Highline Medical Group, which oversees the Vashon Health Center at Sunrise Ridge, is asking all of its non-insured patients on Vashon to pay a minimum down payment of $75 at the time of service.

In a one-page “financial policy” patients are expected to sign, Highline also says those who owe money to the medical organization and whose bills have been turned over to a debt collection agency have to pay off that debt before they can book a follow-up appointment.

The one-pager has some Islanders upset, including members of the Sunrise Ridge Health Services board, which owns the land the clinic sits on. The health center, they said, has long touted itself as a clinic that would never deny an Islander service because of an inability to pay.

The clinic is supported in part by Granny’s Attic, a thriving thrift store some shop at because they believe Granny’s helps to ensure health care coverage for all on Vashon, board members said.

“It’s just not right. It doesn’t fit our community,” said Rick Skillman, a Sunrise Ridge board member and retired CEO of a hospital. “I understand the business reasons. You can’t give away all the care when there’s a chance to get paid. And yet it’s not the philosophy of Granny’s or Sunrise Ridge.”

Kate Hunter, another board member, agreed. “It’s very distressing to me,” she said.

But administrators say the policy is not the wholesale change some seem to think it is.

Susan Pursell, administrator of the Highline Medical Group, could not be reached for an interview. But in a two-paragraph statement e-mailed to The Beachcomber, she said that the clinic will continue to see people in need of urgent care regardless of their ability to pay.

“Unfortunately, we are operating the Vashon clinic at a substantial loss and have experienced increased financial pressures as a result of the economy,” she said in her statement.

“Without Granny’s Attic support, we would not be able to maintain either the caliber or number of physicians we have at Vashon to provide quality health and emergency care to the Island,” she added.

“We would never turn anyone away in need of emergent care. That just will not happen. However, we would need substantial additional financial support to provide free non-emergent, routine care to everyone in need.”

The one-pager marks the first update to the medical organization’s long-standing financial policy and reflects only minor changes, Pursell added in her brief written comment.

Rita Cannell, who manages the Vashon Health Center, concurred.

“This policy has been in effect all along,” Cannell said. “What’s new to us is the fact that they’re sharing a written policy and giving it to the patients to sign.”

The clinic was founded by a group of Islanders nearly 40 years ago at a time when there were scant health care services on the Island. Granny’s Attic was launched shortly after the clinic was started as a way to bring in enough revenue to keep the fledgling organization afloat.

Several years ago, High-line bought the practice and began renting the clinic’s space — a former military barracks at Sunrise Ridge — from what is now called the Sunrise Ridge Health Services board. Today, the clinic boasts five doctors and a physician’s assistant.

Cannell said she knew putting the financial policy in writing and asking patients to sign it would raise questions and concerns.

But the clinic has long worked to find a balance between covering the costs of those who have no insurance and remaining financially solvent and will continue to work with patients to find a way to get their health care needs met, she added.

When people don’t have insurance, they can either apply for Highline’s “charity care” program or government assistance, Cannell said.

Those who don’t qualify for either — patients who, for instance, don’t have the funds for because of a temporary loss of employment but on paper don’t look like people with considerable financial need — will get their bills paid for by Granny’s, which routinely writes a check to the clinic to cover those bills that are about to be turned over to a debt collection agency.

“That’s what we have in place with Granny’s and we’ll continue that,” Cannell added. “We’ll give patients an appliation for charity care, but if they have financial statements that suggest they won’t get charity care, we turn it over to Granny’s and they graciously cover it.”

May Gerstle, a long-time patient at the health center, said that’s the way she interpreted the financial policy when she was asked to sign it recently.

“I think they’re just codifying their philosophy,” she said, adding, “My feeling is that Highline is struggling to make ends meet. This is not a money-maker here. I think they’re just doing everything they can so that they can stay here and serve us.”

But Skillman, with the Sunrise Ridge board, said he fears it reflects a fundamental shift in the way the clinic operates on Vashon.

“I imagine the physicians and staff don’t like it,” he added. “This looks like the heavy hand from the corporate environment on a semi-rural clinic. I don’t like it.”