The Ravalli County Commissioners met with officials from the Public Health Department, the Department of Disaster and Emergency Services and Marcus Daly Memorial Hospital last week to discuss emergency response procedures.

Officials rehashed the coordinated response made this fall to an incident at Stevensville Elementary School in which students and teachers were potentially exposed to rabies when an infected bat was brought to the school and shown to students in several classes. A vaccination clinic was organized and implemented by public health officials and Marcus Daly Hospital played a pivotal role in securing the vaccine from a pharmacy in Arizona.

Although everyone agreed that the response to the emergency was a success in that the vaccine was secured and administered in a timely manner to those exposed who agreed to the treatment, there was also agreement that the implementation of the clinic was not without a few glitches that should probably be addressed before the next emergency occurs.

On the one hand, county officials were led to believe, based upon a Memorandum of Understanding (MOU) between the county and the hospital signed in 2003, that the hospital would provide nurses for the vaccination clinic. That didn’t happen. On the other hand, the hospital did not expect to have to foot the bill for the cost of the vaccines, which came to a total of about $120,000. Due to the way the incident unfolded, however, the hospital has paid the bill and it is unclear when and by whom they may be ultimately reimbursed.

The MOU was adopted in 2003 following the attacks on the World Trade Center and was designed primarily to address events in response to the use of weapons of mass destruction. In relation to hospital staff and Public Health officials, the MOU states “having acknowledged that there may be times when they will be called upon to assist one another they do hereby adopt the following agreements to provide mass casualty care and mass immunization response in a WMD incident.”

Marcus Daly Hospital agrees in the MOU to open the Bitterroot Clinic or Old Ambulance storage facility to handle overflow if the hospital Emergency Room should be overwhelmed, or to be used as a triage site when facing a Public Health communicable disease or bioterrorism event. But the MOU states specifically that that decision will be made by the hospital administrator with guidance from public officials. The hospital administrator also has the authority under the MOU to decide if the hospital will participate in quarantine and isolation efforts.

In essence, the agreement is peppered with words like “may” or “can” in relation to the hospital’s participation and leaves that decision primarily to the hospital administrator. It is also questionable whether the MOU even applies to the rabies incident at Stevensville, since it was not a ‘communicable disease’ and was not related to an event of bioterrorism. As Ravalli County Disaster and Emergency Services Director Ron Nicholas noted, it did not even constitute a countywide emergency since it was such a localized event.

Concerning the hospital’s refusal to provide nurses for the rabies vaccination clinic, CEO of Marcus Daly Hospital John Bartos said that the chronology of the whole event needed to be taken into account.

He said that when the hospital was first contacted by Public Health officials they were only asked if they had any rabies vaccine. They responded that they had only one dose on hand and asked why the inquiry was being made, but they received no answer. Next they got a call from State Public Health officials to order the vaccines on behalf of the school. It turns out that the Arizona pharmacy with the vaccine could only ship it to a hospital that had the ability to handle and store it correctly. Thus it was the hospital that ordered and received the vaccine and consequently got billed for it. But it did so under the belief that county or state public health officials were really ordering the vaccines and would pay for it.

The County, on the other hand, was told that the school’s insurance company would pay for the vaccine and the immunization clinic. Since then the county has been informed that the school’s insurance company is only willing to pay for the vaccines administered to students and teachers exposed in the classrooms. Due to the fact that the vaccine must be administered in a timely manner (within 10 days of exposure, if possible) enough vaccine was ordered to treat everyone exposed. But since immunization was voluntary and many people exercised their right to decline the treatment, the hospital was left holding about $29,000 worth of unused vaccine.

State public health officials have agreed to keep the excess vaccine and use it for treating future rabies cases around the state. When used and paid for the money will be returned to Ravalli County. The vaccine will keep under refrigeration for up to three years.

The county itself has also determined that under the law the county is not required to administer shots in such a situation, but only to notify people to get in touch with their own health care provider.

Commissioner Carlotta Grandstaff has written a letter to the school and its insurance company stating that the county is not responsible for any of the bill.

“It is unconscionable for the school, directly or through its insurer, to request and accept the assistance of the county to obtain and administer the rabies vaccine after students were screened, then deny responsibility for payment of the vaccine because of a technicality regarding who placed the order,” wrote Grandstaff.

In the meantime, Bartos told the Commissioners, the hospital has been put in the position of providing the county and/or the school with an interest free loan of $120,000, by paying the bill and waiting for eventual reimbursement.

Regarding the request for hospital nurses to participate in the vaccination clinic, Bartos said that he could not just send out nurses to participate without some sort of agreement with the county.

