Is women's healthcare a priority at SJI Hospital District?

The contentiousness of the 2015 hospital district election on San Juan Island was re-awakened at the February 22, 2017 San Juan County Public Hospital District 1 (PHD)  Commission meeting. Discussing the possibility of entering into a contract with Planned Parenthood to provide services PeaceHealth Peace Island Medical Center (PIMC) cannot provide due to its status as a Catholic healthcare organization, the gulf between those for one and those against was wide. 

Commissioner Dr. J. Michael Edwards placed the needs of 10th-graders smoking marijuana or tobacco as a higher priority than providing women access to sexual and reproductive healthcare.  Commissioner Mark Schwinge vehemently opposed giving even "a penny" to Planned Parenthood saying, "When we cannot settle on things, I think we need to consider moral aspects. Moral law ultimately has to hold sway."

The three commissioners - Monica Harrington, Bill Williams and Barbara Sharp - who won election to the board in 2015 after expressing their support of providing a full-range of reproductive healthcare services, shared their reasons for pursuing a possible contract with the local Planned Parenthood Office. It is open one day a week in Friday Harbor. 

Commissioner Harrington believes the services should be provided and that it benefits both the patients and PIMC if the PHD partners with Planned Parenthood. Harrington believes the PHD is subject to the state Reproductive Privacy Act (RPA) which mandates district's to provide a full-range of reproductive healthcare  services if they also subsidize maternity care services.

The 2015 Hospital District Elections were controversial with much heated discussion related to the limitations on women's healthcare services provided at PeaceHealth Peace Island Medical Center. Because PeaceHealth is a Catholic healthcare mission, they are constrained by doctrine from providing a full range of reproductive services.  

Harrington said, "PeaceHealth has published written materials that says they provide some maternity care services including pre-natal counseling through physicians. They treat pregnant women in ER. Frankly this is wonderful that they provide these services to islanders."

Commissioner  Barbara Sharp believes a 2014 opinion by an attorney hired by the PHD was correct when it said the PHD was not subject to the RPA because he said PIMC did not provide maternity care. However she said that didn't mean the PHD shouldn't provide those services. She said, "I’ll be frank I’ve always supported Planned Parenthood. To me they provide charity care to our community. Their fees are on a sliding scale."

The board in a 3-2 split voted to have Sharp and Harrington draft a contract between Planned Parenthood and the PHD.

San Juan County Public Hospital District #1 authorizes Commissioners Monica Harrington and Barbara Sharp to draft a contract between the Public Hospital District and Mount Baker Planned Parenthood for the provision of sexual health and reproductive health services for San Juan Island, including but not limited to: contraception, long-acting reversible contraception, health screenings, reproductive health counseling, sexually transmitted disease testing, treatment and counseling, sterilization procedures and counseling, and pregnancy-related health services. 

Sharp said she will not agree to use the entire amount of the funds available to go to Planned Parenthood because there are other needs that should be funded also.

Under the 50-year contract the PHD signed with PeaceHealth, almost all of the tax revenue collected by the PHD is given to PIMC. Last year, the commissioners negotiated to have $50,000 a year, kept back to use to cover services not offered by PIMC. (Editor's notre: The amount has been corrected from an earlier posting.)

Commission Chair Bill Williams said, "My view of healthcare, it has to be available, it has to be accessible, it has to be affordable, it has to be high quality, that means safe. If we can provide that and we can do it within the money we’ve got, I say why not."

Edwards said there was a lot of mis-information about PIMC doctors not writing prescriptions for birth control. 

PIMC's approach to the doctor's ability to prescribe birth control - it is forbidden under the Bishop's Ethical and Religious Directives that PeaceHealth officially adheres to - has been called a "Don't Ask, Don't Tell" situation.  A PIMC patient who spoke during public comment, related her experience. At an appointment with a PIMC physician, he agreed she needed a prescription for birth control but he told her he would not write one and referred her to the visiting gynecologist from Island Hospital. So she paid for two appointments. For refills she must remember to book an appointment with the heavily scheduled doctor who only is at PIMC two days per month. 

In order for readers to get a fuller scope of the discussion, here are lengthy quotes from each commissioner. The video of the meeting can be viewed here

The resolution they discussed and approved is posted at the end of this article. 

MONICA HARRINGTON: 

"PeaceHealth has published written materials that says they provide some maternity care services including pre-natal counseling through their physicians. They treat pregnant women in ER. Frankly this is wonderful that they provide these services to islanders.

