When it comes to health care providers on Vashon-Maury Island, Jeff HansPetersen, MD, an island physician, has seen plenty of turnover.

He worked at the Sunrise Ridge clinic off of Vashon Highway when it was operated by Highline Medical Group. That was before CHI Franciscan took over the clinic in 2013, and before the current provider, Neighborcare Health, acquired it in 2016.

Now, HansPetersen is seeing the Sunrise Ridge clinic at something of a crossroads again, as its future remains uncertain after Neighborcare’s CEO announced the clinic is losing money. Those developments are set against the backdrop of voters going to the polls next month to decide whether the island should create a public hospital district (PHD).

The less-than-perfect scenario has led HansPetersen to contemplate whether he should resign from the clinic and become a “lean-and-mean practitioner,” providing care to patients on his own.

“It seems like each year, it’s a question of, ‘Is the clinic going to be here next year?’” said HansPetersen in a recent interview with The Beachcomber, speaking for himself, not NeighboreCare. “As a resident of the island, a father, a husband, it’s difficult to feel secure in my family’s stability on the island given that there may not be an alternative option if I can’t continue working at the Sunrise Ridge clinic.”

The fear of instability is reason enough for HansPetersen and several other current primary care providers on the island to support a PHD, which would establish a board to, among other duties, determine a tax for residents to help pay for health care services. But not all current island providers are for the initiative and one former hospital executive who lives on the island has some concerns about it.

In an email to The Beachcomber, Mary Schilder, director of marketing communications for Neighborcare Health, said the Seattle-based provider does not have any plans about what to do with its Vashon clinic after the PHD vote.

“Our hardworking team members on Vashon are simply continuing with the work of providing quality primary care to the community,” she wrote.

Schilder also acknowledged the funding challenges of Neighborcare Health and the island’s two previous primary health care providers and said, “a sustainable, predictable funding source is likely the only way to ensure primary care services can remain on Vashon into the future.”

But she stopped short of offering an endorsement from Neighborcare of a PHD.

“We are not planning, participating or leading the campaign in any way,” Schilder wrote. “It is up to the residents of Vashon to decide on the Public Hospital District by voting in November.”

Support for hospital district

If passed, Proposition 1 would create Hospital District No. 5. and a board of commissioners, which would have the power to own and operate the island’s health care facilities. No hospital would be established on Vashon-Maury, however.

The board would also be able to, among other things, hire a superintendent to make sure it is following regulations and ensure the district is on good financial footing; enter into contracts and set a levy rate to help pay for health care services.

“First and foremost, it is a vote in favor of having primary care services on the island, because I don’t foresee primary care services remaining available on the island to the scale they have been historically,” HansPetersen said. “If you want to have a clinic that is providing services to the widest range of people in all economic situations, there isn’t currently an option that is as realistic as the hospital district.”

He said a PHD is not “a cure” for the health care challenges of the island. Instead, he sees it as, “a tool that gives Vashon as a community an opportunity to make primary care and services financially viable.”

“And to give the Vashon community a voice in determining what shape those services take,” HansPetersen said.

He hopes that perhaps a PHD would provide incentive to obtain urgent care and more staff and availability for after-hours emergencies.

HansPetersen wants islanders to pass Proposition 1 and agree to make a PHD, “the next step in our community experiment.”

A colleague of his, Jessica Wesch, MD, the medical director of the Neighborcare Health clinic told The Beachcomber in an email that one of the reasons she is a supporter of a hospital district is because without it, there might not be a “medical safety net” for the island’s elderly population.

“I fear for them the most,” she wrote. “They cannot be served by a Skype doctor or by a retail pharmacy walk in clinic, nor by a traditional 15 minute medical visit. We must protect Vashon Island as a safe place to grow up and grow old. Our Hospital District can help support a model of care delivery that meets the needs of our aging population so that no one is left out and all can thrive.”

Opposition to hospital district

One opponent of a PHD, Kelly Wright, ND, who owns Vashon Natural Medicine, declined an interview with The Beachcomber for this story. However, made her views known in the King County voters’ pamphlet.

