As the Wyoming Legislature’s budget session began, lawmakers had at least 10 bills to consider related to transgender people, gender-affirming care, pronouns, obscenity and school programming. 

As the week ended, only three measures remained. 

The rest failed to receive enough votes for formal introduction, a higher bar because non-budget bills require a supermajority.

The fact that legislation like House Bill 50 – What is a woman act failed to garner enough votes may be a sign of lawmaker pragmatism and a focus on the budget, said Wyoming Equality’s Executive Director Sara Burlingame. But perhaps it was something else, too, she added. 

“I’m not sure if this is true or not,” she said, “but I think it’s possible that people have grown really fatigued of hearing people be really hysterical about what’s in other people’s pants.”

The Senate was the only chamber to formally introduce bills that could still affect trans Wyomingites this year — in part because of disagreements between factions of House Republicans. The first reading of the budget bill also went late into the evening in the lower chamber Friday, leaving limited time to introduce additional legislation before a key deadline.

The first gender-based bill to achieve introduction and head to committee was Senate File 94 – An act regarding compelled speech and state employers. Mirroring bills and laws in many other states, Sen. Lynn Hutchings (R-Cheyenne) said she’s sponsoring this constituent-requested legislation to protect state employees from repercussions if they misgender someone.

That is, the state wouldn’t be able to “compel or require an employee to refer to another employee using that employee’s preferred pronouns,” under threat of adverse actions, to maintain employment, or to secure a contract, grant, license or other benefit. 

Those still required to use a coworker’s preferred pronouns can sue under this bill.

Burlingame said she fears the legislation could enable harassment by those who intentionally misgender coworkers because of their looks. She recalled an incident with a female state employee.

“She worked with a man who wouldn’t use female pronouns for her and referred to her as male. She wasn’t,” Burlingame said. “But she was able to go to HR and get it resolved. Because in the state of Wyoming, we believe in decency and good manners and people aren’t allowed to mock you or deride you for your appearance or how you present yourself.”

Old and new

Two other bills headed to committee hearings are Senate File 98 – Statute of limitations-medical procedures on minors and Senate File 99 – Chloe’s law-children gender change prohibition, both sponsored by Sen. Anthony Bouchard (R-Cheyenne).

Senate File 98 allows minors who received “gender transition services” to sue a doctor over that treatment until the age of 21. 

“It just includes the hormones, puberty blockers, surgeries — all of it,” Bouchard said Friday.

Noting someone who had surgery while still a minor and regretted it, Bouchard said, “this is happening all over the country where there’s just two years that they can actually come back and say, ‘whoa wait a minute, this doctor did this to me.’”

Studies show that situations like what Bouchard described are exceedingly rare. Less than 1% of people who undergo gender-affirming surgeries regret it, according to a study of nearly 8,000 teens and adults who underwent these procedures. 

Regardless, there is no evidence that gender reassignment surgeries are performed on minors in Wyoming. 

Senate File 99 is a rerun of a bill that failed during the general session last year, minus a section about health insurance. Named after a woman who underwent a mastectomy as a child in California and later regretted it, Bouchard has championed the legislation both years.

“It has teeth in it,” Bouchard said. “[The bill] says you can’t do it in Wyoming, you can’t change the sex of a minor.”

That includes using surgeries, hormones or puberty blockers. 

Opponents of last year’s bill — like Wyoming Medical Society Executive Director Sheila Bush — argued it demonized doctors who don’t use surgeries but in rare circumstances do use medications like puberty blockers “to give kids more time.”

“I think what we have with this bill is a sad example of when politics overcomes good policy,” Bush told the Senate Labor, Health and Social Services Committee last February. “Good policy might have looked like working together and crafting a bill that maybe outlawed the procedures and surgeries.”

There are exceptions in the bill, including for genetic sex development disorders and abnormally early puberty, but some of those testifying last year feared there weren’t enough protections, and that parents of disabled children could be affected. 

Meantime, a federal judge in Idaho blocked enforcement of a similar law in that state last year, citing violations of the Due Process Clause and Equal Protection Clause under the Fourteenth Amendment of the U.S. Constitution. 

“It just includes the hormones, puberty blockers, surgeries — all of it.”

Sen. Anthony Bouchard (R-Cheyenne)

As WyoFile reported last year, trans people have the highest rates of suicide among any identified group, according to research and a national survey from 2015. Meanwhile, researchers have found worse mental health and double the rate of suicidal thoughts and attempts among youth who don’t receive gender-affirming care when compared to youth who do.

Numerous medical groups back the use of gender-affirming care for minors. They include: the American Medical Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, the American Psychiatric Association, the American Academy of Pediatrics and the Endocrine Society, among others.

Wyoming is home to one of the highest suicide rates in the nation, though rates have been falling. 

Failed introduction

Early in the session’s first week, two bills focused on gender and transitioning didn’t receive enough votes to be introduced. That included House Bill 50 – What is a woman act and House Bill 63 – Sex and gender changes for children-prohibited.

House Bill 50, sponsored by Wyoming Freedom Caucus member Rep. Jeanette Ward (R-Casper), aimed to define females and males based on what their “reproductive system was developed to produce” and their chromosomes, with some medical exemptions. 

It specified how the definitions would apply to spaces denoted for females or males in athletics, detention facilities, domestic violence shelters, rape crisis centers, locker rooms, restrooms “and other areas where safety or privacy are implicated.”

“It gives dignity to womanhood by protecting it,” Ward said on the House floor, later referencing a private sorority’s decision to accept a transgender University of Wyoming student into their group. 

A lawsuit over that sorority’s decision was dismissed at the district court level in August, but plaintiffs have appealed. 

House Bill 50 failed introduction 37-24, with 20 Republicans voting against it.

House Bill 63, on the other hand, didn’t go far enough, according to the Freedom Caucus. It would have banned surgeries or procedures altering the sex of — or sterilizing — minors.

“There aren’t any gender reassignment surgeries taking place currently [in Wyoming], but my feeling is that a child under the age of 18 is developing emotionally, mentally and physically, and really … should be prohibited from making those types of decisions that can have such long-term impact on their life,” Rep. Lloyd Larsen (R-Lander) said Wednesday on the House floor. 

But Rep. Sarah Penn (R-Lander) argued “this bill does not go nearly far enough,” pointing to the omission of hormones and medications from the bill.

“There’s other vehicles that are much better, much more encompassing to actually protect our children, and I would urge no vote on this,” she said. 

That bill failed introduction 33-28. 

Bill breakdown

There are other bills this session that could have disproportionately affected transgender people and the larger LGBTQ+ community in Wyoming — but failed to receive enough votes for introduction. These are some WyoFile identified as of Friday.

House Bill 61 – Fiscal accountability and transparency in education: Sponsored by Rep. Penn, this bill would have required school districts to submit exhaustive annual reports on how much they spent to “implement, deliver or support” programs that directly — or indirectly — address social issues, political or social activism, and diversity, equity or inclusion. 

Districts would also need parental or guardian permission for kids to participate in classes or training involving those programs. Others in the district would be allowed to opt out.

The bill’s definitions of the programs include topics that polarize society, school-endorsed activity meant to affect or prevent change in government policy, and policies that promote “differential or preferential treatment of individuals or classifies such individuals on the basis of race, color, sex, national origin, gender identity or sexual orientation.”

House Bill 68 – Obscenity-impartial conformance: This short bill, sponsored by Rep. Ben Hornok (R-Cheyenne), would have eliminated a statutory exemption that allows people within “bona fide” schools, colleges, universities, museums or public libraries to have or disseminate what the state considers to be “obscene material.”

Burlingame said legislation aimed at theoretical obscenities has targeted trans people in other states.

“The obscenity [bills] we definitely include in our ‘hostile to trans folks’ category, just because that’s how we’ve seen it implemented in other states,” she said. “The existence of a trans person is what’s being weaponized and called obscene.”

House Bill 88 – Public display of obscene material: Rep. Pepper Ottman (R-Riverton) sponsored this bill, which would have made it a misdemeanor to “publicly communicate” obscene material. The legislation defines that phrase to mean: “[D]isplay, post, exhibit, give away or vocalize material in such a way that the material may be readily and distinctly perceived by the public at large by normal unaided vision or hearing.”

