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Should there be a place for faith-based medical care providers in a public hospital district? That’s the question raised recently on San Juan Island—months after the opening of PeaceHealth’s Peace Island Medical Center last year. Raising the question after the new hospital doors have opened seems poorly timed at best, but basic questions about whether, with whom, and how public hospital districts may partner with private health service providers are not new. People who work in or with public hospital districts across Washington are hearing the questions more and more often as medical care organizations across the state work to integrate our health services.


Health service organizations in Washington state are structured as for-profit, nonprofit (which may or may not be faith-based), or public. I’ve represented the state’s fifty-seven public hospital districts for a dozen years; before that I worked for all the hospitals in our state for eighteen years. Washington’s system of care has evolved over more than a century, and its people have come to rely on organizations of different types working together to meet their health care needs. Improving our quality—our outcomes and our patients’ experiences— demands that these different organizational types become ever more tightly integrated by sharing medical records and managing care across different settings. Partnerships are BOTH the future of medical care organizations AND the path to better health.

For hospitals operated by districts in rural areas (and nearly all of them are), the conversations about if, when, how, and with whom to partner are challenging. Most (but by no means all!) public hospital districts operate small “Critical Access” hospitals. Most of them also support (and in some cases operate) the main sites for primary care access within the district’s boundaries. The taxpayers own these systems, and poor economic conditions in rural Washington have made tax dollars an essential part of the balance sheet for many of these places since the early 1980’s. Reforming entitlement programs like Medicare and Medicaid seems critical to reducing the federal deficit—but cuts to those programs will hit rural medical care providers especially hard, because most of the insured patients they treat are covered by these programs. Understanding both what a public hospital district needs from a partnership AND what it has to offer potential partners can be a challenge when the local business proposition is bleak.

What does all this mean for partnerships between faith-based care providers and public hospital districts? Well meaning people, acting from principle, can and do disagree on strongly held beliefs and values. At the risk of being accused of “moral relativism,” I’d urge we not let allegiance to our personal or political convictions cause us to lose sight of some practical truths.

Here are a few realities at play in virtually every community served by public hospital districts where partnerships or collaborations are under consideration:

- Partnerships, by definition, demand give and take; neither partner gets to dictate all the terms to the other. Talk to any person in a successful marriage if you doubt me.

- Not many organizations are banging on the doors of our rural hospitals to see how they can help. In the past, almost all patients were seen as good business; now, Medicare and Medicaid don’t cover the cost of care delivered (and that’s mostly what rural districts have to offer). Most public hospital district leaders—large or small--feel very fortunate when they find a potential partner willing to join with them in service to the people in their districts.

- The hot-button services that are so often the focus of community controversy – with passionate voices on both sides – generally have NEVER been provided by our districts. When local leaders have their hands full trying to keep the lights on and meet payroll, they may not have the luxury to turn away a potential partner because that partner won’t offer a service that was never offered by the district in the first place.

I’ve heard and read a lot of “what-ifs” and fears of the future/the unknown in the public discussion about Catholic health care in San Juan County. Those fears, by their nature, are nearly impossible to address—what, after all, can we know for sure about the future? In the case of United General and Peace Island hospitals, the partner – PeaceHealth – is well known in the Northwest. It has a long history and tradition of service. The challenges of providing faith-based care in a secular society are not new. I would suggest strongly that PeaceHealth’s record be carefully considered before the community reaches judgment.

One “what if” that I haven’t heard raised in San Juan is this: What if PeaceHealth hadn’t stepped forward, committed $20 million, and put itself on the line to partner with the San Juan Public Hospital District? Does anyone think there would be a beautiful, LEEDS-certified, state of the art medical facility open there today? Or would the future of health care on San Juan Island look as uncertain as the future looks for care in a dozen other public hospital districts?

Before I close, I want to add a shout out to the volunteers who serve as public hospital district commissioners and hospital board members. They spend untold hours making sure that health services are available to their neighbors—hours that not a lot of people in their communities are wiling to commit. It is, far too often, a thankless job. In my view—and I’ve watched a lot of district business over thirty years—the commissioners in San Juan County Public Hospital District #1 have performed their duties in the best tradition of public service. Their actions have been deliberate, open, thorough, inclusive, thoughtful and, by any measure, exceedingly successful. They accomplished what seems impossible: bringing improved services and greater health care access to San Juan Island without raising taxes. In many places, this would be cause for congratulations and celebration. I hope that, in the debate over services that PeaceHealth doesn’t offer, the community doesn’t lose sight of what these commissioners have managed to deliver to their constituents.

Public-private partnerships are often touted as the best of all worlds – bringing public sector transparency and civic engagement together with private sector efficiency and agility. Instead of making it more difficult to form these partnerships, I submit we should be encouraging them. The health of the people who rely on public hospital districts for care is at stake.

Jeff Mero
Executive Director
Association of Washington Public Hospital Districts

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