King County Elections staff will recount ballots on Dec. 12 and post results the following day.

Three other races have triggered automatic recounts: Enumclaw School District Director No. 4, City of Bellevue Council Position No. 1 and City of Des Moines Council Position No. 6.

According to certified results released Nov. 29, Gene Pollard leads with 4,613 votes to Karyn Denton’s 4,607 votes.

The election’s outcome could have lasting effects for the district, which operates Snoqualmie Valley Hospital and is getting ready to break ground on a new $37 million facility.

Pollard ran on a reform platform, and openly criticized the district’s new hospital as unnecessary.

He has accused the district’s administration of mismanagement and of exposing the district’s voters to financial risk.

If the final count favors Pollard, he has said he will push administrators to justify the new hospital.

He is concerned that it will wallow in the shadow of Swedish Medical Center’s new Issaquah campus, which is a little over nine miles by car from Snoqualmie Valley Hospital’s planned site on Snoqualmie Ridge.

Increasing the district’s transparency and improving customer services would also be priorities if elected, Pollard said before and after the election.

Denton supports the administration, which she used to belong to as the district’s former chief operating officer. She currently holds the contested commissioner’s seat.

The board appointed her to the position after former commissioner Fritz Ribary resigned to become the hospital district’s communications and marketing director.

During the campaign, Denton said she would work for improving services and keeping costs down.

She declined to comment for this article

This election is the first time in 10 years that a commissioner’s seat has been contested. In 2001, Carol Hoch beat Julie Ostergard with 53 percent of the votes counted.

Snoqualmie Valley School Board candidate Geoff Doy increased his lead over incumbent Caroline Loudenback. Doy, who ran on a reform platform, leads by 80 votes with 40 percent of all potential votes tallied. King County election officials had expected a 52 percent turnout across the county.

Doy trailed on Election Day, but overtook Loudenback on Wednesday.

In the only contested race for North Bend City Council, Ryan Kolodejchuk took a dominant lead over Piper Muoio for an open seat. Kolodejchuk extended his lead from 39 to 71 votes with 45.6 percent of potential votes counted.

Reform candidate Gene Pollard increased his lead over Karyn Denton for a position on King County Public Hospital District’s board of commissioners. Pollard leads Denton by 43 votes.

The award praises hospitals that have earned a perfect record of hand hygiene for three consecutive months.

In a letter to the hospital, association president Scott Bond called the award a real achievement for the hospital.

The award, Bond wrote, “recognize(s) that this is a commitment to safe care which extends to each patient that walks in your door.”

Criteria for the award include rates of hand hygiene, evidence-based measurement of use of soap and sanitizer, and how the measurement compares to the number of patients in the hospital.

Winners also had to have high rates of flu immunization among coworkers and high marks on other indicators of infection prevention.

According to an association press release, proper hand washing or hand sanitizing can reduce the spread of infection by 25 percent.

The award was first given in 2005.

Fewer than 10 percent of Washington hospitals qualified for the award in 2011.

The association handed the award on a points-based system. Hospitals with a high level of hand hygiene received nine points.

Hospitals with a high level of workforce flu immunization received five points.

Hospitals received bonus points for infection prevention measures at the national top 10 percent.

Nine hospitals in Washington received the award, said Fritz Ribary, communication and marketing manager for Snoqualmie Valley Hospital.

This is the first time the hospital received the award.

The association’s website stated that hospitals in Puyallup, Tacoma, Othello, Bellingham, Prosser, Colville, Sunnyside and Seattle were awarded this year.

“It means two things: It’s always nice to be recognized by your peers by winning a pretty stringent criteria,” Ribary said. “Two, it’s an indication of cleanliness and the actual amount of time we put into paying attention to cleanliness and patient care.”

Sebastian Moraga: 392-6434, ext. 221, or smoraga@snovalleystar.com.

The race comes at a critical time in the hospital’s history. It has broken ground on a new $30 million facility on Snoqualmie Ridge.

