When islander Eric Pryne was running for a seat on the proposed public hospital district board of commissioners, he called up some commissioners on other islands and asked, “OK, what am I getting myself into?”

Since that time, islanders voted overwhelmingly to establish a hospital district and now, Pryne finds himself preparing to be of five commissioners responsible for overseeing health care services, as hospital districts are mandated to do by statute. As Pryne prepares, he is armed with a wealth of knowledge about other island hospital districts, particularly Orcas and Lopez’s.

“In fact, even before the election, I went through the first couple of months of minutes from Orcas and Lopez commission meetings and made a list of things that they did in the first couple of months,” Pryne said. “It’s a pretty daunting list of what needs to be done. We need to essentially create a tiny government from scratch and we can look at their experience and their actions on how to do that.”

Pryne and another soon-to-be commissioner, Tom Langland, say Orcas and Lopez are case studies for how Vashon-Maury Island’s commissioners should set up and run its hospital district.

“We can learn a lot from them,” Pryne said.

Langland said learning from what other hospital districts are doing is “a huge part of getting started.”

“If somebody’s got a working model of what we need going, it doesn’t make much sense for us to ignore that and, as they say, go back and reinvent the wheel,” he said. “I do think we would not really be representing the public’s interest if we didn’t look at other models that are not on a similar scale to us.”

“Almost impossible to find [a provider]”

Pryne said the Orcas and Lopez hospital districts piqued his interests not so much because they were islands, but because of other similarities, he felt those districts share with Vashon-Maury Island’s.

“Like Vashon, they voted to establish public hospital districts because their clinics were in danger of shutting down without that fixed support. They were established to support primary care,” he said. “And (I was also interested) because they’re new.”

Lopez Island Hospital District was created in 2017 and Orcas Island Health Care District installed the following year.

Lopez has one clinic on the island, run by the University of Washington, while Orcas has two clinics — one run by UW and another by a nonprofit, the Orcas Family Health Center, according to Anne Presson, the superintendent of both districts.

She said while the Health Center nonprofit ran one of the Orcas clinics even before the hospital district was created, Island Hospital ran the other one on the island — as well as the one on Lopez.

Eventually, it became clear that Orcas Family Health Center and Island Hospital could not sustain the clinics on their own, she said, so the importance of establishing hospital districts became all the more crucial.

“It was almost impossible to find someone to come in and run these clinics in the absence of the public hospital district,” Presson said. “It really allowed us to be able to find a partner and have a robust primary care clinic on these islands.”

The Lopez and Orcas hospital districts provide subsidies to its respective clinics. Levy rates have also been set by both boards; Lopez is levying 75 cents per $1,000 of assessed property value — the maximum allowed before a special election would be required for the board to levy a higher rate — and Orcas levies at 65 cents, Presson said.

“I think people understand that if you want to live on an island and have health care on the island, the only way to do that is to provide a guaranteed form of income to subsidize the cost of running these clinics,” Presson said. “Knock on wood, it hasn’t been an issue.”

Orcas

Once the Orcas Island Health Care District board of commissioners started meeting, its first goal was to organize itself, according to Richard Fralick, president of the board.

“We had to get a bunch of infrastructure in place having to with the basic organization of the hospital district. That consumed a fair amount of time,” he said. Fortunately, a couple of people that were on the hospital board of another entity had experience doing that.”

The next step was to negotiate into contracts with both clinics so that “we had some input in what was going on with them,” Fralick said.

“We basically sat down with the governing boards of both clinics and negotiated what the subsidy would look like and what the relationship would be,” he said. “That consumed us the first few months.”

Fralick said the agreements between the Orcas Family Health Center and UW were well-received by the community.

“I think the community understands this is a temporary solution,” he said. “We had a town hall meeting a few weeks ago where we told them … the practices are sustainable, so you can get the care that you need, but that in the long-term, we are going to have to make some changes.”

That is because the clinics are asking for more subsidies from the district and the cost of health care services continues to rise, he said.

“If you look five years into the future, with the increases that we’re seeing in the costs of delivering services, it’s unsustainable,” Fralick said. “We cannot afford to subsidize the practices as they currently exist once we get further down the road. We have to come up with a model for the community that is sustainable in the long-term.”

Lopez

The Beachcomber was not able to reach any of the Lopez Island hospital district commissioners before press time.

But the superintendent, Anne Presson, said a challenge for Lopez was transitioning from one clinic operator to another.

“When you have a transition in a clinic operator, that’s always difficult. The staff (of the clinic) needs to get used to the new process and procedures and the community needs to get used to it,” Presson said.

She called UW a “large and sophisticated” operation.

“(It) can’t be as nimble as maybe they would like to be for a little clinic here on an island,” Presson said. “So figuring out how to best work with them in a way that solves the issues of the community but respects the process that UW had to go through to accommodate our uniqueness, that’s taken a little bit of time — but we’ve made so much progress.”

Overall, Presson sounded an optimistic note on the way the clinic is operating.

“In the third year, I feel like they’re hitting their stride and they’re really reaching their full potential,” she said.

Now, the commissioners are getting ready to sign another three-year contract with UW to operate the clinic.

“Everyone is happy with how things are progressing,” Presson said.

“A full-time job”

Presson wants islanders here to understand the effort their district commissioners will put into the job.

“Especially in the first year, it is like a full-time job,” she said. “This is a volunteer position and we’re working all the time — weekends, nights .”

Fralick agreed, saying, “If you want to do it right, it takes a lot of time.”

“Vashon will have a unique set of problems and a unique set of solutions to those problems and I think if they approach the job with diligence and good spirits and conscientiousness, they will be able to deal with them — that’s what we would hope,” he said.