House Bill 136 – Gender identity-definition repeal: Sponsored by Rep. Hornok, HB 136 sought to repeal the definition of gender identity from the education section of state statutes. 

That definition is: “as stated in the Diagnostic and Statistical Manual. A person’s gender identity can be shown by providing evidence, including but not limited to medical history, care or treatment of the gender identity, consistent and uniform assertion of the gender identity or the evidence that the gender identity is sincerely held, part of a person’s core identity and not being asserted for an improper purpose.”

House Bill 156 – Best interests of a child-gender affirming treatments: Rep. Rachel Rodriguez-Williams (R-Cody) sponsored this bill.

It would have added specific language to several parts of Wyoming statute stating: “To the extent applicable, in determining the best interests of the child under this article, there shall be a conclusive presumption that it is not in the best interests of the child to undergo any gender transition or gender reassignment procedures.”

That includes hormones and puberty-blocking medications.

For more legislative coverage click here.

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John Washakie knows what it means for friends and family around the Wind River Indian Reservation to go missing.

“Abigale Washakie was my niece,” he said during a press conference Thursday in Fort Washakie. 

She had a family and home, he said, but drifted off and became involved with someone. She went missing. And then she was found.  

“She was murdered and put in a trash can in Riverton,” he said.

He also knew a girl named Adrianna Goggles. When he worked at the local library, he remembered her checking out one Phyllis Reynolds Naylor book 14 times.

“They found her remains frozen in a snowbank,” he said. 

Washakie is a member of the Eastern Shoshone Business Council. After he spoke, Lloyd Goggles, chairman of the Northern Arapaho Business Council, needed a moment before he could talk. When he did, he said the effects of these murders and missing people go beyond the confines of a family — or even the reservation.

“It affects all the surrounding communities,” he said. 

In Wyoming, fewer than 3% of residents are Native American. Meanwhile, about 12% of homicides here were perpetrated against Native people in 2022, according to a 2023 Wyoming Survey & Analysis Center report. 

While homicide rates against Indigenous people in Wyoming have started to decline, “[t]he 2022 five-year average homicide rate for Indigenous people was 18.3 per 100,000, nearly six times higher than the homicide rate for White people,” the report states.

The vast majority of those missing or murdered are kids. 

After years of local and state initiatives — ranging from a task force and reports to a missing persons website and a new alert system — the FBI is now starting a 90-day initiative to gather more information on missing and murdered people in the state. That includes an effort to compile a complete list of cases involving Native Americans as well as solving cold cases. 

The FBI is the main agency investigating these crimes on the reservation.

After the three months of data collection, the agency says it will research and investigate tips. The timeline of that work being presented to the tribes and public will depend on how much analysis the tips prompt, the FBI added. 

“Findings will be presented to the Eastern Shoshone and Northern Arapaho tribes, then to the public,” it stated in a press release. 

It’s asking the public to provide the FBI with tips via the hotline 307-433-3221 and the email address WYMMIP@FBI.gov.

The FBI has been cooperating with more local agencies and is responding to a consistent call for more and better data, according to Public Affairs Officer Vikki Migoya. Based on what the FBI learned from an MMIP initiative in New Mexico, the agency wanted to create something uniquely impactful for Wyoming, she said.

“MMIP isn’t a ‘one size fits all’ issue,” she said. “We have worked with the Eastern Shoshone and Northern Arapaho to craft a plan specific to here.”

Rifts

There has long been a strained relationship between tribal members and law enforcement, especially federal agencies. 

That rang true in the 2023 WYSAC report, which identified the rift as an ongoing challenge to reporting missing and murdered people in Wyoming. 

“I believe that some people that have had an unfriendly encounter with the police (and there are many) have little faith that anything will be done,” an unnamed community stakeholder is quoted saying in the report. 

The FBI sees this 90-day initiative as a step towards healing some of that relationship, having sought out input and assistance from the Eastern Shoshone and Northern Arapaho business councils.

“This is an opportunity to shine another light on the MMIP crisis.”

Lloyd Goggles, Northern Arapaho Business Council

“In the past, tribal members have not always been comfortable working with law enforcement in general and the FBI specifically,” the agency stated in a press release. “The FBI recognizes these historical barriers and wants to do everything possible to improve the flow of information.”

Goggles appreciates these efforts from these federal partners, he said, and asked for both tribal and non-tribal community members to participate.

“It’s an important step because it also encourages healing,” he said of the initiative. “This is an opportunity to shine another light on the MMIP crisis. And I know that other people across the nation go through similar things … but this is our chance to achieve a measure of justice.”

Even if people don’t trust the agency, FBI Assistant Special Agent In Charge Leonard Carollo said, they can potentially bring information to others who they do trust.

“We understand that they might not want to come talk to us, they might not have trust in us or law enforcement,” he said. “If that’s the case, come to their tribal leaders or other tribally respected members of their community, and they will come to us. It takes time to build that trust, and we’re willing to be patient.”

Another challenge with working with the FBI has long been a perceived lack of transparency when it comes to cases like murdered and missing tribal members. 

News sources, long scrutinized for their role in perpetuating harmful stereotypes and under-reporting these crimes, want more information from the FBI, too.

Responding to a question about that during the Thursday press conference, the FBI’s Migoya said, “We are very restrictive in what information we can give to the public about victims and about cases that are open.”

She acknowledged that the agency’s protocols are different from local law enforcement, adding, “We are going to do our best to communicate as clearly as we can to the tribes as well as to the public about that,” she said. 

From the ground up

National efforts to address the inequities in murders and kidnappings among Indigenous populations have spanned nearly a decade. Many of those efforts have come in the form of trying to get law enforcement agencies — tribal, state and federal — to improve communication and better track this demographic.

However, a key point in the discussion is a lack of resources. That’s for both tribal members and law enforcement tasked with addressing crimes involving them. 

Many see this as a continued failure on behalf of federal, state and local governments nationwide. 

When asked about FBI resources going to this particular initiative Thursday, Carollo said he couldn’t reveal numbers. 

However, he said there is a “large presence” of permanent FBI personnel in Lander and that there could be more resources and agents allocated to the area as the agency sees fit.

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Last winter killed most of western Wyoming’s mule deer. 

That prompted calls to kill predators, and wildlife managers listened — even though there was little scientific support to prove it would work to bring deer back.

Because of speculation that mountain lions would hold the deer population low, more were targeted — and killed — in the regions where winter hit mule deer the hardest. 

There were outfitter calls to kill more black bears, too, though the Wyoming Game and Fish Department did not update its quotas to grant that request, citing the already heavy bear harvest. 

The ecological and political implications of the historically severe winter that lasted well into spring 2023 still linger. For another predator species — coyotes — the implications remain as well. 

Meeting Jan. 16 in Cheyenne, the Wyoming Game and Fish Commission approved a $200,000 sum requested by wildlife managers to supplement existing aerial gunning of coyotes in western and south-central parts of the state. Like lions and bears, coyotes dine on mule deer, especially fawns. 

“Last spring we recommended it would not be the time to go do it because we had [deer] coming through the winter in such poor condition,” Game and Fish Chief Warden Rick King told the commission. “We recommended that we wait and reevaluate that this winter, and we’ve done that. We feel that this would be the time, if any, to do predator control work action like this.” 

Although it hasn’t been decided where and when the funds will be expended, King did specify that the funding would be routed to the federal government: specifically, a branch of the U.S. Department of Agriculture known as Wildlife Services. 

“We would contract with Wildlife Services to do the work,” King said. “Our local managers would identify key fawning areas to go do that work. They’d get started this spring, and implement that control action before, during and potentially just after the fawning.” 

The Wyoming Game and Fish Department putting its budget, which is funded through hunting and fishing license revenue, toward aerial predator gunning is nothing new. The $200,000 will come from the agency’s discretionary pot of money, Game and Fish director Brian Nesvik said in the meeting. 

Game and Fish has routinely helped fund the Wyoming Animal Damage Management Board, which had an overall budget of $4.2 million last year — a record. Projects the wildlife management agency have paid for include research, but also special predator-killing efforts aimed at protecting species like mule deer, pronghorn and sage grouse.

There’s also precedent for extra Game and Fish spending on coyote killing in the aftermath of severe winters that hit ungulate herds hard. After the big winter of 2016-’17, the agency spent $100,000 to shoot coyotes from aircraft on mule deer fawning grounds in the Little Mountain area and southern Wyoming Range. That effort, also contracted to Wildlife Services, yielded 177 dead coyotes, which pencils out to $565 per canine. 