Gene Pollard Occupation: Retired (former Foreign Service Officer and city official) Contact: genepoll@yahoo.com

Karyn Denton Occupation: Registered nurse Contact: karyn.l.denton@gmail.com

Only a few years ago, Public Hospital District No. 4, which runs the hospital, was in the red. The hospital’s designation as a critical access hospital and its subsequent transition to primarily a rehabilitation facility have turned its financial situation around. But to get in the black, the district did have to close two clinics to cut costs and free up money for new technology.

Despite the new facility, hospital administrators acknowledge that big questions about how the hospital is paid loom in the future.

Enter the two candidates running for Commissioner Position No. 3: Gene Pollard and Karyn Denton, who was appointed in July to a vacant position on the board.

Pollard’s campaign is focused on improving the hospital district’s decision-making process by making it more transparent and open to the public.

Public Hospital District No. 4, which operates Snoqualmie Valley Hospital, is selling $15.3 million in bonds to refinance existing debt, raise money for initial work on the site of its new facility and buy new equipment for that site.

The district’s board of commissioners approved the bond sale at its Sept. 22 meeting.

“It takes a load off taxpayers,” said Jay Rodne, the district’s attorney.

It also puts the district near its limit for nonvoted debt of about $20 million, Rodne said.

Of the money raised by the bond sales, $11 million will be used for refinancing existing debt, and $4 million will be spent on equipment and work for the site of the district’s new hospital.

The facility is expected to cost about $30 million, and will be located on a nearly nine-acre site on Snoqualmie Parkway and Southeast 99th Street.

Grading has already started on the site.

The $4 million will also pay for infrastructure improvements on the site and equipment for the new facility. The equipment will include medical imaging machinery, Rodne said.

“We’ll be leasing the hospital, but the responsibility to equip it still lies with us,” he said.

Developer Terry Moreland will provide the construction financing and own the facility until the district buys it back three to five years after it is built.

Moreland, based in Bakersfield, Calif., could not be reached for comment.

Moreland will lead a team that will include Soderstrom Architects, of Portland, and Absher Construction, of Puyallup.

The district picked Moreland from several applicants this summer.

Last April, the district sought developers to help build the new facility using a lease-leaseback structure. The developer will help finance the new building, which the district will lease and then purchase.

Under that approach, the hospital will not have to take on any debt.

The district had been looking for a new hospital site for several years.

In 2008, the district purchased a site near the interchange of Interstate 90 and state Route 18, but that move fell through after the district found out that it would be too expensive to develop. The district settled a lawsuit from that sale in November, agreeing to buy land formerly used by the RV campground Leisure Time for $7 million.

The Snoqualmie Tribe bought the existing hospital for $30 million, which it will pay off by May 2015.

Construction is expected to begin in January, according to Rodger McCollum, CEO of King County Public Hospital District No. 4, which manages the hospital.

“This latest process has moved forward very quickly with a lot of details to attend to, so I haven’t really had the time yet to let it all sink in,” McCollum said.

The new site will make the hospital more accessible, allow it to improve services and boost its revenue, district officials said.

The district had been in rough financial times just a few years ago, but since McCollum took over in 2007, it has been profitable, according to the most recent report by the state auditor.

The district has been looking for a new hospital site for several years.

In 2008, the district purchased a site near the interchange of Interstate 90 and state Route 18, but that move fell through after the district found out that it would be too expensive to develop. The district settled a lawsuit from that sale in November, agreeing to buy land formerly used by the RV campground Leisure Time for $7 million.

The new hospital will be on a nearly nine-acre site on Snoqualmie Parkway and Southeast 99th Street.

The Snoqualmie Tribe bought the existing hospital for $30 million, which it will pay off by May 2015.

In April, the district sought out developers to help build the new facility using a lease-leaseback structure. The developer will help finance the new building, which the district will lease and then purchase. Under that approach, the hospital will not have to take on any debt.

Moreland will lead a team that will include Soderstrom Architects, of Portland, and Absher Construction, of Puyallup.

Moreland could not be reached for comment.

The new executive director, Kim Arellano, was elected by the foundation’s board of directors in May to take over after serving as a board member. The foundation — an independent, nonprofit organization — supports the hospital district through advocacy, education and fundraising.

Kim Arellano

Arellano said she plans to continue to focus on the foundation’s mission of supporting the hospital’s growing technological capabilities, offering networking opportunities for local health care providers and providing services, such as the hospital’s Affordable Access Voucher Program.

