Clinic Meeting

June 28, 2007

It was standing room only as a crowd of 80-100 people crowded the Wahkiakum County board of commissioners meeting room Tuesday to talk about developments at the Wahkiakum Family Practice Clinic.

County officials have been trying to deal with an expected $250,000 budget deficit at the county-owned clinic by increasing the county appropriation to the clinic by $125,000 and by the clinic reducing expenditures an equal amount. Last week, commissioners voted to reduce clinic staff by 1.6 positions.

Many of the crowd were there because of an anonymous flyer which appeared around the county late last week. The flyer said the clinic’s doctors were leaving and it urged people to contact county commissioners to tell them to “keep the clinic, keep the doctors.”

During the discussion which lasted until 1:15 p.m., Commissioners Tom Doumit and Dan Cothren—Commissioner George Trott was away in Alaska—explained the steps they’re taking to address the situation, and Dr. Keith Wright outlined his plans and feelings and those of Dr. Richard Avalon and Nurse Practitioner Margie Godfrey.

Doumit, acting as temporary chair in Trott’s absence, opened the discussion by disputing some of the points of the flyer. The doctors aren’t leaving, he said, nor have they formally said they intend to leave.

“We can only assume they will honor their contracts,” Doumit said.

He added that the board and clinicians had had several discussions about staffing and employment, but those were conducted in executive session.

He also disputed a flyer statement that the clinic without doctors doesn’t meet the community’s needs—he called that an untested premise, and that such a clinic would increase costs to taxpayers.

The board and clinic staff have been working to find other sources of money to fund the clinic, he said, with the goal of minimizing any need for taxes to support the clinic.

The Wahkiakum Community Foundation has started an endowment fund for the clinic and is seeking donations from the public; officials are studying the suggestion of a user or subscriber fee and other revenue generating possibilities.

Doumit, and later Dr. Wright, reviewed the clinic’s financial situation.

Peace Health, the previous owner of the clinic, had been losing money on its outlying clinics, they said, and they planned to close the clinic in 2004. When county officials learned of that plan, they moved to buy the clinic to maintain the service for the community. At that time they believed they would face a deficit of $50,000 to $100,000, and that deficit could be reduced by achieving federal Rural Health Clinic status, which increases reimbursements for federal programs.

The extra revenue wasn’t sufficient, however, and with rising costs, the projected deficit for this year is $250,000.

“We said we would fund an extra $125,000 and we asked the clinicians to find another $125,000,” Doumit said. “To their credit, they have spent hours and hours on this.“There’s no easy fix.”

Several citizens asked if the county couldn’t cut programs like mental health and domestic violence and also use reserves to free funds for the clinic.

Health and Human Services Director Judy Bright said the county pays only $15,000 for mental health services; the rest comes from state and federal funds.

Carol Carver of St. James Family Center reported the center operates the domestic violence shelter on a contract with the county; the program is funded 100 percent through grants, and the shelter pays rent to the county.

Doumit and Cothren said reserves had shrunk considerably in the past few years as expenses rise and the revenue from state managed trust timberland decreases—a trend that should continue for several years. The county is facing a shortfall for its own programs, they said, and cuts could be in store for them.

A reserve of at least $1 million is needed, officials said, so they can finance the operation of county government.

Cothren said it is possible the county could borrow from the reserves to fund the clinic, but the money must be repaid. To freely spend a reserve, the board would have to ask voter approval.

Dr. Wright told the audience he was grateful for the strong showing of support; he added the clinicians have been working amiably with the commissioners to find a solution to the funding problems.

He attempted to clear up his and Dr. Avalon’s employment plans: Wright said he has not been offered a job anP where else. However, both he and Dr. Avalon have decided they will not renew their contracts when they expire at the end of 2008. In addition, he said, Dr. Avalon has received an offer for a position elsewhere. “Will he take that? I don’t know,” he said.

A clinician’s position requires lots of time, he added, and that has an impact on one’s family. “My family is a big factor,” he said.

“The clinic is going to have to change,” he added. “I ask myself, ‘Do I want to be part of that?’ There’s good and bad in the decisions that we have to make to make the clinic financially viable.”

Doumit said the commissioners would hold their first meeting to form an advisory committee that evening Tuesday. That committee will be charged with developing recommendations for the future operation of the clinic.

People who have already agreed to serve on it include Cathlamet Councilmember David Goodroe, Dr. Wright, Carol Larson, Dave Blatt, Crystal Stanley, Dr. Doug Martin, Sandi Benbrook-Rieder, and others to be named.

The board also authorized a consultant to analyze clinic operations and make recommendations for better operations.

Until the board has those recommendations, advice from the advisory board, and a better picture of revenues, it will be hard to determine what to do, commissioners said.

Puget Island resident Dean Wesner challenged citizens to support the commissioners and fund raising efforts.

People such as Kaiser Permanente clients who don’t normally use the clinic should join in, he said, because the clinic is a vital part of the community infrastructure, especially for emergency medical services.

If all citizens contributed, the deficit could be addressed, he said. Several persons said they would contribute and assist in fund raising activities.

Karen Bertroch, executive director of the community foundation, said the foundation has two funds for the clinic. An older fund generates money for clinic equipment and can be used for operations, she said; the other, which is new, is an endowment to provide long term funding.

Doumit and Cothren said they are committed to having a doctor at the clinic, and so is Trott, they added.

“I couldn’t imagine us here without a doctor,” Cothren said. “The clinic will be here, at a sustainable level.”