“Health care is a human right which should be available to all, but a new tax on those who need help the most is not the way to solve it,” she wrote with Maury Islander Hilary Emmer.

Wright and Emmer believe a vote for a hospital district is a vote to keep Neighborcare open, but a spokeswoman for the organization said there were no plans about what it would do if the initiative passes, and one commissioner candidate, when asked, shot down the accusation.

“Opponents want to make this election a referendum on Neighborcare. It’s not,” wrote commissioner candidate Eric Pryne in an email to the newspaper. “It’s about keeping a clinic on Vashon — and I’m not wedded to Neighborcare as its operator.”

Rick Skillman, an islander and former hospital executive, knows what it’s like to report to a board of commissioners at a hospital district in California.

Skillman made clear he is not outright opposed to a PHD, as it could help fund urgent care on the island. He just has some concerns with having commissioners, given his experience with them.

“You’re always at risk because it’s a political organization,” Skillman said. “I’ve been the CEO in the hospital district. … The biggest challenge I had was a board that was politically oriented. They had their own agendas, they campaigned and raised (money) in order to get to be a commissioner.”

Skillman said Vashon’s commissioners would also have to “manage expectations” from community members.

“It’s going to take a year or more for them to figure out how to work and what they’re going to do,” he said. “My concern is that they don’t do that, but they rather say, ‘How are we going to spend the money?’ That’s not the first question. The first question is, ‘Who are we?’”

Rural health care

Bruce Amundson, a retired family physician in Shoreline who is aware of Proposition 1, has spent much of his medical career in rural health care. In Spokane, he trained doctors in Eastern Washington communities before coming westward to the University of Washington’s School of Medicine. There, he helped run a research project to better understand the health care needs of rural communities.

“Communities of small size are able to sustain a narrower range of services because they don’t have the population and the dollars, obviously, to provide everything that can happen in a Seattle or a Portland,” Amundson said. “So, what’s important is that rural communities need to try to define and maintain a range of services that is realistic, but has to be provided at a level of quality that is similar that is what would be provided in cities — otherwise, it’s not fair to the people that live there.”

He did not feel comfortable directly assessing Vashon-Maury Island’s health care system because he has not practiced on the island.

Instead, there is “well established” research, Amundson said, in terms of what people in rural communities want in their local health care services. One is access to emergency services and the other is primary care for families.

“Emergency services, primary health care services that would include care for adults and children within the range of what’s possible,” Amundson said. “A good primary care system really can provide a very important broad set of services for people in the community.”

He noted that not everyone in rural communities receives health care in the place where they live, which is true for many Vashonites.

“We may not know how many … but we know that’s particularly the case in communities where they’ve had a turn over of health care providers or physicians,” Amundson said. “People will often get frustrated and establish care outside so they will have more continuity.”

The island has, in fact, seen turnover in recent years with health care providers. In the spring 2016, CHI Franciscan Health closed the clinic at Sunrise Ridge. The following September, Neighborecare announced it would open a clinic in the same spot. Last year, Neighborcare officials explained that, as a federally qualified health center, they are reimbursed for services differently than other clinics. In fact, Medicaid — which provides health coverage for people with low incomes — is the only form of payment that meets or exceeds the cost of a visit.

When communities have low populations, the ability to sustain a local clinic financially can become a challenge, which is why the Legislature made it possible for communities to establish Hospital Districts, Amundson said.

He has consulted with Protect Vashon Healthcare — formerly the Vashon-Maury Health Collaborative — which garnered enough signatures to put the initiative on the ballot — though he declined to say outright if he supported one for the island because he believes every community has different needs.

Amundson thinks such districts can be beneficial to rural communities.

“Whatever the revenue that comes in from the clinic itself, if it’s not enough to maintain the local clinic, then the tax revenue becomes a supplement in order to try to ensure that you can sustain the services,” Amundson said. “I’ve worked with communities and seen that establishing the districts and the extra revenue … often makes the difference between whether they have local services or whether they don’t.”