“We will listen to the needs of the community and help enable the district to provide for them,” she said in an email to the Star.

The greatest challenge to achieving the foundation’s goals is fundraising.

“With a limited pool of financial resources, it will be critical for the foundation to make sure we are combining resources with other organizations, so we are not competing with them,” she said. “We’re looking to leverage the relationships with larger organizations that have a stake in the hospital and community to help us fund programs.”

Among the largest fundraising events for the foundation is its golf tournament in September.

Arellano is a longtime Valley resident. She graduated from Mount Si High School in 1988. She is the owner of Arellano Consulting, a career-counseling business she founded in late 2009. She is also president of the Snoqualmie Valley Women in Business.

“We saw what Kim could do as a board member, so it was a no-brainer to tap her for the position of executive director when it became available,” foundation President Jim Schaffer said in a news release. “Luckily, she said yes.”

Learn more about the foundation by emailing foundation@snoqualmiehosptial.org or calling 260-3140.

“We don’t have the ability in the current tax and economic climate to take on more debt, so we’re partnering with a developer for more debt-capacity,” said Rodger McCollum, chief executive officer of Public Hospital District No. 4, which runs the hospital and its clinics.

The new hospital will allow the district to expand existing services. It does not plan on adding any services. The district’s clinic on the Ridge will not move.

The district is seeking a public-private partnership, something rarely done in hospital construction in the US.

“We could be writing the book on a new way of financing hospitals,” McCollum said.

The developer will put up the cost of the building, and the district will lease the facility and eventually buy it outright.

“Public-private partnerships are done around the world in healthcare, but they haven’t been done in the US,” said Mike Marasco, an independent developer at one of the two information sessions.

The district has been unable to raise the money needed to begin construction in 2012, but it hopes to begin soon while construction costs remain low.

As a result, it put out a request for bids on the project, which is expected to cost about $35 million. Most of the money — $30 million — will come from the Snoqualmie Tribe, which has committed to buying the district’s existing hospital facility.

The rest of the cost will be covered by the sale of federally-backed bonds available through a program that helps hospitals get credit. But the approval process for the program, run by the U.S. Department of Housing and Urban Development’s Federal Housing Administration, is slow, and likely won’t be finished until late 2011 or early 2012, according to McCollum.

Even so, with the construction market still lagging, the big-ticket request drew plenty of interest.

“Anybody who throws the $30 to $35 million lure out there is going to get a lot of people following,” said Randy Hinton, an engineer with Rice Group.

He and several dozen other people in the construction industry filled two information sessions to capacity. Latecomers had to stand.

Hospital officials want to build the new facility with better access than the current location, which is off Meadowbrook Way.

McCollum hopes the new site, which will be much more accessible from the freeway, will mean more business for the hospital. The current site can only be reached from I-90 by cars traveling eastbound.

The district already has purchased an 8.77-acre site in the Snoqualmie Ridge II development, and has applied for permits for grading and clearing the land from the city.

“We’ve gone through all the hoops we’re required to go through to get approval at the federal, state and local levels,” said Jay Rodne, the district’s general counsel. Rodne also represents the 5th Legislative District in the state Legislature.

Dan Catchpole: 392-6434, ext. 246, or editor@snovalleystar.com.

A different kind of hospital

Steve Daniel, the hospital’s chief financial officer, expects it to keep making money in the coming years thanks to its location, its designation as a critical access hospital and its swing-bed program for patients who need long recovery times.

“That’s our big market niche,” Daniel told developers interested in building the project.

It doesn’t pay for big hospitals in the area to keep patients with slow recoveries in a bed. But because Snoqualmie Valley Hospital is a critical access hospital, it has a better reimbursement rate from Medicare, which also pays the cost difference for non-Medicare patients.

Acute-care hospitals, such as Swedish, are not reimbursed for recoveries that take longer than normal.

“That is a type of service that Swedish is not able to provide because of some financial structures,” said Dr. John Milne, Vice-President of Medical Affairs for Swedish. “If we don’t get (the patient) out in four or five days, we really start losing money.”

