(soft music) - [Anna] Coming up on the premier episode of "IMPACT."

Montana has seen an explosion in vacation rentals, leaving county sanitarians scrambling to inspect the ones they know about and worry about the ones they don't.

- [Jim] Hopefully we can do our best to stay ahead of it and keep people safe.

- You don't think about it until something happens.

- This baby's heartbeat.

- And a controversial measure awaits voters on the ballot this fall.

What do politicians and physicians think of the Born-Alive Infant Protection Act.

- This is black and white.

That baby is alive and innocent, and we're gonna do what we can to protect it.

- What this ballot initiative is going to do is put a healthcare provider in between this newborn and the family.

- [Anna] That's next on "IMPACT."

(soft music) - [Announcer] Production of "Montana PBS Reports: IMPACT" is made possible with support from the Otto Bremer Trust, investing in people, places and opportunities in the Upper Midwest, on the web at ottobremer.org, The Greater Montana Foundation, encouraging communication on issues, trends, and values of importance to Montanans, and viewers like you, who are friends of Montana PBS.

Thank you.

- Welcome to the premier episode of impact.

I'm Anna Rau.

Our new series strengthens our commitment to news and public affairs programming on Montana PBS.

A team of correspondents based in Missoula, Bozeman and Billings will bring you stories, investigations, and specials with depth and context.

(soft music) Our first story takes us to Flathead County where the number of vacation rentals has more than tripled in the last five years.

That growth has hamstrung health and safety inspectors and allowed many hosts to fly below the radar, potentially putting guests at risk.

(keyboard clicking) Flathead County sanitarians are always on the go.

- [Jim] The schedule is chaotic.

We had over 1,400 phone calls for the month of July.

- [Anna] Tourists, enamored with the combination of a popular lake and a large year round ski and mountain bike resort have made Flathead County ground zero for the vacation rental explosion in the state.

Some new construction projects like these town homes are being built and managed entirely as vacation rentals with no individual owners or long term residents.

- And we have a beautiful view.

Glacier park is close.

Flathead lake is close.

I can see why people are drawn here.

- [Anna] Jim Wardensky is the Environmental Health Manager for Flathead County.

He says the explosion in vacation homes has swamped his four Flathead County sanitarians who are tasked with inspecting them.

- 2018, we had about 300 licensed public accommodations.

2020, that doubled, about 650.

And then, like I said, 2022, it's only July, we're at 1,100 and growing.

- [Anna] Danielle Peirce is a registered sanitarian who inspects vacation homes in Flathead County.

She points out that all short term rentals in Montana must have an inspection to earn their public accommodations license and operate legally.

- We hold vacation rentals to the same standards that we hold hotels, 'cause you're serving the public.

It's a public accommodation, it's a transient population.

It's not your family.

- [Anna] Listings on the booking platforms can vary from luxury mansions, to extra rooms in barns, to tent sites and sanitarians need to inspect them all.

- If you're camping in a tent, where do you go to use the restroom?

Does the, the property owner have porta potties available to you?

Do you have potable water for drinking and bathing and washing dishes?

- Sanitarians check water supplies and hot tubs for pathogens, sewer systems for overloading and cleaning protocols throughout.

Anything that might make a guest sick or worse if they're not up to standard.

How often when you do these inspections, do you find things that could have been an issue had you guys not gotten in there and done an inspection and a licensure.

- Daily, I'd say.

Just whether it has to do with septic tank size, anti-slip surfaces in the bathtubs, water temperatures, what type of cleaners they're using in specific areas at the home.

- Are any of those things potentially dangerous or hazardous to a guest?

- Yeah, absolutely.

- Without that guidance provided from our office and the sanitarians, there is potential that people could be harmed or become ill as a result of it.

- [Anna] As critical as this inspection is, many vacation rentals in Flathead County and across the state are operating without one.

How many unlicensed short-term vacation rentals do you think there are in Flathead County?

- I honestly don't know.