Before his board unanimously approved the $200,000 in extra 2024 funding, Game and Fish Commission President Ralph Brokaw asked if the 2016-’17 coyote gunning had any effect on mule deer fawn survival. 

“What bang did we get for our buck?” Brokaw asked. 

There’s no evidence, the chief warden told him, that it helped. 

“We don’t have any direct correlation to show that predator control work created any kind of spike in fawn numbers,” King said. “We just don’t have that data, it’s really tough to tease that out.” 

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More and more Wyoming students aren’t getting vaccines.

These aren’t the much-maligned and distrusted COVID-19 vaccines, though. They’re long-utilized inoculations against diseases like polio, diphtheria and measles, Wyoming Department of Health data shows.

Wyoming requires a range of vaccines, but since 2020, the number of K-12 students securing exemptions has grown from 714 to 1,224 — an increase of 71%. There were 130 more in just the last year. 

The vast majority of students still get vaccines — more than 90% of Wyoming kindergarteners get all the shots — but this growing minority puts kids with cancer, immune disorders and the unvaccinated at risk.

With a less robust herd immunity resulting from fewer vaccinated people, diseases like measles have reared their ugly head, leading to outcomes like pneumonia, diarrhea, ear infections and — in rare cases — death. The World Health Organization recommends a 95% inoculation rate against measles to keep the highly contagious virus from spreading — others argue even that wouldn’t be enough in some cases. 

Only about 91% of Wyoming kindergarteners had the MMR shot — vaccinating against measles, mumps and rubella — last school year, according to the Centers for Disease Control and Prevention. 

Who’s exempt?

While medical exemptions are a contributing factor, they’re a small minority, making up only about 2% in 2023, according to Wyoming Department of Health data. That leaves religious exemptions.

“I certify that I have a religious objection to the immunization(s) indicated on this form and therefore am requesting a waiver to the mandatory immunizations for myself or my child to attend a Wyoming preschool, child caring facility or school (K-12),” the waiver required for an exemption states. 

The waiver goes on to have guardians state that they understand their child won’t be allowed to go to school during a “vaccine-preventable disease outbreak,” and, “I understand the risks and possible outcomes of my decision to exempt my child from the mandatory immunizations, which may include serious illness, disability or death.”

Purely ideological exemptions, or those stemming from a busy schedule, are theoretically not allowed in Wyoming.

“The law does not allow parents/guardians to request a waiver simply because of inconvenience,” the health department states. As presented on the health department’s website, the exemption policy emphasizes that “Wyoming statute does NOT allow for the authorization of waiver requests based on philosophical beliefs.”

Seeking a religious exemption does not require any proof, though.

University of Wyoming community and public health professor Christine Porter said that the increased exemptions are likely not the result of growing devotion to religious doctrine.

“So it’s not really, in most cases, about religion,” she said. “It’s about, you know, fear and beliefs … And again, I know that the parents who apply for these are trying to protect our children with the knowledge and understanding that they have.”

“I understand the risks and possible outcomes of my decision to exempt my child from the mandatory immunizations, which may include serious illness, disability or death.”

Wyoming religious exemption form

While this trend of more exemptions started years before COVID-19,  the pandemic certainly didn’t help. Porter said for the MMR shot, many nefarious rumors started in the late 1990s after a paper erroneously claimed that it could cause autism. 

“That paper was horrific science,” she said. “It had 12 participants, and it was ultimately retracted because they thought the data was fraudulent and badly analyzed, even among just those 12. But the damage had been done.”

The studies tying the vaccine to autism have since been ridiculed for their lack of scientific rigor. Meantime, other studies — including one with hundreds of thousands of participants — found no such connection. 

Vaccines do have side effects, including those shots required in Wyoming schools. However, the benefits of these required shots outweigh the risks, Porter said. 

Still, a Kaiser Family Foundation survey found that there’s a growing number of people who believe exemptions should be granted. It showed that from 2019 to 2022, the number of people who think MMR vaccines should be required of healthy school children dropped from 82% — as reported by the Pew Research Center — to 71%. 

Over the same time frame, there was an increase in those who believed parents should be able to decide whether to vaccinate their school-age children, swelling from 16% to 28%. 

“Among Republicans and Republican-leaning independents, there has been a 24 percentage-point increase in the share who hold this view (from 20% to 44%),” Kaiser found.

That means the majority of people still support these vaccinations on both sides of the political aisle, but with growing anti-vaccine sentiment, public health experts are concerned that vaccination rates won’t be enough to prevent future outbreaks of highly contagious diseases.

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Four Missouri hunters argued in court papers filed Friday that the owner of Elk Mountain Ranch perpetuated Wild-West history by illegally trying to block others from thousands of acres of public land so he can use it exclusively.

In documents submitted to the U.S. 10th Circuit Court of Appeals, the hunters defended a federal Wyoming judge’s decision that they did not trespass when they crossed through the airspace above Fred Eshelman’s property to hunt public land in Carbon County.

The Missourians accessed some 6,000 acres of public land by corner crossing — stepping from one piece of public land to another at the common corner with two pieces of private land, all arranged in a checkerboard pattern. Corner crossing is accomplished without setting foot on private property.

“Congress and the courts have rejected every device that has the effect of enclosing the public domain in the Checkerboard and obstructing reasonable access thereto.”

Hunters’ brief before the 10th Circuit

The case pits the public’s right to access its property against private property rights in a legal rodeo that could undo customary restrictions on corner crossing and affect the routes to some 8.3 million acres of public land across the West.

In their recent filing, the hunters defended the decision by Chief U.S. District Judge Scott Skavdahl, who ruled last year that Eshelman could not obstruct their passage. Relying in part on the 1885 federal Unlawful Inclosures Act, Skavdah ruled against Eshelman in the ranch owner’s civil suit that sought to forever bar the public from corner crossing to reach property that belongs to all Americans.

Eshelman joins a long list of “cattlemen and powerful others” who have tried to control the public domain, the hunters’ filing states. Those forces achieved temporary control first with barbed wire, prompting Congress to pass the 1885 law, the filing contends.

“[T]hese public land monopolists ignored, evaded, or tried to invalidate the UIA,” the hunters’ attorneys wrote, “but their efforts withered under repeated judicial scrutiny.”

The Unlawful Inclosures Act is once again under attack by Eshelman and his Iron Bar Holding’s company who seek to exclude the public from its own property, the filing states.

“[Eshelman] cannot use a trespass lawsuit to transform common corners into hardened checkpoints blocking access to the public lands beyond,” the filing reads, “and so [Skavdahl] properly rejected Iron Bar’s claims.”

All across the West

Skavdahl’s ruling applies to a 40-mile-wide swath across southern Wyoming where federal railroad-construction land grants created an ownership checkerboard on either side of the Union Pacific line. As a result of Skavdahl’s ruling, corner crossing is now legal there.

Eshelman’s Iron Bar Holdings has title to the 22,045-acre wildlife-rich Elk Mountain Ranch, which enmeshes thousands of acres of checkerboard federal, state and municipal property near Saratoga. Eshelman’s civil suit against the hunters claims they trespassed by passing through the airspace above his land. Such corner crossing, if legal as Skavdahl determined, diminishes the ranch’s value by up to $9 million, according to one Eshelman assertion.

In a separate criminal case, a Carbon County jury in 2022 found the four men — Bradly Cape, Phillip Yeomans, Zachary Smith and John Slowensky — not guilty of criminal trespass when they hunted in 2020 and 2021. But Eshelman filed a civil suit, lost, and is appealing that judgment by Skavdahl to the 10th Circuit.

That court has jurisdiction over Wyoming, Colorado, Kansas, New Mexico, Oklahoma and parts of Idaho and Montana in Yellowstone National Park. Consequently, a decision by the 10th Circuit would apply to all those states and perhaps beyond.

A Montana landowners’ group argued as much when it filed a brief, supporting Eshelman, which contends the 10th Circuit decision will have West-wide consequences. Some 8.3 million acres are considered “corner locked” by any definition that corner crossing is illegal.

