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Islanders express skepticism over recent health care merger

Brad Roter, MD, asks questions of Dianna Kielian, the vice president of mission for the Franciscan Health System, at the recent meeting about the system
Brad Roter, MD, asks questions of Dianna Kielian, the vice president of mission for the Franciscan Health System, at the recent meeting about the system's recent affiliation with Highline.
— image credit: Courtesy Photo

More than 200 people attended last week’s meeting with representatives from Highline Medical Center and the Franciscan Health System — a meeting that left many concerned that Catholic theology may affect care at the Vashon Health Center and others feeling that some islanders do not understand the importance of the recent merger to sustaining health care on the island.

Highline CEO Mark Benedum and Dianna Kielian, the vice president of mission for the Franciscan system, were invited to address islanders last Thursday after a group on Vashon raised concerns about the recent merger between the Catholic Franciscan Health System and Highline, the Burien organization that manages the Vashon Health Center.

Officials from both health organizations have assured Vashon residents that care at the heath center will not change as a result of the merger, and they reiterated the same message at Thursday’s public meeting.

“There will be no change in health services at the clinic,” Benedum said. “I am not certain why people choose not to believe that, but that is the case.”

In her opening remarks, Kielian said the affiliation will

provide islanders access to more specialty services, ranging from cancer care to kidney dialysis.

“We are very dedicated to keeping the same level of service, and, in fact, enhancing the services on the island for you,” she said.

However, after a long question-and-answer session that moderator Jim Hauser said was “in diplomatic terms, a free and frank exchange of ideas,”

it seemed few people left the meeting entirely satisfied.

May Gerstle, who organized the meeting with Kate Hunter, said she had mixed feelings after it was over.

“I came away with more information than I had before and more concerns,” she said.

The night’s messages were not clear, she added.

“We got different and conflicting answers from the three people who fielded questions,” she said.

Retired physician Chris Davis, however, felt differently and noted that some in the audience were not polite. After the meeting, he wondered if the Franciscans would still want to serve Vashon.

“I felt some people were rude to the point of being truculent,” he said.

During the course of the evening, several people questioned the role a set of guidelines — the “Ethical and Religious Directives for Catholic Health Care Services” — play in the Franciscan system. The U.S. Catholic Conference of Bishops wrote the directives, which require Catholic health care systems to adhere to them.

Many of the concerns raised stem from the directives themselves, which forbid contraception, fertility services and abortion, including for ectopic pregnancies, a life-threatening condition for women.

Frequently when fielding questions about the directives, Kielian answered with longer responses but with a similar message: The directives guide the physicians, but the patient-physician relationship is sacred, and doctors treat their patients according to what is medically best for them.

Specifically, she said, doctors prescribe birth control, make referrals for fertility services and abortions and, in the case of an ectopic pregnancy — a concern that arose in one question — physicians save the life of the mother.

Some said they felt the speakers were failing to give straightforward answers to questions about the directives and were sticking to scripted responses.

At one point, Leslie Brown addressed what she said was an apparent dichotomy — that the guidelines call for adherence as a condition of employment and limit some care very specifically, yet the speakers were saying that Franciscan physicians provide care they deem medically best for the patient — care that could contradict one or more directives.

“I want to know what the truth is,” she said to applause and cheers from the audience.

Kielian responded, in part, that the directives guide the Franciscans in the sacred work of healing and they are a continuum of moral judgment. Brown seemed to be looking for an absolute answer, she said, and because medicine has few absolutes, Kielian could not give her one.

Toward the end of the evening, Tim Johnson, the manager of Granny’s Attic and the president of the Vashon-Maury Island Community Council, returned to the directives because, he said, he felt people wanted a direct yes-or-no answer about them.

“Yes or no,” he said. “Does your contract with your physicians specify that they will follow the directives?”

Kielian responded, “Yes, they do. Yes, they do. Our employment contract does.”

Dr. Stephen Spare, president and chief medical officer of the Franciscan Medical Group, and Benedum both said more follow-up was called for. Benedum said that there are few absolutes to be given, but one can be: Physicians can do what is best for their patients.

Spare also provided input.

“The contract specifically states we will not interfere with their medical judgment,” he said.

In other lines of questioning, some asked about the Death with Dignity Act and the limits Franciscans might place on doctors.

