Ledford and Harrington candidates for Public Hospital District Board Position #3

Monica Harrington and Jenny Ledford are candidates for position #3 on the San Juan County Public Hospital District Board of Commissioners. Following are their answers to eight questions.

1. What should the Public Hospital District do to encourage voters to approve the EMS levy which will be on the ballot in 2016?


The key to earning voter support is presenting a trustable, sustainable budget that deserves support. To get there, the Public Hospital District Board needs to work with EMS to build a budget without preconceptions that fits our values and our pocketbook. The Public Hospital District needs to operate transparently, ask tough questions and invite scrutiny. What are the costs of service? How does that compare with other remote, isolated communities? Are we providing fair value and getting the job done well?

At both Microsoft and the Bill & Melinda Gates Foundation, I managed multi-million dollar budgets that were always subject to an intensive review process. Long ago, I also worked at Crater Lake National Park as a seasonal NPS Ranger dispatching emergency services (in a remote location) so I have boots-on-the-ground experience. And I’m an instrument-rated pilot so I understand the transportation issues involved in transporting patients when the weather deteriorates.

Before I recommend an EMS budget to the voters, I will have asked the tough questions so that I can feel comfortable defending the budget and working hard for its approval.


Work toward developing an effective communication platform that would both inform and enable voters to better understand the vital issue of ensuring continued assess to the highest quality emergency response possible. 






2. Should the Public Hospital District provide more oversight to EMS or is the current level adequate?


The Public Hospital District needs to exercise its oversight authority. Two EMS levies have already failed. Islanders love our emergency responders but the failed levies are a sign that voters either didn’t trust the budget or they didn’t trust the process. In either case, it’s a leadership issue that can and should be addressed.

One of my goals is to ensure EMS has the structural support and leadership needed to do their jobs well. I want to hold EMS leadership accountable and then empower EMS and the EMS teams to constantly strive for ways they can deliver better, more efficient service that all islanders can feel confident in and proud of.


Oversight is adequate at this time.

3. Should the Public Hospital District contract with other entities – private physicians, hospices, Planned Parenthood, etc. – to provide for services not offered at PIMC?


Absolutely. The job of the Public Hospital District Commissioners is to provide for the needs of the district. If PIMC fails to provide health care services that islanders want or need, now or into the future, then the PHD should be able to contract for those services elsewhere. Because of the restrictions PeaceHealth imposes on its physicians, contracting with other providers is the only way the public hospital district is going to be able to comply with Washington State law and meet its obligations to district residents.


PIMC does do these types of services currently. There is always the opportunity to work closer with other Island healthcare providers and off-island providers to meet additional services warranted.

4. What, if any, concerns do you have about religiously-based restrictions on health care at PIMC?


I’m a strong proponent of the separation of Church and State.

Section 11 of the Washington State Constitution says very clearly that “No public money or property shall be appropriated for or applied to any religious worship, exercise or instruction, or the support of any religious establishment.”

To the extent that PeaceHealth can operate as a services vendor, providing services that meet the health care needs of islanders, it can and should be contracted with to provide those services, subject to appropriate oversight and review. However, under federal and state law, it cannot impose its religiously-based restrictions on all of us. The Public Hospital District should have the right and ability to contract for services islanders want and need, now and into the future, without regard for PeaceHealth’s or any other vendor’s religious preferences.


 Well informed candidates understand fully any limits to services by a Critical Access Hospital are not based on religion.

 5. Do you want Peace Island Medical Center (PIMC) to close?


No, nor do I want San Juan Health Care Associates or Planned Parenthood to close. All of them are providing crucial health care services to island residents.

The contract with PeaceHealth is a subsidy-for-services agreement. Over the next 50 years, the San Juan Public Hospital District will fund, on an inflation-adjusted basis, more than $80 million in health care services through outside vendors. As a public hospital district commissioner, I want to be able to flexibly provide for and/or subsidize the services islanders want and need through whichever vendors are able to provide those services most effectively and efficiently.

During my time at Microsoft and the Gates Foundation, I managed many long-term multi-million dollar service agreements. The key to making a services agreement work is ensuring that whoever is paying the bills - in this case, the Public Hospital District on behalf of island residents - has the ability to contract with whoever can provide the appropriate services at the most reasonable cost. If a particular vendor can provide all of the services efficiently while offering fair value, it can work to have an exclusive contract, subject to ongoing review. However, if a vendor can’t provide all of the needed services – and PeaceHealth’s religious restrictions keep it from providing services islanders have made clear they want and need, including reproductive health services and access to Death with Dignity, then other vendors necessarily become part of the mix. It’s common sense and smart business and it’s what makes long-term service contracts work for all parties.