I have suspicions there's a lot, but I don't have a solid number.

- You don't know what you don't know.

- There's a lot of uncertainties.

There's a lot of questions that people have and people would like information.

- [Anna] Dr. Elena Bigart is a social scientist and research associate at the Institute for Tourism and Recreation Research.

During the pandemic, Dr. Bigart and her colleagues produced a report that found more than 12,000 known vacation rental listings in Montana.

The study did not break out how many of those are actually licensed.

- That would be something that is very interesting to look at because we truly based our like findings in the numbers on the AirDNA data provided to us.

- [Anna] Dr. Bigart and her colleagues got data for the study from AirDNA, a data gathering and analytics site focused on vacation rentals.

The company pulls the data directly from listings on Airbnb and VRBO.

When we searched the site looking for data on Flathead County, the search returned 2,669 full homes and 134 private rooms being offered on Airbnb, VRBO, or both.

Remember, Flathead County has officially inspected and licensed only 1100 vacation rentals.

But in Flathead County, knowing there are potentially hundreds of unlicensed listings and having the ability to track them down are two different things.

In fact, many times hosting sites don't reveal the actual address for a vacation rental until after a user has put in dates or booked with a credit card.

And there are many smaller online booking platforms that sanitarians don't know much about.

- We just don't have the time or the staff to go chase everybody down.

Like while we're doing other inspections, we cover a lot of area, we'll see signs pop up, or while researching one complaint, we'll see another complaint.

- [Anna] And complaints are common.

The morning our cameras were in Flathead County, sanitarians were chasing down a new complaint on a vacation rental.

- This is a report, Flathead City County Health Department.

- It's the same story across the rest of the state, swamped sanitarians doing their best to license the vacation rentals they know about.

Did you get the sense that there's enough people to handle?

- Certainly not.

That's what we heard.

I would ask county officials about all those numbers and other things, and we just simply don't have staff to work on that, so no, I can tell you from my conversations, there was concern.

- [Anna] Bozeman has the second highest number of vacation rentals, with 511 licensed hosts.

But the AirDNA data shows 824 full homes and 85 private rooms listed on the largest booking platforms.

In Missoula, there are 120 licensed hosts, but AirDNA shows data for 606 full homes and 54 rooms.

It's not just the county sanitarians who are overwhelmed and concerned about these unlicensed vacation rentals, Missoula fire inspector, Jamie Porter, knows that if Montana hosts are operating without a license, they probably haven't had a critical fire inspection either.

- When folks are purchasing these homes intending on renting them out as a temporary stay, it does change the occupancy classification.

And so they have to bring that structure up to current code.

They need to expect that most likely the egress windows aren't to code, the stairways may not be up to current code.

And so these are all improvements that have to be made before they truly are approved to be a tourist home.

- Porter also checks for fire and electrical hazards like overloaded extension cords, electrical panels with no schedules or missing breaker covers.

And of course, Porter checks for the most basic safety devices, carbon monoxide and smoke detectors.

One online platform listed smoke detectors and carbon monoxide detectors as amenities.

When we filtered our search to only include listings with detectors, nearly 200 fell off the list.

Do you consider them to be amenities?

- Not at all.

That's a requirement.

Any place where people are sleeping, it's a requirement that they have a smoke alarm in that room.

- [Anna] That's why Porter says a fire inspection is so important to making sure vacation rentals are safe for guests, but like Peirce, she sees many hosts who are not taking that step.

- You spend time with friends and they're like, "yeah, I'm pretty sure that the apartment upstairs is being used as a VRBO because everyone who comes in is different every time."

Just those kind of comments.

- And you know you haven't inspected those.

- Exactly.

Like I said, I'm the one who does the majority of the inspections.

And when I hear where they're at, it's like, yeah, I'm pretty sure I didn't do it.

So I'm guessing that's not inspected.

- [Anna] So why are there so many unlicensed vacation rentals in Montana?