In its ruminations, the appeals court will consider a series of cases that tested the 1885 UIA. Those include “Leo Sheep,” which decided the government could not construct a road across a checkerboard corner; “Mackay,” in which a sheep herder won the right to trail his flock across private checkerboard to reach the public domain; and “Camfield,” where ranchers erected fences on their checkerboard sections to effectively block access to public land.

Eshelman, Wyoming Stock Growers Association and the Montana landowners all say Skavdahl interpreted those decisions, other court rulings and various laws incorrectly. The hunters, through attorneys Ryan Semerad, Lee Mickus and Alexandria Layton, assert that Eshelman is trying to exert a “nonexistent right” of excluding others from the public domain and that corner crossing therefore is not violating property or a property right.

Eshelman can exclude others from Elk Mountain Ranch, but he cannot extend that exclusion to property he doesn’t own, the hunters argue. Although property rights grow from state statutes, even those do not override federal laws, including the UIA, according to the filing.

“Congress and the courts have rejected every device that has the effect of enclosing the public domain in the Checkerboard and obstructing reasonable access thereto,” the hunters state. “This Court should likewise reject Iron Bar’s lawsuit as one more device that would unlawfully enclose public land.”

Spilled ink

Eshelman’s interpretation of laws and decisions are flawed as he “plows the same barren ground” as those who have sought to skirt the Unlawful Inclosures Act before, the hunters state.

Eshelman can’t use Wyoming trespass law to obstruct passage to the public land, they say. Obstructing access is a nuisance that has and should be abated, they say.

“[T]o abate the nuisance of unlawful monopolization of public lands, the Supreme Court concluded Congress could regulate the use of private land to enclose or obstruct access to public land,” the hunters say. “The strict rules regarding trespass upon lands are not entirely applicable, or, at least, are very much modified,” their brief states, quoting one court decision.

The 1885 UIA was a reaction to “a few would-be cattle kings … trying to leverage ownership of railroad sections in the Checkerboard to obtain exclusive control over the entire landscape,” the hunters state. The Mackay case, which Skavdahl relied on in ruling against Eshelman, stands firmly under scrutiny, they say.

“Iron Bar spills much ink criticizing the District Court’s reliance on Mackay,” the brief states. Instead, Mackay supports access and is “a trailhead signaling the way forward.”

Both parties have asked to debate the case in front of the court in Denver.

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After enjoying a respite that lasted for a couple of years, the coal industry tipped back into its long-term downward trajectory in 2023. Early signs suggest that the progressive decline could worsen in the new year.

Wyoming has led the United States in coal production since 1986. It supplied more than 41% of the country’s coal last year, federal data shows. But the state’s coal output has plummeted since it peaked 15 years ago. Wyoming’s mines produced barely over half as much coal in 2022 as they did in 2008 — and the numbers for 2023 trended even lower.

The COVID-19 pandemic resulted in less electricity use, causing coal demand to drop by more than usual in 2020. “In 2021, it started rebounding, and then in 2022, coal did really well, because gas prices were really high after Russia invaded Ukraine,” said Michelle Solomon, a senior policy analyst at the think tank Energy Innovation. “And then in 2023, gas prices moderated and coal kind of went down again.”

The Wyoming Consensus Revenue Estimating Group’s most recent forecast described the industry’s strong performance as a “rebound” that is coming to an end. The state’s coal production “continues to follow broad downward trends interrupted with occasional increases, which are not sustained,” the report said. Its takeaway: Global events gave an unexpected boost to the state economy, but Wyoming can’t keep counting on coal.

Despite the “yo-yo effect” the coal market has experienced since the start of the decade, Solomon said, “it’s settling into a further decline looking into 2024.”

Tough competition

A lot of factors shape the direction of the coal market. The vast majority of coal mined in the U.S. — and practically all of the coal mined in Wyoming — is shipped to the power sector, and coal-fired power plants are retiring in droves across the country as utilities seek to shrink their carbon emissions and rely as much as possible on cheaper renewable electricity sources.

U.S. Sen. John Barrasso (R-WY) has fought to slow the national shift away from coal, calling it “a recipe for disaster for our country and for our citizens” and arguing that “coal will be an important part of our energy mix for decades to come” during a committee hearing in November. But while some coal plant retirements have been delayed for months or years in response to the increased costs of burning natural gas for electricity, or amid concerns about reliability, other retirements are being accelerated.

In addition, plants that are still operating are using less and less coal. On average, the country’s coal fleet ran at under half of its full capacity in 2022, down from 60% a decade ago. Most plants are being used significantly less than that, said Seth Feaster, an energy data analyst at the Institute for Energy Economics and Financial Analysis, a think tank. “What we’ve found is that you have about a quarter of the plants being run a lot, and three-quarters of the plants hardly being run.”

Coal is also struggling to compete with other, cheaper sources of electricity. The spot price of natural gas, which soared to multiyear highs above $8 per million British thermal units in 2022, is back under $3 at Henry Hub, which is the U.S. benchmark. Wyoming coal struggles to compete with natural gas when its spot price drops below that $3 threshold, according to the Wyoming Mining Association.

There was a time, decades ago, when coal provided over half of the country’s electricity. Last year, that share was closer to one-fifth. And between January and October of 2023, coal’s market share dropped to new lows for several consecutive months and never climbed out of the teens.

In 2024, for the first time, the total amount of electricity generated from wind and solar in the U.S. is projected to surpass that from coal.

That renewable energy milestone follows a 2023 report from Energy Innovation which found that it would be cheaper to replace every coal plant in the country with renewables — with the sole exception of Gillette’s Dry Fork Station — than continue to burn coal. In many cases, when coal plants are kept in use in favor of lower-cost electricity sources, “the people that it’s hurting are the electricity ratepayers who are having to pay more money,” Solomon said.

Rocky Mountain Power has made a similar argument during its high-profile attempt to raise electric rates. The utility testified before the Wyoming Public Service Commission that the high market prices for coal and natural gas were responsible for over 90% of its proposed rate increase, WyoFile reported previously. Though the commission only approved a fraction of the utility’s request, it’s the largest increase Wyoming ratepayers have faced in a long time.

Hazards ahead

As far as coal is concerned, there have been a lot of useful developments over the last few years. Hot summers and reasonably cold winters caused high demand for electricity to power air conditioners and furnaces. In the wake of the COVID-19 pandemic and then the war in Ukraine, natural gas markets went wild, prompting utilities to rely as much as possible on coal. Wyoming coal prices soared, too, and the two public companies that own mines in the Powder River Basin reported above-average profits.

The industry’s fundamental troubles haven’t gone anywhere, however. Despite its declining use, coal remains the leading source of carbon dioxide emissions from the power sector. Researchers and some utilities are making headway on advancing carbon capture technology — and the federal government is investing heavily in innovative new projects — but commercial success stories have so far been scarce.

Meanwhile, what’s left of the country’s shrinking coal fleet is aging fast. The rapid expansion of wind, solar and battery storage is curtailing the amount of coal that utilities want even during periods of high demand. And rail shortfalls have limited Western mines’ ability to increase production to meet the added demand that does arise.

“If you do get a recovery in demand, like after the pandemic, but the railroads can’t adjust, that’s all lost revenue,” Feaster said. “You’re not going to sell that coal again later on.”

It’s likely, he said, that the new year will get off to a particularly meager start for the coal industry. Power plants’ coal stockpiles heading into winter were the highest they’ve been since 2020. The National Oceanic and Atmospheric Administration forecasts that this winter will be unusually warm across much of the country, slowing the rate at which utilities use their stockpiles and putting a damper on coal demand well into 2024.

As coal plants continue to shutter, unless new buyers emerge to take their place, the cost of producing and transporting each ton of Wyoming coal will go up. “You’ve got all these mines chasing fewer and fewer customers, fewer and fewer tons getting shipped out,” Feaster said. The looming question, he added, is, “How long can all of these mines stay viable?”

The post Wyoming coal could be in for a rough year appeared first on WyoFile.

A fourth elk has tested positive for chronic wasting disease near where elk closely congregate around hay provided to supplement their winter diets.

The Wyoming Game and Fish Department sent word on Dec. 26 that a cow elk tested positive for the always-lethal neurological disease, which is caused by misfolded proteins called prions. The animal was found in elk hunt area 92, which includes portions of the Hoback River basin, Wyoming Range and Upper Green River basin.

