting them to refile a nearly identical case in Teton County. While Natrona County is home to Wellspring, patients in Teton County use the clinic’s services, but have been turned away since the new laws went into effect, according to a lawyer for the plaintiffs.

When the case moved to Teton County, it landed before Owens, who had presided over a legal challenge by the same group of plaintiffs to a pair of abortion bans passed by the Wyoming Legislature in 2023. Owens in November ruled those bans violated the state constitution, and that case is now before the Wyoming Supreme Court.

Attorneys for the state, who are tasked with defending the new abortion laws, challenged the move to Teton County, saying it amounted to “forum shopping,” the practice of filing a case with a court that a litigant believes will be more favorable to them. They also said Forgey couldn’t schedule the emergency hearing until he received proof that the defendants had been properly served. 

In a hearing last month, Owens concluded the latest case belongs in Natrona County, where the lone clinic affected by the new laws operates. The plaintiffs quickly refiled the case there, where it was assigned again to Forgey on March 24, court records show. The following day, Wyoming Supreme Court Chief Justice Kate Fox requested the case be assigned to Campbell. That request did not explain the reassignment or why an outside judge was needed. Beside Forgey, three other district judges serve in Natrona County.

A hearing on whether to pause enforcement of the new abortion laws is now set for April 8 at the state courthouse in downtown Casper. Lawyers for the abortion providers say those laws — like the bans passed in 2023 — violate Wyomingites’ constitutional right to make their own health care decisions.

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Wyoming doctors and abortion providers seeking to stop two new anti-abortion laws from going into effect refiled their case in a Natrona County court this week after being dismissed by a Teton County judge.

The state’s only abortion clinic, Wellspring, in Casper, has not taken in new patients since Gov. Mark Gordon signed one of the two bills into law last month, according to court filings. That law requires Wellspring to be licensed as an ambulatory surgical center — health care facilities that perform surgeries but are not hospitals. The classification comes with Department of Health inspections and rules and regulations, such as building codes. Critics see the law as carefully crafted to force Wellspring’s closure. 

Wellspring’s lawsuit, in which it is joined by doctors, nurses and a fund that helps Wyoming women access abortion health care, has bounced between courts since Gordon signed that bill. 

A judge has yet to issue a ruling on whether to block the new laws from taking effect pending judicial review, and so the clinic has remained closed to Wyoming women seeking in-clinic abortions. According to the plaintiffs’ court filings, Wellspring referred 56 women to providers out of state in the first five days of the closure. 

Plaintiffs first filed their case in Natrona County on Feb. 27, the day Gordon signed the clinic restrictions into law. But, after five business days passed without a response to their request for an emergency hearing in Natrona County, the plaintiffs pulled the case from that court, according to an attorney for the plaintiff doctors.

Plaintiffs then filed the lawsuit in Teton County, where 9th District Court Judge Melissa Owens in 2024 ruled against two total bans on abortion that the Wyoming Legislature had passed previously. Those bans are now in front of the Wyoming Supreme Court, but the Legislature has continued passing new regulations to block access to abortions and drive Wellspring out of the state. 

The second new law Wellspring and its co-plaintiffs are challenging in this year’s lawsuit requires a transvaginal ultrasound and then a 48-hour wait before someone can receive abortion pills in the state. There is no medical reason for that ultrasound, opponents of the law say, which is designed to discourage women from seeking abortions.

Gordon vetoed that bill, but the Legislature voted to override his rejection and it became law. 

Lawmakers behind the bills argue they are trying to keep women safe, though Wyoming Speaker of the House Chip Nieman has said that he hopes the ultrasound bill, at least, gets women to rethink their abortions.

Shifting the newest lawsuit to Owens’ courtroom drew accusations of “forum shopping” by state Senior Attorney General John Woykovsky, who is representing the state in its defense of the Legislature’s handiwork. But if quicker action from a friendlier judge was the plaintiffs’ goal, the strategy did not work.

On Friday, Owens threw the case out of her court and told the plaintiffs that Natrona County was the proper venue. She made the ruling from the bench after a 90-minute hearing in which Woykovsky argued that Natrona County District Judge Dan Forgey had not received proper proof the defendants had been served in the case.

That same day, plaintiffs filed their case again in Natrona County and are awaiting a response from Forgey, according to court filings WyoFile reviewed Tuesday. The civil complaint seeking an injunction is itself unchanged. All of the defendants have been served and acknowledged receiving notice of the case. On Monday, plaintiffs again asked for a scheduling conference to put an emergency hearing on Forgey’s calendar.

