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For the last three years of pandemic turmoil, health care providers have carried the burdens of patient care, changing safety standards, combating misinformation and much more. Some have left the field entirely or taken travel contracts to find better pay and avoid burnout. The strain on the medical workforce has prompted renewed focus on an old question: Who takes care of health care workers?
That’s one of the threads we focused on in a feature story this week about medical professionals trying to overcome addiction, both for the sake of their patients and their own livelihoods. Doctors, nurses and other medical professionals, like the rest of the population, deal with substance use disorders and mental health issues. But the stigma surrounding those challenges and the high expectations placed on the health care workforce — by licensing boards, employers and patients — can make it hard to seek help before a problem turns into a crisis.
For years, Montana was one of many states with a home-grown recovery and monitoring program for medical workers. The nonprofit Montana Professional Assistance Program (MPAP) accepted participants who self-referred for help as well as those directed to enroll by their licensing board as a result of disciplinary action. The state-contracted program used a system of random drug testing, case management, treatment referrals and peer support to help professionals keep or regain their ability to practice safely.
That program unraveled in 2022 when the state Department of Labor and Industry decided not to renew MPAP’s contract and bring operation of the recovery and monitoring program within the agency. A few months later, responding to criticism from medical boards and associations, the state changed course and began searching for a new third-party contractor. The winning company, which took over management of the services in 2023, is Maximus Inc,. a multi-billion-dollar Virginia-based contractor that touts years of experience running similar assistance programs in California.
The labor department told MTFP it saw Maximus as a “premier provider for the services that adhere[s] closely to industry best practices.” Current participants in the program, however, describe the new company’s protocols as “overwhelming” and “ludicrous,” saying it makes them feel more like numbers on a page than real people on personal recovery journeys. Critics of the new program fear the strained relationship between health workers and Maximus risks undermining the whole point of an assistance program — providing not only an open door, but one that people are willing to walk through when they’re struggling.
We hope the story sheds light on a little-known aspect of Montana’s addiction and recovery reality. If you have thoughts about the piece or more insight into the dilemmas health care providers are facing, don’t hesitate to reach out.
—Mara Silvers, Reporter
By the Numbers 🔢
Score received by Montana’s Office of Public Instruction on a state Department of Administration review of OPI’s contracting procedures — a score DOA characterized as “failing.” DOA’s review found that OPI failed to retain adequate records about its solicitation and execution of contracts for third-party services, had not adequately trained its staff on policies governing the solicitation of bids and awarding of agency contracts, and failed to show that it had verified the eligibility of vendors prior to awarding contracts. As a result, “Effective immediately, OPI must submit all procurement activity over the small purchase threshold (with a total contract value of $10,000 or more) to [the State Procurement Bureau], and SPB will complete the procurement action on behalf of OPI,” according to State Financial Services Division Administrator Cheryl Grey.
—Alex Sakariassen, Reporter
Rules of Order 🧑⚖️
The first transgender woman in the Montana Legislature will likely not be allowed to speak about bills on the House floor for the remainder of the session after Republicans determined she broke decorum when criticizing Senate Bill 99, controversial legislation restricting gender-affirming care for trans youth, earlier this week.
Rep. Zooey Zephyr, D-Missoula, is a freshman lawmaker and a vocal opponent of the slate of bills Republicans have brought forth this session that restrict health care and expression for transgender Montanans. Her criticism was especially sharp on the afternoon of April 18, when the House was debating amendments from the governor’s office to SB 99.
She told lawmakers they should be ashamed for endorsing legislation that could force a transgender minor to go through puberty without receiving gender-affirming medical care, a circumstance Zephyr called “tantamount to torture.”
“The only thing I will say is if you vote ‘yes’ on this bill and ‘yes’ on these amendments, I hope the next time there’s an invocation when you bow your heads in prayer, you see the blood on your hands,” she added.
The comments generated objections from House Republican leadership, who said they would not tolerate being shamed by anyone in the chamber. Later, the Montana Freedom Caucus, a hard-right legislative subgroup, called for Zephyr’s censure in a press release that also misgendered her.
While she wasn’t officially censured, on Thursday House Speaker Matt Regier, R-Kalispell, made it clear that Zephyr would face serious consequences.