“The cow elk appeared to be in good body condition and based on examination of the carcass it is likely the elk was wounded by a hunter and succumbed to its injuries,” Game and Fish spokeswoman Breanna Ball wrote in an email.

CWD, a similar affliction to mad cow disease, has spread throughout the country and slowly westward across Wyoming since the 1990s. There’s no vaccine or means of treating the disease, which is considered a major threat to ungulate populations in North America.

According to Ball, the suspected hunter-shot cow that recently tested positive for CWD was found in the Fisherman Creek drainage, a tributary of the Hoback River that’s located in the same general area as Game and Fish’s Dell Creek and McNeel Feedgrounds.

Much attention has been paid to the spread of CWD into Wyoming’s elk-feeding region, partly because biologists anticipate grave consequences for herds that have become dependent on hay distributed daily during most winters. The U.S. Geological Survey recently projected that CWD will infect 42% of elk in the feedground herds of western Wyoming within 20 years of the disease’s arrival. Populations and hunter opportunity, in turn, would crater, falling from roughly 16,000 elk today to 8,300 animals over the same period in the Afton, Fall Creek, Piney, Pinedale and Upper Green River elk herds.

To date there have been four CWD-positive elk found within the feedground herd units, Ball said.

The first detection, in the Jackson Elk Herd, was of a cow killed by a hunter in Grand Teton National Park (elk hunt area 75) late in 2020. There have been detections in the feedground region farther south every year since, including positive tests from elk in hunt area 98 south of Pinedale in both 2021 and 2022.

The post Chronic wasting disease advances near Wyoming’s elk feedgrounds appeared first on WyoFile.

Mandi Lew, a third-generation Wyomingite who grew up in Rock Springs, set out to deliver babies in southwestern Wyoming as a profession. Instead, she watched maternal health care options erode to such a degree that she took her skills elsewhere.

Lew delivered babies in Kemmerer before that birthing facility shut down in 2022. Nearby Rawlins also closed its OB ward around that time, “which is a huge gap,” she said.

Lew also worked as a labor and delivery nurse at the Rock Springs hospital for 12 years, but when she became a nurse midwife, hospital bylaws would not permit her to practice without a supervising physician. That was untenable, she said.

Lew still lives in Rock Springs, but now she commutes two hours to deliver babies at Layton Hospital in Utah.

“I went to school to do this, to support and help my community,” she said, but Wyoming wore her down. “I’m like, ‘OK, fine. I’ll just go deliver in Utah.’”

Lew, who still offers reproductive health care in Rock Springs, sits on the OB subcommittee of Gov. Mark Gordon’s Health Task Force, which aims to strengthen Wyoming’s health care workforce and examine ways to improve access for the state’s residents. In that capacity, she can provide a first-person perspective.

If the erosion in care continues, Lew said, it will have grim consequences. Mothers will put off or forgo prenatal care, travel long distances or give birth in emergency rooms with nurses who aren’t trained in labor and delivery. “Our maternal mortality rate and infant mortality rate is going to significantly increase,” Lew said.

“I don’t see it getting any better any time soon until we can make some changes,” Lew said. “Women deserve choices. Families deserve choices.”

Securing those choices is a challenge in this rural state. Over the course of WyoFile’s investigation into the state’s maternity care shortages, however, it’s become clear there is a will to find solutions. Medical professionals, government officials and moms want sufficient care for women undergoing what is one most fundamental of human experiences.

But is there a way?

That’s the question WyoFile probes in the final part of “Delivery Desert.”

The problem

A dearth of maternal health care has made pregnancy and childbirth increasingly tricky in widening swaths of Wyoming. This is evident in Fremont County, where moms are opting to temporarily relocate to places like Denver and even the East Coast to deliver babies. It is evident in Rawlins, where families have to travel on Interstate 80, a notorious stretch of highway that closes frequently in the winter months, to deliver in Laramie. And it is evident in Teton County, where overflow patients from elsewhere in the state are putting a large demand on providers.

In 2021, there were 6,235 resident births in Wyoming, according to the state health department. Of those, 76% were delivered in their mother’s county of residence; 12% delivered out of county and 11% delivered out of state. Big Horn and Sublette showed the largest percentages of out-of-county deliveries, at 83%. Neither are home to a birth facility.

Rural maternity care seems to be in a self-perpetuating cycle, according to interviews. As labor and delivery units or OB offices close, obstetricians and midwives are more likely to depart the area, leaving remaining doctors vulnerable to burn-out and potential doctors less likely to see appeal in the positions that are available.

More than 15% of Wyoming women had no birthing hospital within 30 minutes of home in 2022, compared to 9.7% of women nationally, a report by the March of Dimes shows. Women who live farther from delivery hospitals are more likely to experience adverse medical outcomes. Babies are more likely to require a stay in the neonatal intensive care unit.

Wyoming’s issues reflect national trends. At least 89 obstetric units closed in rural hospitals between 2015 and 2019, according to the American Hospital Association. Nationwide, 5% of counties have less maternity access than just two years ago, a March of Dimes Report found.

Maternal mortality, meanwhile, more than doubled in the U.S. from from 1999 to 2019.

The Wyoming Department of Health released the state’s first maternal mortality report in May. It found that from 2018-2020, 13 women died during pregnancy or within one year after the end of their pregnancy. Mental health conditions were the most common cause of pregnancy-related deaths; drug or alcohol use was involved in all six, and all were deemed preventable.

Fixes will have to be tailored to specific demographics and needs of Wyoming communities, according to interviews with community leaders and health policy experts.

In Fremont County, where a single obstetrician and his midwife serve the general population of nearly 40,000, for example, those involved said better hospital accountability, more nurses, better succession planning for anticipated retirements and increasing public awareness could help.

“I think it should be a concern for everybody,” County Commissioner Mike Jones said.

Understanding the gaps 

The OB crunch is a frequent topic of conversation among members of the Wyoming Hospital Association, Vice President Josh Hannes said.

“It’s certainly a big concern,” he said, and it’s one that is complicated by hard choices. For example: Do hospitals continue to lose money on a service line because the community needs it? If so, how do they make ends meet?

“The money doesn’t fall from the sky for a hospital to operate,” he said, “but people expect it right? You’re sick, you’re injured. Whatever services you need, you want to go to your community hospital.”

At the same time, Hannes said, “having a robust health care system and community is an economic driver. It’s an economic development issue.”

In other words, there are many strings woven into health care; as one frays, the entire structure begins to unravel. Each community’s fabric is unique. And so, Hannes said, “As we sit here today, I don’t know that there’s just one or two things that would work everywhere to really make a huge dent.”

Maternal health is also a conversation for Gordon’s Health Task Force, said Jen Davis, the governor’s senior policy advisor for health and human services. That’s why the task force created the OB subcommittee, which is trying to wrap its arms around the scope of OB needs and what barriers exist for expecting families and providers.

There is “really a lot of exploratory conversation right now,” Davis said. “It’s a hard, complicated topic … because there’s a huge safety component around it. Childbirth is a dangerous thing.”

The subcommittee is preparing a survey to send to hospitals. The aim is to assess needs and existing services at a more granular level. With those needs elucidated, Davis said, the group can formulate policy recommendations as early as next year.

A parallel effort could spring from the launch of Wyoming’s Maternal Health Innovation Program at the University of Wyoming, which recently won a $5.2 million federal grant. The program aims to reduce Wyoming’s maternal mortality by researching ways to improve clinical care, workforce development, data collection and community engagement surrounding maternal health. One facet is partnering with the state to create a maternal health strategic plan for Wyoming, according to UW.

Workforce needs 

A major pinch point of rural health care is finding and keeping staff.

“I think other states are in the same quandary that we are,” Davis said. “There’s just not enough providers to go around as it is, and then to try to recruit to Wyoming has always been challenging.”

Hannes said the scope of the problem calls for rethinking the qualities that draw workers.

“It’s not just pay anymore, right? It’s lifestyle,” he said. And attention must go beyond recruitment, he said, to “retention as the place where we can start to move the needle. So the people that we have here, how do we make them really sticky to our facilities and to the state?”

The hospital association has policy recommendations.