“The harm that will be endured by [the state] by issuance of the injunction, (if any), are far outweighed by the irreparable harms plaintiffs will continue to suffer,” under the new laws, John Robinson, the plaintiff’s lead attorney, wrote in a March 21 filing with Natrona County. 

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The same Teton County judge who tossed Wyoming’s two abortion bans last year dismissed on Friday a separate lawsuit filed in Jackson that sought to block two new Wyoming abortion laws, saying the case belonged in Natrona County, home to the affected Wellspring Health Access clinic.

Ruling from the bench after a hearing that lasted more than 90 minutes, 9th District Judge Melissa Owens said that “any injury that occurred, occurred in Natrona County.” The ruling means that Wyoming women who have not had access to abortion services since the de facto ban went into effect Feb. 28 will have to wait until the case is presumably refiled and then considered by a different judge.

In the five days after one law went into effect, Wellspring referred 56 patients to other clinics for abortion-related services, almost all of them out of state, according to court papers.

Two doctors, two abortion care providers and an individual woman filed a nearly identical suit in Natrona County when one of the new laws went into effect, challenging its constitutionality. That law imposes a series of new regulations on abortion clinics by mandating they be licensed as “ambulatory surgical centers.” A second, which went into effect days later, requires abortion patients to undergo a transvaginal ultrasound and a 48-hour waiting period before receiving abortion medications.

The plaintiffs sought emergency court action on requests for a temporary restraining order and an injunction. But when a Natrona County judge did not respond to their emergency request in what they perceived as a timely manner, they dismissed their case there and filed the carbon-copy action in Teton County.

“We could not get any type of response” 12 days after filing the action, five business days after the last communication from the court, said Marci Bramlet, an attorney representing the plaintiff doctors. One of her clients, Dr. Giovannina Anthony, has an OBGYN clinic in Jackson and refers clients to Wellspring, the only clinic in the state that provides procedural abortions.

Wellspring has ceased offering those services because of the new laws and has turned away at least three clients from Teton County, Bramlet said. She rejected an argument by state Senior Attorney General John Woykovsky that the group was “forum shopping.”

In November, Owens decided two other anti-abortion law challenges — those involved outright bans — in favor of nearly the same suite of plaintiffs.

The Teton County filing was “not because of what we were hearing,” Bramlet said, but “because we were hearing nothing.” Her clients did not believe their case was being taken seriously and, meantime, “injury is ongoing and could be catastrophic.”

Woykovsky said Natrona County District Judge Dan Forgey couldn’t act until he received proof that required court papers had been served on defendants there. Owens appeared to agree there was no foot-dragging on Forgey’s part, that the doctors had waited only a few days before dismissing one suit and filing the other.

Regardless of Judge Forgey’s timing, Bramlet said her clients had a right to dismiss their action as they saw fit and refile it anywhere in Wyoming, given that the new laws cover the entire state. Although Woykovsky’s court pleading was for a change of venue back to Natrona County, Owens saw it as a request for dismissal and acted thusly.

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In Casper, critics and defenders of the state’s largest hospital have been pushing contrasting narratives about its owner for more than a year. 

One story goes that since Banner Health purchased Wyoming Medical Center in 2020, management has allowed unacceptable slips in the quality of care for patients. The other contends that Banner has provided crucial resources to sustain care through the pandemic and beyond. 

Now, an arbiter will provide what many hope is a clear answer to the question of how well Banner is managing Wyoming Medical Center. Natrona Collective Health Trust — which has oversight of Banner’s contractual compliance — recently retained a third-party consultant to independently monitor Banner Health to determine if it is indeed fulfilling its commitments.

“We applaud the hiring of an outside monitor, this holds promise for the future,” longtime Casper doctor James Anderson told Natrona County Commissioners during a meeting on Banner in early March. Anderson is a member of the group that’s been raising alarms over the hospital’s operation.

The local Banner administration, Anderson added, “finally seems to understand what is needed to provide quality health care in Casper and Wyoming.”

Banner Health executives, who have defended their management, also support the hiring of the health care management consulting firm, PYA. It can clarify in an impartial way a matter that’s been much disputed, CEO Lance Porter told the commission. 

“There’s a lot of opinion on, are we in compliance with post-closing agreements or are we not,” Porter said. “Really what’s lacking is the subject matter expertise. So I really support what’s being done … to find an outside monitor, a subject matter expert.”

“And if we have things we need to improve on, then I am committed to doing that,” Porter said. 

