— by Margie Doyle —
All nine candidates for the five positions for the Orcas Public Health District were present at the March 14 Town Hall organized by the Coalition for Orcas Health Care (COHC) in a non-partisan citizen-led effort to establish a Board of Commissioners for the fledgling Public Health District (if voters should approve the April ballot.
After opening statements, the panel answered questions from the audience. Moderator Diane Berreth outlined the protocol to be observed. Richard Fralick, Pegi Groundwater, and Patty Miller are all running unopposed in their positions.
Bill Bangs, Diane Boteler, John Dann and RJ Myers are all running for Position #4.
Art Lange and Leif are both campaigning for Position # 3 (although Leif has made no bones about his opposition to the establishment of a Public Hospital District (PHD) this year).
When asked why he was running for a PHD commissioner position, given his opposition to the establishment of a PHD, Leif said, “I’m advising people to vote no until we get to the details because we can always vote again.” He cited the meeting called by the UW Orcas Medical Clinic staff just prior to the Town Hall as evidence that many details are still unresolved.
RJ Myers spoke to a question regrading the collaboration that will be necessary in developing the PHD: “One of the things that is exciting about this opportunity is when we get to a place where we feel we’re firing on all cylinders, when we know each other in referrals from provider A to provider B, establishing some rapport, so that what’s going on isn’t a mystery to other practitioners.”
[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””] For more information about Public Health District, get informed at coalitionfororcashealthcare.com/[/perfectpullquote]
When asked how he would ensure that taxpayers who may not be registered patients would be able to receive care at the UW medical clinic, Art Lange said he was unaware of anyone being told to go somewhere else when they went to the UW Orcas Clinic.”Anyone can schedule an appointment, and you have to fill out the paperwork [to register at the clinic].”
Diane Boteler was asked how the PHD will provide health care access for all, given that the Affordable Care Act (ACA) insurance mandate has been repealed. She replied, “It’s a great question because UW projections are based on most people having access to insurance. It’s going to be a moving target as the federal government changes regulations. The cost of covering uncompensated care will be going up and we’ll have to look at those numbers.”
Bill Bangs responded to a question asking what “leverage” will the commissioners have with UW, “given we’ve raised $1M and they’ve had months [to set up their systems at UW Orcas Medical Clinic]”
Bangs answered, “The good news is they really want to perform here. Our leverage comes from making [known islanders’ issues with the clinic]. Right now it’s kind of a mystery: for instance the blood draw case, they’ve come back to say ‘We’ll change our policy and make blood draws available to anyone.’ They don’’t want to fail , that’s the primary leverage we have.”
Pegi Groundwater was asked how the PHD commissioners would determine where money goes between the current island “paradigm” of patients seen either by the UW Orcas Clinic or Dr. Shinstrom’s Orcas Family Health Center.
Groundwater replied, “We’ll take into account each practice [that comes to the PHD for funding]. their patient load and their financials. We want to support all the patients on the island; to support each of them to the extent they need support.”
Lange responded to further questioning about how to determine what if needed to financially maintain the current paradigm, saying “It’s possible if and when a PHD is passed and elected officials have to come up with a proposed levy rate that it could be totally different [from the current amount now projected]. [UW Orcas Clinic manager ] Deborah Gussin has said that they expect their revenues to increase because they’re improving scheduling. If you want me to give you a number, I’d say between 55-60 cents[per $1,000 assessed property valuation]. But I wouldn’t bet the ranch on this.”
When asked for a show of hands of those committed to a contract including birth control and abortions, all candidates raised their hands.
Patty Miller explained that the five-commissioner structure is determined by Washington State Law, which allows for 3-, 5-, or 7-member commissions. The members of the coalition who were responsible for getting this on the ballot and to the council for a resolution, agreed that 5 was the best number, given the amount of work necessary.
Art Lange spoke to a comparison with the San Juan Island levy of $1.42 which supports two fire districts, prescriptions, EMS, airlift, hospital beds and overnight care: “My reaction to your question is I don’t want to compare apples to oranges. First we don’t want a hospital… we should focus on what do we need and how do we accomplish that. We need to define what we need.”
