11/09/2007: "Letters On Hospital Proposal"
To the Editor:
The current discussion regarding a multi-million dollar hospital proposal for Friday Harbor has one important element missing: the need for a public forum and vote by our taxpayer residents to decide if we really want and need such a costly enterprise.
Any other approach disenfranchises the citizens of this community.
Our current medical facilities are adequate and hospital care, when needed, is only minutes away.
To the Editor:
Yes it’s a noble cause, however, it comes with a majestic budget. Can our small population that comprises Hospital District # 1 afford it, and the huge associated cost of equipping it, plus staffing and maintenance? Orcas, Lopez, Blakely, Shaw and Waldron Islands are not included in the hospital’s taxing district.
This leaves the burden of shouldering the costs on the taxpayers of San Juan, Henry, Pearl, Brown, Johns and Stuart islands. All but San Juan island are sparsely populated. Per the San Juan County Assessors office there are only 6,335 non-exempt tax parcels on San Juan Island. Per the state Office of Financial Management, the population of our entire county stood at 15,900 and it only grew by 200 people during the previous 12 months. Subtract out just the population of Orcas and Lopez islands leaves only 8,610 residents. Does this warrant even the consideration of a $20 to $30 million expenditure on a new hospital?
Every resident of the tax affected islands will pay for the proposed hospital either directly or indirectly. The local merchants and landlords can ill afford to absorb the increased taxes and will be forced to pass on the added costs. This will increase the price of everything: housing, food, gas, heating oil, lumber, hardware, etc. Whether you own or rent a home, you will be paying for this increased tax.
With three excellent, full service hospitals nearby on the mainland, ask yourself, do we really need the increased financial burden of a new hospital that won’t be full service? Please keep in mind; in many instances a trip to the mainland will still be required.
It appears the majority of our taxpayer-supported entities have huge want lists:
New Transfer Station
New Government Center
Storm Water Drain Tax
New Public Works Facility
It’s amazing to find our government officials wondering why affordable housing is scarce to non-existent. There’s even conversation amongst these same officials of creating another bureaucracy called a “Housing Authority”. This is not a cure for the intrinsic problem, which is needless and excessive spending of our tax dollars. If allowed to continue on its current course, many of our island’s retired senior citizens on a fixed income will be economically forced to leave.
Has the time arrived to seriously consider turning over to private enterprise both the hospital and the transfer station?
With all these wants one has to wonder who the heck is watching the store? Are we striving to leave our children and their children a legacy of taxation that they can’t afford? Or are we on a mission to make a healthy person ill when they get their tax bill?
San Juan Island
To the Editor:
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.
San Juan Island