Jefferson County Medical Society endorses McComas based on inaccurate information

“Physician, Heal Thyself” is a biblical quote, from Luke, who was a physician. The saying meant that during the rejection of Christ, that Christ would be told to fix his own faults before criticizing those of others. It could be applied last week to Dr. Steve Erickson, the head of the Jefferson Medical Society as he led a campaign to get the society to back Bruce McComas over Cheri Van Hoover for Hospital District Commissioner.

Minutes of the meeting were leaked to me and they tell an interesting story. First, the society apparently has never endorsed a political candidate in recent memory. Not even the threat of Donald Trump, a foe of Obamacare, (which has been responsible for helping the hospital stay in the black) was seen as enough of a threat to take a stand.

Now, apparently the threat of a skilled midwife, RN and ARNP,  carrying two degrees and one certification has . A woman with a background as a counselor in a community-based mental health crisis intervention and the  chair of national committees for the American College of Nurse-Midwives, chair of Ethics Task Force for Northern California Kaiser Nurse-Midwives Peer Group and Educator & Health Policy professor and nationally recognized for instructing medical, nursing, and midwifery students seems to have spooked the doctors of our town just before Halloween.  If these aren’t qualification enough to get medical professionals to endorse her, just what is? They can’t criticize her credentials so they go after her motives. They say that we ‘need’ a business person in the role, yet where were they when they elected commissioner after commissioner over 40 years with virtually no specific business acumen?  With that background the argument could just as easily be made that the hospital has done wonderfully without a businessperson on the commissioners.

The minutes stated that,”

Steve Erickson express the majority view of the meeting, which is that the two newest commissioners have been pushing for financially risky endeavors such as a subsidized dental clinic and a takeover of the county mental health services.  As far as anyone can tell, candidate Van Hoover is sympathetic to those views and candidate McComas is more concerned with maintaining the financial health of the county hospital system.

That statement puzzled me. I could not understand why Dr. Erickson was attacking the investigation that Mr. Glenn is leading into the dental clinic and mental health clinic.

The ‘risky financial endeavors’ that Dr. Erickson mentioned were originally raised as part of a multi-year community effort to prioritize county health needs. Called the “Community Health Improvement Plan” nearly 100 members of the community participated, including Mike Glenn, many hospital staff, (not Dr. Erickson apparently), Public Health, and others. The entire CHIP document can be found at :

CHIP Document

with a summary chart here:

CHIP Summary

I have attended or listened to all the Commissioner meetings since last fall, have interviewed both Mr. McComas and Ms. Van Hoover, attended 3 different candidate forums,  and never had come to the same conclusion as Dr. Erickson. I contacted Commissioner Kees Kolff and asked him about this allegation. Here’s what he told me (emphasis added):

Dental Health has been a concern of board members even before I was elected, in particular Tony Deleo. During the first year of my term I worked to get an outside agency, namely SeaMar, to come to the county since they had been so successful elsewhere. At that time Mike Glenn had already stated to the board that he would start in the fall of 2016 to explore options for JHC to provide dental services. With unanimous support from the board, he (Mr. Glenn) has spearheaded getting:

  1. the State to authorize the same reimbursement for Rural Clinics as for FQHCs (like Sea Mar) making it potentially sustainable, b. our legislators included $1 million into the hopefully soon to be approved state capital budget, for a 6 dental chair facility, and c. there is interest on the part of the Wash Dental Foundation to perhaps provide an additional $500,000.
  2. Behavioral Health service integration with medical services will be mandated shortly in our state, and is considered “best practice”. That has been the goal for several years, supported unanimously by the board. We jointly hired a Psychiatrist to spend half her time with JHC and half with Discovery Behavioral Health. Then it became evident that more integration would be best for both entities, especially the clients. Some in the community hoped that it would be a purchase of DBH and others that it would be a merger, when in fact we learned along the way that the only way to continue to get the kind of reimbursement that would make it pencil out, was to do a unique affiliation. Mike Glenn and his team, including Dr. Mattern and others on the medical staff and leadership team, spearheaded the effort, with unanimous board support.

