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Services during Pandemic – update

COVID update 5/13/2020
Posted by:
Joleen Falkenburg MD
Niobrara County Health Officer
Niobrara County Hospital Medical Director
The governor and State Health Officer released new public health orders today. I have attached a link below but it becomes overwhelming to interpret the legal document. This order is in effect as of May 15th, and shall remain in effect until May 31, 2020. The orders declare loosening of previous restrictions to allow for gatherings of 25 or less (previous orders were 10 or less). There are lengthy guidelines for businesses to attempt proper spacing and hygiene.
Here is a summary for Niobrara County: we have already opened up businesses and asked them to abide by some hygiene guidelines and restrictions. Such as; closing bars at 10 pm. I am hopeful that as business owners and citizens; we have some sense of responsibility, camaraderie, and selflessness regarding our county and community.
These guidelines cannot be easily policed/enforced. We are self governed and expected to comply to the best of our ability.
The good news is that Niobrara County rarely gathers for large events and I am optimistic that our upcoming summer events will still occur; including the Alumni Golf Tournament, Legend of Rawhide, and Niobrara County Fair. I expect local roping clubs and rodeo gatherings to proceed as scheduled because the restrictions have been loosened. If you or your organization is concerned; feel free to contact the public health department and we will consider the need for paperwork regarding a variance.
I attached a picture of the clinic staff and each person’s family. (See Facebook for pics). They have sacrificed time, energy, and peace of mind in order to sustain us and assist me with my sanity. I am forever grateful for their effort. Housekeeping, maintenance, IT, central supply, and an amazing hospital/ECF team full of nurses and techs have continued to provide wonderful support and care for the ECF residents and our patients; I just don’t have a picture to include all of them. But I am grateful and I am humbled by the love from our community members.

COVID update 5/6/2020
I wanted to offer a few clarifications, although I have stated them before. I am the medical director for Niobrara County Hospital and I am the MD caring for patients through Rawhide Rural Health Clinic. I am also the Niobrara County Health Officer; which is a completely separate role from the employment under the umbrella of the hospital. I choose to communicate on this page as a service to our patient population but I didn’t want to confuse citizens that hospitals or clinics should push for reopening of individual counties. It is up to the discretion of the County Health Officer and the State Health Officer. I was asked to fill these positions unrelated to lengthy qualifications and a shiny resume; but more so because I am the only MD in the county. 🤔😊Having said that, I take the roles seriously and try to perform within a standard of care for utmost regards of public health and patient care/safety.
Wow, that was wordy. Now to the crux of this post. With additional verbiage and restrictive guidelines; the variance put forth to the State Health Officer (signed off by me but substantial paperwork completed by the public health regional supervisor, Melanie Pearce, DNP, RN) was approved late last night. Our local restaraunts and bars can reopen under certain restrictions. I do believe some of these are necessary to follow for phases of reopening and to reduce upswing in cases of COVID. For example; I’ll take full responsibility that I wrote guidelines for closures at 10 pm. This virus does not understand time, obviously. But the disinhibition that comes with additional alcohol consumption into late evening hours can lead to reduced respect for hand hygiene and personal spacing. I do not feel that some of the other guidelines can be realistically enforced, such as keeping separate parties 6 feet away from each other. I’m asking businesses to be responsible and try their best. Each business can create a reopening plan within these guidelines based upon staffing and food/supply availability.
Don’t rush out to the bars tonight, folks. They may not even be open. More importantly, have some discretion and try to respect spacing and hand hygiene. Our local citizens have done such an amazing job with compliance and personal responsibility. Prove to the rest of the state that we can be self governed and respectful of our neighbors and those at risk. Be kind. Support your small businesses. But try not to congregate in groups and jeopardize the health of our county. These orders can change immediately if there is any concern for an outbreak of COVID.
I will virtually meet with business owners tomorrow to help them interpret the guidelines and open up in a conscientious fashion. Happy Wednesday, Niobrara County. We’re on our way to some version of work, living, and normalcy.

COVID update 5/4/2020
We filed paperwork with the state health officer to request a variance for our local restaraunts/pubs/bars. Although I’ve put great thought into alternative options for outdoor dining, limited capacity, or other restrictions; I do not feel that our local small businesses can support staff and financial viability with those limitations. Therefore, I am asking for a reopening with only table separation restrictions and hygiene guidance. I will let you know the outcome for approval or denial or requested changes as soon as I receive that information.
I really do believe in balancing the public health needs with our local economical situation. Recognize that this is easier to accomplish in Lusk than an urban area such as Cheyenne. I can track cases on my own as we only have one rural clinic/hospital and I have a great team within the Niobrara county Public Health department to assist me with contact tracing and notifications. An increase in cases or outbreaks may occur and we can respond appropriately. I am very thankful to the local businesses and citizens whom have been compliant and respectful. Now is the time to show our gratitude and work toward safe and necessary reopening.

