Montana COVID-19 testing
Montana COVID-19 testing lab
Montana COVID-19 testing lab
Boulder River Bridge view
Boulder River Bridge view
Combat Crochet
Combat Crochet
Montana Governor Steve Bullock at Innovate Montana 2019
Montana Governor Steve Bullock at Innovate Montana 2019
Bikers and Hikers stranded at Mystic Lake Cabin
Bikers and Hikers stranded at Mystic Lake Cabin
Goat Fire mapped at 300 acres
Goat Fire fought in rugged terrain
Goat Fire fought in rugged terrain
Griz management exceeds sustainable mortality rate
Griz management exceeds sustainable mortality rate

Sept 8, 2021

MISSOULA, Mont.—The Missoula Symphony Orchestra continues its triumphant return to live music with the season opening concert: “Motors, Emperors and Activists.” The magnificent “Emperor” piano concerto by Ludwig van Beethoven along with stirring works by two female composers, Ethel Smyth and Missy Mazzoli, mark the symphony’s first live performance in the Dennison Theatre since the pandemic outbreak in 2020.

 Concertgoers can choose between two weekend performances of “Motors, Emperors and Activists.” The first will take place on Saturday, September 18 at 7:30 p.m., and the second on Sunday, September 19 at 3:00 p.m. The performances will also be live streamed for anyone who purchases a ticket and is unable to attend in person. **Masks are required in the Dennison Theatre, under requirements from the University of Montana.

 The annual Symphony in the Park concert was a huge success in August, and a great introduction to the orchestra’s new music director, Julia Tai. Tai is keeping the excitement going with her first performance of the season in the iconic Dennison Theatre.

 Tai was the final pick of five candidates, making her the first female music director of the Missoula Symphony Orchestra. Her new role officially began in 2020 with the symphony’s first-ever virtual season in response to COVID-19. Tai is now looking forward to experiencing Missoula and the arts community in person.

 “I couldn’t be more thrilled to call Missoula my new home and celebrate life, music, and togetherness with you all,” Tai said. 

 The orchestra will perform Missy Mazzoli’s “River Rouge Transfiguration,” Beethoven’s “Piano Concerto No. 5 ‘Emperor,’” and Ethel Smyth’s “Serenade in D minor.” The concert’s featured guest artist is pianist Jeffry Biegel.

 Those wishing to purchase single tickets for “Motors, Emperors and Activists” or season tickets for the remainder of the 2021-2022 season can do so at missoulasymphony.org



With less than half of its eligible population vaccinated, Cascade County is marshaling support from local emergency responders, tackling misinformation one-on-one, and trying hard to keep morale high.
Cascade COunty Montana health department
Credit: Mara Silvers / MTFP

GREAT FALLS — Bowen Trystianson enjoys solving puzzles. These days, that proclivity is a good fit for his job.

Like many health officials in Montana fighting the COVID-19 pandemic, and trying to convince the public to help, deputy health officer Trystianson and his colleagues at the Cascade City-County Health Department are facing profound obstacles. In a community of more than 81,000 people, just about 46% of the eligible population has been inoculated against the virus. Among residents age 12 to 29, that statistic plummets to 28%. 

“I remember seeing that on a graphic that I get and I was like, ‘oh, cool,’” Trystianson said, followed by a sarcastic chuckle. “So yes, that is unfortunately very low.”

The knotty challenges facing the county’s health department are piled in no particular order. A slate of new state laws have seriously weakened the authority of local health officials. Department staffers are battling low morale. There’s widespread public skepticism and defiance about the available vaccines, despite their proven safety and efficacyMisinformation continues to spread like weeds on social media. 

To be clear, Trystianson said, answering questions about public health is one of the most fulfilling parts of his job. He respects and even appreciates that Cascade County residents have stacks of questions they want answered before “everybody just jumps on board” with vaccines. 

“Their challenges are valid, their concerns are valid, and they do deserve answers,” Trystianson said. “What’s unique about this situation is that I have people who won’t necessarily believe the answer I give them.”


Cascade County does not have the lowest rates of vaccine uptake in Montana. Other counties, including neighboring Toole and Chouteau, report even smaller percentages on the state dashboard, with a similar drop-off for younger residents. 