Snoqualmie Valley Hospital gives Swedish and other acute-care hospitals a place to discharge patients who are taking more time than expected to recover but are not in critical condition.

“We see ourselves as very complementary,” Milne said.

McCollum has the same view. He told the prospective developers that Swedish’s new location in the Issaquah Highlands will likely mean more business for Snoqualmie Valley Hospital.

“We don’t have the ability in the current tax and economic climate to take on more debt, so we’re partnering with a developer for more debt-capacity,” said Rodger McCollum, CEO of Public Hospital District No. 4, which runs the hospital and its clinics.

The district recently put out a request for bids on the project, which is not expected to cost more than $35 million.

With the construction market still lagging, the request drew plenty of interest.

“Anybody who throws the $30 to $35 million lure out there is going to get a lot of people following,” said Randy Hinton, an engineer with Rice Group.

He and several dozen other people in the construction industry filled two information sessions to capacity. Latecomers had to stand.

Hospital officials want to build a new facility with better access than the current location, which is off Meadowbrook Way.

That constant dynamic has kept the King County Flood Control District busy since it was created in 2007.

But falling house prices threatened the district’s ability to collect taxes this year. A state cap on property taxes for newer taxing districts threatened to cut off its revenue.

A last minute deal with eight fire districts saved the district’s 2011 levy. But the flood control district was expected to face the same problem in 2012.

The state Legislature has granted the flood control district at least a temporary reprieve.

The House and Senate passed legislation March 4 to exempt the district from the state-imposed cap on property levies. Fire districts are also not limited by the cap, which limits the amount of combined property taxes to $5.90 per $1,000 of assessed value.

Most taxing districts, which include hospital and park districts, are maintaining their budgets while home values are falling. That means they have to take a bigger share per $1,000, which has pushed some up against that cap.

The flood control district will still be subject to a constitutional limit of property taxes of 1 percent — or $10 per $1,000 of assessed value.

“The district attends to critical health, safety and welfare needs of citizens,” Snoqualmie Mayor Matt Larson told the House Ways & Means Committee in February.

Flooding has devastated Snoqualmie time and again, causing economic and social damage.

“Incidents of domestic violence, divorce, and job and school struggles measurably increase due to the grinding and unending stress that families experience for days and months following a flood event,” Larson said. “Dissolved chemicals, such as fuel, sewage and fertilizers, contaminate flooded homes threatening the health of the most vulnerable.”

The flood control district has spearheaded efforts in the Valley to mitigate the fallout of flooding. Since its inception, it has paid for more than 50 projects on the Snoqualmie, Tolt and Green rivers. It also pays for the Flood Warning Center, which coordinates county response and information dissemination during flooding.

House gives less leeway

There are differences between the legislation passed in the House and Senate, which will have to be ironed out before the bill is sent to Gov. Chris Gregoire.

The Senate bill, which passed 44 to 2, completely exempts the flood control district from the tax cap.

The House, where opposition was stronger, gave the flood control district less leeway. The House bill sunsets the exemption after 2017, and an amendment offered by Rep. Ed Orcutt, R-Kalama, exempts only $0.25 from the $5.90 cap.

“We could live certainly with the amendment and if need be with the sunset, because we’re primarily concerned about the next five to six years,” said Kjris Lund, the flood control district’s director.

The district only collects $0.11 per $1,000, so it would not be affected by Orcutt’s amendment. Lund said there are no plans for increasing the amount.

In 2010, the district collected $35 million. It has requested $36 million in 2011.

The flood control district could look into taking out a bond to pay for projects, Lund said.

But “even without pro-rationing, we have had so many emergencies,” she said.

Problems with the Green River’s Hanson Dam have sucked up tens of millions of dollars in recent years.

Lund said she will ask the district’s board of directors to consider borrowing from other government entities.

Protecting Si View Parks District

The Senate’s bill also protects the Si View Metropolitan Parks District from the $5.90 cap.

The parks district and King County Public Hospital District No. 4, which supports Snoqualmie Valley Hospital, could have to split a cut of $0.30 per $1,000.

For the parks district, that means a loss of about $250,000, about one-eighth of its operating budget, according to Travis Stombaugh, the district’s director.

