Montana
St. James hospital in Butte losing surgeons, union raises concerns about workers, patients – Daily Montanan
St. James Healthcare in Butte appears to have lost more than half of its surgeons in the last year, and the Montana Nurses Association is urging Intermountain Health — which runs the hospital following a 2022 merger — to prioritize retention of critical health care providers.
Roughly one year ago, the hospital counted nine or 10 surgeons, and it has just four after Intermountain failed to retain three in contract negotiations and two others retired, according to the Montana Nurses Association.
“This is a really big impact” for surgical services, said Robin Haux, labor program director for the Montana Nurses Association.
St. James counts 67 beds in southwest Montana and is the only acute care facility in the region, according to information from Intermountain Health. A story about the merger from NBC Montana said it served nearly 40,000 members of the community in 2022; Intermountain did not provide an updated figure.
In an email Friday, Intermountain Health did not dispute the union’s count of the more than 50% decrease in surgeons in the last year. In response to a question about plans and a timeline for filling positions in Butte, Intermountain emailed a statement with remarks from an interim president.
“We are excited to welcome several new providers across various specialties to St. James and Intermountain Health in the coming months,” said Pam Palagi, interim president of St. James Hospital, in a statement from an Intermountain media relations manager. “Those specialties include neurosurgery, orthopedic surgery, general surgery, endocrinology and walk-in care.”
Intermountain Health’s corporate offices are based in Utah. Its website says it works in seven states including Montana and at 33 hospitals and 385 clinics. It touts that it is “reimagining health care,” offers “pioneering research,” provides personal and affordable care, and is a partner with the Las Vegas Raiders.
The merger between Intermountain Health and SCL Health created the 11th largest nonprofit health care system in the U.S., according to NBC. At the time, the former president of St. James said patients would see a logo change as a result, but they could expect to see a high level of care continue.
“The great quality care that you are used to receiving will stay the same, and how you access and utilize our services will not change,” said then-President Jay Doyle in 2022 to NBC.
Friday, however, Haux and Montana Nurses Association labor representative Emily Peterson said patients already are seeing impacts from the departures of providers. The lost doctors who have not been replaced include a urologist and gastroenterologist.
Peterson said the hospital recently had to reschedule three weeks’ worth of procedures for patients after Intermountain lost one surgeon. She said it canceled two weeks of appointments after it lost another.
“That is one big concern for our nurses,” Peterson said. “They know these patients need help, and it was more upsetting to them that the patients that needed procedures weren’t getting them than it was for them to not get their hours.”
However, the union is seeing employees have hours cut or have to take eight to 12 hours of paid time off a week. And without needed providers and a full schedule, they worry about the potential for staff cuts in the future.
“It is causing a lot of concern with the nurses and the surgical techs,” Peterson said.
A petition launched Friday asks Intermountain, a nonprofit healthcare system that describes itself as the largest in the intermountain West, to address the crisis by prioritizing the retention of providers, strengthening their contracts, and keeping registered nurses and other staff in Butte.
The Montana Nurses Association has roughly 25 nurses in surgical services at St. James and 132 members at the hospital altogether. The Teamsters of the Montana AFL-CIO represent additional staff such as CNAs, or certified nursing assistants.
“This is really about protecting the ability to provide high quality care and really vital services and vital care to the community,” Haux said.
To fill one gap, a traveling doctor is slated to help temporarily, but at a high cost, Peterson said.
Dr. Nathaniel Readal, a urologist, said Friday he declined to sign a new contract with Intermountain because he believes some of the language in the agreement put him at risk legally.
Most surgical specialists are generally required to take seven to 10 days a month of being on call, but in Butte Readal said he took an average of 270 to 300 days a year. That means staying within 30 minutes of the hospital and being available to deal with an emergency; in other words, it means no skiing, fishing, beer or golf.
“I take more call because there’s nobody else to do it. We have a pretty large patient base,” Readal said.
But he said he interpreted some of the language in the contract to suggest he would have to be on call and available basically around the clock and every day for existing patients he had cared for in the past.
