— by Tom Eversole —
Madie Murray’s January 26 letter brings a human perspective to cases for and against the proposed hospital district. Thank you, Madie!
The 55+ aged people, who “put a burden on the island” are also great contributors to our community in time, treasure and talent. They have contributed to their own medical care fund (Medicare) for the past 30 – 50 years and deserve to be able to get care where they live. If/when the practices close, they will lose that opportunity. Those folks have funded schools, fire departments and libraries for the same 50 years – some without ever using those public resources themselves. They have upheld their end of a covenant with the rest of society.
The letter may have misstated the current state of after-hours urgent care. We only have that now, if you are lucky enough to contact and get a physician, PA or nurse practitioner to come in after hours. It is my understanding that UW does not yet have someone who is on-call and required to come into the clinic after hours, if the nurse triage determines it is medically necessary. That is something the PHD commissioners could assure through funding of both existing practices for after-hours urgent care.
I have learned from EMTs that they are called upon to provide primary care during the day and after hours. People frequently show up at the fire station – and reasonably so given their circumstances. I don’t think primary care was ever the intent of the fire district levy. Increasingly, as more and more residents have no primary care provider, EMS is called upon to provide unsponsored care. Emergency Medical Service workers have told me clearly that EMS is not a sustainable substitute for primary care. If the medical practices leave, they cannot fill that gap.
Additionally, many people with insurance believe that off island air transport will cover their after-hours medical care needs. Air transport is reserved for only serious medical emergencies that would not be managed by primary care anyway.
I really appreciate Madie’s point about people wanting to finish their lives in the place where they live and call home. The island attracts many fine people, who retire here and contribute for years before they die. We all aspire to “age well on Orcas.” Without a hospital district, the rest of the slogan could become “but then move someplace else.” Without medical practices on the island, we will compel many elders to leave their island homes and start over in new mainland locations, just because they can’t access medical care here.
Like Madie, I sincerely hope we all get to age well on Orcas and to live out our days here with those we love.That’s how it should be!
Just wondering— is it guaranteed in writing that Shinstrom’s clinic will receive patient proportional funding & how does that work? They have served low income islanders for years—what are the protections for that purpose?
Excellent question Susan. I would like to see the method used to determine the allocation of funds (and opportunities) among medical providers to be fair, transparent and open. More important, this should be the intention, no, the obligation, of all the would be commissioners. If I feel that we are not playing on a level field—disproportionately favoring one provider over another—I will find it very difficult to support this effort.
Susan, a very, very good question. Nothing is guaranteed anywhere. There are no agreements binding the Hospital District because it does not exist. Only the elected Commissioners can enter into one. UW has a written agreement with the Medical Foundation which seems to commit islanders to paying UW a substantial subsidy. On Lopez, the District adopted the pre-existing foundation agreement’s obligation, IIRC. I see nothing in the UW agreement about any obligation to serve the uninsured or underinsured, which Dr. S has done for decades. Also, to the extent that Dr. S’s clinic is not a government entity, there seems to be at least a question whether the Hospital District can pay it a subsidy as envisioned.
Also, there appear to be no patient visit data available from the OIMC or any other practice to allow islanders to determine the appropriate distribution of subsidies. These are readily available to the health care providers from their data systems, but have not been collected, at least not to my knowledge, and I’ve asked several times. How many patients get all services off island; how many get services from which practices on island? How many are insured? How many have no insurance or funds to pay charges or co-pays and deductibles?
Happy to be corrected, if necessary.
I have personally witnessed my husband leaving home to attend to patients who need care after-hours.
Susan – The new commissioners will be setting the policy on who would received support. They will have wide latitude. Until they are elected, they cannot write any contracts. They can only make promises as to what their vote might be once elected but cannot be sure who else will be elected with them. Because the commissioners will be elected and have open meetings along with a public budget, the process will be far more open than it has been. Madraona Voices is distributing a survey to the public and asking each of the candidates these types of questions. You are encouraged to participate and in the survey and to see how the candidates respond. We will post that prior to the candidate forum. MadronaVoices.com
Peg – Any health related service can be subsidized by the hospital district. This includes anything from home visits by a care provider to a private practice doctor. It is up to the commissioners to choose who and what they will support. They have very wide latitude.
Some of the questions in the survey that we are distributing ask about where islanders get their care and how many leave the island for care. We have had more than 500 people complete the survey so far and invite anyone that hasn’t yet to add their voice.
Which survey is this? I’ve heard nothing about it.
Oh, wait–the online survey?
These are all wonderful questions and comments! I STRONGLY suggest each and everyone attend the Coalition’s (coalitionfororcashealthcare.com) meeting – the next one THIS SATURDAY, Feb 24 at the Senior Center at 10 a.m. The Commission candidates will be there and you can ask all your questions and get them answered. Also, visit the website above for a lot of those answers as well. I believe this may be the web address to the Madrona Voices survey referenced in Steve Smith’s comment. https://www.madronavoices.com/phd-survey
Any health service may be contracted for; I see nothing that allows an almost open-ended SUBSIDY not tied to individual patient visits or even addressing uncompensated care for uninsured or underinsured patients. (That’s the UW contract.). No promises can have been made to either practice. It would be prudent for the commissioners to obtain a legal opinion (from a qualified law firm, not the association) about whether sums can be transferred with no tie to individual patient services.