The fact that Cascade County is average, located near the middle of Montana counties’ vaccination rates, remains a source of deep concern to its health care officials. As they explain, the median is not a happy place to be.

With less than half of the county’s eligible population vaccinated, the Delta variant is continuing to infect more people, said Trisha Gardner, health officer for the city-county health department. The vast majority of new cases are among unvaccinated residents.

“We are seeing this spreading in multiple different venues. Every place from workplace to family gatherings, barbecues, weddings, funerals,” Gardner said. “What we’ve found is that the people that are getting exposed had multiple opportunities to have an exposure.”

The most recent report from Benefis Hospital in Great Falls showed that the 28 patients hospitalized on Monday for COVID-19 took up a small but impactful portion of its total bed capacity. The motivation for Gardner and Trystianson’s work is that many of those hospitalizations could have been prevented if patients had received a vaccine and reduced their exposure.

“There’s a strong attempt to resume life as it had existed prior to the pandemic,” Trystianson said, referring to social events and gatherings that county residents are attending in droves. “I do understand people wanting to get back to normal. The only problem is that in order to do that, you have to overlook that things are still not normal. You have to ignore that risk.”

Oftentimes, awareness of risk emerges only after someone has started showing COVID-19 symptoms, or when their illness takes a turn for the worse, Trystianson said. That realization can be especially unpleasant for younger residents who consider themselves part of a low-risk population.


Heading off preventable illness, death and regret among unvaccinated people requires local health employees to be in the right place at the right time. 

The goal, Trystianson said, is figuring out “how to be where they’re at” to offer the vaccine when it’s most convenient. That way, he said, “they don’t have to take an additional step to go get it.”

Critical to that strategy is making sure that people who are unconvinced about the vaccine can have their questions answered and then have immediate access to a shot. Despite the skepticism he often hears from Cascade County residents, Trystianson said he’s seen the approach work in real time.

When the department set up a vaccination site for nine days at the state fair in late July and early August, complete with a posterboard graphic outlining facts and fictions about vaccines, Trystianson recalled, some residents told him they had not gotten the vaccine out of fear that the shots would negatively affect their fertility, an idea that has gained traction despite being researched and debunked in recent months.

Trystianson said he explained how medical researchers have determined that theory to be false and, in doing so, convinced the women the vaccines were safe. 

“I gave them the vaccine right there,” he said. “They were on the fence until that point, and then after having that discussion, addressing their concerns, we gave the vaccine right there.”

There are still plenty of people who remain unconvinced about the safety and benefits of the shots, Trystianson said, many of whom have come to trust only limited sources for information about the vaccine, such as the anti-vaccination and anti-mask group America’s Frontline Doctors, which sells the parasite-fighting drug ivermectin to treat COVID-19, an unproven approach that Montana’s state health department recently warned against.

“I don’t have an issue with people continuing to question the vaccine. My issue is more when they won’t accept a fact-based answer. That becomes a hard thing to address,” Trystianson said. “And I’ve had that happen. I’ve had people tell me that where I’m getting my information from, regardless of the source, is somehow corrupted.” When that happens, he said, “I can’t convince that person.”

Figuring out who remains open to legitimate information, and who doesn’t, can be a time-consuming process. But the efforts at the state fair were not for nothing. After setting up a booth every day, the health department said, it vaccinated 124 people, more than half of whom were under the age of 40. 


Even as the availability of vaccines has dramatically improved the toolbox for fighting the pandemic, Cascade health officials point to bills passed by the recent state Legislature as examples of new setbacks and blockades for local health departments.

Gardner highlighted a handful of bills supported by the Republican majority and signed by Gov. Greg Gianforte this spring. House Bill 702, which broadly prohibits discrimination or disparate treatment based on vaccine status; House Bill 121, which requires oversight and approval by local elected officials for any proposed public health department rules or regulations; and House Bill 257, which generally restricts local health departments from issuing fines and restrictions to businesses and customers, effectively gutting local mask mandates.

I would say those are the big three that have really affected the authorities with public health,” Gardner said. “And, you know, addressing communicable diseases in particular.”

Cascade County Montana Health Department covid
A sign at the Cascade City-County Health Department presents COVID facts and fictions. Credit: Mara Silvers / MTFP

Without being able to ask someone their vaccination status, order someone to self-quarantine or isolate, require extra safety precautions for unvaccinated people, or mandate masks or proof of vaccination at businesses or public gatherings, Gardner said, much of the communication from the health department now comes in the form of recommendations.