Without an exemption from the state cap, the parks district “will have to make cuts,” Stombaugh said.

State Sen. Cheryl Pflug, R-Maple Valley, submitted an amendment that lets the parks district ask voters to protect its levy from the $5.90 cap. Pflug represents Snoqualmie Valley and other parts of east King County.

Dan Catchpole: 392-6434, ext. 246, or editor@snovalleystar.com.

King County Hospital District No. 4, which operates the hospital, is still securing financing for the $40 million project, according to Rodger McCollum, the district’s CEO.

The district plans to use a combination of money from the sale of the current hospital and bonds backed by the federal government.

Much of the cost will be covered by money from the Snoqualmie Tribe, which has agreed to buy the existing hospital facility for $30 million. The final payment is due May 2015.

The rest of the cost will be covered by the sale of federally-backed bonds available through a program that helps hospitals get credit. But the district must be approved to participate in the program, run by the U.S. Department of Housing and Urban Development’s Federal Housing Administration.

To qualify, the district must show three years of positive revenue — more money coming in than going out.

The district has had financial troubles in recent years.

The Washington State Auditor’s Office published a report in spring 2009 finding that the district did not have enough money to cover its costs and that it had not properly handled money collected from a previous bond. Overall, the auditor found that the district complied with pertinent laws and regulations.

District officials told the auditor’s office that the operating losses it posted from 2004-2007 were start-up costs of expanding its inpatient capacity, which would ultimately bring in more revenue.

The district is beginning to see results from those years.

“Patient utilization has increased quite substantially,” Chief Financial Officer Steve Daniel said. “It means we have more patients in the hospital, and we’re serving more people.”

The district has had positive revenue since 2009, McCollum said.

“We showed a small one last year. We’ll show a small one this year,” he said.

The district should have positive income again in 2011, he added.

While the district needs to show positive income for three years, the last year can be a partial one.

Using 2011 as a partial year will allow the district to finish the approval process in eight months, McCollum said.

“There shouldn’t be any reason we shouldn’t be approved next year,” he said.

Once approved, work would begin on the nine-acre site for the new hospital, to be located on Snoqualmie Ridge near Interstate 90. Construction should be completed in 18-24 months, McCollum said.

By using the FHA program, the district will not need to bring a bond to voters. The debt from the bond will be paid for out of the district’s operating costs.

The new hospital will have 25 beds, with accommodations for family members in each room. There will also be a heavy emphasis on incorporating new technology, such as telemedicine, which connects patients with off-site medical experts.

The existing hospital has about 30,000 patient visits a year, including 4,000 emergency room visits. The district’s total annual revenue is about $30 million.

Dan Catchpole: 392-6434, ext. 246, or editor@snovalleystar.com. Comment at www.snovalleystar.com.

Editor’s note: This story has corrected information about the number of employees laid off.

Snoqualmie Valley Hospital has closed its Fall City and North Bend medical clinics and plans to redistribute its resources on new technology, CEO Rodger McCollum said.

Both clinics began operating in 2005, when the Valley had a shortage of primary care providers after several left the area or retired, according to McCollum.

“We had a responsibility as a hospital district to make sure people had access to primary care,” he said. “That has changed substantially in the last six months.”

He noted that people now have more choices in the Valley, including Swedish Medical Center’s clinics in Snoqualmie and Meadowbrook Clinic in North Bend.

The two clinics closed the week of July 12. McCollum said he would not be sure how much money the hospital saved until he learned how many patients had transferred to other clinics or other providers.

The North Bend and Fall City clinics were not yet profitable, but they were close, with North Bend at about 50 percent profitability and Fall City at about 80 percent profitability, McCollum said.

About 10 people worked at the two clinics, but most were relocated to other hospital locations. Two people were laid off.

The hospital still has the Snoqualmie Ridge Women’s Clinic and the Snoqualmie Ridge Medical Clinic. At the hospital’s main campus, it has the Snoqualmie Specialty Clinic, Primary Care Clinic and Snoqualmie Valley Rehabilitation Clinic.

The hospital also pays for a nurse at the Sno-Valley Senior Center in Carnation and plans to pay for a two-day-per-week nurse at the Mt. Si Senior Center in North Bend starting in January, said Mt. Si Senior Center Director Ruth Tolmasoff.