“We’re really interested in seeing if we can get the Legislature to refund the nurse loan repayment program,” he said, referring to a health care professional loan repayment program lawmakers haven’t funded since 2018. Hannes believes Wyoming is missing out on medical staff; his group has heard anecdotes of physicians who wanted to be in Wyoming but went elsewhere because they would get their loans repaid.

Another idea, he said, is signaling to potential employees they will be safe in Wyoming. The WHA supports efforts to make assault, battery or threats of violence against health care workers their own crimes, he said.

Other tools hospitals nationwide are testing in order to attract workers include offering more flexible scheduling and even signing bonuses. But because traveling nurses and doctors can find more lucrative work that might offer less onerous schedules, many in the medical field have shifted to that kind of position.

Small gains, other opportunities

Wyoming’s Maternal Mortality Review is the result of a 2019 cross-state partnership with Utah. Because of that, it’s hard to ascertain long-term patterns of maternal mortality. But the program’s first report did come with recommendations for ways to prevent these deaths. They include improving access to behavioral health services, improved care coordination by providers, better access for provider training and bolstered community support services.

One of the recommendations was granted: increasing the ability to access insurance longer into the postpartum period.

“We at least took that first step to say, ‘yes, we’re going to extend postpartum Medicaid benefits from 60 days to 12 months,’” said Jen Simon, founder of Wyoming Women’s Action Network.

Advocates have tried for many years to convince lawmakers to expand Medicaid, meanwhile. Wyoming is one of 10 states that hasn’t adopted expansion.

Clinics and reproductive health advocates in states with poor maternal health outcomes have also worked to expand access to community-based doulas, something Simon is researching. Doulas are not medically trained, but they offer professional support for mothers before, during and after childbirth.

The state might rethink its reliance on doctors and do more to maximize the valuable skills doulas, midwives and others have to offer, Davis said. “Can we look at how we could leverage those professionals in a more meaningful way and build capacity within the state for looking at the workforce, because those might be easier to recruit or to train up in our state,” she said.

Tracy Rue of Lander has a different vision for supplementing maternal care in his hometown. His group, the Healthcare Partnership of Lander, is gathering resources to identify gaps, he said. But one of his goals is to open a women’s pavilion, which would directly impact OB services.

The pavilion, a standalone facility for gynecological and maternal health care as well as deliveries, won’t come easily, he said. “We have to invest in ourselves, and this is going to be a big investment,” Rue said.

Freestanding community birth centers often use a midwifery approach but partner with hospitals if complications arise. Rue is among Fremont County locals critical of the for-profit hospital model of companies like SageWest Healthcare, which operates the Lander and Riverton facilities.

Another support lever could come in the form of transportation assistance. Wind River Family and Community Healthcare, for example, has a robust transportation system for transporting patients who need to see specialists. That clinic serves tribal patients.

Government’s role?

Wyoming’s health care challenges have long been a topic of state discussion, Rep. Loyd Larsen (R-Lander) said. But solving them can be tricky.

“We have to be careful that we demand health care be in every community,” Larsen said. “It’s not sustainable. And it’s the challenge that all rural states are having.”

There’s the philosophical question of the state’s obligation to fix these kinds of issues, he said. “Does the state have a role in ensuring that health care is provided to the citizens of the state? There’s a segment of the population who says, ‘Absolutely, they do.’ And there’s a segment of the population that says, ‘No, not at all.’”

There are hospitals across Wyoming that are near financial distress, he noted. But lawmakers must also ask themselves: “Is it the state’s role to make sure that all those hospitals succeed?”

That being said, the Legislature approved $10 million in federal stimulus funds for the Riverton Hospital District’s effort to build a community-owned hospital — an effort prompted by what many claim is substandard service at the town’s investor-owned, for-profit hospital. SageWest Health Care, which operates the Riverton hospital, closed that facility’s labor and delivery ward in 2016.

Another Legislature-supported effort is the WWAMI Medical Education Program, which is affiliated with the University of Washington School of Medicine. It’s considered one of the state’s strongest tools for keeping promising young doctors in the state. The program is designed to be a win-win — if a participating student goes to work in a designated underserved rural area, the program pays back up to 75% of their tuition costs for the returned service. The Wyoming Legislature annually funds 20 seats for the University of Wyoming in the program.

Since the start of the program in 1997, 194 students have earned medical degrees through WWAMI and completed residencies, according to UW.

About 68% of graduates who completed residency, or 131, have returned to Wyoming to practice medicine. Of those 131 returnees, 102 remain in Wyoming practicing medicine — or 53% of graduates who completed residencies.

Lawmakers can also hurt Wyoming’s health care landscape. And they’ve done harm, many argue, by passing a pair of abortion bans — though enforcement of the bans has been held up in the courts.

Hannes’ association has not taken an official position on those bills. But based on what he has heard in legislative testimony and committee meetings, he said, “it sounds like maybe … there is a cooling effect” on providers wanting to practice in the state.

Simon also believes the bans’ message factors into where women of childbearing age want to live. Statistics on Wyoming’s so-called “brain drain” indicate that nearly twice as many women between the ages of 25-29 left the state than men, she said.

All told, it reverberates “in terms of health care, but it also reverberates in terms of who stays in our communities, who’s working in the state, who’s helping to make the state continue to have cohesive and vibrant communities,” she said.

Conclusions

Back in Fremont County, Commissioner Jones has heard a lot of people say it’s time to form a hospital district. But, he said, the piecemeal way things are now — a for-profit hospital in Lander, a new hospital district in Riverton — complicate that prospect.

“Rather than having a centralized approach, we have a fragmented approach,” he said. Still, he said, the district conversation may be inevitable.

“I think the question that we’ll have to wrestle with is whether we go back to a public-funded hospital model,” Jones said. “I’m not saying I advocate that direction, but I don’t know that we can avoid it.”

“Babies come. And when they come, you can’t stop them.”

Dr. Jan Siebersma

Laura Gibbons, a family practitioner who provides obstetric care to tribal patients at Wind River Family and Community Healthcare, doesn’t think Fremont County’s maternal care challenges are futile. She herself delivered at SageWest Lander.

“I think people have to care to fix it and it’s going to take that work, but I do think it’s fixable,” she said. One place to start is attracting more nurses to the hospital so support staff is in place, she said.

One thing is certain, said Dr. Jan Siebersma, a Fremont County gynecologist who recently stepped away from delivering babies: The issue cannot be ignored or wished away.

“Babies come,” he said. “And when they come, you can’t stop them.”

The post Before fixing Wyoming’s maternal health gaps, agencies aim to understand them appeared first on WyoFile.

LANDER—When teacher Fredde Reed became pregnant with her first child in March, her choice for prenatal care was easy, she said.

“Being Native American enrolled, I can receive care at Indian Health Service,” said Reed, who is Eastern Shoshone. Reed and her wife weren’t initially certain they would stay with IHS through the birth. They wanted to explore other options in Fremont County.

But those options have dwindled significantly in recent years. Meanwhile, two clinics on the Wind River Indian Reservation — one run by IHS, a federal agency, along with Wind River Family and Community Healthcare, run by the Northern Arapaho tribe — have been building their maternal care services.

So at IHS, Reed established care with Dr. Matt Graf, a family practitioner with obstetrics training, and was assigned what felt like a whole team of staffers to keep track of her pregnancy. She also found resources through the clinic to connect with other expecting mothers.

“They are building a really good program to support moms,” Reed said. “Especially women who don’t have a lot of support.”

Reed’s experience is notable in this New Hampshire-sized county of nearly 40,000, where non-tribal residents have a single obstetric practice to visit for prenatal and delivery care. Many women travel long distances for prenatal care and to deliver because they are uncomfortable with just one option and the likelihood it creates for delivering with an on-call traveling doctor.

On the Wind River Indian Reservation, meanwhile, IHS and Wind River Family and Community Healthcare, commonly known as Wind River Cares, have made targeted efforts to ensure they meet the pregnancy and labor-related needs of their Eastern Shoshone and Northern Arapaho patients.

“I think in a lot of ways … [our patients] have more resources than the general community does,” said Dr. Laura Gibbons, who is part of a maternal health team at Wind River Cares.

Growth and needs

Gibbons is a family practice doctor with obstetrics training, meaning she can deliver babies but not perform surgeries like c-sections.

For more than a year, she was the only full-time OB provider at Wind River Cares, which operates clinics for tribal patients in Arapahoe, Ethete and Riverton. But late this summer, her clinic hired another family practice doctor with the same OB training, plus one who can perform c-sections.