Meanwhile, just a reminder that when the inpatient psych unit did not pencil out financially in spite of a grant for over $1 million, the board unanimously turned down the grant.

Finally, the CHIP effort also included the County and the City. A director for the program will hopefully materialize, since both the County and JHC committed money to hire one.

Although the CHIP has many ideas and priorities, they will be implemented by the different entities in the community only if they are affordable.

Hope that helps.

Cheers, Kees Kolff, MD, MPH

 

Dr. Katie Ottaway, also in attendance at the meeting brought this issue up, as the minutes state:

“Ottaway objected that community access committees have argued in favor of the dental and mental health services and that the hospital district should take those concerns seriously.”

Dr. Erickson and the others were unconvinced.  However, the vote, while claiming to be representing the “majority” of the physicians in the organization, which, according to Dr. Erickson has 25 members, had only five were present at the meeting. Dr. Erickson claimed that at the meeting they decided that they would endorse if 75% of the members who chose to express an opinion. Those who didn’t attend the meeting or responded via email were not counted as part of the threshold, so in essence, the decision was made by a minority. Dr. Erickson told me that not a single member endorsed Ms. Van Hoover, but Dr. Ottaway told me she was the lone dissenter present at the meeting.

This election for a minor county position, usually draws little to no attention. It has taken an ugly turn as some supporters of Mr. McComas have taken to a smear campaign of Ms. Van Hoover, fueled by stories like this one that Dr. Erickson used to convince the medical association of the supposed danger to the hospital by supporting Ms. Van Hoover.  I’ve also heard the stories myself directly from Bruce’s supporters that Dr. Kolff recruited Ms. Van Hoover. That is wrong. Commissioner Kate Dean was responsible for urging Ms. Van Hoover to run . Additionally, Facebook posts have lent more fuel to the misinformation campaign being waged by those same people. At this stage, I have no idea who will win. Mr. McComas has a huge amount of signs but a long time political campaign manager in town told me that “signs don’t matter, knocking on doors does.” Ms. Van Hoover has worn out her shoes doing just that.

At a recent hospital district commissioner meeting, a special consultant was hired (at a not to exceed non competitive bid of $20,000) to help mend the fences between the feuding factions. On one side are Matt Ready and Kees Kolff. They represent a belief that the Commissioners role should be more expansive than simply managing the CEO and rubber stamping all that he does. They would like to see the Board of Commissioners act more as a champion for getting health care to *all* the people in the county. There are issues at the hospital worth addressing from a policy point of view. While the hospital is doing well it has it’s share of issues, just as all bureaucratic organizations do. The faction of Marie Dressler, Jill Buhler and Tony Deleo are on the side of saying that the job is narrowly defined. They don’t want to ‘color outside the lines’ and accuse Mr. Kolff and Mr. Ready as interfering in the day to day operations. I can’t agree with that assessment, and it seems like more stories to tell Bruce’s supporters.

I listened to the opening hour of the meeting, and you could cut the tension coming from Mr. DeLeo and Ms. Buhler with a knife. You can listen to the whole recording here. The first hour is probably all you need to review.

Given the level that even the distinguished members of the Medical Society has sunk to, by not holding off making a decision until they clearly understood the facts behind the allegations, (which was requested of them),does not bode well for this election or next year’s election. Regardless of who wins the sour taste of accusations made against qualified candidates will linger. The Democrats have been warring between themselves as the Bernie faction challenges the traditional party people who brought us to a near domination of the political landscape with their hard work. The  Republicans seem willing to say and do anything to try and regain their positions in the county.

It also shows the depths that the medical society will go to in order to protect the status quo. There are plenty of positive things going on at Jefferson Healthcare. Mike Glenn and his staff have done an outstanding job of building reserves and expanding services. However, issues such as physician recruitment and retention, costs of services, and a lack of transparent pricing are just a few issues that continue to drive possible patients, such as myself, to take my healthcare elsewhere. That, in the end, will do more to harm Jefferson Healthcare than a well qualified woman who has spent a career in healthcare and health policy, which is the primary focus of the Hospital Commissioners.