As a result County Attorney George Corn fashioned an agreement and submitted it to hospital officials. But Bartos refused to sign the agreement because it did not include indemnification of the nurses protecting them from liability and it left the hospital footing the bill. Bartos said there was also the problem of ensuring that the hospital ER was not left understaffed during the clinic in case there should be any sort of emergency at the hospital. Given all these considerations, Bartos decided not to send any nurses to the clinic.

Marshall Bloom, administrator of the Rocky Mountain Laboratory, noted that, in terms of the basic response to the rabies exposure, “all’s well that ends well.” But he also noted that the single most common problem to emerge during emergency responses has to do with communication, or lack of it, between various agencies and the public. He suggested that this incident and the problems related to provision of nurses and payment of costs could be used as a “wake up call.”

Bloom said that a local emergency planning committee had already been established and that all the key players, including the lab, have a seat on that committee. He suggested that this committee would be the logical entity to design a response plan that would include and coordinate all the agencies, public and private, that might participate in such emergency responses. He said a plan with clear designation of responsibilities needed to be worked out to address the operation, logistics, implementation and the financing of emergency responses in the county.

Sonny LaSalle, on the Board of Directors of Marcus Daly Hospital and a retired Forest Service official, said that the Incident Command System, adopted by the Forest Service to fight wildfires, is a good model for addressing emergency situations of any kind. He said a plan needs to be put in writing that clearly designates roles and responsibilities including how the response will be paid for.

Commissioner J.R. Iman said that it seems like five different organizations came together to respond to this event and did a good job, but the cost of it all was left with the hospital. He said that if the county wants cooperation from private entities in response to public emergencies they had better be ready to pay them.

Although everyone present seemed to be in agreement that a plan of action delineating roles and responsibilities, including financial responsibilities, needed to be worked out prior to the next emergency, no specific timeline was set to achieve that result.

Bitterroot Inaugural Ball scheduled

By Michael Howell

Do you want to enjoy the festivities surrounding the Presidential Inauguration ceremonies, but don’t want to endure the crowds in Washington D.C.? You can come to the Bitterroot Inaugural Ball instead.

The Ravalli County Democratic Women’s Club is sponsoring a local Inaugural Ball at the Bitterroot River Inn on January 20, from 7 to 11 p.m. with a live link on a big screen to the events in Washington D.C., including a replay of the swearing in ceremony of President Barack Obhama.

The cost of attending the gala affair is $40 per person at the door. All proceeds from the event will go to Supporters of Abuse Free Environments (SAFE).

SAFE is a program designed to reduce and respond to domestic and sexual violence in the community. It was founded by the local Soroptimist chapter in 1987. The organization sponsors an emergency shelter for people suffering from sexual abuse or domestic violence and offers 24-hour advocacy for victims as well as transitional housing for those who need it. The program also sponsors prevention work and community coordination.

According to SAFE Director Stacey Umhey, the organization is experiencing a special need for additional funds this year since losing a few federal grants totaling about $170,000 that it has been awarded annually for a number of years. Those grants went a long way in meeting the project’s annual budget of about $570,000. Without them the program has been forced to scale back, eliminating some staff as well as its children’s program, which was designed to specifically help children who either witnessed abuse or were otherwise affected by violence in the home. Umhey said that SAFE serves about 500 people a year.

If you want to attend the Ball but don’t have the proper attire, you might think about stopping in at Safe on First Thrift Store located at 410 N. 1st Street in Hamilton. Proceeds from the store also go to support SAFE.

There will be dancing and music provided by the Big Sky Mudflaps. Food and drink are available. There will also be a raffle of political memorabilia such as political buttons from past elections including Kennedy/Johnson, Nixon/Agnew, Lee Metcalf and Theodore Roosevelt buttons. An inaugural parking sign from 1969 is also being raffled.

Cause for celebration

Human rights group to celebrate MLK birthday, election of first African-American president

By Michael Howell

The Bitterroot Human Rights Alliance (BHRA) has sponsored a local celebration of Dr. Martin Luther King’s birthday for the last fifteen years. This year Dr. King’s birthday and the historic inauguration of America’s first African-American president are falling within a day of each other and BHRA is going to kick up its collective heels at a joint celebration.

BHRA invites the community to join them at the River Street Dance Studio in Hamilton on the corner of 2nd and River Street on Saturday, January 17. Following the membership meeting scheduled for 7 p.m., a screening of Barack Obama’s historic speech on race, delivered in response to the flap over his association with Reverend Wright, will begin at 8 p.m. Dancing to the Sky Moose Band will begin at 9 p.m. Refreshments will be served and a $5 donation is requested. It is rumored that Abe Lincoln will be attending.