The clinic also employs two nurses dedicated solely to pregnant women, moms of young children and their kids. Lander obstetrician Dr. Thomas  Dunaway, the only practicing obstetrician serving Fremont County, also contracts with the clinic for surgical needs.

It’s becoming a well-staffed team. That’s important, because as maternal care is shrinking in many parts of rural America, pregnancy-related risks are particularly high for Native women. American Indian people are more than two times as likely to die from pregnancy-related causes than non-Hispanic white people, and roughly twice as likely to experience severe maternal morbidity.

“Most of our patients are high risk,” Gibbons said, for reasons ranging from age (35 or older) to high blood pressure and gestational or preexisting diabetes.

No employees of IHS could obtain permission from the federal agency to talk to WyoFile by publication.

Unique needs

Transportation is a significant need associated with health care on the reservation — it’s a 3,500-square-mile area of scattered communities, and it’s far from urban centers where specialists are often found.

Wind River Cares operates a transportation system specifically to fill these needs, whether it’s a case of a maternal-child-health nurse picking up a patient to bring her to appointments at the clinic or the transport of a high-risk pregnant patient to see a maternal-fetal specialist in Denver.

The system is crucial, Gibbons said.

“It’d be impossible to function and provide patients the care they needed if we didn’t have that,” Gibbons said.

Gibbons credits Wind River Cares CEO Rick Brannan for prioritizing maternal care. Brannan, she said, was “aggressive and willing to hire more obstetrical providers for our group … I do think Wind River Cares has done a very good job of building access for our patients.”

And as a physician who spent all those months as the clinic’s sole maternal health doctor, Gibbons is relieved to see the team grow. Birth volume has bumped up in recent months, but even without that factor, she said, a bigger staff can just provide more comprehensive care.

The erosion of maternity care providers elsewhere in the county, she believes, “has just increased the pressure” to bulk up the clinic’s resources.

Still, for all the efforts, all Fremont County patients are vulnerable to the realities of rural medicine, she noted, including a provider dearth.

“It’s no secret, like, OB is not the only specialty we wish we had more of,” she said. “We’re short on doctors of all kinds.”

Happy patient

Many expecting mothers who talked to WyoFile traveled to places like Thermopolis, Casper and Salt Lake City to give birth.

Reed and her wife, in contrast, had planned to drive about a half mile from their house to Lander’s SageWest hospital, where Graf has privileges to deliver babies.

“I could give birth in Thermopolis or Jackson,” Reed said in early November. “But I really like Dr. Graf and I like the program that he’s building and I’m confident in that. So that’s kept us here.”

Plus, she said then, her December due date means “it’s going to be winter so you can’t really count on the roads being open.”

Babies have a way of scrambling the best-laid plans, which is what happened in Reed’s case. Shortly after talking to WyoFile, she and her wife were traveling in the Denver area when her blood pressure spiked. Her doctor recommended she go in for monitoring, and Colorado medical professionals found she had severe preeclampsia — a dangerous pregnancy-related condition.

They induced Reed’s labor, five weeks short of her due date. She gave birth, and her daughter spent 13 days in the NICU, a resource Fremont County hospitals don’t have.

“We were extremely lucky to have been in the Denver area and to deliver there,” Reed said after the birth. “If we had been home, our baby would have been flown and we would have been separated.”

The post As nearby maternal care dwindles, tribal clinics build it up appeared first on WyoFile.

LANDER—Jan Siebersma has delivered thousands of babies during his three-plus decades in obstetrics. He’s seen it all: twins and breech babies, marathon labors, emergency cesarean sections, even the rare en caul delivery when the infant emerges in the intact amniotic sac.

Working in Fremont County for the past 15 years has kept him busy. The New Hampshire-sized county is home to nearly 40,000 people and several towns, but as of 2016, Lander is the only one with a hospital that delivers babies.

As recently as 2021 Siebersma provided care alongside another OB and two midwives at the Lander Medical Clinic; all four delivered at the hospital. There was also a private practice in town. “We had a nice amount of providers, and a relatively nice life,” said Siebersma, a tall man who keeps his gray hair cropped short.

But then the clinic’s other obstetrician stopped working due to a medical issue, and one of the midwives left the practice.

“So then, [midwife] Sam Skelton and myself were left with a practice that had been built up for four people,” he said. “The thing about obstetrics, you can’t just turn the faucet on and turn the faucet off. So during that time, I just really got burned out.”

Siebersma tried to facilitate the hiring of another OB to relieve the burden, even asking the hospital to recruit another provider. But ultimately, he had to step away. Siebersma delivered his final patient’s baby in early 2023.

That left Dr. Thomas Dunaway, who employs a midwife, as the sole obstetrician serving the general population of pregnant patients in Fremont County. (Tribal patients on the Wind River Indian Reservation have access to specifically contracted doctors.) Dunaway did not respond to several interview requests.

Siebersma continues to see gynecological patients. He also works as a locum tenens doctor for SageWest, meaning he takes on-call shifts to deliver babies. But unlike before, the patients are not women he’s previously established care with and seen for prenatal checks.

Taking locums calls “is vastly different than having, you know, 150 patients that are pregnant that I’m responsible for,” Siebersma said. That type of workload is what you sign up for as a rural obstetrician, he noted. “But there comes a point where … enough is enough. It gets onerous after a while, constantly being available.”

Siebersma’s story of spending inordinate hours helping bring babies into the world — perhaps to the detriment of his own health and family life — is common among rural obstetricians, according to interviews with medical staff and experts.

His decision to stop practicing obstetrics is one piece in a complex puzzle of factors that have eroded services in this sprawling central Wyoming county, and the state as a whole. Though Wyoming has 23 counties, it is home to just 18 birthing facilities. Several facilities have shuttered labor-and-delivery units in recent years. Doctors have retired, closed offices, limited their practices or left the state to practice elsewhere. The providers who remain are left to grapple with taxing call schedules, the uncertainty of relying on unfamiliar traveling nurses and the responsibility for many patients with little backup.

Lander’s SageWest Health Care hospital has recruited a new obstetrician who will start at the hospital in 2024, CEO John Whiteside said, along with a family practitioner who can deliver babies.

“The desire in my heart is still that I do want to work and help the people of Wyoming … Sometimes things have to break for them to get fixed.”

Natalie Eggleston, , OB-GYN who grew up in Jackson

Having more hands on deck could help, providers say, but is unlikely to change the predominant climate of gusting headwinds.

Shrinking obstetric options have consequences not only for providers, but for their patients. Many women here travel for maternity care, risking dangerous road conditions and adverse outcomes. In part two of this series examining Fremont County’s OB shortage, WyoFile looks at the impacts on the oversubscribed medical professionals keeping the system afloat.

‘Couldn’t make it work’

Nurse midwife and mother of four Chase Ommen grew up in Riverton. She has many years of experience in Fremont County’s OB realm — she worked as a labor and delivery nurse in the nearby Lander hospital and later as a nurse midwife at the Lander Medical Clinic, providing a range of women’s health care services and delivering babies in the hospital.

Ommen started as an OB hospital nurse in 2011, and looks back at that time fondly.

“We were a rocking team,” she said. “We had great nurses, great providers, we had an amazing manager of our unit. And we all worked together very well. The community had choices in providers at that time, and that’s huge for a patient … and also, we provided really great, up-to-date, evidence-based care.”

There was healthy competition between the Lander and Riverton hospitals, she said. Then in 2016, SageWest, both hospitals’ out-of-state, for-profit owner, closed the Riverton OB unit and consolidated the campuses’ services. Lander’s birth volume spiked, Ommen said, and her manager became saddled with too much work and too few resources, ultimately resigning. Many felt the support from administration “wasn’t there.”

The situation didn’t improve. Working as a midwife years later, she recalls spending her days seeing patients in the clinic and her nights in the hospital delivering babies. She barely slept. “It was awful,” she said.

Ultimately, she said, she hit too many barriers — financial and otherwise —  to practice midwifery in Lander. She found a midwifery and family practice position in Billings, Montana, packed up her family and left Wyoming.

“It was really really hard for us to leave Lander,” Ommen said. “Not what we wanted.”