"PeaceHealth does not say they provide no maternity services. In my view there is no doubt the PHD is already subsidizing maternity services. According to the provisions of the RPA, which is Washington  state law, it is not optional. If a PHD  supports maternity care services, the the PHD is obligated to provide other reproductive health services. Note this obligation in the PHD’s alone, it is not the obligation of PeaceHealth to provide these services through the RPA. If we get sued it is us. Already this PHD has spent tens of thousands defending itself on legal services.

"PeaceHealth has objections based on doctrine about providing some reproductive health services. PeaceHealth is not subject to provisions of RPA. The PHD is.

"I want to support reproductive health services on our island including access to long-acting reversible contraceptives. .. With the pill the effectiveness rate over a year of typical use is 91 percent. Which essentially means under typical use a woman on the pill has a 9 percent chance of getting pregnant. With long-acting reversible contraception the chance is 1 percent. I want to support these services.  The advantage with Planned Parenthood, and it is one I am sure that many people in the audience can appreciate, is that there are many people in our community who want and need sexual and reproductive health services and they shouldn’t have to guess whether or not they can get those services at their provider they want to visit.

"So for certain audiences, and this includes young people who often don’t want to go to the same facility as their parents, it’s really important that we have these services available in our community. And people know that they can go to PP and they can get these services We have a provider who is capable of providing these services. By supporting these services through the PHD  we can insure that PeaceHealth can offer maternity care services without having to hide the fact that they can do it. And I think that is something we should all encourage.

"I want pregnant woman to know that they can get maternity care services through PeaceHealth and that the public hospital district supports those services. And I also want people of reproductive age and frankly boomers who are having sex and need access to sexual disease testing and treatment to be able to go to Planned Parenthood.

"And another thing about sexual health services people often don’t want to go to their regular physician for those services... What Planned Parenthood does is offer these services in a completely non-judgmental, just treatment-based way. They are very trusted among the populations who use them.

"When it comes to public input you should walk around with me in town as I go to restaurants or go through the checking line, there are so many women who thank me for standing up for Planned Parenthood because that is where they go for services. And I want to support those services.

MARK SCHWINGE:

"There is nothing progressive about killing unborn babies. Unborn babies are not pathogenic and killing them is not healthcare. Planned Parenthood  is our nation’s largest abortion franchise. The committee on excellence in maternal healthcare reports that in 2012 a panel of physicians meeting in Ireland, a country with one of the world’s lowest rates of maternal mortality,  concluded, "We affirm that direct abortion, the purposeful destruction of the unborn child, is not medically necessary to save the life of a woman." They further stated, the prohibition of abortion does not affect in anyway the availability of optimal care to pregnant women.

Planned Parenthood is a bad community partner recently called to account for its merchandising of aborted baby body parts.  

EDITOR's NOTE: At this point he was drowned out with boos from audience members objecting to this mention of this debunked accusation against Planned Parenthood. Williams reprimanded the audience and Schwinge continued with his remarks. 

"Planned Parenthood  is a money-making franchise with highly paid executives. Planned Parenthood  has not presented to us any specific donor request for known quantified needs. It is too controversial to receive tax dollars.

"Many of our citizens and I,  strongly oppose giving even a penny of taxes to Planned Parenthood  Funding. Planned Parenthood is a hobby horse and political goal for some. Our tax dollars should be spent for better reasons that scoring political points.

"Our community needs financial help to advance para medicine, fall prevention,  hospice, pallative care, mental health services, dementia care and to reduce substance abuse by youth. CHNA (Community Health Needs Assessment) has identified these genuine needs. 

"Sensible district residents line up on both sides of this controversial issue. We do listen to the public. Thank you for those on both sides of the issue who have taken time to write...

"Finally, what we are discussing here is a tension between civil and moral law. When we cannot settle on things, I think we need to consider moral aspects. Moral law ultimately has to hold sway. We must decide not to draw any contract with Planned Parenthood, even a draft one. Instead let’s focus on funding para medicine, fall prevention,  hospice, pallative care, mental health services, dementia care and  programs to reduce substance abuse by youth.

J. MICHAEL EDWARDS:

"Couple of points, Number one, I think just for starters we have to look at the initial subsidy agreement and the non-compete clause that is cited in this resolution. And that is there is no use talking about anything that is already offered by the medical center and/or its visiting physicians. And that is the basis of my question to Beth tonight. What are the clinical offerings out there.

"There is a lot of historical mis-information. In terms of PIMC does not distribute birth control pills, IUDs, and in times past vasectomies, pap smears, human papillomo virus titers. Vast majority of those bases are covered. As part of our due diligence, we are obligated to find out before we even approach Planned Parenthood to do like kind services. Granted there is a price point. But we do contribute substantially to charitable care and Peace Health has its own waiver of charges based on need.