Richard Fralick explained the different terms of the five PHD commissioners. “The RCWs [state laws] set up staggered terms: the two highest vote-getters get a six-year term, than next two get a four-year term; the candidates with the least number of votes get the shortest term. This set-up assures that the board doesn’t all change at the same time.”
Bill Bangs said the method used to determine the needs and goals of the community should figure in “a survey of existing practices to start and look at what the demands are.” He referred to the website Orcas Rant and Rave for learning many of the voices in the community. “We should look at the surveys and see what the outcomes of 20,000 visits per year are.”
John Dann explained succinctly that he withdrew from position 5 and went to position 4, “Because Patty Miller [in position 5] is so well known, I’d have a better chance.”
A questioner asked Bill Bangs, “With a diminishing resource of physicians, how are we going to deliver the level of health care with the scarce resource of physicians. We’re being asked as property owners to hand over resources, how can you guarantee we’ll have physicians on the island?”
Bangs responded “The PHD will establish the ‘pool of money’ that will pay the doctors. If you make sure we have enough money, they will be here.”
Diane Boteler answered the question “How does being a physician make you a better candidate?” saying, “The ideal commission is a mix of talent, Pegi, Richard, Patty are all expert in legal, government, scientific and organizational [fields], and provide a lot of experience to put together to build up the best health care system.” She added that her perspective and experience as a medical doctor would add to that system.
When asked if the board was aware of other medical doctors on the island and if they would be included in the PHD Commissioners’ considerations, Art Lange said that any primary care providers licensed by the state would be eligible for consideration for PHD resources.
RJ Myers answered questions about his background preparing him to be a commissioner, citing his experience working for hospitals (including UW Medicine) and school districts and state organizations. He added that as an EMS “I feel like a part of the team; and I have a goal to make that a new paradigm in San Juan County and feel we’re contributing to the greater health.”
Final statements:
Art Lange: “There’s no question there are risks involved, [the basic question is] do you trust the candidate’s competency and motives, that we’re open and transparent, that we have your interests in mind. You are taking a risk that these candidates are trustworthy, an important ingredient in creating the kind of PHD we want to have.”
Bill Bangs: “The PHD represents change and some of us are a little leery of change, which is going to come whether there’s a PHD or not. If there’s no PHD, there’ll be more uncertainty; with PHD we have some promises of improved urgent care under local control that is financially stable. I’m committed to get the public hospital district passed.”
Diane Boteler: “The best care is having a knowledgeable doctor who knows you. The PHD isthe best way to deliver urgent and after-hours care in collaboration with the EMS. I know what excellent, cost-effective, rural health care should be.”
John Dann: “I am willing and able to offer my time and support to the PHD and work with the others involved.”
Leif: “The reason why I ran in opposition to Art, was, when I was a grad student, Art said, ‘Let’s have coffee’ and we shared concerns about health care. If I ran against him, there would be great conversation and if you vote for me, maybe he would help me. If you vote for him, maybe I’ll drop from sight.”
Patty Miller: “I am fully committed to earn your trust. This is an exciting time for the community to take responsibility for and take control of sustainable health care. Thank you to the COHC for leading the charge and bringing this issue to the forefront. I ask you to me in voting yet to establish a PHD for the community.”
Pegi Groundwater: “The PHD is very important. For the last six years I’ve worked to help sign up for the ACA and Medicare insurance as volunteer. Access to doctors is so important here on Orcas Island. That’s why I support the PHD.”
Richard Fralick: “The COHC has spent a fair amount of time putting together ballot measures and town halls. The time has come for us to invest in a PHD to make sure we have sustainable health care on the island. With this slate of candidates, you can rest assured they’ll justify your trust. They will set the tone for health care for this community in years to come.”
RJ Myers: “When my friends asked me, ‘Why are you doing this?’ I answered ‘Why aren’t YOU doing this?’ I may never have the opportunity to be on a forming board of a PHD again in my life, and definitely not be with these people. I’m excited to bring my ideas to the table, even if I’m not elected.”
Further information on the Public Hospital District ballot measure and the PHD Commissioner candidates can be seen at https://www.coalitionfororcashealthcare.com/