Spare said physicians are not allowed to prescribe a life-ending medication, but they are free to discuss patients’ options. Typically, he said, the link to the Death with Dignity Act website is provided, as well as the a phone number for the Department of Health, which can provide more information.

Earlier in the evening, Benedum had also addressed end-of-life issues.

“Your decisions at the end of life will be respected either in our clinic or in our hospital,” Benedum said. “That is very important to me as an individual and a CEO.”

Voicing more concerns about the directives, Laura Worth asked what kind of “chilling effects” they might have on hiring, important partially because Vashon has two physician openings. Benedum noted that the Franciscans have begun helping in that recruitment process.

The Franciscan system hired 75 physicians last year, Spare said, again stressing that the physician-patient relationship is paramount and addressing her concerns about religious influence.

“I can tell you that as a Presbyterian, I don’t spend a lot of time in my recruitment interviews talking about the Catholic Church,” he said. “This idea that we are under hierarchical control of Rome is just not the case.”

May Gerstle asked if a citizens advisory group might form on Vashon to work collaboratively and give input to Highline on what islanders are passionate about.

Benedum responded affirmatively.

“I am all for it if it’s a two-way street,” he said. “Let’s do it.”

Benedum was not available the day after the meeting, but issued a statement affirming his support for such a group.

“Looking to the future, we would welcome the opportunity to work with community members to further develop and grow health care services on Vashon. Citizen engagement is an important part of building healthy communities,” he said.

Earlier in the evening, when the issue of the directives and ectopic pregnancies came up, Davis tried to offer his perspective from the rear of the room, but in the tightly moderated event, he was asked to hold his comments.

From 2002 to 2004, Davis served as the director of emergency services at St. Joseph Medical Center, the Franciscan’s hospital in Tacoma. In a later interview, he addressed some islanders’ concerns about the directives in general and ectopic pregnancies in particular.

Asked if the directives intruded on care during his time there, he responded with a clear answer.

“Quite the opposite,” he said.

As an example, in the emergency room at St. Joseph’s, physicians treated approximately one woman a month with an ectopic pregnancy, he said, “with fast, appropriate, life-saving care. … At no time were the ob/gyn doctors exercising limited paradigms of care.”

Toward the end of the evening, a man who identified himself only as David spoke about health care and its current fiscal realities.

“Health care is changing whether we want it to or not,” he said.

He asked both the audience and the board if the clinic was in the red or the black, and where it might be in five years.

“If we do not do something, then this clinic will not be here,” he said.

It is this point that some islanders believe was lost in the meeting.

Davis, too, stressed the financial realities at the health center.

“We really need the Franciscans to bail this clinic out,” he said. “If the clinic folds, where are people going to go?”

Davis said he believes concern about reproductive issues is admirable, but island health care needs are broad and require a range of services. He also questioned how many health care systems would be eager to support a money-losing clinic on Vashon.

Sunrise Ridge Board President Greg Martin also attended the meeting, and said he, too, was frustrated by the tone of the evening and many important issues that were not addressed. Many people he talked to, he said, felt the same way.

The Sunrise Ridge board, he said, helps to provide for medical care on the island.

“The landlord is waiting to see how we can assist Highline and the Franciscans in providing the best care we can on Vashon,” he said.

Johnson, however, said he talked to many people who were upset about the evening, feeling as though they had been “handled” and that answers had not been forthright. But he, too, is concerned about access to care and feels many of those questions should be explored. In his role at the community council, he said he plans to ask the board if they would be interested in hosting Highline and Franciscan representatives again, this time focusing on a wider range of issues, including Medicare, Medicaid, possible expansion of the health center and urgent care.

In closing the meeting, Hauser noted there had been repeated ambiguity, but also clarity and a lot of searching questions.

A few days after the meeting,  Hauser said he believes the night’s conversation was typical for the island when it starts working with large, outside entities.

“We begin relationships with sharp, close questioning,” he said.

And then he reiterated his final words of the meeting: “This is the beginning of a long relationship,” he said.

Voice of Vashon recorded this meeting. Watch it at 6 p.m. Tuesday, Thursday and Sunday and at noon Monday, Friday and Saturday. Stream the video “on demand” at voiceofvashon.org.

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