San Juan County Hospital Board District board members Dr. Michael Edwards and Lenore Bayuk spent a few hours Friday, September 28 polishing a letter in response to one from the Coalition for Health Care Transparency and Equity. The full Hospital Board worked on a draft during a September 27 workshop using a letter provided by PeaceHealth attorney Stu Hennesy, and Hospital Board member George Foster.
Foster's letter was preferred as it was considered less emotional, Hennesy's had "way too many words".
Edwards said, "Some of the driving forces are salient five years ago, are salient today, but in response to the the coalition inquiries they aren't salient in that context, so I would exclude them."
Introducing his letter, Foster said, "In a prelude, in response to the coalition, there was a lot of rancor. I put this together in an effort to shut down some of that bias."
The board compared the letters.
"You have a little bit of this pertinent history," said Edwards.
"I think it is worth including that piece about how we had approached other healthcare organizations, said Bayuk,
"Not that we were desperate when we hit PeaceHealth," said Edwards. "In the relative sense PeaceHealth was the shining star, above all the others as far as I am concerned.
"I think a lot of the community understands that," said Foster. "I think the issues regarding the Coalition are the two other that I have mentioned - the Seattle Bishop and the intent of the PeaceHealth partners - and that's just nuts."
"PeaceHealth emerged as the organization of choice, said Edwards. "We had multiple choices."
Bayuk said, "They were the only ones that were willing."
"No, that's not the case," said Edwards. "Well, it depends on which starting point you want to adopt. Our initial inquiries started with the University of Washington. They were willing to dance, but the parameters by which they were willing to dance were egregious."
"We wanted to reach that point where we were not willing to raise taxes," said Board member Keri Eathorne.
Contract language was mentioned.
Bayuk said policies and the letters from the nuns have been posted since the last board meeting. They are on the San Juan County Public Hospital District website sjcphd.org.
Concerning services available Edwards said, "This is dependent on composition of the medical staff. Just earlier this week, when Dr. Sullivan, who is going to be physician, ED (emergency department) director, county-wide EMS medical director will be when asked by the folks from Orcas as well as Lopez, what will the clinical offerings going to be over here. He has no answers, because it's totally driven by medical staff, their desires, their patients' need and want, their capabilities, what they feel comfortable doing in a rural setting. Particularly with an upstart facility. It is going to be ultra conservative. As far as the eventual performance in the new facility, good, better or indifferent, it is going to take time to appreciate that. To react to hypotheticals prior to that facility getting up and running, just doesn't make sense to me."
Bayuk said, "The question and concern was that, and that was voiced in the letter was, what reproductive care is going to be dealt with, because of PeaceHealth and their policy, indicates that they cover abortion in emergencies in two situations."
"We are not going to do ob except in emergencies just like it is now. Basically the same services we provide now."
"Including death with dignity, none of our physicians subscribe now." said Edwards.
"They don't participate. They refer," said Bayuk.
Keri Eathorne asked where the guarantee of the same services being provided was stated.
Bayuk said, "The definitive agreement here - provision of clinical services:
1.1.13 PeaceHealth shall assume all financial responsibility for, and shall exercise due diligence in providing, all clinical personnel reasonably necessary to provide high quality, safe and compassionate healthcare at the combined clinic/hospital facility. PeaceHealth agrees that such clinical service shall, at a minimum, include the following items: primary care, emergency care, imaging services, diagnostic services, observation services, and simple medical admissions, provided that the District and PeaceHealth may mutually amend those specifications.
Bayuk said, "Another thing I think that is important to keep in mind, I discussed this with Nancy Steiger of PeaceHealth and Jim Barnhart, when a facility has certain policies and procedures in place, if people practice in violation of those, they could lose their accreditation. If they lose their accreditation they are like on their lips, they can't get funding, they lose their medicare funding. Policies and procedures are guarantees they will provide those procedures. They can't cover every primary care procedure.
"We can't guarantee every, can't predict the future. Basically policies and procedures. Unless we are willing to meddle forever with the agreement about policies and procedures," said Edwards.