When she attempted to speak on Senate Bill 458, sweeping legislation that would insert a binary definition of sex into state law, Regier didn’t recognize her. House Minority Leader Kim Abbott, D-Helena, inquired as to why.
Regier responded that it’s his prerogative under legislative rules to disallow a member to speak on the floor in order to maintain decorum.
“It is up to me to maintain decorum here on the House floor, to protect the dignity and integrity, and any representative I don’t feel can do that will not be recognized,” Regier said.
Abbott objected, kicking off proceedings in the House Rules Committee, which — unsurprisingly, given the sizable majority Republicans hold on that and other committees — upheld Regier’s ruling.
Regier later told reporters that he will not be recognizing Zephyr on the floor unless she apologizes.
“If I can’t trust that they’re going to stay within decorum moving forward, and until that happens and that trust is restored, there’s not going to be any recognition,” he said.
Zephyr told MTFP she has no intention of apologizing. She chose her words, she said, with “clarity and precision.”
“I have lost friends to suicide this year,” she said. “I field the calls from multiple families who dealt with suicide attempts, with trans youth who have fled the state, people who have been attacked on the side of the road, because of legislation like this. I spoke with clarity and precision about the harm these bills do. And they say they want an apology, but what they really want is silence as they take away the rights of trans and queer Montanans.”
Decorum has a purpose, she said, but can also be used by the party in power as both a “shield and a cudgel.” Republicans have used graphic language when debating abortion in the past, but don’t seem to face repercussions, she added.
Deer Lodge Rep. Gregory Frazer is one of the few House Republicans to consistently vote against his party’s LGBTQ-related legislation. He said Zephyr could have perhaps worded her criticism differently, but that her passion and frustration are justified.
“The part about blood being on hands — the way I took that is more addressing the potential for suicide than anything else,” he said. “It’s a very real potential.”
He said he hoped Regier’s decision to not recognize Zephyr — which has already attracted national press attention — wouldn’t result in blowback to the legislative Republican caucus, but that “anything is possible.”
—Arren Kimbel-Sannit, Reporter
Viewshed 🌄
An iconic western Montana River is included in the nonprofit American Rivers’ Most Endangered Rivers list of 2023, largely due to the public health and ecological risks posed by the unengineered berms — mounds of gravel, essentially — separating the Clark Fork from an unremediated 1,000-acre pulp mill site. The Clark Fork Coalition, a Missoula nonprofit that owes its start in the mid-1980s to contamination concerns stemming from pulp mill operations, is hoping its namesake’s inclusion on this year’s endangered list — it’s No. 5 of 10 — will inspire the U.S. Environmental Protection Agency to escalate the pace and breadth of cleanup at the site.
Montana lawmakers have shown a willingness to step in, too. On Thursday, the House Natural Resources Committee passed a resolution that will direct the state Environmental Quality Council to weigh in on Smurfit-Stone cleanup to give the state and its residents a louder voice in that federal process.
—Amanda Eggert, Reporter
Glad You Asked 🙋🏻
As the session comes closer to its finish line, many lawmakers are making their best efforts to get their bills passed through the Legislature.
But when it comes to bills whose original intent has been mangled by amendments, what’s a lawmaker to do?
Rep. Jonathan Windy Boy, D-Box Elder, is facing that challenge with two of his bills: one to require stronger reporting on the implementation of Indian Education for All, and another to codify an Indian Child Welfare Act in state law. Both bills have been amended and are set to be heard again on the House floor.
In an interview with MTFP, Windy Boy described his intention to ask for a “do not concur,” which means he’ll ask his House colleagues not to vote for the bill as amended. If his motion passes, the bill will head to a conference committee for further deliberation on the amendments.
“It’s all about strategy here to make things work, to make things pass,” Windy Boy told MTFP.
According to the Legislature’s 2023 rules, either chamber can request a conference committee if the bill’s sponsor rejects amendments. House leadership can then appoint three representatives and three senators to the conference committee, which would debate the disputed amendments until all parties agree on a new version of the bill to send back to the floor for debate and a vote.