Of course not. 

6. Do you think restrictions on health care services provided at PIMC will increase as more changes are made at top levels of management at PeaceHealth?


Probably. Individual people come and go, but PeaceHealth has had an unusual amount of executive turnover in the last year. A new CEO has been hired, and several very senior executives have been moved out. What this means is that whatever private promises or assurances might have been made by individuals in the past are subject to change as those individuals move on.

That’s why it’s so important to pay attention to the actual written policies of an organization. Large organizations commit their policies to writing because it’s a way of setting and enforcing standards and expectations for staff who might come from many different backgrounds.

As it happens, PeaceHealth is required to submit its policies to the Washington Department of Health. Those policies, which are available online, make clear that PIMC imposes restrictions based on its religious mission. As an example, PeaceHealth makes clear that it will follow a patient’s advance directive only so long as that directive “doesn’t conflict with hospital policy, State or federal law, or the Ethical and Religious Directives for Catholic Health Care.”

PeaceHealth policies also make clear that it restricts reproductive health care for religious reasons.

We should assume PeaceHealth will follow its own published policies and then make whatever adjustments we need to make to ensure we can meet the needs of district residents. As an example, because PeaceHealth refuses to “promote or condone contraception,” it makes sense to contract with a health care provider who will commit to providing island residents with modern, effective contraception with no restrictions.

In all of this, it’s important to remember that we’re talking about our tax dollars.


Please refer to my answer on question #4.

 7. How should the Public Hospital District respond to the recent ACLU letter regarding the Reproductive Privacy Act?


The ACLU has essentially warned the San Juan Public Hospital District that it is violating Washington State Law.

The hospital district board must comply with WA State Law; it doesn’t have an option to not comply. And, in fact, the law the ACLU says the San Juan PHD is violating is one that San Juan Islanders overwhelmingly voted to support.

As a practical matter, when an entity like the ACLU raises substantive issues saying that you’re violating State law, the smart thing to do is to figure out how to get into compliance with the law.

The Public Hospital District in Jefferson County, which serves the Port Townsend area, faced this issue a few months ago when they received a similar letter from the ACLU. Their response was to put together an expert task force to help them figure out how to comply with the law and better meet the health care needs of district residents. The Jefferson County PHD recently unanimously adopted the task force recommendations. As a result, they will soon be operating in compliance with the law and deliver better service to district residents.

We can do the same. There are many people in WA State who want to help us make sure we’re operating in compliance with the law. I’m speaking at a conference next month that is sponsored by the University of Washington Law School and the UW Department of Obstetrics & Gynecology and am certain that we can easily find competent people to help us sort through these issues.


Public Hospital District candidates have no details of the PHD Commissioners response to the ACLU letter or its content specifics regarding the Reproductive Privacy Act. The PHD#1 of San Juan Island policies up-hold all healthcare related existing initiatives voted upon by the people of Washington State. Assertions by the ACLU would need to be addressed by the current board and board council. I do not offer speculation without more facts.

 8. Why should voters choose you rather than your opponent?


I’m committed to working hard to support better health care for this community. I’ve been endorsed by Planned Parenthood Votes NW and the San Juan County Democrats because I’m a strong advocate for patient and taxpayer rights. I became involved in these issues because I care so deeply about the health care we’re all paying for.

I support WA’s Reproductive Privacy Act and Death with Dignity Act and want to ensure the rights protected under those laws are available to island residents. I’m also a successful businesswoman, who’s worked for large businesses (Microsoft) and very small businesses that grew into larger ones (Valve, Picnik). I’m committed to public service and have a strong track record in the nonprofit sector (Bill & Melinda Gates Foundation, Code for America, NetHope). I also know how to manage complex processes, work collaboratively, and listen intently. San Juan Island is my home, it’s where I want to live out the rest of my life, and I want our health care system to work better for all of us.  


1) My only agenda is to be of service to our community.

2) I am a full-time resident with a history of serving, along with my husband, our community in an array of activities. He through coaching and influencing students and athletes. We both mentor and are involved in sharing our talents and gifts freely with our island community. We both love our relationships and our roles here and will continue to participate where we find opportunities in making a meaningful contribution to improving peoples lives.

3) I have a uniquely qualifying background, I effectively work with large government agencies and private corporations in improving performance outcomes, solving and resolving issues and strategic planning. Always, my work was outcome oriented.

4) I am truthful person. I have no personal bias toward people of faith or those who have no religious background.  

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