If you are on the fence, or a supporter of Bruce because of these allegations, I urge you to at least research the facts before voting.

Under Trump’s New Budget, If You Don’t Work, You Don’t Eat: Republicans Are Kicking People Off Food Stamps – Newsweek

Just another day in Trump’s America. Your neighbors will be joining others in the food bank lines. Does this lead to a healthier America? Or are we heading to the Hunger Games?

UPDATE: The budget resolution passed by the House on Thursday will push millions of already struggling people off food stamps, leaving the neediest Americans—children and the elderly among them—without food.

The $4.1-trillion budget will take over $150 billion away from several poverty programs, including the Supplemental Nutrition Assistance Program (SNAP), which helps low-income people keep food on the table, by giving them small amounts of supplemental money to spend on groceries—anywhere from $100 a month to $700 a month for a family of five, according to the Center on Budget and Policy Priorities.

http://www.newsweek.com/under-trumps-new-budget-if-you-dont-work-you-dont-eat-republicans-are-kicking-679749

What the state stands to lose if Congress doesn’t reauthorize children’s health program – News Tribune

Hope our local medical professionals can decide to take action on this. I know they are busy but they found time to do political endorsements.

Washington state leaders are fretting over the possibility Congress might not revive a program that provides health insurance to more than 60,000 low-income children in the state.

http://www.thenewstribune.com/news/politics-government/article177542146.html

Congress Is So Incompetent It Can’t Fund Health Insurance for Kids – VICE

The headline says it all. And the tie in to our local Hospital District is that this is likely to push us financially from black ink to red. And what were our local physician’s medical society doing about such a looming crisis, with more to come in the Medicare and Medicaid cuts? Were they coming out and deciding they were going to sound the clarion call and warn the population of the looming crisis? Ask them to call their legislators to ‘save the children’? Nope. They were getting together to  vote to endorse a man with no significant health care experience over a woman with a lifetime of policy and medical background. Just like the voters last year that voted for Trump, who is putting the local hospital in jeopardy by endorsing these cuts. Did these same physicians feel compelled to get together last year in the run up to the election to warn the population of the impending disaster that Trump likely would bring to healthcare at both the national and local scene? Nope. Have they ever endorsed a candidate before? Apparently not. But I digress, I’ll cover that tale of our local petty politics  in another post at a later date. Here’s our latest medical fiasco on the national level.

Last Saturday, Congress failed to reauthorize the Children’s Health Insurance Program (CHIP), jeopardizing systems that provide low-cost insurance for almost 9 million kids and hundreds of thousands of pregnant women in families that make too much money to qualify for Medicaid but still need assistance. Legislators failed to renew other safety net programs as well. But missing the window on CHIP was a particularly egregious fumble, and one of the clearest signals to date of how desperate this Republican-led Congress is.

https://www.vice.com/en_ca/article/pak4k7/congress-is-so-incompetent-it-cant-fund-health-insurance-for-kids

Important Jefferson County Healthcare Commissioners Meeting – Wednesday 10/4 at 9 AM to 4PM

EDITORS NOTE: Though this meeting is a public meeting for a public hospital, it was not advertised in the Port Townsend Leader, nor has been yet in the Peninsula Daily News. It is on the Hospital Commissioners web site. The meeting is about conducting a board assessment that is going to  focus to some degree on the conflict and tension in the board itself. The top question in the information below is, “What do we expect from each other and how will we work together?” This is the unspoken crux of the meeting. Board tension has been high over the last year. There is a rift between what can be construed to be a group supporting a very narrow definition of the role of Hospital District Commissioner and those supporting a more widely defined one. Between a more status quo approach and a more expanded, outwardly facing approach. People actively engaged in the current commissioner campaign might find this a very enlightening meeting to come witness.

September 28, 2017
TO: Jefferson Healthcare Commissioners
FROM: Jill Buhler, Board Chair
SUBJECT: October 4, 2017 Board Retreat
Thank you for your support of and participation in our Jefferson Healthcare District (Jefferson) Board Retreat scheduled for October 4, 2017. The retreat will be held in the Jefferson Healthcare, Victor J.Dirksen Conference Room from 9:00 am – 4:00 pm. Thank you, too, for participating in the Board Self-Assessment process as your input has helped to formulate the work session agenda and objectives.

