As part of a series of meetings regarding health care, last week a group of islanders gathered to share what services they would like to see on Vashon, offering up ideas from urgent care to visiting specialists to a new clinic facility closer to town.

The meeting was the second of three in a series that the Vashon Maury Health Collaborative is hosting. Earlier this month, islanders and Neighborcare Health officials talked about the current state of health care on Vashon, including the $350,000 shortfall Neighborcare is facing. Also discussed were then were many islanders’ frustrations with the clinic, including long wait times for appointments and a phone system that does not readily allow patients to talk to clinic staff. The final meeting in the series, set for Tuesday, Oct. 30, will focus on how islanders might financially support current and future services.

Last Wednesday’s meeting, however, was given almost entirely to what people wanted. Collaborative member Tim Johnson moderated the event.

“What we are trying to do here is not solve the problem in three meetings, but we are trying to model a dialog that we would like the community to engage in … about what we have, what we want and how we get there,” he told those gathered. “This is a conversation, and what we are trying to do is talk to each other tonight specifically about what it is that we want.”

Across the room, filled nearly to capacity, people shared their ideas, including reduced wait times for appointments, longer appointments, better synchronization of medical records with outside health care providers and clinic hours that extend well into the evenings and weekends. Others said they would like to see imaging capabilities on the island — ultrasound, CT scan or MRI — and more services in general, from more mental health care to substance abuse treatment. Additional providers, both medical doctors and nurse practitioners, was also a request, particularly after Neighborcare asked two physicians to leave this summer in a cost-cutting measure, and a nurse practitioner followed shortly after.

Neighborcare CEO Michael Erikson and COO Meredith Vaughan also attended the meeting. Erikson addressed the cost of expanding clinic hours on weeknights until 8 or 9 p.m. and offering full weekend hours. Doing so, he said, would cost about $250,000 per year.

The night was in many ways a brainstorming session, and there was not a discussion about if the island needs that many hours of care, although Melissa McEachern, an islander and Neighborcare nurse, noted that she did not believe there would be that much demand for services. Erikson, who attended specifically to address the cost of items on the wish list, indicated most communities the size of Vashon do not have access to primary care clinics for all the hours that were discussed.

“That is a significant amount of health care for an island of 10,000 people,” he said.

Currently Neighborcare providers see three patients an hour; dropping that to two per hour and adding physician providers instead of advanced registered nurse practitioners would add about $250,000 more annually, he said. In all, to address several items on the wish list, longer appointment times, more physicians and weekend and evening hours, along with the current annual $350,000 shortfall, would cost about $1 million annually.

Over the years, as the island health care picture changed and doctors no longer offered after-hours services, islanders have expressed interest in more urgent care services.

Erikson addressed that wish as well, saying that for urgent care centers to succeed financially, they need to be located in communities with a population of at least 30,000 people and are therefore not a viable option on Vashon.

As part of the conversation about extending clinic hours, islander Doug Ostrom asked if health outcomes improve with expanded clinic hours in communities.

Erikson responded, saying an answer was difficult to provide, but that if access to health care is suppressed, health outcomes go down. Conversely, providing access to care improves the health of a population.

“The best way to mitigate long-term health care costs is to have a robust primary care system. We have had to skinny down our primary care system because of the unaffordable nature of the island. I would very much want to offer a more robust primary care for you. I would say you would be in a healthier place as an island.”

Neighborcare physician Jessica Wesch also responded to the question, noting that there is some King County data that shows health outcomes are worse on Vashon than in other places in the county. This in line with other data that shows health outcomes tend to be worse in rural areas.

The meeting concluded with the collaborative’s John Jenkel talking about the challenges and successes other communities have faced, from Cle Elum to the San Juan islands. Looking at those communities as a whole, he noted there were patterns that emerged.

“We see a lot of hospital districts out there,” he said.

He added that large concentrated donor efforts have dropped off, in part because of donor fatigue and transparency issues.

“We have been lurching from solution to solution for the last 10 to 15 years, and what our group has been doing and hopes to do is open the dialogue to saying how do we stop lurching from these interim solutions and get into long-term sustainable resolution,” he said.

Jenkel indicated he believes a hospital district — a taxing district that supports health care services — may be the best answer. Then he and other members of the group retreated from that idea, saying it is not their place to recommend options, but noting, too, there are lessons to be learned from communities that have solved their health care sustainability problems.

Rick Wallace, a relatively new member to the collaborative, added his thoughts, saying that all funding mechanisms, from cake sales to hospital districts, should be studied for several reasons, including finding the best solutions — and to seek financial assistance elsewhere.

If we go to the county or feds or whoever, we need to show we have studied the situation and looked at all the possibilities,” he said. “That is really a lot of what is going to happen at the next meeting.”

That meeting was originally scheduled for Oct. 24, but has been rescheduled so it will not conflict with the Washington State Ferries meeting on Vashon that evening. Now, the next health collaborative meeting is scheduled for 7 to 9 p.m. Tuesday, Oct. 30, at the Land Trust Building.