The discussion signified a degree of pacification in a conversation that has been contentious, with critics claiming that while Banner has driven out doctors and created questionable conditions for patients, the bodies tasked with oversight haven’t held its feet to the fire.

New owner, contract stipulations

Banner Health purchased Wyoming Medical Center for roughly $200 million in August 2020. The nonprofit hospital previously operated under a lease agreement with Natrona County, which owned the facility. Banner Health, headquartered in Phoenix, folded the hospital into its network of 33 nonprofit hospitals in six states. 

The Natrona County Commission approved the arrangement, touted by supporters as a way to take advantage of Banner’s resources to create a preeminent facility and reduce the amount of care that leaves the state. Today, Banner Wyoming Medical Center operates two campuses and 14 care clinics.

In the transaction, Banner agreed to comply with contractual stipulations, including providing 24/7 emergency room care and retaining levels of service related to maternity care, trauma care and other essential care. 

But not long after Banner took over, stories began to percolate in the community about service declines, doctors quitting, long waits and poor care. Those experiences spurred a group of concerned citizens to launch a campaign aimed at bringing the level of care back to what they said the community deserves. 

The concerned citizens group formed in 2023 out of a response to stories shared at dinner parties, coffee dates and everyday conversations, said Casper resident Tom Swanson, one of its members. “We learned that the hospital was failing in a number of ways.”

They heard about long wait times, prescriptions not being filled, understaffed departments and an exodus of doctors disrupting continuity of care, he said, along with other troubling incidents. The group worried eroding services would send residents elsewhere, degrading hometown quality and compounding health care challenges.

“A male patient presented in our ER with a ruptured, previously repaired, aortic aneurism the day after Thanksgiving 2023,” the group wrote in an early letter to Banner Wyoming executives and others. “He was sent to Greeley Banner because Banner Health Casper did not have the vascular expertise available here at home. A female patient with a recent oblation procedure at Anschutz, Denver, called to request an appointment with her primary care doctor; she was told the first available appointment was in three months. It wasn’t that way before.”

The citizens brought their concerns to Banner and the Health Trust. Both were slow to respond, they said. They also reached out to the county commission pleading for action. Both the Trust and commission have oversight over whether Banner complies with the 2020 transaction contract stipulations.

Banner administrators defend the facility’s operations under its ownership. Banner’s aim is to be the best hospital in the state and Wyoming’s trusted destination for referrals, CEO Lance Porter told WyoFile in a November interview. 

Because of Banner Health, he said, Wyoming Medical Center has been able to bring on specialized cardiovascular and prostate procedures, invest in new equipment, bulk up its trauma care capabilities and gain approval for a renovation that will entail a new behavioral health unit.

The hospital would not have survived COVID without Banner Health, he said, which provided the crucial staffing resources to handle the load. There was an initial period of transition and rebuilding, he said, and “change is hard.”

Doctors have left, Porter acknowledged. Some didn’t meld well with the integrated health system, others were managed out because Banner didn’t feel they were the best fit. Recruiting has been a challenge, he said, but that is always the case in a rural hospital. At its height, Banner Wyoming had a dozen traveling doctors, or locums, working in the hospital, he said, but that number has since fallen significantly. The hospital has meanwhile continued to garner medical acknowledgements and announce new hires.

There have been mistakes and events that should not have happened, Porter and other executives acknowledged, such as when a patient died in the hospital’s emergency department in view of others in the hospital. They are working to ensure those kinds of incidents don’t repeat.

While the hospital is aware of the concerned citizens’ testimonials and complaints, Porter said, “unfortunately, a lot of this is anecdotal,” rather than backed by data.

The result of the two sides’ arguments was a disagreement over the state of things. Then last month — a little over a year after the group launched its campaign — the Health Trust hired the independent monitor. It’s a move both sides approve of.

“We are not here as a group to destroy the hospital,” Swanson of the concerned citizens said. “We want to make it better. We just want to make it safe and effective for the citizens of Casper and our families.”

Oversight criticism

The Natrona Collective Health Trust is a private health foundation tasked with overseeing the cash and investments of Wyoming Medical Center among other funds. It belongs to a category of organization formed when a nonprofit health system purchases standalone nonprofit hospitals. The trust’s work involves both philanthropy and policy, but it also has oversight over Banner’s contractual obligations.  

As Banner has been hit with criticism, skeptics also have argued the trust needs to do better. The nine-person board lacks health expertise needed to complete its duties, the concerned citizens group said. 

