3/8/22 by Jefferson County Hospital District Commissioner Dr. Kees Kolff, with major input from CEO Mike Glenn.
“Thanks for this opportunity to address your questions about secular healthcare services in Jefferson County and how you as local residents can support that service.
I assure you that my fellow Hospital District Commissioners, Mike Glenn and his leadership team, and all of our staff at Jefferson Healthcare are committed to being 100% independent as a provider of secular healthcare here in East Jefferson County. We have been so for decades, we are so now, and we are committed to being so into the future.
Last week I listened to the League of Women Voters forum held in Port Townsend in 2014 regarding the Ethical and Religious Directives for Catholic Healthcare Services and it strengthened my conviction that this is an important topic.
Then yesterday I listened to the recording of your January meeting with the folks from Kitsap County and the group Save Secular Healthcare Washington, and I learned more about why we all should be increasingly concerned.
It’s obvious that the US Conference of Catholic Bishops went the extra mile in their 2018 6th edition of the ERDs with stronger language for bishops to ensure that there are no loopholes in any arrangements that might allow the offering of “immoral procedures.” With about half of WA state hospitals, and many clinics and hospices services under their control, we all have reasons for concern.
First I would like to answer the specific questions that Bruce was kind enough to send me. Then I would like to talk a bit about the serious challenges we face as a small, rural healthcare system and ask you for your support.
- When patients are given a choice of referrals for non-emergencies (like hip surgery, etc.) is the question of secular vs non-secular considered by our providers?
First let me say that we have an excellent orthopedic team that can do hip surgery here. But patients always have a right to specify their preferences regarding non-emergent referraIs or second opinions, regardless of their reasons. Providers will naturally consider secular status if prompted, but it may not be in the front of their minds when needing to make a referral. It certainly wasn’t when I was practicing medicine, but then again there were fewer Catholic healthcare systems 40 years ago. Providers invariably tend to refer to settings where they believe their patients will receive the best care, but there may be more than one such place. When you are a patient, please make your wishes known if you think that ERDs will affect the care you need. Obviously, the more services we provide locally at Jefferson Healthcare, the better assurance we have that patients can stay here for care and that their wishes are carried out.
- What is the current nature of JHC’s relationship with any of the Catholic hospital networks?
In order to better communicate with other hospital systems, we had to go to the most common locally used electronic record system called Epic. It was way too expense for us to contract directly with Epic, so we contracted with Providence Hospital. They support the service but we own the medical records. Our Epic contract is due to be renegotiated this year with Tegria, a new supposedly secular technology company formed in 2020, by none other than Providence. We have NO religious restrictions on how we use the Epic system or ERD language in the existing Epic agreement, or for that matter, in any of our other agreements or contracts. We will continue to make sure there are none in all of our new agreements.
Although we had some telemedicine contracts before the pandemic, they have become even more critical in the past few years. We contract with Insight for telepsychiatry, Providence/Swedish for telestroke, Radia for teleradiology, and NorthWest Pathology for telepathology. This includes approximately 50 different providers. We are currently negotiating for extended telemedicine services with Eagle Telemed, a physician-led, for-profit, Atlanta-based organization that according to an email I got from them this morning, is “not affiliated with any religious organization.”
Our providers refer to other hospitals based primarily on where they believe the patient can get the most clinically appropriate care. For cardiology, it’s usually St. Michaels. For stroke care it’s Swedish, unless it is determined to be from a bleed, in which case it is Harborview, which is also the place we send people with major trauma. Realistically, our hands are often tied and Catholic hospital services are usually much more available than are providers in secular institutions, like the University of Washington.
- Are specialists from St. Michael who provide services in JHC facilities, for instance the cardiologist, bound to the St. Michael ERDs while they are here?
Mike Glenn does not believe he is bound by ERDs, but is confirming this for me. However, this may not really be a relevant question. If the patient is seen here in a clinic or in the hospital, he/she still has access to all end-of-life services we provide. This continues to be an option for patients with cardiac conditions either with their primary care provider or with a hospitalist if the patient needed to stay in the hospital here.
- If someone needed to be moved from our ER or elsewhere in the hospital, how does JHC decide what facility they will be moved to? Are there steps we can take to make sure we are taken somewhere that will honor our advance directives and living wills?