If such a patient came in with an acute issue and Readal was, say, skiing and unreachable, he said he could be at medical legal risk as the agreement was drafted. He didn’t quibble with compensation, he said, but he requested language in the contract that would protect him legally, and Intermountain did not provide it.
“That was the thing they were unwilling to change and why I would not sign the contract,” said Readal, who had signed previous contracts before the merger.
A story about Readal in the Montana Standard in 2018 said he completed his medical degree and residency at renowned Johns Hopkins Hospital in Baltimore and was working to make healthcare better and more accessible at St. James. In a way, the story said he represented the “future of Butte.”
The story said he and his wife were already a part of the community. Friday, however, Readal, said he is evaluating all his options for the future, in part because standard healthcare contracts make it difficult to remain in a community and care for patients if a provider doesn’t want to work for the medical group that staffs the hospital, or Intermountain in this case.
In the email from Intermountain, Palagi said the industry comes with some churn.
“Transitions in hospital leadership and physicians are common in the healthcare industry,” Palagi said. “At St. James, we prioritize continuity of care and employ robust recruitment strategies to ensure smooth transitions and maintain high standards of patient care.
“ … The bottom line is that St. James Hospital and Intermountain Health remain committed to ensuring the residents of Butte and southwest Montana have access to top-notch, patient-centered care right here in their home community.”
The Montana Nurses Association said the administration at St. James wants to protect frontline employees such as nurses, CNAs, and other staff. Haux said they know how hard it is to replace those positions.
“But we also know they will not be able to continue this without providers and without a full schedule,” she said.
Haux said the petition does not force action by Intermountain. However, the Montana Nurses Association and Teamsters of the Montana AFL-CIO may pursue other options that would put pressure on the healthcare system if leaders do not respond.
“I don’t think … that will sit well with the Butte community if they choose not to respond,” Haux said. “That’s a very tight, close-knit community.”
Montana
Montana State doctoral student awarded national research service grant for gut microbiome, arsenic research
MISSOULA — Four out of five members of Montana’s Public Service Commission were in a federal courtroom in Missoula Thursday morning, as the PSC’s former president challenges the disciplinary action taken against him earlier this year. Now, newly released documents are shedding more light on to what led up to this point.
(Watch the video for a closer look at the case.)
New documents shed light Montana PSC dispute
Commissioner Brad Molnar has sued President Jeff Welborn, Vice President Jennifer Fielder and Commissioner Annie Bukacek – the three PSC members who voted in May to require him to work remotely, after an investigation into complaints about his workplace conduct. Molnar has claimed he is being unfairly punished for constitutionally protected speech, and he asked Senior U.S District Judge Donald Molloy to allow him to return to the PSC offices.
Matthew Monforton, Molnar’s attorney, told the judge that barring Molnar from the building was limiting his ability to do his job.
“He has not been officially kicked out of office, but his voice has clearly been diminished,” said Monforton.
But Natasha Jones, an attorney representing the other three commissioners, said the findings were about behavior, not just speech, and that the PSC’s action was a reasonable response.
“These are serious concerns about a pattern of conduct that has made employees quit,” she said.
Jonathon Ambarian
On Tuesday, Molloy ordered the release of redacted versions of two full investigative reports into Molnar’s conduct – more than 100 pages of documents. Monforton had moved for the full reports to be made public, and Molloy ruled attorneys for the other PSC members hadn’t shown a compelling reason to keep the documents under seal as long as the names of people involved in the investigation were obscured.
While the names remained redacted in the investigation reports, the attorneys for Welborn, Fielder and Bukacek also filed additional documents – including a public declaration from Bukacek and from former PSC executive director Alana Lake, providing information about their allegations against Molnar.
The two reports, from an outside investigator, cover Molnar’s alleged actions over two periods: the first from February to August 2025, and the second from August to October 2025. The investigation began after the first formal complaint, filed by Bukacek in May 2025 – though the reports say employees had been bringing up concerns about Molnar’s behavior informally for several months prior.