The county commission appointed Jennifer True to one of its two seats on the board in March 2024. When she was called up to address the board during the recent meeting on Banner, she gave her formal resignation — offering deep misgivings about the body’s spending patterns.

“When I accepted this role, I did so with hope for the transformative change the trust could bring to Natrona County,” she read from her resignation letter. “Instead, it has become clear that the organization has strayed from its founding mission. Rather than prioritizing community impact, collaboration and responsible stewardship, the trust has developed a culture of spending — marked by extravagant expenditures, self-promotion and a troubling lack of fiscal accountability.”

Trust CEO Beth Worthen defended the body when reached after the meeting, saying its expenditures are in line with, if not below, comparative boards around the country. She also said the board’s recent hiring of consultant PYA is intended to support its oversight duties.  

“We take our responsibilities related to monitoring the contractual commitments very seriously,” Worthen said, “and as a part of that, we felt like additional expertise was needed.” 

PYA began work in January. It has been examining the contracts, toured the facility and started combing through Banner’s annual reports. It will report its findings to the county commission in July, Worthen said. 

In a press release announcing PYA’s engagement, the trust called it “a collaborative effort to ensure transparency and accountability in the implementation of Banner Health’s commitments.”

Natrona County Commission Chair Dave North said he looks forward to PYA’s finding. During the March meeting, he commended Banner for making recent good-faith improvements.

“I know you’ve had some hiccups,” he told CEO Porter at the meeting. “There’s still a few that I would like to sit down and talk to you about.”

The citizens group hopes the county keeps a close eye on the matter, it says. 

“We all know the stories that have appeared … the horror stories that we’ve had at Banner,” Swanson said. “Not to say that the [Wyoming] Medical Center didn’t have some of those horror stories, but we’ve had quite a few. We’ve had too many for the citizens of Natrona County.”

CORRECTION: A previous version of this story listed an incorrect vocation for Tom Swanson. -Ed.

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Gov. Mark Gordon vetoed a bill Friday that says abortion is not health care except in cases of rape or incest or to save a mother’s life.

The Wyoming governor’s decision is significant because the state Supreme Court is preparing to hear a Jackson doctor’s challenge to two 2023 abortion bans. The legal challenge hinges on similar questions: whether abortion is health care and whether the Wyoming Constitution, which guarantees an adult’s right to “make his or her own health care decisions,” guarantees the right to abortion.

In November, Teton County District Court Judge Melissa Owens struck down both bans, saying the laws curtailed pregnant women’s right to make health care decisions. Gordon appealed Owens’ decision, and the Supreme Court is set to hear oral arguments April 16.

In vetoing Senate File 125, Gordon deferred to Wyoming voters and the Supreme Court. He said that Senate File 125 largely “reiterates and recodifies” the 2023 abortion ban and that the Wyoming Legislature “overstepped its bounds” by trying to prescribe through state statute what health care is — and isn’t. The courts, not legislators, are responsible for interpreting the constitution, Gordon said, adding that signing the bill would extend legal battles and cause confusion.

“My veto will avoid unnecessary delay, prevent even more legal battles, allow for clarity and finality through the Court’s eventual decision, and preserve the precious separation of powers so essential to containing the excesses of government,” Gordon wrote in a letter to Speaker of the House Chip Neiman, who co-sponsored the bill.

If lawmakers want to protect “the unborn,” the governor added, they should wait for the Supreme Court ruling and correct “deficiencies.”

Because the Wyoming Legislature gaveled out March 6, Wyoming lawmakers are now all but unable to override Gordon’s veto.

Gov. Gordon has now split multiple times with the Wyoming Legislature over abortion policy. While he backed a new law that changes how abortion clinics are regulated and would force the only surgical abortion clinic in the state to close, Gordon vetoed a bill that would require women to obtain a transvaginal ultrasound 48 hours prior to a medical abortion, without exceptions for rape or incest.

The Wyoming Legislature overrode that veto. Shortly afterward, Wellspring Health Access, the first abortion clinic in Casper and the only procedural and medical abortion clinic in Wyoming, sued the state over the two new laws, asking Judge Owens to rule on the case.

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The ongoing halt to abortions in Wyoming will continue for at least another week after a judge Thursday said it will take that long before she could even set a schedule to hear arguments for an emergency pause on new abortion restrictions.

The debate over two new laws restricting abortion procedures took place via a telephone conference before 9th District Judge Melissa Owens of Teton County. She was ready to set a date to hear arguments on a temporary and emergency ban against two new laws — one established a string of new regulations that forced Wyoming’s only full-service abortion clinic to stop seeing patients two weeks ago — when attorneys for Gov. Mark Gordon objected.