“It’s disappointing, yes, from my perspective, because I don’t feel that there was ever a time that we overstepped our bounds with authorities,” Gardner said.

“I think there was a misperception of how we used that authority previously,” she said. “Even when we did mandates such as the mask mandate or different closures, our first goal was always, always education. We didn’t assign fees or fines to anybody.”

One of the ripple effects of the Legislature’s “additional restraints” on health departments, Gardner said, is that their communication, education and advice no longer carries the weight it did prior to the pandemic. Information coming from the department can only be effective when the community trusts the messenger. 

To that end, Cascade is shifting its public communication strategy. Starting this week, the department has revamped its partnership with other emergency responders, including Cascade County Disaster and Emergency Service, Great Falls Fire Rescue, and Great Falls Emergency Services, as well as local school districts, hospitals and other health care groups. The coalition’s mission is to share messages about how to fight the pandemic and ensure the public knows those statements have widespread support. 

“I think that’s the ultimate goal,” Gardner said, adding that many of the same community partners have been coordinating closely over the past year even if the public didn’t realize it. “Presenting that in a very unified voice and way to the community, I think, can help and just make a difference. It’s not just us alone.”

The coalition had its most recent meeting on Tuesday. A spokesman for the health department said the group’s first messaging focus will be to show appreciation for health care providers working to care for patients sick with COVID-19. 


Even on days when the health department feels like it’s taking small steps forward, employees said, it’s critical to keep morale from crashing. As the months of pandemic living drag on and case counts surge again, Gardner said, it’s inevitable that local officials and health care workers can burn out.

“Even looking at something like fire season — it’s a season,” Gardner said. “This is a pandemic that we don’t know at all when it might end. And that uncertainty is a difficult thing, I think. For a lot of people, myself included. It takes its toll.”

Gardner’s strategies for retaining her current staff and protecting their well-being include creating better boundaries between work and home life and trying to curb staff from consistently working extra hours. In her personal life, Gardner said, she tries to stay off of Facebook as much as possible to avoid the stream of negative comments directed at the health department, public health strategies and the vaccines.

“It’s just not a good thing for me to go down that rabbit hole,” Gardner said. “You know, I check what I need to do and try to get off and avoid some of the more contentious pieces of it.”

Along with comments from supporters and people expressing appreciation for the health department’s work, the Cascade City-County Health Department Facebook page also draws plenty of ire from people who are opposed to the vaccines and the department’s efforts to distribute them. Responding with patience is sometimes easier said than done.

In a July 30 post promoting vaccine availability at the state fair, the health department offered a free wristband voucher for fair rides to anyone who got a shot. One commenter, out of more than 300, said the incentive and vaccination effort “reminds me of the eugenics programs during WWII,” suggesting the inoculations are deadly.

“Dude we offered to let people ride the Tilt-a-Whirl,” the department replied. “You can’t possibly compare those.”

Trystianson acknowledged the frustration he often feels about the vocal opposition the county is facing. He processes those emotions at home or with friends, he said, so when he comes back to work to answer more calls and find more answers for vaccine skeptics, he can continue to see those interactions as opportunities.

Most mornings, Trystianson said, he’s “not necessarily jumping out of bed” with excitement. “Snow White-style, having birds tweet all around my head while I get ready for the day,” he chuckled. “It’s not quite that magical.”

“Sometimes I require that shower and that cup of coffee to kind of reframe my head,” he continued. His ideal approach is “not to blame, not to just write people off, but to seek information and to see how I can actually improve it. And that’s usually what I come in here with. Just kind of a calmer determination to try to see if I can make things better.”

Asked what additional tools they could use to continue combatting the virus, Gardner and Trystianson both voiced the need for more staffing, including contact tracers and people to administer vaccines. But they also landed on a wish for the community: patience, understanding, and openness to learning about a rapidly evolving situation. 

“I hope the community knows that we are trying our best. We’re not trying to be frustrating, we’re not trying to kind of pull the rug out from underneath them,” Trystianson said. With the resources they have, he said, they’re working as hard as they can.