COVID Update 4/29/2020
I thought Wednesday might go better if I brought Dale Brisby along for the COVID battle. 🤠😂.
I’ll be virtually meeting with business owners/leaders today to come together with a safe plan towards reopening. The governor’s office extended some restrictions, but also offered local decision making to occur through variances. I’m clarifying that process today. We will still try to pass through appropriate phases and monitor illness, hospitalizations, etc. We will be reopening businesses over time, but are likely too late in the school year to reopen for a short interval and risk transmission without substantial benefit for the students. Our superintendent has come up with some great ideas to allow limited groups to return over phases and allow for adequate spacing. The school will release that information/plan as they clarify details and coordinate staffing. Please be patient with them.
I have met with some pastoral leaders yesterday and believe we have formulated guidelines to get people back to church as soon as we safely can.
Understand that hot spots/outbreaks can occur and we just have to respond to that appropriately and expeditiously. Thanks for your support, respect, and working together as a community.

COVID Update 4/27/2020
Happy Monday, everyone!
I wanted to offer some updates. I have yet to see a formal reopening plan released by the governor’s office so we will watch for those guidelines this week. However; I do not believe that Niobrara county should be managed the same as Natrona county so I am working with public health and the emergency management services team to design some phases of reopening. We granted exemptions to some local small hair/nail salons late last week. I will monitor illness, case loads and hospitalizations as we proceed with phases of reopening. Please be patient and recognize that the public health officials want to balance all needs—health, personal liberties, and the economy.
Along with administration, I have decided to allow limited visitation to Prairie Pines, our extended care facility. You may visit your loved one with no more than 3 visitors at one time. Hand hygiene such as hand washing or hand sanitizer will be required upon entry, along with a facial mask. We would prefer meeting on the outdoor deck. Please refrain from visitation if you feel ill in any way. Even if it is just achy or tired.
Finally; I realized that when patients come in and see my attire that they are a bit alarmed. We have been taking these precautions for a month now and we will continue to take the utmost care of our staff and patients. I thought it may be useful for you to understand the effort it takes to don and remove personal protective equipment and therefore, the delay in prompt visits or phone call returns.
We do not have antibody tests available yet. This is not necessarily a detriment to care. We cannot use it as a diagnostic tool and we aren’t certain of the time frame when patients convert to IgG (chronic antibodies). Also; it will be a positive test even if you had a different strain of coronavirus earlier this year, and I did have viral respiratory panel results that were positive for those other strains in February. So that test still offers some challenges and misguidance. I can offer referral recommendations to other facilities if the curiousity is unbearable for you; but please recognize the limitations of that test.
I hope this clears up some questions. We will get back to a new normal in our lives as quickly and as safely as possible. Take care, get out in the sunshine, and appreciate your blessings.

COVID Update 4/23/2020

COVID Update 4/16/2020

COVID Update 4/9/2020

Coronavirus Update 3/18/2020
First off; my lipstick is holding up well with all of the mask changes; so I’m feeling pretty confident about that 😊
The COVID-19 tests that I sent off earlier this week returned negative. A viral respiratory panel showed rhinovirus for a child tested from the local area. That virus can cause similar symptoms such as cough, congestion, runny nose or sore throat. It can cause a fever in children, but rarely in adults.
I have sent off some additional tests and will keep you all updated. The people tested were either significantly ill or had travel outside of the area. So thus far; no known cases in Niobrara County. If/when we do have a case; I will work with public health and emergency management services to create an emergency operations center (EOC); which can provide additional support staff and availability for supplies.
If you have a fever or cough; please try to manage at home and consider coming in only if medications haven’t worked or if you have respiratory distress or other concerning symptoms. Don’t panic. There are many other viruses circulating other than just this coronavirus novel subtype. All viruses can only be managed supportively with fever control and cough relievers; and worse case scenario; hospitalization with respiratory support if complications ensue. Thank you to everyone for their kind words and support.
Medical Director
Dr. Joleen Falkenburg