Dr. Bigart and researchers at the institute found one big reason, ignorance.

- It's not very easy to find this information.

So if you just try to look online and try, okay, what do I need to do to rent my place out, in some places it's clear, but there are lots of other places that it's just really, really uncertain what people need to do.

- I don't think a lot of people realize that they're supposed to be licensed, honestly.

- [Anna] There's no checklist or centralized place for potential hosts in Montana to become aware of the need for a public accommodations license and figure out how to get one.

- I was trying to find more information about this public accommodation license.

And I had troubles actually finding that myself.

- Do you think you'd like to see those online platforms inform hosts about the need for licensure in the state of Montana.

- I've reached out to them, and just given them a copy of like our statute, just sent them a copy of what's required in our state, and didn't hear anything.

- [Anna] We asked the two largest booking platforms, Airbnb and VRBO, why they don't provide specific information on what's required in Montana.

Airbnb did not answer the question directly, but referred us to their website, where they do provide general guidance and they urge hosts to contact local officials about inspection and licensure.

We did not get any response from VRBO.

- They're working with communities all over the world.

It's pretty hard for them to keep track of those regulations.

- [Anna] The booking platforms clearly do place the responsibility on the host.

You are responsible for understanding and complying with any laws, rules, or regulations.

Even if information were readily available through the booking platforms or the state, inspectors we talk to believe some hosts would still choose to fly below the radar for a simple reason, money.

- We will say that they have to limit how many people can stay in the house, according to the septic size, and they don't want to do that.

- One of the common problems that we see is, of course, from an entrepreneurial standpoint, people are trying to maximize their profits based on whatever dwelling they have.

- Do you think, or is it your sense, that this is done willfully or that they're just ignorant to the requirements?

- I think it's a combination.

I like to give people the benefit of the doubt.

I think a lot of times, as you educate people, they're like, oh, I didn't realize we're supposed to do that.

And then others it's like, look, you have multiple properties, you knew.

- [Anna] In Flathead County, even after these sanitarians informed host they were operating illegally without a license, some hosts simply refuse to comply.

- You can only wag your finger at people for so long.

And if it doesn't have teeth behind it, they may continue to do what they're not supposed to do.

- [Anna] The teeth end up being the Flathead County attorney's office.

This is where sanitarians refer hosts who continue to flout licensure requirements.

These redacted letters show the legal steps taken to pressure one host with an inadequate sewer system and another host who had been operating since 2014 with no license or inspection.

The Flathead County attorney declined to interview for this story, but they confirm they usually get swift compliance once letters go out to hosts.

So what if the worst happens and a guest is sickened or injured at a vacation home?

If the host is licensed, county sanitarians can revoke that license, but there may not be much recourse for the guest.

- That's something interesting too, to look into, how does that work?

Who's responsible if something goes wrong?

So that's a good question you're asking.

- Airbnb told Montana PBS they offer insurance that covers the host and the guest, but there are limitations on coverage.

Other hosts may not be carrying enough insurance to adequately cover accidents or injuries.

Ultimately, agreements with online platforms are clear that hosts are independent operators and that guests are in a buyer beware situation.

It is your responsibility to investigate a host service to determine whether it is suitable for you.

For example, host services may carry risk of illness, bodily injury, disability, or death, and you freely and willfully assume those risks by choosing to participate in those host services.

- If you're walking into place and you're looking at it and saying, "this does not look right, this isn't safe," don't stay there.

- Be an advocate for yourself.

If you have questions about things, be an educated consumer.

- [Anna] Given all of the unknowns, staying at a vacation rental that at a minimum has been inspected and licensed could give visitors peace of mind when they book their stay.

- Just forget my job, forget what I do, as a consumer, I feel like I should be guaranteed for my health and wellbeing and my family's if we take part in this.

So I think it's very important we wanna keep everybody healthy and safe.

- Vacation rental inspections and licensure are public records.

If you want to know whether or not sanitarians have inspected the vacation rental you are considering booking, you can call the county health department.