They recently filed a motion asking Owens to transfer the case to Natrona County. That’s where lawyers for abortion providers filed their original suit, along with a request for an emergency hearing and temporary halt to the new regulations, on Feb. 28.

Eleven days after that filing and without any action from the Natrona County court, the doctors and clinics dismissed the case in Casper and refiled it in Teton County.

Gordon’s attorney, Senior Assistant Attorney General John Woykovsky, claimed the abortion providers, their backers, two doctors and another woman, purposefully refiled in Teton County seeking a friendly judge. Owens has ruled on other litigation challenging Wyoming’s anti-abortion laws, striking down two abortion bans passed in 2023. That case is currently in front of the Wyoming Supreme Court.

Court papers filed by the abortion providers make it clear “that this is a case of forum shopping,” Woykovsky said. “They essentially state that they were dissatisfied with Judge Forgey’s response to their motion for a [temporary restraining order] and hope to obtain a more favorable result in this court.”

Woykovsky made Gordon’s point formally in a motion to change the case’s venue back to Natrona County.

Citing her court’s packed schedule and the issues at hand, Owens set a hearing for Friday, March 21, on Gordon’s change of venue request only.

“The only thing the court can at this point be prepared to hear next Friday with the time we have allotted would be the change of venue hearing,” she said. “So that’s all that we’ll be setting at this point.”

One issue at a time

Lawyers for the providers and doctors argued for an earlier hearing and for one that would consider both the change of venue and an emergency request to block the two new abortion-restricting laws. But Owens didn’t agree to those requests.

The doctors and providers filed the case in Natrona County, site of Casper’s Wellspring Health Access, which provides in-clinic abortions. They refiled the case in Teton County because a doctor in Jackson refers patients to various other clinics and advises patients who seek medical care, including abortions.

“Plaintiffs and their patients are experiencing ongoing, severe, and irreparable injury — including direct harms to Plaintiffs and their patients in Teton County,” the providers said when they dismissed the case in Casper and refiled it in Jackson. “Plaintiffs have no choice but to dismiss the Prior [Natrona County] Action … and re-file it … in the hope of securing a timely hearing.”

At issue are two new abortion-restricting laws. One creates a series of new regulations on abortion clinics in Wyoming by requiring them to be licensed as “ambulatory surgical centers.” The second requires abortion patients to undergo a transvaginal ultrasound and a 48-hour waiting period before receiving abortion medications.

Because of the new laws, Wellspring Health Access, the only clinic in Wyoming that provides in-clinic abortions, said it has stopped performing abortions. It had performed 71 abortions between the start of the year and Feb. 27. In the five days after the laws went into effect, it referred 56 patients to other clinics for abortion-related services, almost all of them out of state, according to court papers.

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The Wyoming Department of Health announced Friday it had confirmed the state’s first case of bird flu in a human.

The patient, an older adult woman from Platte County, is being hospitalized out of state and represents the third hospitalization related to H5N1 in the United States, according to the department. 

Still, the development does not “require a high level of concern among most Wyoming residents,” Dr. Alexia Harrist, state health officer and epidemiologist, said in a press release. 

The woman has health conditions that can make people more vulnerable to illness, according to the press release, and she was likely exposed to the virus through direct contact with an infected poultry flock at her home. 

“Our staff has followed up with other people who had contact with the flock and the patient, and will continue working with state and national experts to monitor the situation carefully for Wyoming,” Harrist said. 

The virus has been known for several years to infect wild birds in Wyoming, and has also been confirmed in mountain lion cubs, snow geese, foxes, great horned owls, bald eagles and chickens. 

Last June, the state confirmed its first case infecting dairy cows. 

While the risk may be low, the department has several recommendations to avoid contracting the virus. It advises against consuming raw milk, or uncooked or undercooked poultry, eggs and other animal products. The department also recommends avoiding direct contact with wild birds, as well as wild or domestic birds that appear ill or have died. 

Sick or dead birds may be reported to the Wyoming Game and Fish Department by calling 307-745-5865. 

Infected birds shed virus through their saliva, mucous and feces, according to the department. Human infections can happen if the virus then gets into a person’s eyes, nose or mouth, or is inhaled. 

Infections in humans can range from no symptoms to mild illness to severe symptoms, such as pneumonia requiring hospitalization. Signs and symptoms may include fever, chills, cough, sore throat and runny or stuffy nose, among others. 

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