BY:  - SEPTEMBER 1, 2021 7:31 PM

 Rimrock Foundation, the state’s largest chemical dependency and rehabilitation service, is in downtown Billings (Photo by Darrell Ehrlick of the Daily Montanan).


Montana is seeking a Medcaid program waiver from the federal government to allow reimbursement for short-term in patient stays at larger mental health institutions, a practice generally banned under the Social Security Act that state health officials say could help boost bed capacity in treatment facilities and fill gaps in the continuum of care.

The feds have already approved waivers exempting 32 states from the exclusion, with several more under review, so Montana would be far from alone. And it could mean a positive step toward achieving equity in mental health treatment, one that could also save the state money and allow for reinvestment in other mental health programs. But it’s not as common sense a fix as it might sound, with some critics warning that the state might be prescribing the wrong solution to a real problem — a shortage of mental health and substance-use treatment capacity.

“From the information we have, we have no idea if this is going to help with waiting lists,” Beth Brenneman, an attorney with Disability Rights Montana, told the Daily Montanan in August. “In the meantime we have a crisis in staffing. And this isn’t doing a thing to address that.”

The prohibition against using Medicaid funds for short-term in-patient stays has been in the Social Security Act since its passage in 1965, an attempt to dissuade states from building federally-funded large mental institutions and encourage them to fund their own in-treatment programs. Specifically, it prevents states without a waiver from receiving Medicaid reimbursements to pay for non-elderly patient stays at facilities with more than 16 beds. But since 2015, roughly coinciding with the growing opioid abuse epidemic, more and more states have successfully sought waivers allowing them to receive Medicaid reimbursements for in-patient substance use disorder treatment, with a much smaller number of states receiving waivers for mental health treatment.

Most states aren’t expected to provide waiver evaluation results until 2024 or 2025, according to the Kaiser Family Foundation. However, preliminary reports found increased utilization of services and provider participation, in some cases accompanied by gains in access to residential treatment, fewer emergency room visits and even some investment of recovered state funds in community-based care, Kaiser found. 

Montana is seeking a waiver for both substance use disorder and mental health treatment, somewhat uncharted territory, and it’s asking to get reimbursed for stays of an average of 30 days  — generally, the maximum length that the Centers for Medicare and Medicaid Services has approved in the past. The state has identified the Rimrock Foundation in Billings and the state hospital in Warm Springs as the facilities that can receive Medicaid reimbursement under the waiver, according to DPHHS spokesman Jon Ebelt, though there “may be other residential facilities in Montana who do not currently serve Medicaid members who may choose to do so based upon the … waiver.”

Warm Springs is currently supported by the state general fund, meaning savings from the waiver, if approved, could be reinvested by the state, though exactly how much isn’t year clear. And the state posits that there’ll be a benefit to capacity and quality of treatment as well.

“There is a need for short-term stays in inpatient hospitals and inpatient substance use disorder treatment centers as people are on their way to recovery,” Zoe Barnard, an administrator with the Department of Public Health and Human Services, told a legislative interim panel in August. The state must present its Medicaid waivers for review to the Children, Families, Health, and Human Services Interim Committee.

The request is part of a package of what are called Section 1115 waivers that the state designed to implement the HEART Fund, a mental healthcare program backed by Gov. Greg Gianforte that was created under the state’s landmark recreational marijuana implementation bill, HB701. The fund will receive regular $6 million contributions from marijuana tax revenues, among other sources.


As part of the HEART program, Montana’s waiver submissions also include requests for Medicaid-funded programs to treat stimulant-use disorder, provide benefits to people incarcerated in the state prison up to 30 days prior to release and tenancy support services. As a whole, experts and advocates who spoke at the Children and Families interim committee meeting in August applauded the waiver proposals for their holistic treatment of mental health and substance use disorders and the efforts to improve the continuum of care.

“It is impossible to separate substance use disorder and mental health, just as it is impossible to separate mental health from physical health,” said Mary Windecker, the executive director of Behavioral Health Alliance of Montana.

But the IMD exclusion proved more controversial, for a number of reasons. Brenneman, for example, questioned how well what amounts to a funding source switch will really address the need in the system. Some institutions in the state — Rimrock, for example — already operate Medicaid-eligible facilities with fewer than 16 beds. 