The most important thing you can do is make sure your personal healthcare directives are in order and filed at the hospital. The attending doctor, with consent from the patient if at all possible or with a designated family member, makes all referral decisions. Care is managed by doctors at the bedside. Jefferson Healthcare as an organization has no role in that decision, but merely helps facilitate the transfer. Regionally there is a severe shortage of beds and hospital staff caused by this pandemic. We frequently have to make dozens of calls to EVERY possible hospital just to find an appropriate bed for a medical emergency. The stress on our staff is enormous. During my years in practice I never had to deal with that problem. I can imagine that secular v. non secular care may not be at the top of the list of concerns. That said, I think our doctors are mindful of secular wishes, but equally mindful of finding an available bed.
- What can we do to make sure that we preserve secular healthcare in East Jefferson County?
At the LWV forum in 2014, Mike Glenn described our sincere commitment to secular healthcare. He and the Board have never waivered. However, the former CEO of the former Harrison Hospital formerly in Bremerton, said, “If you aren’t worried about the future of small, rural hospitals, you should be.” Unfortunately, that’s even more true today than it was then. More than 200 rural hospitals have closed in the US since 2005, and more than 50 of those in the past 3 years. Here in Washington however, hospitals are not closing but they are “merging”, or perhaps better said, “selling out”, and mostly to Catholic health service organizations. Enumclaw, Tukwila, Arlington, Monroe, Sedro Woolley and other communities have lost local control.
Under Mike Glenn’s administrative leadership, we have followed a strategy of growth with more services. There are 2 primary reasons:
a. The first is that our community desperately needs the care locally and it is the best way to assure our patients get the care they need and want.
We are the only rural hospital/clinic system in the state offering medical/surgical abortion services. We are active supporters of end-of-life care including death with dignity options, and have even provided that service in the hospital, though many people prefer to die at home. We offer terminal sedation with our Home Health and Hospice care, and my mother benefited tremendously from that support when she died at home here in Port Townsend. We have also added dental, dermatology, oncology and cardiology services just to mention a few.
b. The second reason for growth is to provide greater financial viability. The greater array of services we can offer, the more diversified is our revenue stream and the more we can benefit from economies of scale. Greater stability means less likelihood of needing to sell out to an outside, bigger system.
So here are 5 things all of us can do:
- Get a booster shot against the coronavirus if you haven’t already done so. We need to end this pandemic which has stretched the capacity of our hospital district both financially and with staff burnout and shortages. Jefferson Healthcare has gone well beyond what most hospital systems do in our collaboration with the local health department, often without reimbursement. Yet we still have about 3, often taxing, unvaccinated patients each day in hospital beds.
- Be mindful of the fragility of the rural health eco-system. Rising costs and shrinking reimbursements will stretch us even more in the near future. We are small and unique. Potential legislative solutions in Olympia for large system problems may have serious, unintended negative consequences for small systems like ours where profit margins are slim. Two bills that are current hot topics are the nurse staffing bill which would drive up our costs, and the charity care revisions bill which could drive down reimbursement. We live in a complicated, imperfect world with a dysfunctional federal healthcare system and sometimes we have to choose the lesser of two evils.
- Please use our local hospital system! Use it or lose it! Please get your care here whenever you can, since our survival depends primarily on revenue from the services we provide.
- Please participate in the master plan process that Jefferson Healthcare is launching later this month. There will be many opportunities for public input as we plan to replace a 1965 building that the city has mandated we replace, improve space for our current providers, and add more space for additional services.
- Support the bond that we will need to fund part of our master plan. Some people think that the hospital district gets significant financial support from local property taxes. In fact, we get only about $500K per year, less than 0.4% of our operating budget. Olympic Medical Center in PA gets 2.2%, Island Hospital in Anacortes, 5.5%, and Whidbey Health in Coupeville, 5.9%. Each of them more than $5M. Our tax revenue barely covers the cost of special Public Hospital District administrative requirements and compliance. In addition, the public bidding process we are required to follow costs us several million dollars per year. That’s one reason we applied for and received special permission to go with a design-build process for our master plan.
In summary, Jefferson Healthcare plan to stay secular and independent, but can only do so if we grow to meet the challenges and opportunities ahead. This will require a successful master plan supported by this community. I hope you all will support that effort.
