How a public hospital district saved services in the San Juans
Two years ago right around this time of year my family, like most of yours, had been cooped up at home for nearly 7 months due to COVID-19. We needed a break. We decided to visit Friday Harbor, the only incorporated town in the San Juan Islands, on a rainy October weekend. After just four days of watching the ferries come and go out the window of the AirBnB rental where we stayed, I was in love with the island. Impulsively, I purchased a small condo in the downtown area. Every month since we've journeyed north — including the four ferry reservations, two different ferry crossings, two bridges, and one pass — to visit. My children have explored expansive state parks, spent hours playing frisbee at the Coupeville ferry landing, witnessed a seal giving birth in Anacortes, and watched from the Lime Kiln lighthouse as Southern resident orcas frolicked in the sea.
On San Juan Island I was first exposed to the ways in which a public hospital district, the subject of my last two columns, can prevent a rural, underserved community from losing emergency care — which we known is a struggle familiar to Kitsap County residents now. In my previous column I promised to share some stories where public hospital districts have successfully supported health care services in their communities. I chose to start with the San Juan County Public Hospital District #1 (SJCPHD.)
On Spring Street in downtown Friday Harbor, the Inter Island Medical Center, the main health clinic on the island, was struggling to stay afloat financially. The community did not want to lose their health care. In 1989, they voted to approve a tax levy to create a public hospital district. Those tax dollars supported continuation of the clinic, which served San Juan Island, as well as outlying islands such as Brown, Henry, Johns, Pearl, Spieden and Stuart.
About 15 years later, the clinic facility was falling apart. It was not economically feasible to repair the structure. The community decided to a new facility was needed. The community began to discuss what kind of health facility would best meet the needs of those living on San Juan Island. Ultimately, they decided that a Critical Access Hospital (CAH) — a hospital designation which keeps rural facilities open through higher reimbursement rates — would serve them best.
After a period of review and evaluation, community leaders chose to partner with PeaceHealth. The organization was interested in providing rural care and willing to finance and build a new hospital to do it. At the same time, the community began to question how to cover health care services for those who could not afford it. An amendment was added to the public hospital district agreement to provide charity care when necessary.
By 2012, construction of the $30 million medical center was completed, on budget and on time. The community benefited in many ways from having a hospital facility. PeaceHealth brought more jobs. Staffing increased from 25 to 55 full-time employees. PeaceHealth also provided services which had not been available before. For instance, outpatient surgery, ten beds for overnight stays for those patients with non-life-threatening conditions, and access to chemotherapy treatment.
In Kitsap County, we have an ongoing debate about the ethical and religious directives limiting certain healthcare services at St. Michael Medical Center, a Catholic hospital. San Juan Island faced these same questions because PeaceHealth is a Catholic organization. In 2015, a woman working at Skagit Valley Hospital, a public hospital district facility, claimed there was an “unwritten policy” not to perform abortions there. A lawsuit was filed by the ACLU arguing that the public hospital violated state law by referring patients to private clinics to terminate their pregnancies, because it created illegal barriers to abortion. A judge ruled that public hospital districts in Washington State which provide maternity care must offer abortions, because abortions are part of the full spectrum of maternity services.
After the ruling, the San Juan Public Hospital District leaders asked PeaceHealth to provide abortion services. PeaceHealth declined. In the community, a heated debate ensued as to whether the district should fund services PeaceHealth did not offer, such as abortions. In May 2017, commissioners on the San Juan County Public Hospital District voted to subsidize services at the Friday Harbor Planned Parenthood in a 3-1 vote. Leaders essentially said, if you are not going to provide the full spectrum of maternity care, we are going to take some of the subsidy we pay you and pay that to Planned Parenthood instead. And they did.
Which brings me back to my own story.
Every time the San Juan Island ferry rounds the bend toward breathtaking Friday Harbor, I am filled with hope for healthcare in rural communities. And as this community contemplates creating a public hospital district, I feel that same sense of hope to ensure choice in my healthcare, that of my children, and beyond.
As the SMMC emergency department struggles to keep up with the volume of ill and injured patients coming through their doors, we do not have enough primary and urgent care clinics to share the load. Our elected leaders and our local hospital monopoly will not solve this problem. We must take matters into our own hands. We, as voters, as I outlined in the last column, can choose to put the creation of a public hospital district on the ballot in 2023 in order to fill the healthcare gaps that already exist.
Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.
This article originally appeared on Kitsap Sun: Niran Al-Agba Public hospital district healthcare San Juan Island