—JoVonne Wagner, Legislative Fellow
Verbatim 💬
“Shame on the Legislature and shame on the governor. It’s absolutely despicable, it’s embarrassing, and I want to thank all of you for your hard work, for your tireless commitment to kids, and for doing what’s right to try to make sure we have the best educators in front of our youth in this state as we can.”
—Kelly Elder, chair of the Certification Standards and Practices Advisory Council, addressing fellow members about the group’s elimination during its final meeting April 19. CSPAC was established by the Legislature in 1987 to offer the Board of Public Education insight from active Montana educators on regulations governing teacher quality and licensing. The council raised the ire of Gov. Greg Gianforte and state Superintendent Elsie Arntzen last year over its attempted inclusion of the word “equity” in the state’s educator code of ethics. House Bill 231, which passed the Legislature April 17, eliminates CSPAC as part of Gianforte’s broader red tape relief effort. The governor’s office has said the “equity” dispute and the council’s elimination are “entirely unrelated.”
—Alex Sakariassen, Reporter
Public Comment 🗣️
The Lolo National Forest is soliciting public input on its long-overdue forest plan rewrite process, which is expected to take several years.
The last plan to create an overarching management plan for the Lolo National Forest was adopted in 1986. The Forest Service is supposed to update those plans every 15 years, so the rewrite marks a major milestone for management of the 2-million-acre national forest. The 1986 plan is a whopping 415 pages and includes details about everything from the agency’s timber harvest approach to its wildlife habitat goals and the agency’s direction regarding Forest Service employees’ interactions with the public.
Thus far in the rewrite process, the Forest Service has completed an initial inventory of free-flowing rivers that meet basic criteria for “wild and scenic” designation. Now it’s soliciting input on which of those rivers are particularly strong candidates by virtue of “outstandingly remarkable values” that “owe their existence to the presence of the river, are located on the river or within a quarter mile and contribute substantially to the functioning of the river ecosystem.” They can include recreational, scenic, geological, historical and cultural values, as well as wildlife- and fishery-related values.
The Forest Service is also undertaking a similar inventory and evaluation process for wilderness designations. Per the Wilderness Act of 1964, a wilderness area is one “retaining its primeval character and influence, without permanent improvement, or human habitation, which is protected and managed so as to preserve its natural conditions.” As with a wild and scenic river designation, the Forest Service cannot independently adopt a wilderness designation — it can only forward recommendations to the U.S. Congress, which has ultimate designating authority.
The public has until May 16, 2023, to provide input on the draft wild and scenic rivers inventory and draft wilderness inventory. Written comments are accepted online or can be mailed to:
Lolo National Forest Supervisor’s Office
c/o Amanda Milburn, Plan Revision
24 Fort Missoula Rd.
Missoula, MT 59804
Additional info on the plan rewrite process is available at in-person and online sessions. Curious what a recent plan rewrite in another region of the state has wrought? Here’s a run-down of the plan the Custer Gallatin National Forest adopted last February.
—Amanda Eggert, Reporter
On Our Radar 
Amanda — I’ve been anxiously tracking Wyoming’s bleak winterkill situation these past few weeks, partly to learn why our neighbors to the south are seeing such heavy ungulate mortalities. A recent Wyofile story offers a compelling clue: There’s an “inverted snowpack” in parts of Wyoming, western Wyoming in particular, that has prevented antelope and mule deer from accessing the lower-elevation forage many rely on in the spring.
Alex — I’m not a regular Daily Show viewer, but I caught a social media post this week about the appearance of a familiar Montana voice on Tuesday’s episode. If you’re curious to hear what Montana-based conservationist and public lands advocate Ryan Busse has to say about recent changes in the firearms industry, check it out.
Eric — For more than a century, the Boy Scouts of America has incorporated Native American symbolism into its ceremonies (often quite clumsily, judging by my experiences as a teenager). This fascinating piece from NBC News reporter Graham Lee Brewer takes a good, long look at the debate over whether it’s time for the youth organization to update its practices.
Mara — A few months ago, I met New Yorker staff writer E. Tammy Kim in the Capitol building as she was reporting a feature about public libraries and the political blowback they’ve experienced in some parts of Montana. I’ve been waiting for the piece with much anticipation and can officially say it’s excellent and well worth your time.
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