McCollum acknowledged that with the closing of the Fall City clinic, there is now no medical facility in that area. The clinic had already stopped serving children 14 or younger in May, he said.

He dismissed rumors that it was a methadone clinic. He added that the clinic’s Advanced Registered Nurse Practitioner Patti Yetneberk specialized in pain management, and would often see people experiencing chronic pain, but it was not the clinic’s main focus.

“The Fall City clinic was not a drug abuse clinic,” McCollum said.

Fall City resident Sharlet Driggs said the closure of the clinic affected everyone who pays property taxes to the hospital. Residents living in Hospital District 4 pay a 45-cent levy tax for every $1,000 of property they own. Residents also pay a 16-cent bond tax for every $1,000 of property they own, which ends next year, McCollum said.

“It is another sad loss to our community,” Driggs said.

Red Oak Residence Administrator Laure Wilbert said some of its residents used primary care physicians at the North Bend clinic.

“The relationship you have with your primary care provider is really personal and to have it suddenly change is a disruption for these guys,” Wilbert said.

Red Oak has medical contingency plans for all of its patients, which were put into action when staff heard of the clinic’s closure.

“Because of the kind of health care we provide, we need to be able to contact somebody immediately,” Wilbert said.

These are not the hospital’s first clinic closures. From 2006-2008, it operated a clinic in Maple Valley, but found it hard to refer patients to Snoqualmie Valley Hospital if more treatment was needed because of the distance, McCollum said.

Focus on new technologies

As the hospital district moves forward, it will be affected by health care reform, although it is too early to say how, McCollum said.

“What we do know is that health care delivery will change,” he said. “There is going to be less money in the system and there is going to be increased scrutiny of the ethics of the healthcare we do deliver.”

For example, healthcare professionals can save money by not ordering unnecessary or duplicate tests. One of the new technologies the hospital is investing in will help reduce these expensive inefficiencies, McCollum said.

The technology, called the Health Information Exchange, allows healthcare professionals to upload electronic patient charts into a secure, statewide database.

Many medical facilities already use electronic medical charts, including parts of Evergreen Medical Center, Group Health Cooperative and Virginia Mason Medical Center. In spite of the electronic records movement, most hospitals buy programs that are not compatible with software at other hospitals, meaning patient records still must be faxed or mailed if a patient gets care at different facilities.

With the Health Information Exchange, a patient’s records would be available at any hospital in the state. A federal program will likely follow, McCollum said.

If a Snoqualmie Valley Hospital patient were in a car accident in Seattle and taken to Harborview, the Health Information Exchange would allow emergency room physicians access to the patient’s medical history.

“That allows us to order less tests and have a more complete picture of the patient’s health,” McCollum said.

He said the hospital would be online with the Health Information Exchange in about three months.

The second technology the hospital is investing in is already being used. Instead of having specialists there in person, the hospital will invest in telemedicine.

The hospital already uses teleradiology, because medical images can be shipped easily, and it plans to expand its teleservices to other fields, including neurology and wound care.

“If we have a stroke patient or a suspected stroke patient, it will be great to get the neurologist on telemedicine on the other end consulting with the patient,” McCollum said.

Telemedicine will save patients a trip to specialists’ offices. Plus, a patient’s primary care physician will be present during the specialist’s consultation, meaning the two healthcare professionals will be on the same page.

The specialist will have access to the patient’s medical records through the Health Information Exchange.

McCollum said the hospital would have telemedicine services set up by the end of the year.

The Snoqualmie Valley Hospital Auxiliary will hold a plant and bake sale at the Mount Si Senior Center. Above, six members of the auxiliary meet at the senior center to discuss their goals. (Photo by Laura Geggel)

Every year for 10 years, Mae McLean has grown flowers and plants to sell at the Snoqualmie Valley Hospital Auxiliary plant sale. This year, she is transplanting her hostas — a lily-like plant — into waiting flowerpots.

“I tell you, we sell them cheaper than at anywhere else,” McLean said.

The proceeds help the nonprofit raise money for its work with the hospital.

