Public hospital district answers

The county’s only hospital district has constituents asking questions about how a hospital district works. To lift the veil, the Journal has asked officials the same questions. Here are a few answers.

What is a public hospital district?

A public hospital district delivers health care services to areas that can’t afford them. Elected officials determine services based on citizens’ requests and property taxes generate the money.

San Juan County Public Hospital District No. 1 was created in 1989 to operate the Inter Island Medical Center. But the center wasn’t a hospital, and billing for emergencies – like a broken arm at 3 a.m. – proved too expensive.

So, in 2009, district commissioners signed a contract with PeaceHealth to operate a hospital on San Juan. The tax revenue used to operate the old Island Medical Center now helps to pay for services at the new PeaceHealth Peace Island Medical Center.

What happens when the district wants to fund new services?

The district accumulates about $1 million in property taxes, annually. As of November 2017:

• 3 percent funds administration, like rent and employees’ salaries.

• 5 percent funds services PIMC can’t provide.

• 92 percent funds PIMC services.

Each year, PIMC develops a plan to monitor county health needs. The needs are determined by county health data and interviews with specialists and written in a report. The needs/gaps in the last report are:

• Adult immunization rates

• Youth tobacco, marijuana and alcohol use

• Dementia care

• Lack of behavioral and primary care coordination

• Access to hospice

Community Health Improvement Consortium

The Community Health Improvement Consortium is a community organization that works together to meet those needs. The consortium is comprised of:


• The public hospital district

• The county’s health department

• Planned Parenthood

• SJI, Orcas and Lopez Family Resource Center

• Hospice of San Juans

• SJI Community Foundation

• San Juan Island Library

• Compass Health

• SJC Community Network

Community Collaborative Committee

The Community Collaborative Committee is a new PIMC organization that also helps to meet the identified county health needs. The committee is comprised of:

• The PIMC board

• The public hospital district

• County health department

How are district services determined?

PeaceHealth determines services based on:

• Adequate staff and physicians, as well as specialized equipment

• Cost-effectiveness

• Nurse and physician competency

• Mission alignment

For example, when PIMC opened, it didn’t offer colonoscopies. Soon, staff learned many went off island for the procedures, so they found physicians who could visit the hospital to perform the surgeries; they found adequate, competent physicians, it was cost effective and it aligned with the hospital’s mission. Now about 30 colonoscopies are performed at the hospital a month.

But what about services PIMC doesn’t provide?

In 2017, three new district commissioners voted to take $50,000 from the roughly $1 million of tax revenue given to PIMC. That money could pay for services PIMC can’t provide, according to their requirements for service, in the section above, while not hindering services they currently offer.

Last January, commissioners requested PIMC provide the full range of services for women’s reproductive health care. Staff denied this request because it did not align with the Catholic nonprofit’s mission, including to not perform elective abortions. So commissioners looked at another island organization to possibly contract with — Planned Parenthood.

So what services will be funded?

Some commissioners want the $50,000 to fund services from the PIMC report, as they’ve been identified as the most needed. Some of those services could be provided by PIMC and are being addressed, like increasing adult immunization rates. The $50,000, however, cannot be used for services the hospital is able to provide — it goes against the contract.

Other commissioners attest PIMC will fund those services through the above groups, with the tax money set aside just for the hospital. However, some needs on the PIMC report, would not be addressed by hospital services, such as youth tobacco, marijuana and alcohol use. It is not the hospital’s expertise and would likely be addressed by Compass Health.

Women’s reproductive health care isn’t listed on the PIMC report. Some commissioners say that means it’s not a critical county health care need. Other commissioners have given many reasons as to why it is a need, including minimal PIMC appointment availability. Gynecologists visit PIMC twice a month. They are from Island Hospital and are not funded through district funds; only PIMC services are funded through the contract.

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Staff photo/Hayley Day                                District Chair Bill Williams shared this diagram at the March public hospital district meeting.

Staff photo/Hayley Day District Chair Bill Williams shared this diagram at the March public hospital district meeting.