Clinic financing may soon be headed to primary ballot

Wahkiakum County officials may decide next week to ask voters to approve formation of a hospital district to assume control of the Wahkiakum Family Practice Clinic.

County commissioners and department heads discussed the issue Tuesday morning with clinic Business Manager Crystal Stanley and agreed to discuss the matter again next Tuesday after meeting with members of the Clinic Governance Board.

The move came as Commissioners Dan Cothren, Blair Brady and Lisa Marsyla authorized Treasurer Paula Holloway to issue an $80,000 interest bearing warrant so the clinic could cover payroll and other expenses.

Stanley commented that a variety of factors have kept the clinic from reaching the break-even status which the governance board envisioned last fall. Instead, the clinic is 7 percent short of predicted revenue for the first quarter of 2009 and is running a deficit of approximately $34,000, Holloway said.

Some help may come next month from the Town of Cathlamet. Council Member David Goodroe, who also serves on the governance board, asked the council to approve a $50,000 payment to the clinic to help cover expenses, and after hearing unanimously favorable public comment Monday, the council seemed ready to grant the request.

However, Town Attorney Tom Doumit warned that the town ordinance governing the timber reserve fund lacked wording to authorize a 2/3 majority vote, as required by state law, to spend the funds on the clinic. The council members asked Doumit to prepare an amendment to the ordinance so that they could vote the appropriation at their May 18 meeting.

Action needed now

The county officials agreed that the county itself is in financial trouble itself and cannot continue to subsidize the clinic. They discussed several options and seemed to favor a proposal to form a hospital district to collect taxes and run the clinic.

Commissioner Brady also suggested ceding the clinic to a federal health district, and Cathlamet resident Mike Cochin suggested the clinic could impose membership fees on patients. Officials commented that merging with a federal health clinic could change how patients are seen or treated at the clinic, and they thought Cochin's suggestion would need more study to determine how much revenue could be raised and how reliable it would be.

The governance board has been considering the health district concept, and there were comments that it might be the most stable.

Because of the time needed to get a new district going, Brady urged the other officials to consider putting a measure on the August 18 primary election ballot. That means that the language for the proposition must be submitted to the county auditor by May 26.

The voters would first be asked to approve formation of a district and to elect a preliminary board of directors in case the district is approved. If the voters approve formation of the district, the board could meet and set a tax levy proposal which would go on the November general election ballot. The district could start collecting tax revenue in 2010.

If the measure skipped the primary and was approved on the November ballot, the tax rate couldn't be set until 2010, and collection wouldn't start until 2011.

"We need to move," he said. We don't have two years; we don't have the money."

Marsyla expressed concern that putting the measure on the primary ballot might rush the campaign. Supporters need to present accurate, coherent information to voters, she said. Errors or bad information could jeopardize the whole process.

At that point, the officials agreed to discuss the matter with the governing board and revisit the issue next Tuesday.

Action needed now

Town officials asked for public comment on a proposal to appropriate $50,000 for the clinic, and they spent close to 90 minutes discussing the issue Monday evening.

Seventeen people commented in favor of the town supporting the clinic, and letters came from two other parties also in support. Some of the comments included:

Former Council Member Andy Lea said he is not a clinic patient but sees many benefits to the population of the county and the town. The county has appropriated tax money to support the town pool, he said, so it would be good for the town to support the county clinic.

"It seems to me that the clinic is an essential public service," said life-long Cathlamet resident Fred Johnson. The clinic needs stability to put its plans into effect, he added, so the town should consider contributing $50,000 a year for the next three years to help the county provide that stability.

"We'll never have a viable clinic unless all public leaders commit to it," he said. "Commitment is needed. You should set the example."

Many speakers pointed out the economic ties the clinic has in the community, especially to the pharmacy, nursing home and assisted living center. All would struggle to survive without the clinic, they said.

Cindy Faubion, a clinic nurse, commented that each time there is public discussion of clinic finances, it hurts morale of clinic patients and employees. Patients who feel insecure about their care may transfer to other clinics.

"Those of you who have struggles in your businesses know how hard it is build back up when you've lost customers," she said.

"Lack of support drags us down," said Dr. Janice McClean, clinic physician and medical director. "Without money, we can't move forward and so we just limp along. We need to have this community come together and move the clinic along."

McClean added reassurances that she intends to continue her interim work at the clinic until it's on stable footing. "I'm not leaving," she said.

Commissioners Cothren and Marsyla attended the council meeting.

"We're trying to buy some time," Cothren said when asked to comment. "We need a clinic here. It saves lives. I've seen that. Economically, if you don't have a clinic, you lose a lot. We need a shot in the arm to get over the hump. We're about there."

When there was no more discussion, council members said they wanted to move as expeditiously as possible to approve the appropriation. They did table a motion to appropriate the funds so that they could amend the ordinance to allow the 2/3 vote needed to make the expenditure.

"I'm not a user of the clinic, but I believe it can't go away," said Council Member Bob Rendler.

Goodroe reviewed some of the work the governing board has done in the past 18 months. They won a grant from the Murdoch Trust to finance expansion of the clinic buildings to accommodate more staff seeing more patients and generating more revenue. The clinic opened enrollment of new patients a year ago and has had 250 new patients enroll since then, with 90 new patients in the first three months of 2009.

"That tells me that we can successfully complete that plan," he said.

"I'm impressed with the breadth and variety of the information presented," said Mayor Dick Swart.