FRONT PAGE

Clinic to pursue formation of hospital taxing district

by Meg Olson

The boards of the Aydon Wellness Clinic and the Pioneer Project are teaming up to move the community clinic from pilot project to permanent. “The grant was a great accomplishment but now that’s done,” said Pioneer president Brian Canfield. “This time it’s about community ownership,” said fellow Pioneer board member Steve Berman, who with Canfield and Mark Millman is preparing to ask the voters to support the creation of a public hospital district and a new property tax levy to support continued clinic operation. “It’s really up to the community.”

In May of 2002 the Pioneer Project secured a three-year grant to pay for the start-up of the clinic. When the grant expires in April 2005 the clinic will either close its doors or it will need another funding source to keep going. “The grant was for start-up, not continuance,” Millman said.

Canfield explained that serving a small population with a sliding-scale fee system so medical care can be available to all income levels translated to a clinic that, while it is vital to the community, is not expected to break even. “Costs exceed revenues and are projected to do so in the future,” he said.

Despite losing money, Canfield said the clinic is doing better than they had projected in the middle of its second year of operation.

Approximately 100 patients a month come in to see nurse practitioner Virginia Lester for everything from a cold to a stroke. She also dispenses prescriptions for antibiotics and other medications. “We’re already recognizing what we would expect to see in the third year,” Canfield said.

Virginia’s husband Ed, a retired laboratory supervisor, has volunteered to set up and operate a laboratory that can perform sophisticated fluid analysis on the spot. “I could not have lived in Point Roberts had the clinic not existed,” Berman said, explaining he needed healthy monitoring that involved weekly blood analysis. “I need to work. I don’t have time to be driving and calling all over in Bellingham.”

Through a partnership with the Interfaith Community Health Center in Bellingham, the clinic provides round-the-clock telephone advice, and staff from Interfaith can fill the gap if the Lesters go out of town, or provide specialized care. For example, said Chris Green, part-time clinic employee and volunteer firefighter and EMT, the clinic has been able to bring in mental health professionals. “The need is enormous,” he said.

Millman said the concept of a public hospital district was precisely to help small rural communities meet those needs, when the user base wasn’t there to pay for the complex requirements of medical management. “It’s impossible for a rural community to provide medical service on a self-financing basis,” he said. “It requires the support of the community, and it’s necessary to the community.”

It was unrealistic to think grants could cover the clinic’s operating shortfall, according to Canfield. “There are 1,000 people asking for every grant available so to expect grants to always be there to cover an operating shortfall is folly,” he said. However, Millman added, as a public health district they were always able to apply for grants for capital projects, equipment, or even additional services.

The path to permanence for the clinic starts with voters approving an ongoing funding source and streamlining management, Millman said.

Negotiations with the Interfaith clinic are now underway for that organization to completely take over running the clinic, management of which today is split between the fire district, clinic staff and Interfaith offices in Bellingham. “You do the whole shebang and provide for us upfront the level of service you will provide and how much you will charge for that service,” is the proposal the group took to Interfaith, Millman said, and got approval from the executive who will take it to the health center board the last week in August for preliminary approval.

By early September, Millman said, they will begin circulating a petition, the start of the formal process through which the citizens of a community form a public hospital district (PHD). “We’d like to see an overwhelming majority of community members support this,” Millman said. If the county finds the petition sufficient, signed by 10 percent of the registered voters who cast a ballot in the last general election, they will put the formation of the district before the voters of Point Roberts in either the next general election or a special election.

State law allows communities to establish a PHD to own and operate hospitals and other health care facilities and to provide hospital services and other health care services. To help pay for those services the district is also empowered to raise revenue by a levy of property tax up to 50 cents per thousand dollars of assessed valuation, and up to 75 cents per thousand with additional voter approval.

Millman said when the petition goes to voters they hope to have a solid budget amount for the next several years and a contract with Interfaith to run the clinic. The difference between the contract amount and the clinic’s projected revenue will determine the amount the district will ask voters to approve. Canfield said they are estimating a levy amount in the vicinity of 30 cents per thousand dollars of assessed valuation, an amount similar to what the local parks district collects. “”For the average household it’s the cost of a dinner at McDonalds for four,” Berman said. Millman put it another way. “If the clinic’s not here and you have to drive to Bellingham only once a year to get to the doctor, you’ll pay as much for the trip as you would have paid in taxes to keep the clinic here,” he said.

Millman said they hope to have the formation of the district, election of three district board members, and the adoption of the levy on the ballot at a special election in February.
If approved by voters the board of the new hospital district will sign the contract with Interfaith, who will take over complete administration of the clinic but likely retain local staff members. The relationship with the fire district will be reduced to the lease of the clinic premises and the district itself will have no paid employees, with Interfaith taking over the position of district administrator. By having a professional health care provider running the clinic, Millman said three advantages will be realized: financial discipline and management discipline to make the clinic more efficient and keep costs low, and a new level of privacy and confidentiality. “They won’t have their means and needs being judged by a group of their fellow citizens,” Millman said of the clinic’s patient base.

The board itself would provide oversight, “to make sure we’re not paying too much,” Canfield said, and make final planning decisions. He added he did not envision any substantial changes in direction after the formation of the district. “People who want to make it a trauma center are trying to turn the clinic into something it wasn’t intended to be,” Canfield said. “The clinic is a primary health care provider and that’s what we want to preserve.”

If voters approve the levy currently being proposed they will not be giving the district board authority to raise the levy if they decide a bigger operation is needed. “Once it’s fixed you can increase it more than one percent without going back to the voters,” Millman said. “If a board came in that got too adventurous you can vote against it.”

Without approval of the new district, Canfield said the clinic would shut down in April at the end of the grant period, effectively stranding a quarter of a million dollars spent on leasehold improvements and equipment. “There’s been so much done to this point I think it would be silly to lose what has already proven itself a very valuable asset,” Canfield said.

“What we’re asking for is a fraction of the quarter million, a thin line in what you pay in county taxes, but strategically it means a lot to this community,” he concluded.