“It seems to me that the real plan is to use the capacity that’s already there to kick the can down the road,” she said in the August meeting, adding later that the state needed to provide more information to justify its claims. 

Ebelt said the state’s demand for in-patient and residential treatment beds exceeds capacity, “with the IMD exclusion exacerbating the access shortages.”

“While there are treatment facilities that do accept Medicaid patients, the 1115 demonstration waiver will provide additional resources for Medicaid members who may currently have to wait to receive services,” he said.

Other committee questions about the IMD exclusion waiver were more philosophical in nature, with lawmakers asking the Department to reconcile the state’s objective of getting more patients in home and community-based treatment with a proposed policy change that would seem to incentivize in-patient care in, among other facilities, Warm Springs, which is authorized to involuntarily treat some patients.

“Using federal Medicaid dollars on involuntary commitments to the state mental hospital … doesn’t seem consistent with the waiver’s goal of moving Montanans to community-based behavioral health care,” said Rep. Danny Tenenbaum, D-Missoula.

He and others also questioned the potential implications of using a patient’s own Medicaid dollars to commit them involuntarily to a state institution. 

“Although the HEART Waiver has many many good parts to it, I do have to object to anything that would violate an individual’s civil rights,” said Joel Peden, executive director of the Montana Associations of Centers for Independent Living, citing the U.S. Supreme Court’s decision in Olmstead v. L.C., which held that individuals with mental disabilities have the right to be treated in the least restrictive manner possible. “Any move that increases the possibility of somebody being sent to the state mental hospital is not following by those rules. We can’t put a price tag on somebody’s civil rights.”

The state, for its part, said securing Medicaid reimbursement for short-term stays at Warm Springs is necessary, in part though not exclusively because it’s the only facility that can treat involuntary commitments.

“Sometimes, they are a necessary component of a person’s treatment trajectory,” said Barnard. “Over half of the individuals who come to Montana state hospital — that’s 800 admissions per year — over half return to a private residence. Having a way for individuals to be treated on a short-term basis for mental illness and indeed sometimes their substance use disorder — that might include involuntary medication, and the state hospital is only one that does involuntary — can be core on individual’s trajectory to recovery.”

The state will review public comment on the HEART Fund waivers through September and submit final documentation to the feds by the end of September; if approved, the changes would take effect in January of 2022.

“By receiving FFP for Medicaid members in the Montana State Hospital, DPHHS will be able to reinvest those savings to ensure good quality of care and to improve access to community-based services,” Ebelt said.



Governor says parents should have final say on masking

BY:  - AUGUST 31, 2021 4:49 PM

 Masks in a shop window (Getty Images).


Gov. Greg Gianforte and the Montana Department of Public Health and Human Safety published an emergency rule asking local school boards to follow state guidance when issuing mask mandates, calling into question the benefits of wearing masks to ward off COVID-19 in a school setting.

While the rule does not mandate anything, it encourages school boards to let parents have the final say over whether their child should be required to wear a mask. In a statement, Gianforte, a Republican, said there is “inconclusive research” surrounding masking in schools and asserted there are “adverse impacts of masking on a child’s health, wellbeing, and development.”

Current guidance from the Centers for Disease Control and Prevention recommends indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination. The updated CDC recommendations came as the more infectious delta variant began to spread across the country.

Also, on Tuesday, the state reported 890 new positive COVID-19 cases, the highest since Dec. 17, 2020 pushing the state’s seven-day case average above 500 for the first time since Jan. 13. The state also reported 13 new deaths and 28 more active hospitalizations.


The rule directs schools weighing mask mandates “should consider, and be able to demonstrate they considered, parental concerns in adopting the mandate.”

The rule further states schools should “provide the ability for students, and/or parents or guardians on behalf of their children, to choose to opt-out based on physical, mental, emotional, or psychosocial health concerns, as well as on the basis of religious belief, moral conviction, or other fundamental right, the impairment of which may negatively impact such students’ physical, mental, emotional, or psychosocial health.”

Across Montana, schools have hosted contentious debates over masking policies. Among the districts mandating masks are Missoula, Whitefish, Bozeman, Billings and Helena. Last week, a group of 11 parents and the nonprofit Stand Up Montana — a vocal anti-mask organization — sued three Missoula school districts over their mask policies.

