SHERIDAN — After passing the Senate on second reading without issue, House Bill 82 — which would authorize the construction of a skilled nursing facility for veterans in Buffalo — appears poised to be signed into law, but some local concerns remain.

Sen. Michael Von Flattern, R-Gillette, successfully motioned to have the second reading of HB82 delayed to Tuesday to verify the financial viability of the proposed Buffalo facility.  The bill requires the state partner with the community on a loan to build the facility, Von Flattern said he wanted to double-check the numbers to ensure Buffalo, and the state, would not struggle to repay that loan.

Sen. Dave Kinskey, R-Sheridan, said the fact that the concern was not raised on second reading is good news for the bill as written.

“My understanding was if (Von Flattern) had any concerns he would raise them on second reading,” Kinskey said. “I did have a conversation with him — I don’t want to speak for him — but the conversation I had was he was comfortable that wherever the facility was it would be financially viable.”

Kinskey added that the state spent $300,000 on a study that reviewed the viability of housing the facility in several communities in the state and he was confident that all three of the finalists that study selected — Buffalo, Casper and Sheridan — could support the facility medically and financially.

The Buffalo facility has also faced opposition from physicians in Buffalo.

Johnson County Health Center Interim CEO John Osse said the JCHC signed a memorandum of understanding with Johnson County and the city of Buffalo last week that eased some of the concerns the hospital district had about locating the facility in Buffalo.

“We were concerned that the cost of the workforce would go up significantly to the point that it would impact our financial viability,” Osse said.

The MOU guarantees that the city and the county would support the hospital district’s efforts to obtain an extra mill levy — a property tax that would provide revenue for the JCHC — in the event that the veteran’s facility negatively impacts the JCHC’s finances.

Ultimately, though, an extra mill levy would need to be approved by Johnson County voters.

Individual physicians in Buffalo have also raised concerns about the quality of care the facility would deliver if it was located in Buffalo.

Last month, Dr. Alyse Williams, a family medicine doctor at the JCHC, submitted a letter cosigned by seven Buffalo doctors to the Legislature’s Transportation, Highways and Military Affairs Committee that said Buffalo’s medical community would have trouble effectively treating the acute patients a skilled veteran’s nursing facility would attract.

“…These patients are medically complex, they require several sub-specialists that we simply do not have consistently in our community,” Williams wrote.

Williams’ letter argued that building the facility in Buffalo would increase the burden on the already-overworked physicians in Buffalo and offer the veterans relying on the facility incomplete care options. For instance, many veterans suffer from psychological and behavioral conditions and, Williams wrote, Buffalo is not currently equipped to treat, or even manage those conditions; the letter explains that there are no psychiatrists in Buffalo or on the JCHC medical staff. Further, the hospital does not have a “locked unit” or the nursing staff necessary to provide the one-on-one supervision patients with behavioral issues often require.

Osse said the MOU has not assuaged the concerns of those physicians.

“The doctors feel the same way (they did in January),” Osse said. “The administration is looking at it from a financial perspective to make sure we remain financially viable. The physicians’ point of view is from a medical quality of care issue…The hospital’s position is to remain neutral.”

Kinskey, though, said the concerns the Buffalo physicians have, while valid, are not unique to their city.

“The concerns raised relate to shortage of appropriate medical staff and that is an issue in Buffalo, that is an issue in Sheridan, that is an issue in Casper, that is an issue in Cheyenne, that is an issue in the entire United States of America,” Kinskey said. “So that is a concern that will have to be addressed in every community regardless of where the skilled nursing facility goes.”

Further, Kinskey said the assisted living facility already in Buffalo would help offset some of the staffing concerns about the facility and the city and the county have been working with Sheridan College in Johnson County to develop programs that would provide more medical personnel for the community.

“I believe that everything that can be done is being done and much more than I think is being done in most communities,” Kinskey said. “In a way, it’s good that the issue was highlighted because it tells us we’ve got to swing into action not just in Buffalo, but everywhere.”

The Senate is expected to consider the bill on its third and final reading Thursday.