Ever since the hospital opened in 1983, the auxiliary has been at its side.

The auxiliary helps the hospital buy things on its wish list, including a resuscitation mannequin, wheelchairs, therapy equipment and emergency response buttons for low-income seniors in Snoqualmie Valley.

When the hospital closed its doors from 1992-1994 and again from 1997-2000, the auxiliary jumped into action.

“When it opened again, the ladies came in and cleaned the whole building top to bottom,” said Gretchen Wilson, the auxiliary’s co-publicity chair.

Every December, the auxiliary puts up a Christmas tree in the hospital’s lobby and decorates it with a medley of ornaments.

“They’re very helpful to us as well as providing that joy for us,” hospital Executive Assistant Valerie Huffman said, remembering the holiday cheer the tree brought to spruce up the lobby.

And, for the third year in a row, the auxiliary is offering a $1,000 scholarship for local high school graduates who plan to enter a medical field.

They also donate money to the Mount Si Helping Hand Food Bank and the Operation Santa Claus, run by the King County Sheriff’s Office.

“They’re just a wonderful group of ladies,” Huffman said. “They’ve been great to the hospital.”

For the auxiliary’s core base of about 20 women, the group is about camaraderie and community altruism.

The auxiliary welcomes men too, but “do you know anyone brave enough?” Wilson said, grinning as the rest of the women laughed.

“It’s just been the highlight of my life,” McLean said.

Marilyn Gusé, of North Bend, agreed.

She joined the auxiliary after the hospital’s emergency room doctors saved her life. In 1994, a mere two weeks after the hospital had reopened its doors, Gusé had a heart attack.

“They used the paddle on me,” she remembered.

Following her heart surgery, a friend told her about the auxiliary and she joined because she wanted to give back to the hospital.

Now, she helps the auxiliary on a monthly basis, volunteering her time for the spring plant sale and the fall bazaar.

Though the plant sale features flowers and ornamental wreaths, the auxiliary will simultaneously hold a bake sale, a rummage sale and a drawing with tickets going for the great price of $1 each.

Support from Ace Hardware, Home Depot and Carmichael’s True Value help the plant sale be a success and the auxiliary hopes to raise between $800 and $1,200 from the plant sale, McLean said.

“It’s been great fun to volunteer and support the hospital,” Kay Boyle, of Snoqualmie, said. 

What to know

• What: Snoqualmie Valley Hospital Auxiliary plant sale
• When: 9 a.m. to 2 p.m., May 1
• Where: 411 Main Ave. S., North Bend

Get involved

• To learn about joining the Snoqualmie Valley Hospital Auxiliary, call Mae McLean at 425-888-2101.
• The auxiliary meets the fourth Thursday of every month. The next meeting is at 7:30 p.m. May 27, Weyerhauser Room, Snoqualmie Valley Hospital.

Laura Geggel: 392-6434, ext. 221, or lgeggel@snovalleystar.com.

Caring for an elderly parent or spouse can be hard work, but there are resources in the Snoqualmie Valley that can make it easier.

Caregivers are invited to Caresharing, a forum for people caring for older adults who would like to learn more about resources in the upper and lower Valley.

Debbie Anderson, a geriatric program specialist at Snoqualmie Valley History, said caregiving is both a demanding and rewarding job. She encouraged caregivers to attend the free forum, so they could learn about local programs, like Adult Day Health at the Sno-Valley Senior Center and the Caregiver Advocate Program offered through King County’s Senior Services.

The forum features several speakers, including Marty Richards, a licensed independent clinical social worker, University of Washington faculty member and author of “Caresharing: A Reciprocal Approach to Caregiving and Care Receiving from Aging to Illness and Disability.”

Richards said caregivers face a host of problems, the most common including insufficient time and communication difficulties. In spite of these, caregivers and the people they care for can grow from the experience, said Richards, who lives in Port Townsend.

“A person who has never cooked before, because his wife has always done it, may learn to adequately cook when his wife is unable, and may even gain satisfaction from it,” she said.

Even if people receiving care have impaired cognitive abilities, such as from a stroke or Alzheimer’s disease, the caregiver can still bond with them by reading poetry, listening to music or making art together, Richards said. She encouraged the caregiver and the person receiving care to work together. For instance, if a caregiver helps his wife into a wheelchair, she could encourage and thank him.