"In Section 2.2.2. we have the right to recommend future services," said Bayuk. "And PeaceHealth agrees to give good faith consideration."
Wrapping up their response Foster said, "put it in writing is all we can do," said Foster.
"It is emotional", Eathorne said. "Just how much time, how much effort, how many people were involved in this."
The final letter is expected to be available later this week. The board must meet to approve it before it can be released.
The Coalition's letter is posted below:
We, the undersigned, appreciate all of the hard work the commission has done in bringing a hospital to San Juan Island. The hospital will play an important role in the fabric of our community for generations to come.
As the new facility is getting ready to open, we have specific questions for the hospital commissioners about the subsidy agreement that was made with PeaceHealth and how that will affect health care for islanders in the near-term and over the 50- year lifespan of the agreement. We feel compelled to ask these questions because we believe it’s critical to ensure that health care needs of current and future islanders are addressed in a fair and equitable way.
We know there are many islanders who have expressed an interest in these issues, and the hospital board has said that it wants to operate with transparency, so we respectfully request the hospital board to respond in writing and publicly to the following questions/concerns:
In the agreement, PeaceHealth has the right to merge, acquire, or be acquired by another facility that shares its same mission. It has declared its intent to merge with a division of another, much larger Catholic health system, Catholic Health Initiatives (CHI), resulting, in the CHI CEO’s words "in a fully integrated new health system." Catholic Health Initiatives says on its web site and in its employee handbook that it follows the Bishops' Ethical and Religious Directives. The bishops' directives prohibit many types of medical procedures and require others and according to one of the directives, all employees are required to follow all of the directives as a condition of employment. Among the forbidden services/activities/procedures:
• Abortion under any circumstance, including in the case of extrauterine (ectopic) pregancies, rape, or incest
• All contraception, including IUDs, The Pill, and emergency contraception (Plan B)
• Sterilization, including tubal ligation and vasectomies
• Participation by physicians and other health care providers in the Washington Death with Dignity Act (DWDA), which was approved by 72% of the voters in San Juan County, including providing information about the DWDA to patients, as well as referrals to organizations that provide counseling and support to patients who want the option to use the law
The directives also require employees to disregard patient health advance directives if they conflict with the bishops' directives. This means, among other things, that patients similar to Terri Schiavo who are in persistent, vegetative states must be given artificial nutrition even if the patient has expressly directed otherwise through an Advance Directive.
Given all of the above, here are our questions:
• What written and legally binding guarantees did the hospital board get from PeaceHealth that services and practices currently available through InterIsland Medical Center but which are in conflict with the bishops' directives, especially those related to reproductive health (e.g., IUD placement, birth control services), will be available in theory and in practice at the new taxpayer- subsized medical facility over the life of the agreement?
• What written and legally binding guarantees did the hospital board get from PeaceHealth that patient advance directives, especially with respect to artificial nutrition (feeding tubes) will be followed?
• Given that between 95% and 97% of taxpayer health care dollars funded through the hospital taxing district and not subject to voter approval are committed to PeaceHealth through the next 50 years, what legally binding provision is there for funding health care treatments that are not or will not be available through PeaceHealth? (An example today might be reproductive health services; an example into the future might be treatments for Parkinson's or other diseases made possible through the use of embryonic stem cells, which the bishops' directives expressly forbid.)
• After seven years, PeaceHealth has the ability to withdraw from the agreement with three years' notice if reimbursement rates change substantially or if they determine that the hospital is not financially viable. What provisions exist for the District to withdraw from the agreement over the next 50 years if future hospital board commissioners believe that PeaceHealth is not meeting the health care needs of islanders?
We look forward to reading your responses and we thank you for your attention to these issues.
Coalition for Health Care Transparency and Equity
The following articles may be of interest to readers.
PeaceHealth pay on upswing for execs published on The Register Guard
Unholy Alliance from the New Republic
Holy Family Planning published on LEO
Earthly Concerns published by The Economist