When Siebersma ended his OB practice, nurse midwife Skelton’s services were also lost to the community. That’s because she had a collaborative agreement with Siebersma; the hospital requires such an arrangement for a nurse midwife to deliver.

Skelton said the gaps in care are hard on families. “The idea that you will likely get prenatal care and then go in and have someone completely different show up for your birth, I think that’s anxiety-inducing for a lot of women.”

Certified professional midwife Heidi Stearns helped Fremont County mothers have home births for 15 years until she retired at age 65 in June.

With her retirement, she said, women seeking home birth options must look to midwives who are willing to travel to Fremont County from elsewhere. She refers people to a Worland-based midwife. Worland is 88 miles from Riverton and more than 100 from Lander.

Rural midwifery is tough to sustain, Stearns said — you are on your own in many ways. The specter of an abortion ban in Wyoming and other states also weighs heavily on midwives like herself, Stearns said. For example, she used misoprostol, which abortion opponents have targeted, for treating postpartum hemorrhaging.

“It’s really scary to do births without those medications,” Stearns said.

In Idaho, anti-choice laws have driven many OB-GYNs from the state, leaving women and pregnant patients with few choices in a newly deserted health care landscape. Wyoming lawmakers have passed a pair of abortion bans, though enforcement has been held up in the courts.

“I think Idaho is a good model of what would come if all the bans went into effect” in Wyoming, said Jackson OB-GYN Giovannina Anthony, who is among the plaintiffs challenging Wyoming’s bans in court.

Incentives and disincentives 

Obstetrics is not as profitable a specialty as many others, which experts say is one factor driving rural hospital labor and delivery closures. A 2022 study on rural obstetric challenges found that about 40% of rural hospitals lose money on their obstetrics programs due to factors such as Medicaid reimbursement rates. In addition, medical liability insurance premium rates are higher as a percent of gross income for specialties considered high-risk, such as obstetrics.

Another challenge to the specialty involves volume. Doctors need a large enough patient base to treat the gamut of issues and keep their skills sharp. In obstetrics, ideally that means lots of normal births as well as the complicated cases, which can be valuable learning experiences.

Rural areas often lack that volume. They are often also short on other medical resources found in urban centers, including specialists who can help with complicated cases and enough colleagues to share the call-schedule load. Retaining support staff has also been a challenge even as employees like nurses and anesthesiologists are vital for delivery wards.

Those and other factors make it difficult for rural facilities to compete with urban centers for doctors. Wyoming has long grappled with this.

The University of Wyoming participates in the WWAMI Medical Education Program, which is affiliated with the University of Washington School of Medicine. It’s considered one of the state’s strongest levers for keeping promising young doctors in the state. The program is designed to be a win-win — if a participating student goes to work in a designated underserved rural area, the program pays back up to 75% of their tuition costs for the returned service. The Wyoming Legislature funds 20 seats annually in the program.

Growing up in Jackson, Natalie Eggleston always wanted to be a doctor. When she learned about WWAMI as a teenager, she figured she’d found her ticket. “It was like, ‘all right, that’s how I get to medical school.’”

After her undergraduate studies in Utah, she was accepted into the selective WWAMI program and pursued obstetrics as a specialty.

She completed her residency and OB-GYN training in California. When it was time to come back to Wyoming, however, she started having second thoughts. She worried that the Roe v. Wade reversal, and Wyoming’s abortion-ban laws, would affect her ability to provide full reproductive care to patients.

“To imagine myself coming back to a place where I would have to basically put my own security and my job potentially ahead of what I know to be the right type of care to offer patients … It kind of seemed like an impossible place to put myself in so early in my career,” she said.

Other challenges of rural medicine factored in. She started to realize how low-resourced some of the practices were and how difficult mentors would be to come by.

“I kind of wanted to keep some of my volume and my resources high before I was ready to be the best doctor that I could be in a rural area,” she said.

And in Jackson, where she strongly considered returning, the cost of living is too high even for many doctors to afford, she said.

So Eggleston instead accepted an OB-GYN position in Billings. There is still time to return to Wyoming and claim WWAMI’s financial incentives. If she doesn’t, however, she will miss out on about $250,000 in loan repayments.

“The desire in my heart is still that I do want to work and help the people of Wyoming,” she said. “Sometimes things have to break for them to get fixed.”

As of 2022, 131 out of 194 Wyoming-WWAMI graduates, or about 68%, have completed residency and returned to Wyoming to practice medicine, according to the University of Wyoming.

Other providers

Fremont County families had 442 babies last year, according to state records, but only 339 were born in the county, indicating that 103 babies — almost one in four — were delivered elsewhere. That translates to an increased load on obstetric providers in places like Thermopolis, Jackson and even other states.

Hot Springs County’s delivery numbers jumped by 65% between 2011 and 2022.

“Fremont County, it’s a heck of a lot bigger than Hot Springs,” said Dr. Travis Bomengen, a Thermopolis family practitioner who provides OB care at Hot Springs Health. “And so, our numbers have gone up from that standpoint.”

The trend has spurred staffing changes to ensure enough providers are on hand, Bomengen said. Hot Springs Health has satellite clinics, including one in Riverton. They held off expanding for some time, Bomengen said, but the need became apparent. “That was kind of our mindset for trying to get down there and help out with some of the shortages.”

Teton County also fields spillover from other communities. At Gros Ventre OB-GYN in Jackson, employees struggle to keep their heads above water, obstetrician Maura Lofaro said one August evening after hours from the office she shares with Dr. Shannon Roberts and nurse midwife Christina Kitchen.

When she started practicing in Jackson 26 years ago, “there were actually too many of us,” Lofaro said — about eight providers in obstetrics. And it was a crowded field for some time.

But in just the last couple years, she said, five providers stepped away from OB or cut their volume. And suddenly “it was like trying to drink from a firehose,” she said, “the volume was like, pouring in.”

St. John’s Hospital has helped by hiring a locums to help Gros Ventre’s providers handle the on-call delivery schedule, she said, and efforts are underway to recruit more doctors.

Meantime, “we have not turned any woman away from this office. We have made it work.”

That includes patients from Fremont, Sublette and Sweetwater counties. Lower-priority needs do get pushed off, Lofaro said. GYN patients calling for an annual exam won’t likely get seen for four to five months, for example.

The biggest challenge is not the patient volume — it’s retaining staff like nurses. “It’s just that we don’t have the support staff,” she said.

St. John’s Hospital plans to continue to support the staffing needs of its birth center into the future, Hospital CEO Jeff Sollis said during a hospital board meeting this summer.

“We will continue to be a resource for Fremont County families who are seeking high-quality obstetrical [care],” St. John’s Communications Officer Karen Connelly wrote to WyoFile in an email.

In early November, Jackson OB-GYN clinic Women’s Health and Family Care, which collaborated with Gros Ventre OB-GYN, announced it’s closing Dec. 15 “due to financial reasons.” In a letter to patients, the clinic said its doctors will continue to practice at other Jackson locations. “With the rising cost of overhead, including rent, labor, and supplies, our private practice is no longer sustainable,” the letter said.

Fears

Of all the births Siebersma has experienced over the years, it wasn’t necessarily the rare ones that were the most harrowing.

“The ones that are scary are when women had severe preeclampsia at 26 weeks, and there’s a snowstorm, and we can’t [fly] them out and we have to do a stat c-section, and we have a pound-and-a-half baby that the pediatricians are trying to stabilize in order to get him out,” he said.

And yet, part of what he found gratifying about delivering babies in rural Wyoming for so many years were the situations that tested his skills. “I like caring for really sick people,” he said.

Looking forward, Siebersma says he worries the eroding provider base will lead to less prenatal care and more of these scary scenarios. There is a lot of high risk in Fremont County, he noted: high levels of diabetes, high blood pressure and substance abuse. The hospital already sees women in labor who received no prenatal care, Siebersma added. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care, according to the Office on Women’s Health.

“Ten years ago, I would have patients coming from Jackson or from Rock Springs or Casper, Dubois, Thermopolis, to deliver here,” Siebersma said. Now, that situation seems to have reversed.

It won’t be easy to undo.

“It’s a very complicated problem that didn’t just occur when I stopped seeing OB patients in January,” he said. “It’s been going on for a long time.”

Midwife Ommen called the situation “terrifying.”

“It makes me angry for the community,” she said. “I worry for them.”

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