BHRA was formed in 1994 as an affiliate group to the Montana Human Rights Network. According to founding member John Schneeberger, the local group was formed in response to militia activities that were rocking the county at the time.

“The local militia was filing multi-million dollar liens against local officials and threatening them with violence. That threat of violence galvanized the community and our group was formed in response,” said Schneeberger.

Since that time BHRA has participated in a number of issues, including protesting the efforts to ban the book, “I Know Why the Caged Bird Sings” by Maya Angelou, at the Hamilton Library. The group also helped in the passage of I-155, to expand Medicaid and CHIP to cover all the children in Montana. They sponsored local vigils for Mathew Sheppard, a gay man who was beaten to death and hung up on a fence because his sexual orientation. BHRA also opposed the efforts to include Intelligent Design instruction as part of the Darby School program. Following the attack and threats made against local environmentalist Larry Campbell, the group sponsored a petition/resolution to guarantee the right of people to participate in civic issues without the fear of being threatened or attacked. They actively opposed the Gay Marriage Ban. The group also sponsored a community discussion on polygamy and acted in support of the County Floodplain Administrator who has come under fire, had her property vandalized and been threatened for enforcing the county’s floodplain regulations.

Longtime member Bill LaCroix said that the organization worked hard on getting Dr. Martin Luther King Day declared a national celebration in Montana and the recent election of the country’s first African-American President was further cause for celebration this year.

“It means we’ve gone several miles in the right direction,” said LaCroix.

Kickoff for Horizons program in Stevi

A community dinner is planned to help jump start the Horizons program in the Stevensville/Lone Rock area. Horizons is a community leadership program aimed at reducing poverty in small rural communities faced with economic decline and demographic change.

This Friday night, January 16, residents of the Stevensville/Lone Rock community are invited to the first discussion group (Study Circle) for Horizons. These community conversations and action ideas will focus on poverty and talk about how to make the community thrive.

A free dinner will be provided and community members of all ages are encouraged to attend. Dinner will begin at 6 p.m. in the multi-purpose room at the Stevensville School. Afterward, from 7 to 8:30 p.m., discussion groups will be formed to address issues of poverty in the community.

The Horizons program will pay for baby sitters, elder care and transportation for those who need it. For more information call Katelyn Andersen at the Montana State University/Ravalli County Extension Service at 375-6611.

New members appointed to County Planning Board

By Michael Howell

The Ravalli County Commissioners appointed five new members to the Ravalli County Planning Board on Monday.

Unanimous votes for approval were made following motions to appoint Jim Dawson as the Lone Rock School District Representative, Cheryl Tenold as the Stevensville School District Representative, and to reappoint Mary Lee Bailey as the Victor School District Representative.

Appointments to the Corvallis School District and the At-Large positions were disputed, however.

First Commissioner Greg Chilcott moved to appoint Brian Glenn for the Corvallis School District position and Commissioner J.R. Iman seconded. But according to unofficial minutes of the meeting, Commissioners Jim Rokosch and Carlotta Grandstaff expressed a preference for appointing Fran Maki. Grandstaff said that the Planning Board could use some representation by agricultural interests and Maki fit the bill.

Chilcott and Iman voted to approve Glenn for the Board but that motion failed when Rokosch, Grandstaff and Driscoll voted against it. Following a subsequent motion to approve Maki, she was appointed with Rokosch, Grandstaff and Driscoll voting in favor and Chilcott and Iman voting against.

A similar course of events followed when Chilcott moved to reappoint Dale Brown to the At-Large position. Rokosch noted Brown has had several absences from the Board meetings. He stated he would like to see Skip Kowalski appointed as At-Large Representative. Iman stated Brown brings his experience to the Planning Board and has physical experience in the area of situations that have occurred and working with the DEQ. Driscoll stated she would like to see Lee Tickell be appointed for his background and experience.

The motion to approve Brown was defeated on a 3 to 2 vote, with Chilcott and Iman voting in favor, but the other three commissioners voting against. A subsequent motion by Driscoll to appoint Tickell was approved by a 3 to 2 vote with Chilcott and Iman voting against it.

Holcomb appointed to Stevi Council

Robin Holcomb was appointed to the Ward 1 Council seat on the Stevensville Town Council on Monday evening. She is filling the seat vacated by Susan Evans. Evans’ seat became open when she was appointed Mayor following the resignation of former Mayor Bill Meisner. Holcomb will serve the remainder of the term which expires on December 31, 2009.

Holcomb has worked for Rocky Mountain Bank for the last five years. She is vice-president of the Stevensville Civic Club and also volunteers with the Stevensville Main Street Association.

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