Coronavirus update 3/17/2020
In order to inform, educate, and hopefully reassure our local patients; I will attempt to offer weekly updates on this FB page in regards to SARS-CoV-2 (the Novel coronavirus subgroup that causes the disease COVID-19). With that painful terminology out of the way, I want to remind everyone that medical professionals are also learning new things each day about this virus. Those details are being released to the public around the same time we receive them. As an example; I am caring for patients and cannot check my email frequently to know the exact number of cases in Wyoming. So some of you may feel that you have more “facts” about this situation than I currently understand. But rest assured that I am feverishly reviewing the literature regarding the care of previous patients (such as those hospitalized in Italy) to understand the standard of care for treatment and testing.
This past week, I have seen an increase of upper respiratory cases (cold, cough and occasional fever) in our community. I saw a child early last week with influenza B. I saw an aged adult with fever and cough last Thursday and when preliminary rapid tests returned negative; I did test the patient for COVID-19. The patient was quite ill which prioritized the testing so I received that result last Friday evening; approximately 30 hours after I tested the patient. It was negative. Some test turnaround times for mild cases may be up to 7 days. I am releasing this information to assist you; not to worry you. I AM testing patients. I currently have 8 test kits with more on the way so I am NOT testing every sniffle. I have to be judicious. I am using my clinical judgement and recognizing that someone with a cough can still have bacterial pneumonia or a pulmonary embolism (lung clot). I am NOT allowing this virus to cloud my care of the patient. I performed 3 new tests of upper respiratory panels and some COVID-19 tests on 3/16 to try to better understand what viruses could be circulating through our community. This will empower us with knowledge. We are a rural community so I feel that you should all be aware of the effort I am putting towards this rather than to withhold information until it’s released from the Department of Health. I will keep you informed as I obtain information. This is a large geographical county, so some patients may seek care elsewhere and then a positive case could be reported to me just as quickly as it is released to the public.
It is important to socially distance ourselves. Fortunately; the local population is familiar and comfortable with that. I know many of you are in the midst of calving. You can still support your local merchants by making trips to the grocery store and Rancher’s Feed/Herren’s/Allbright’s Tru Value. They need your business. Try to make short visits and distance yourself from others by approximately 6 feet if possible. You can keep your hair appointments or pedicures as these are one on one visits. The owners understand they need to move appointments if they have illness. Order out from your favorite local Restaraunt/pub. Try to avoid groups larger than 10 people. Get a gift certificate from Bloomer’s to use later if you are worried about browsing the store. Thankfully; we have many gentleman in this area of the world; and I have to ask you to refrain from shaking hands at this time.
This will pass. We are trying to limit or slow the spread in order to reduce the burden upon our healthcare system. If you are sick with symptoms of fever or cough; you can manage with Tylenol/Motrin and over-the-counter antitussive (anti-cough) agents. You are welcome to be seen in the clinic if you have concerns for your health. We are open and here for the community’s needs. If you can manage symptoms on your own; please do so and stay at home until symptoms resolve.
The staff is continuing to care for chronic conditions and acute issues that arise. You are welcome to contact us with questions. Wash your hands, be kind, check on neighbors/elderly; and continue your hard work and faithfulness that we all embrace within our local area.
Joleen Falkenburg MD
Niobrara County Hospital Medical Director

3/16/2020 11:38am


As of right now, our clinic plans to operate with normal clinic hours. Our doctors and our staff are dedicated to serving you as long as we can. WE will be monitoring the community impact that the COVID-19 virus is having and will adjust accordingly. We have been continually disinfecting the clinic surfaces, which is standard for our office. Given the Coronavirus COVID-19 pandemic, we kindly request that if you or anyone in your family have traveled out of the state within the past month, are exhibiting any symptoms (fever, respiratory distress, coughing, sneezing, etc.), or are concerned that you may have been exposed to the virus, that you please call our office to discuss symptoms. We want to remain available to the general public for as long as possible to care for you and your family members. Stay safe, wash your hands and avoid touching your face!
To help prevent the spread of illnesses among patients and staff, the decision has been made to send all non-essential staff home. Non-essential staff are those staff members not required to provide immediate patient care. So Admin, HR, Business Office, IT, Maintenance and Supply will be on leave until further notice. As things update and change notifications will be sent out to all staff.

Board Meeting

Niobrara Community Hospital – Board Meeting
Open to the Public

  • January 28th 5:30pm – NCH Boardroom – DATE CHANGED!!!!!
  • February 25th 5:30pm – NCH Boardroom
  • Special Meeting –  March 11th, 5:00pm – NCH Training Room
  • March 24th 5:30pm – NCH Training Room – location changed – Town Hall in the Council chambers – limited seating of 10 people total including the board
  • Special Meeting – April 8th 5:30pm – 105 W. 8th Street – HMS Contract
  • April 28th 5:30pm – NCH Training Room
  • Special Meeting May 5th 5:30pm – 105 W. 8th Street – HMS & Revenue Cycle
  • May 26th 5:30pm – NCH Training Room
  • June 9th 5:30pm – NCH Training Room – Special session
  • June 23nd 5:30pm – NCH Training Room
  • July 28th  27th 5:30pm – NCH Training Room – DATE CHANGED!!!!!!!!
  • Added – August 11th 5:30pm – NCH Training Room – Discuss operations
  • August 25th 5:30pm – NCH Training Room
  • September 22nd 5:30pm – NCH Training Room
  • October 27th 5:30pm – NCH Training Room