— from David Shinstrom, M.D. —

I would like to take this opportunity to respond to several requests I have received to present the history of my time here on Orcas and how we have arrived at the current situation.

First, a little about me. I was born in Kirkland, WA, went to Camp Orkila a couple years, and got to know Orcas well through several family visits. I went to Whitman College in Walla Walla, medical school at the University of Cincinnati and family medicine residency in Augusta, Maine. My first job was at the hospital in Forks, WA for five years. I was then asked by my residency director to return to Maine as a faculty for the Maine-Dartmouth Family Medicine Residency where I was faculty of Dartmouth Medical School. After 10 years I left that job to come to Orcas in 1993.

In a previous letter I summarized the historical difficulty Orcas had in retaining physicians who left either because they were working too hard or not making enough money. The Orcas Medical Center was built in the hopes of being able to retain physicians. I was interviewed by the Orcas Island Medical Building Association (now the Orcas Medical Foundation). They made a recommendation that I should be hired by Island Hospital who would manage the medical practice – which at that time was similar to the current situation which will soon be ending. I was the first employed physician in the new building. There were two other physicians around, Jeanne Olmsted, a pediatrician who saw patients at the medical center two days a week, and Stan Williams, a GP (not board certified) who first came to Orcas to practice medicine in the mid-70s but in 1993 was working off island. I had a strong belief that my mission was to establish a stable, high-quality medical practice. After 23 years, and despite total commitment, my mission to provide Orcas Island with a sustainable medical system has failed. I feel it is due to the reasons listed below which was not of my choice.

Prior to 1993 many patients had decided to get medical care off island due to the previous physician turnover which meant the revenues of the practice were limited, barely $200,000 annually for the year I arrived. For the first four years of my practice, I was the only physician. We would hire locum physicians and mid-level practitioners to help out. The practice grew because of the stability and it was decided to hire another physician in 1997. I convinced a group of generous donors to form the Orcas Medical Support Group who committed to donate $100,000/year to Island Hospital for 4 years which would allow the hiring of two physicians at the same time. I was very invested in sending the message of stability to Orcas residents. Todd Cowdery and Diane Boteler began working in February 1997.

Over the next four years the practice grew with gross revenues peaking at $1.2 million. But, predictably, we were still losing around $200,000/year so in 2000 there was a vote for a hospital taxing district that failed by 47 votes. Jeanne and Stan encouraged their patients to vote no.

Also, during this time, the medical center board (OIMBA) began to be stacked with members supporting Jeanne and Stan. The president, Tom Corbett, asked that I hire Stan. I told him I could not employ Stan because he was not board certified as required by health insurers. Mr. Corbett then went to the CEO of Island Hospital, Phil Sandifer, asking that I be removed. Phil refused to terminate me citing that I was doing an excellent job as medical director. In May of 2000, Phil was replaced as CEO by Vince Oliver. Mr. Corbett made the same request to have me removed and I was fired as medical director at the end of 2000 being replaced by Diane Boteler. At the same time, Todd Cowdery left and Stan was hired. Over the next two-plus years revenues plummeted and losses increased so at the beginning of 2003 Island Hospital announced they would cease management of the Orcas Medical Center practice at the end of that year. Vince Oliver had removed me as medical director in 2000 and cancelled my employment contract the beginning of 2003 but I was able to continue as an independent practitioner using the space at the medical center.

2003 was a very tumultuous year. Diane Boteler resigned in June with two weeks notice. It was determined the medical center board would take over management. There was a lot of pressure from my patients to have me continue at the medical center. There were several meetings in the fire hall attended by hundreds asking the board to hire me. They refused and needed to come up with a reason. In August, 2003, a psychiatrist, Paul Rosenberg, was asked by the board to interview the medical center staff. He issued a report that concluded the staff “unanimously” thought I was disagreeable and impossible to work with. The psychiatrist’s medical license had been suspended for many years by the State Medical Licensing
Board. During his time of suspension he was hired by OIMBA. He received a fee for his interviews and submitted report. I interviewed almost every staff member who said my name did not come up during their interviews. So, clearly it was a falsified report to give the medical board an excuse not to hire me. (As a note here, in my present clinic I have staff members who have been with me for 13 and 10 years, and the same volunteer around since the beginning, and medical students who return for repeat rotations). I engaged a lawyer and was able to read the psychiatrist’s report in his office along with the board president, David Grumney, and Vice President, Bob Lundeen.

It became clear I would not be able to work in the medical center so, at this time, I had three options. I could leave the island which I am certain was the hope of the board. I could sue the board, which, according to the three lawyers to whom I presented my case, all felt it was a slam dunk for breach of contract and defamation of character. Or, I could set up my own practice, which I did almost 14 years ago. I made a slight error in judgement, I did not believe the Orcas Medical Foundation would spend hundreds of thousands of dollars every year to keep their practice viable. As many of you likely have read, I subsidized my practice by taking no
salary for most of the time.

As I said near the outset, my goal for coming to Orcas was to establish a sustainable high quality medical practice. I believe the opportunity is close at hand if we can all agree to find a solution to unify into one practice and work together. Some have mentioned Dr. Giefer and myself approaching retirement age. This is beside the point. The point is I am a long time Orcas physician with great experience in the workings of the medical situation on island and have a wonderful patient following. The point is that I am willing and more than qualified to help get a long-term, sustainable medical practice on track.

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