It's important to note that a fire inspection is separate from a sanitary inspection.

So you will need to ask your host directly if they've had one.

(soft music) Our final story tonight.

In November, Montanans will vote on a measure that would impose fines and prison time on doctors who allegedly do not provide life saving medical care to infants born alive naturally, after an induction or after an abortion.

It seems like a simple choice on the ballot, but physicians and opponents say it is far more complex than it appears.

Correspondent Aj Williams reports.

- [Aj] Representative Matt Regier works from his home in Kalispell in Montana's Flathead valley.

Regier brings back the Born-Alive Infant Protection Act three years after its first introduction to the floor, to address what he believes is a clear issue.

- I believe the core principle of this is not gray at all.

This is black and white.

That baby is alive and innocent and we're gonna do what we can to protect it.

- [Aj] But for doctors, it's not that simple at all.

Dr. Bonnie Stephens is a neonatologist with Community Medical Center in Missoula, where she takes care of critically ill infants, some of whom have had a fatal diagnosis since before birth.

- We can't create miracles as humans, right?

And I think the idea that if a baby is just formed in a way that it's not gonna survive, that somehow us providing resuscitative efforts are gonna somehow create a miracle.

I mean, we're not miracle workers.

We just wanna provide good care.

- There's the baby's heartbeat right here.

A strong heartbeat.

- [Aj] Dr. Tim Mitchell is a fetal maternal specialist who also works at Community Medical Center of Missoula.

He sees patients with high risk pregnancies that include abnormalities with the growing fetus.

Mitchell delivers the devastating news to families that their child won't be able to live outside of their womb.

The options he offers these patients for end of life care could change come November.

- What this ballot initiative is going to do is put a healthcare provider in between this newborn and the family.

- [Aj] Dr. Mitchell says that every case is very complex.

And for the infants that can survive, doctors give the life saving care they're required to by their ethical code and the law.

However, Mitchell says pregnancies with certain death and fatal developments happen much more often than discussed.

Some of the more common circumstances are no amniotic fluid in the womb, no kidneys, which leads to no lungs or little to no brain development.

These experts say that new technology helps them catch fatal anomalies before the child is born, which gives families more information, but ultimately a choice and how to move forward.

Heartbroken families are left to grapple with whether or not they want to continue the pregnancy.

For those that do, they decide between giving birth and having doctors provide end of life comfort care so that they're able to hold their child while they pass away or having medical providers resuscitate their child, despite the fatal outcome.

- My responsibility to the family is to let them know what their options are and how we can support them.

No amount of medical intervention is gonna change those outcomes.

Where I see this bill or this initiative affecting those options is the ability for a family to be able to hold a dying infant, the ability for a family to be able to hold a dying infant, to be able to have their clergy there for baptism and last rites.

- [Aj] But for the Bill's sponsor, representative Regier believes appropriate care is providing lifesaving measures to any infant that is born alive, even if the infant has no kidneys or no brain stem, no matter the prognosis.

- I think it looks a lot better than death.

I think, to me, that is so straightforward, of would you rather be alive and an intensive care unit, or you rather be dead?

Once again, we're coming back to protecting innocent life.

- [Aj] The National Born-Alive Infants Protection Act was passed in 2002, which defines an infant born with a breath and beating heart at any stage of development as a person.

Failure to provide appropriate life saving medical care to a child when a provider is able to do so is considered in infanticide.

Despite this federal law, Regier believes there are some doctors who are still not following the law and ultimately committing in infanticide.

- Whether it's one or a thousand, this is called the Born-Alive Infant Protection Act.

So this is all about what are we gonna do with a baby that is born alive?

Do they deserve the protections of life that you and I do?

- [Aj] Dr. Al Olszewski is an orthopedic surgeon and current chair of the Flathead County Republicans as well as a former state senator and representative.

Olszewski originally introduced the bill to the Senate back in 2019, which was struck down by former governor Bullock.