"Couple of other points. And as Mark alluded to and I mentioned earlier, you know, we have to look at the needs specific to woman’s healthcare in the context of all the other outstanding needs within the community. Particularly when it comes to our youth. In my opinion as a physician, first and foremost is 10th-graders indulging in marijuana, hashish, and even smoking tobacco and that. It has far reaching implications in terms of their mental health, spins off to another huge need in this community behavioral health is way up there second only to immunization. They have a lot of years to live by definition. To delegate monies to Planned parenthood, not that Planned Parenthood is  not a worthy organization,  in deference to delegating money to just what I mentioned is a very serious matter.  Before the board makes a rush to judgment and makes a tacit commitment to Planned Parenthood. We need to do our homework."

BARBARA SHARP:

"First thing we have to look at is the amendment that gives us $50,000 to use for services not covered by PIMC, because they don’t have the facilities, or it is not part of their mission, or whatever the reason -  staffing -  number of reasons they don’t provide the services. What we must look at is things that are outside the scope. I think we can get to that with discussion of the other resolution.

"I’ll be frank I’ve always supported Planned Parenthood. To me they provide charity care to our community. Their fees are on a sliding scale. They are open only one day a week. Smallest clinic in the U.S. A lot of it they give away free, whatever services.   It is a small clinic. It is not equipped to do any kind of surgery. Can do birth control. That’s the key if we can eliminate teen pregnancies through use of birth control. I think that is an important community need... If you want to call that money taken back from PIMC, it is money going to charity care. Just as much as the money we give them that they use for charity care. I've been named to negotiate or discuss or investigate a contractural  relationship with MT. Baker Planned Parenthood.

"I’ll tell you I do not want to give them the whole $50,000. There are other needs on this island and I would like some of our money to address that. But I still think Planned Parenthood Is an important piece. I have always maintained that they are one of our healthcare provider partners as far as the PHD is concerned.

"In our 2.2.2 submissions last year, we did have a question about comprehensive reproductive healthcare services. This was their answer, “We place a high value on the confidentiality of the patient physician relationship including around the discussion and decision around contraception and sterilization.”

"Basically means kind of a medical variation of Don’t Ask, Don’t Tell. You don’t know. A woman wouldn’t know if she can really get if from her physician until she goes in pays her money and sees her physician.And then maybe, maybe not. Again with patient confidentiality, it is a question. Planned Parenthood takes it out of the equation. ... Many people have insurance with high deductible... Planned Parenthood picks up people that normally fall through the cracks.

BILL WILLIAMS: 

"I see us having a discussion with Planned Parenthood  and getting a list of services they would provide. If we have that information, very appropriate that we take that to PeaceHealth and ask them 'Would you see this as a conflict of interest."...

"If they say yes, that’s a conflict of interest, well then that clears it up. If they say well, can’t really say that, think some of those might be but some of those might not be.. If we get into that type of discussion we would be probably doing well to have another vendor that will provide those services and then If there is some overlap and both vendors get along with that, then the community has more options.

"My view of healthcare, it has to be available, it has to be accessible,it has to be affordable, it has to high quality, that means safe. If we can provide that and we can do it within the money we’ve got, I say why not."


SAN JUAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 1 RESOLUTION 17-460

A RESOLUTION OF SAN JUAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 1 TO DRAFT A CONTRACT WITH MOUNT BAKER PLANNED PARENTHOOD FOR SEXUAL HEALTH AND REPRODUCTIVE HEALTH SERVICES.

WHEREAS, San Juan County Public Hospital District #1 (the “District”) and PeaceHealth entered into a Subsidy Agreement for a Combined Clinic and Hospital Facility, dated May 6, 2009, which agreement was amended by a First Amendment to the Subsidy Agreement for a Combined Clinic and Hospital Facility effective October 14, 2010, and a Second Amendment to the Subsidy Agreement for a Combined Clinic and Hospital Facility effective March 28, 2012, and a Third Amendment to the Subsidy Agreement for a Combined Clinic and Hospital Facility effective November 29, 2016 (the “Third Amendment” and, together with the First Amendment and the Second Amendment, the “Agreement”);

WHEREAS, Section 1.2.4 Right of First Refusal to Provide Additional Healthcare Services, of the Agreement states: "In the event the District shall decide to purchase health care services within the District, other than emergency medical response services, PeaceHealth shall have, and the District hereby grants, a right of first refusal to provide those services at the prices and on terms equal to or better than those offered to the District by any third party. This right of first refusal shall include, but not be limited to: home health, hospice, physician services, nursing services, physical therapy, occupational therapy, oncology services, dietary and the direct or indirect provision of ancillary services such as imaging or laboratory....";