Bukacek’s complaint claimed Molnar had repeatedly made what she called “sexualized and demeaning comments.” The examples she cited included saying the PSC should replace “Taco Tuesdays” with “Topless Tuesdays,” reminiscing about watching girls in bikinis as a teenager, and commenting about the beauty of women in areas of China who didn’t get “old and wrinkly.”
In her declaration, Bukacek also claimed Molnar had “maliciously disseminated false information” about her and “engaged in behavior that was dismissive, derisive and otherwise abusive.”
“My primary concern now is not for my safety nor my feelings, but for the rest of the staff who may not have the temperament to speak up or may feel too intimidated to speak up given concerns over job security,” Bukacek said in her declaration.
MTN News
The investigators determined Molnar had violated the PSC’s code of conduct by making comments of a sexual nature, and that it appeared his behavior had continued for some time after he was warned about it. They also found he had behaved unprofessionally and in a belittling manner toward Bukacek, though they said Bukacek herself had at times used “language that could be considered inappropriate” in emails to staff or other commissioners. Bukacek told MTN she “readily self corrected” any behaviors that were brought to her attention.
The investigation also found a violation in connection with a complaint from a PSC staff member, who said he “felt bullied” by Molnar when the commissioner sent an email complaining about his team not being “people with competence.”
However, much of the first report and the entire second report was focused on conduct after the initial complaints, when Molnar was accused of retaliating against people who participated in the investigation. Lake said in her declaration that she saw “an immediate and significant change in his behavior toward staff involved in the process.” She claimed he said he would use an attorney and private investigator to go after people who filed complaints, and she accused him of publicly criticizing her in interviews and removing her job responsibilities because of her handling of the investigation.
Lake said Molnar’s actions led to “declining morale within the agency,” undermined staff members’ ability to do their jobs and damaged her reputation. She said that led her to resign as executive director.
“I believe no employee should be forced to choose between reporting misconduct and protecting their career, reputation, or personal well-being,” she said in her declaration.
Lake has since become Helena city manager.
Jonathon Ambarian
The report said there was evidence to show Molnar had retaliated, including by “making disparaging statements about investigation participants” including Lake, by sending an email warning he could file complaints of his own against people involved, and by taking other actions investigators said could dissuade employees from reporting behavior in the future.
Monforton said during Thursday’s hearing that the initial comments Bukacek complained about were jokes Molnar had admitted were inappropriate, that he regretted saying them, and that he hasn’t made any similar comments in about a year. But he argued the vast majority of the findings against Molnar were about retaliation – and that those were primarily based on speech that the other commissioners don’t have the right to interfere with.
Monforton said it’s unreasonable to punish Molnar for what he said in the July news conference where he announced he was under investigation, in interviews with the media or in commission meetings. He said Molnar’s conduct doesn’t rise to the level of actual retaliation.
“This is an elected official, engaging in speech in his forum,” Monforton said.
He said Molnar may have made harsh comments toward staff, but that he had the right to raise objections about the way the agency does business.
Jonathon Ambarian
Monforton also argued the retaliation claims no longer justify keeping Molnar out of the office, since Welborn, Fielder and Bukacek voted to remove him as president in October and he no longer has the authority he’s accused of misusing. He said there haven’t been further complaints about his behavior since that time.
“We’re not asking for the moon and stars, we’re asking for the status quo as it existed for the last seven months,” he said.
Jones said there is enough evidence to show Molnar would have been punished regardless of whether any protected speech was excluded.
“This is not about a couple of jokes,” she said.
Jones said Molnar made maliciously false statements about people like Lake, and that type of statement isn’t covered by free speech protections.
She also said Molnar’s exclusion from the PSC offices is temporary, and that the PSC will reconsider whether to let him return if he apologizes for his actions, accepts the agency’s code of conduct and undergoes training.
Molloy indicated he saw indications that there was “acrimony” on both sides of the situation, and said he was skeptical it would be resolved easily.
“It would be nice if instead of juvenile behavior, there was professional behavior,” he said.
However, the judge said there was an avenue for Molnar to pursue if he wanted to reach a resolution.
Molloy took no immediate action Thursday. He told the parties he would rule as quickly as he could.
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