Climbing caseloads and the deterioration of available hospital beds in the state is why Dr. Lauren Wilson said she was against the new rule.

“I think this is a huge step backward for COVID control in Montana at a time when our hospitals are overwhelmed and asking for help,” said Dr. Lauren Wilson, vice president of the Montana chapter of the American Academy of Pediatrics, about the new rule.

In a hospital occupancy report published by DPPHS on Tuesday, six of Montana’s 10 large hospitals reported 70 to 90 percent of staffed beds were occupied, and one hospital reported more than 90 percent occupation. The report provided a snapshot of hospital occupancy on Monday.

Just this week, the Billings Clinic announced it was bringing in the National Guard for the second time in two years and postponing non-necessary procedures because it is overwhelmed with COVID-19 patients.

“(The governor’s office) say they reviewed medical literature in making this decision but did not talk to any medical professionals in Montana, and they do not appear to have been consulting with national health experts whose job is to review the literature,” Wilson said.

Montana’s professional health community has been vocal and unified about their support of masking — for children and adults — when indoors.

One area medical professionals and Gianforte agree is vaccinations.

“If more adults were vaccinated in Montana, we would not be having this conversation,” Wilson said.

With 50 percent of its eligible residents fully vaccinated, Montana lags behind other states and currently ranks 43 in doses administered per 100,000 people.

Gianforte and DPHHS announced the rule one day after the U.S. Department of Education announced the launch of investigations into five Republican-led states over their mask mandates, which the department says could be violating the civil rights laws protecting students with disabilities.

At the same time, Gianforte cast doubt on the effectiveness of masks in schools; he said, “some scientific studies we’ve carefully reviewed undoubtedly reveal the adverse impacts of masking on a child’s health, wellbeing, and development.”

Pediatric pulmonologist and mother Dr. Deborah Liptzin, who also sits on her child’s school COVID-19 advisory board, said from her experience kids are happier to be in school than they are upset about wearing masks.

“(The kids) are just so happy to be at school with their friends, they don’t really care about the masks, and the best way to keep kids in school is to use mitigation measures that have proven to work like masking, social distancing,” she said. She added, “I think the politicization of (masks) is what is traumatizing and the adults are making the kids feel like it’s a bigger deal than it is.”



AUGUST 23, 2021 
5:32 PM


 Yellowstone County health officials are hoping the Federal Drug Administration’s full approval of the Pfizer COVID-19 vaccine will help slow the spread of the infection as deaths and cases rise in the county and hospitals fill up.

In a press release on Monday, Riverstone Health reported that three people had died from a COVID-19 related illness during the weekend. Additionally, the health department said hospitals are dealing with a high volume of COVID-19 patients. Those who died include a fully vaccinated man in his 70s with underlying health conditions and two unvaccinated women, one in her 60s and one in her 70s, with underlying health conditions, according to the release. On Friday, Gallatin County recorded its first COVID-19-related death since May.

“The current COVID-19 surge in Yellowstone County has filled Billings Clinic and St. Vincent Healthcare with more pandemic patients than they have seen since December 2020. On Monday, the Billings hospitals together had 81 COVID-19 patients hospitalized, including 19 in ICU and 12 on ventilators. One week earlier, the total number of COVID-19 hospital inpatients was 58,” the release read.

The county recorded 77 new cases Monday, bringing its active case total to 497.

As a whole, the state reported 652 new cases on Monday, with 3,784 active cases and 220 active hospitalizations. The state also reached a vaccination milestone on Monday as it reported that 50 percent of the state’s eligible population is fully vaccinated.

John Felton, Yellowstone County health officer and RiverStone Health CEO, said he hopes the wholly approved vaccine will help get more Yellowstone County residents vaccinated.

“Many unvaccinated Yellowstone County residents have said they are waiting for the COVID-19 vaccine to receive full, regular FDA approval, so they need to wait no longer,” he said in the release. “We should expect a large increase in demand as people waiting for approval join those who have decided to do their part to protect our community through vaccination. Vaccination is the safest, most effective way to curtail the current outbreak in Yellowstone County as well as to keep our schools and businesses open.”

As the highly contagious delta variant continues to spread across the state, health officials have ramped up their efforts to encourage people to get vaccinated and wear masks indoors.