To ensure we maximize our time together please carefully review the pre-reading retreat packet. The enclosed materials will help prepare us for our discussions at the retreat and hopefully generate thoughts on how we as a board can improve our effectiveness. I am excited to share these ideas with you and hear your thoughts on how we can make positive changes that will help us better serve the people we represent.
Many thanks, again, for your time, commitment and support of Jefferson’s important mission.

JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_01JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_02JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_03JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_04JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_05JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_06JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_07JHC10-4-2017 Retreat reading 09-28-2017 FINAL_Page_08

Has Bruce McComas’ campaign overstepped state election law?

I have been very balanced in my approach to the Hospital Commissioner race in Jefferson County, saying that both candidates are very qualified and worthy of consideration. For the sake of transparency and what I am about to say, I want to make it clear that I have supported Cheri Van Hoover over Bruce McComas, more for her point of view rather than think of Bruce as someone unqualified for the position. Frankly if you look at credentials, it would be great to have them both on the Commissioners.

But in a series of ads running in the Port Townsend Leader and the Peninsula Daily News, Bruce McComas may have  broken state law, in showing doctors appearing in uniform supplied by our public hospital or with official employer supplied name badges, standing in what appears to be the hallways of our public hospital or outside the public hospital walls, prescribing Bruce to the readers and public.

The Public Disclosure Commission issued rules and guidelines concerning the use of uniforms in campaigns, and these guidelines are why I believe Bruce’s campaign  may have broken state law. RCW 42.17A.335 states that “Political Advertising or electioneering communication –  any political advertising that either directly or indirectly implies the support or endorsement of any person or organization when in fact the candidate does not have such support or endorsement as illegal.”

These ads may  violate state law in that they “imply” endorsement of an “organization” when in fact the candidate does not have such support or endorsement, because the Doctors in question are clearly wearing identification of the hospital.

RCW 42.17A.555 states that there is to be no use of “public office or agency facilities” in campaigns. Again, the ads in questions appear to be showing the doctors at a public facility endorsing Bruce.

These doctors are considered by the hospital to be a kind of manager. They are in a position of power over nurses and other staff, that have to follow their written directions as part of their job. A doctor could threaten to get a nurse sanctioned. This is something that a former CEO of the mill would understand instinctively.

An article in the The Sentinel, discusses the stresses between doctor and nurse.

http://www.americansentinel.edu/blog/2015/10/06/conflict-in-the-workplace-resolving-the-nurse-physician-clash/

and this

https://www.peltzwalker.com/hospital-sanctions-can-severely-damage-your-medical-career/

There is nothing wrong with these doctors endorsing a candidate. We all have the right to endorse who we wish. It is when you are perceived to be speaking on behalf of a public entity, such as the hospital, that you enter a gray area of election law. The wearing of the hospital uniform is what creates the impression that this is a hospital sponsored endorsement.

All this comes on the heels of a charge filed to the public election commission that Bruce’s supporters inside the hospital were soliciting a voter while she was a patient, which is also a violation of state law.

Eva Raczkowski Bennett has filed a formal complaint with the State Election Commission, charging that hospital employees supporting Bruce McComas attempted to solicit her vote for him while she was a patient at the Jefferson County Hospital. She went on to allege that when she did not respond positively to their solicitations, she felt that her quality of care might be threatened. It is unclear of when or if the state election commission would take up this complaint.

Letter to Center for Medicare & Medicaid Services on changes to 340B hospital programs

This was sent out by the Jefferson Healthcare on their concerns to changes to the 340B program. This program has been used to theoretically fund low cost prescriptions. There are a variety of points of view about what the program has actually achieved, but the hospital is adamantly opposed to the cuts to it.  We likely can discuss this more at the next Citizen’s Healthcare Access group meeting in September in Port Townsend.

340b letter PDF file. Here’s the first page so you can decide if you want to read the whole PDF.

340b letter_Page_1