Olszewski told Montana PBS that as a medical provider, he also believes born alive infant neglect to be an issue.

We asked Olszewski how he responds to the specialized providers we spoke with who claim they have never seen or heard of situations where born alive infants do not receive appropriate care and are neglected.

- They say that they have not seen this issue, then they have not observed it.

As a state legislator, I have had professionals in the healthcare field where they've witnessed this and wished to remain anonymous.

- [Aj] Montana's version of the Born-Alive Infant Protection Act in this upcoming ballot also includes a mandatory reporting process.

Should the ballot measure pass, medical providers who are reported and found to have not performed life preserving measures to all born alive infants with or without a fatal diagnosis would face up to a $50,000 fine and 20 years in prison.

- Especially in this culture today, I believe people feel more silent than they should be and less willing to speak up on a variety of different issues, but it also could be this one too, of a healthcare worker that knows that this is wrong, that we're just letting an innocent life die.

So those mandatory reporting to that, I believe we give motivation for healthcare workers to step up and do the right thing.

- [Aj] Dr. Stevens says mandatory reporting in bills like this could push her and other doctors out of their practice.

- I mean, that would change the practice of medicine in my field.

And it would require me to reevaluate whether I would be comfortable providing that kind of medicine, because it's basically saying that if I don't take a baby away from its family who I know is gonna die, take it away from its family, provide a bunch of painful procedures that I know is not gonna prolong its life and then give it back to his family once it's dead, that if I don't do that, then I could go to prison for 20 years, which means I couldn't practice medicine anyway, that just feels awful.

- A ballot measure like this absolutely is threatening.

It's threatening to the life and safety of the woman, and it's threatening to the life and practice of a physician or a medical provider who's gonna go to prison.

- [Aj] Longtime lawmaker and reproductive rights activist, Senator Diane Sands, says this bill is trying to legislate morality and it's seeking to make a complex issue too black and white.

Should it go into effect, this bill would be added to Montana's legal code in the health and safety section, specifically under abortion.

Representative Regier says that abortion is only relevant if the infant is born alive during the procedure, which medical providers we spoke with say those situations don't happen in modern abortion care.

- [Announcer] Montana citizens came to the state capital... - [Aj] While federal law may have fallen, as a part of Montana state constitution, rewritten in 1972, all Montanans have an express right to privacy and abortion rights is protected under that right.

- And that has not fundamentally changed.

If you have a moral opinion on it, great, go with your own moral opinion.

That's what everyone should do, and we should not be establishing religion in the law.

- This is beyond politics.

It's not what party you are, how you're raised, whatever.

Are we gonna protect an infant that's born alive, breathing, heartbeat on its own?

- [Aj] There's no information in the measure about how a doctor could be reported, who would prosecute the doctor and what crime they'd be charged with.

Olszewski says.

- That's the way law works.

It gives the guidelines and what the intent is for the law.

- [Aj] Legislative services at the Capitol says that if the bill is voted in, their reporting procedure will be created by the legislature or appointed department, and there will be a public comment period.

For "IMPACT," I'm Aj Williams.

- Proponents of the measure say medical workers or family members who observe something they disagree with could report a doctor to a supervisor or medical board.

Senator Sands believes even if the bill passes, it would fail a constitutional challenge at the Montana Supreme Court.

Those are the stories we have time for in this episode.

On our next episode of IMPACT, we'll profile the candidates in the District 2 congressional race, and we'll introduce you to a family that's weathered years of drought and explore possible solutions on the horizon.

Thanks for joining us.

I'm Anna Rau.

(soft music) - [Announcer] Production of "Montana PBS Reports: IMPACT" is made possible with support from the Otto Bremer Trust, investing in people, places and opportunities in the Upper Midwest, on the web at ottobremer.org, The Greater Montana Foundation, encouraging communication on issues, trends, and values of importance to Montanans, and viewers like you, who are friends of Montana PBS.

Thank you.

(soft music)