06/20/2007: "Guest Editorial"

Thoughts On SJI Hospital Proposal
Lest I be labeled one who is trying to nay-say the experts, let me say first that I am a Registered Nurse with decades of experience as a hospital staff nurse, a Public Health Nurse and a Nurse Practitioner in Washington, Alaska, Hawaii and California. I have been many places and worked in many settings. Only the first year of my work was in a city, San Francisco; the rest has been in rural health. I have observed rural hospitals, health clinics and public health facilities throughout my nursing career, and I hope the citizens of this county will recognize I have something valid to say.

I have also been involved with San Juan Island going back to 1970 when my father bought property here. I remember remarking to my father, when the hospital district (a district with taxing powers) was proposed and voted in, that the day would come when someone would think it's a good idea to build an acute care hospital on San Juan Island.

On the surface, having a hospital on San Juan Island sounds wonderful to most people. I listened in while someone answered the recent survey of county residents. The surveyor was very professional, but the survey gave no indication of what was planned except the "Buzz Words," a hospital on San Juan Island. Wouldn't it make more sense, if a “critical access” hospital needs to be built, to build it in the middle of the county? Build it on Orcas? I cannot imagine residents of Orcas, Lopez, Shaw or Decatur using a hospital here, when Island Hospital is so close for them, unless, of course, they are forced to by the “critical access” law, or by insurance companies, Medicaid and Medicare.

Rural hospitals are a dying breed. By and large, they do not make enough money to support themselves. By and large, they are difficult and expensive to staff, not just with nursing staff but also with necessary technically certified personnel such as x-ray, ultrasound, respiratory therapy and laboratory technicians; and, let's not forget we'll need, and probably have on a consultation basis only, a Registered Dietitian, a clinical pharmacist, a Medical Social Worker. By and large, the public ends up paying to have a rural hospital built and run, and eventually departments close - no more OR, no more delivery room, eventually no more acute care beds - leaving a mostly empty building with an emergency room. Ask Beth Roeder if you do not believe me. If she knows her stuff, she will agree.

If the hospital board needs a little more information, I also suggest they investigate the recent problems Trinity Hospital in Weaverville, CA has had meeting its payroll and operating expenses, forcing the county to borrow millions. Trinity County, being largely Federal land, does not have the tax base San Juan does. So we should sock it, tax-wise, to the wealthy part-timers who own property here? I think not. We'll be socking it to retired persons who have been here for years, to those who were lucky enough to inherit property, to those who struggle to be able to live in the islands, many of them the same Medicare recipients this Critical Access Law is intended to help.

A rural hospital, while generally homey and personal, cannot, because of the nature of the beast, give the level of care you will experience in Seattle, Bellingham or Anacortes. Pediatrics and obstetrics are highly specialized. In large hospitals, staff in these units are experts. Surgical nursing is a specialty, pre, peri and post-op. Having an outpatient colonoscopy? Your nurse will be an expert in administering conscious sedation. Will the surgeon bring his own nurse with her/him? Possibly. Possibly not. In any case, your pre-op and recovery will be done by hospital staff. Rural hospital nurses are Jacks-of-All-Trades; they have to be. Pediatrics is highly specialized, and a good peds nurse is a rare bird. I've never met a good ER nurse who liked doing OB, or vice versa, and, let's face it, it's the nurses who keep a hospital together 24/7.

Did I ask where the needed professional staff, nursing and otherwise, will come from? And once they get here, where they will find housing?

We do not need an acute care hospital in San Juan County. What we need are improved emergency facilities, at least on the most populated islands, perhaps with an outpatient and 24 hour holding area on San Juan. Perhaps a case can be made for staffing such a facility 24 hours a day were it combined with an outpatient department that could provide after-hours urgent care and take care of some problems that now require either home health nursing visits or hospitalization on the mainland, such as the administration of certain IV antibiotics.

I will not leave you without a suggestion, Hospital Board. If you must do something to integrate health care on San Juan Island, purchase the Islands Convalescent Center and build a state-of-the-art ER, not in the Islands Medical Center, but adjacent to it and adjacent to the convalescent center. Nursing staff can slide back and forth between these areas. Maybe that sounds silly, but I have seen a combined rural ER and long term care unit work well. Continue to send all acute cases needing hospitalization off island. Yes, run a clinic, a long term care center and an Emergency Room. These may pay for themselves if you can figure the ins and outs of ER physician staffing. If not, at least the island physicians will have improved emergency rooms to work in. I'm guessing, and it's an educated guess, that whatever federal funding is available focuses on inpatient hospital admission and not on emergency care.

And sure, I'll be happy to serve on a committee. Unless the Hospital Board wants a YesMan who will blissfully sign off on Ms. Roeder's plans without giving a thought to what it really means to have a hospital on San Juan Island.

Wendy Russell lives on San Juan Island