WHEREAS, Section 1.2.5 Non-Compete for Subsidized Services, of the Agreement states: "The District shall not compete with PeaceHealth in the provision of those healthcare services that are provided in the combined clinic/hospital facility and for which the District has contracted in this Subsidy Agreement…”;

WHEREAS, Section 2.2.2 Right to Recommend Future Services, of the Agreement states: "...The District shall have the right to provide input on an annual basis concerning the services and procedures provided through the combined clinic/hospital facility, as long as the services and procedures are within the scope, licensure, policies and mission of PeaceHealth...";

WHEREAS, during the first quarter of 2016 (prior to the Third Amendment clarification of Section 2.2.2 which added the language stating the District can only request services and procedures that are within the scope, licensure, policies and mission of PeaceHealth) the District provided input to PeaceHealth regarding nine items. Eight of the nine items on which the District provided input fell within the scope, licensure, policies and mission of PeaceHealth and are being addressed. The ninth item, "Comprehensive Reproductive Health Services", is outside the scope of PeaceHealth and can only be addressed by the District;

WHEREAS, the Third Amendment added a new section number 2.1.2.7, which effective with the calendar year beginning January 1, 2017, reduces the amount of the annual subsidy payable by the District to PeaceHealth by fifty thousand dollars ($50,000); provided, however, that ninety (90) days prior to the end of calendar year 2019, and ninety (90) days prior to the end of the fifth calendar year thereafter throughout the duration of the agreement, the parties are required to review whether the "District Share" should be adjusted up or down for succeeding calendar years in order to provide adequate but not excess funds needed by the District to purchase "Additional Services";

WHEREAS, Initiative 120, the Reproductive Privacy Act, was passed by the people of Washington and overwhelmingly supported by the people of San Juan County in November 1991. It was codified in the Revised Code of Washington as Section 9.02. Section 9.02.110, provides that it is the policy of the State of Washington that:

  • Every individual has the fundamental right to choose or refuse birth control;
  • Every woman has the fundamental right to choose or refuse to have an abortion, except as specifically limited by this act;
  • Except as specifically permitted by this act, the state shall not deny or interfere with a woman’s fundamental right to choose or refuse to have an abortion;
  • and The state shall not discriminate against the exercise of these rights in the regulation or provision of benefits, facilities, services, or information;

WHEREAS, The San Juan County Board of Health adopted a Patient Bill of Rights, on October 22, 2014, which includes the following:

“Patients shall expect their physician to provide all necessary care that is medically recognized as standard of care and is in compliance with all applicable laws. This includes contraception counseling, termination of pregnancy options, initiation of appropriate treatment and referral in cases of threatened abortion with communication with the receiving hospital and/or physician receiving that patient…”;

WHEREAS, The San Juan Island Community Foundation assembled a Community Needs Task Force in 2015 to follow up on the work of the 2009 Critical Needs Task Force and to engage local community leaders and stakeholders to identify the most current and pressing community needs. The Community Needs Task Force issued a report in August 2015 that identified local support for Mount Baker Planned Parenthood as one of four priority health care needs.

WHEREAS, Mount Baker Planned Parenthood provides a broad range of sexual health and reproductive health services;

NOW THEREFORE BE IT RESOLVED BY THE HOSPITAL DISTRICT COMMISSIONERS OF THE SAN JUAN COUNTY PUBLIC HOSPITAL DISTRICT NO. 1 THAT:

San Juan County Public Hospital District #1 authorizes Commissioners Monica Harrington and Barbara Sharp to draft a contract between the Public Hospital District and Mount Baker Planned Parenthood for the provision of sexual health and reproductive health services for San Juan Island, including but not limited to: contraception, long-acting reversible contraception, health screenings, reproductive health counseling, sexually transmitted disease testing, treatment and counseling, sterilization procedures and counseling, and pregnancy-related health services.

RESOLUTION 17-460

1 comment

  • Michelle Loftus Friday, 24 February 2017 10:22 Comment Link

    Sharon, Thank you for covering this in such detail. This comes down to a simple decision of where our hospital district citizens want their money spent. Since the commissioners have taken $50,000 from the charitable fund for our citizens hospital bills we must let them know our community need priorities. This is not a prolife or prochoice decision since abortions can not be safely done on the island. This is a lining up of district needs. Do we think providing charitable birth control is more important than hospice, mental health programs, drug abuse programs, domestic violence programs, home health care programs, nutritional support programs or senior care? Does Planned Parenthood an organization boasting over $300 million is assets and eleven directors making 6 figure incomes need our local money. I think not. Where is the need?

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