— by Susan McBain, Orcas Issues reporter —

Negotiations on the contract between the Orcas Island Health Care District (OIHCD) and UW Neighborhood Clinics (UW) remain slow as a result of delays (thank you snow!), lack of clarity about specifics, and ongoing issues.

At their Feb. 20 meeting, the OIHCD commissioners spent well over an hour discussing the back-and-forth versions of the proposed contract between the two entities. The latest version came from UW and contained their suggested changes, which the commissioners felt generally were made without explanations and were lacking in specifics on services that UW would provide on Orcas. Chief issues, as before, were skills and services, after-hours care, OIHCD input on personnel, and metrics; other issues were indemnification language and the timing of clinic support payments.

OIHCD’s proposed contract had included a detailed list of specific services the commissioners wanted, but UW preferred a more general list, often including the phrase “as appropriate to primary care.” However, Commissioner Diane Boteler, MD, noted that the term “primary care” is very broad, and what UW considers to be primary care may not address the needs of a rural island setting. The commissioners had requested that UW management go through the District’s proposed list of services and identify what they would provide, might provide, and would never provide, but the District has not received a response to date. The commissioners agreed to try again.

On the after-hours care issue, the commissioners agreed again that after-hours access to a physician is critical. Boteler observed, “As far as I can tell, we’re in no different place than we were in May [when the District began operation]. That really frustrates me; I’m concerned they [UW] haven’t been willing to commit to doing what we know is a community need and was one of the reasons that the District was voted in.” Commissioner Art Lange added, “We need a definitive answer,” and said he didn’t see how the commissioners could sign a contract without acceptable language about after-hours care. Although UW has verbally reported some progress, nothing is in writing. Several commissioners took the position that if the District is unwilling to sign a contract unless it contains such language, the commissioners should let UW management know soon.

On the issues of quality metrics and OIHCD input on personnel, the two parties had some areas of agreement, particularly use by the District of existing UW metrics and District input into hiring decisions for medical director and clinic manager. But the commissioners agreed that a meeting between UW management and Lange, Boteler, and Superintendent Anne Presson is imperative and should be held very soon. In the meantime, contract negotiations will continue, focused on clarifying skills and services, suggesting language on personnel management, and clarifying customer satisfaction metrics.

Finally, the commissioners agreed to redo their bid package for roofing the UW clinic building and re-issue the request for proposal. They also created a formal building committee to handle building issues.

The Commission’s next meeting is Tuesday, March 5, at 4 p.m. in the Eastsound Fire Hall.

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