“Yes, we deal with the problems, but we also build on the strengths,” Richards said.

After Richards’ keynote speech, the forum will allow caregivers to mingle and exchange ideas.

“It’s good for caregivers to come together and share their experiences,” Anderson said. “They can learn about new ideas and new resources to help them to provide care for their loved one.”

A panel session will wrap up the forum, with speakers sharing ideas with caregivers and telling them of local resources. Several presenters will address issues, including legal and estate planning, hospice care and how to deal with dementia.

Caregivers are encouraged to R.S.V.P. by calling 425-333-4152 or sending an e-mail to info@snovalleycaregivers.com.

Complimentary respite care will be provided on site, but reservations for that should be made no later than April 16 by calling 425-333-4152 or sending an e-mail to Tammy@snovalleycaregivers.org.

What to know

• What: Caresharing, a free community forum for caregivers
• When: 12:30-5 p.m. April 24
• Where: Carnation Bible Church, 32615 N.E. 45th St., Carnation
• Info: www.snovalleycaregivers.org

Laura Geggel: 392-6434, ext. 221, or lgeggel@snovalleystar.com.

0305-hospital-drill_01

NEW — 1:37 p.m. March 3, 2010

Murray Lorance said he didn’t feel so good. Pale and disoriented, he wandered into the Snoqualmie Valley Hospital emergency room, complaining of chest pain.

Actually, Lorance was faking his heart attack, and for good reason. The retired firefighter has helped many a heart attack patient, and he knew just how to act like one for a drill at the hospital.

Every year, the hospital sees more patients experiencing heart attack symptoms, said Kim Witkop, a hospital physician and vice president of medical affairs. Every month, an average of one or two patients come in complaining of heart attack symptoms — chest pressure, difficulty breathing, discomfort that radiates up into the neck or into the arm, nausea and sweating, Witkop said.

Snoqualmie Valley Hospital doctors have to send any patient suffering from a heart attack to Overlake Hospital Medical Center.

The reason?

The hospital does not have a cardiac catheterization laboratory, called a cath lab for short. Cath labs can save patients who are having a heart attack (when the heart muscle is damaged) before the patient goes into cardiac arrest (when the heart stops pumping blood).

Only three hospitals on the Eastside have cath labs, including Overlake in Bellevue, Evergreen Hospital Medical Center in Kirkland and Valley Medical Center in Renton.

Snoqualmie Valley Hospital was practicing the drill to see if it could get a patient from Snoqualmie to Overlake’s cath lab in 90 minutes or less, a national goal, Witkop said.

The hospital’s drill was almost a year in the making. Before, if a patient were having a heart attack, hospital staff would call Overlake and ask if it could admit the patient.

Now, Overlake has agreed to streamline the process with Snoqualmie Valley Hospital. Plus, the hospital has made a medical form that goes with the patient en route to Overlake, so no time is lost when the patient gets to the cath lab.

“Our goal is to get this choreographed,” Snoqualmie Valley Hospital Emergency Systems Coordinator Rick Green said.

Carolyn Holmes, nurse manager of invasive cardiovascular services at Overlake, said the coordinated effort was important. Before the coordination, the hospital would have to call several numbers at Overlake to get the ball rolling. Now, they just have to call one.

“The faster you go, the more muscle you save,” Holmes said.

As soon as Lorance entered the emergency room, doctors, nurses and technicians jumped into action. Within four minutes, they had run an electrocardiogram, a test measuring the heart’s electrical activity. They called 911, recorded his vitals and gave him a pretend dose of morphine to ease the pain.

At 20 minutes, Bellevue Fire Department Medic One arrived to take part in the transport. If the situation demanded it, the hospital would call Airlift Northwest for helicopter removal, Witkop said.

Lorance, playing the confused sick patient, spoke up and asked why he couldn’t stay in Snoqualmie.

“I wish you could, but we don’t have the facility here,” Dr. Duane Anderson said, talking about the cath lab.

By 55 minutes, Lorance was at the Overlake emergency room, although that time would have been slightly faster if the ambulance driver had turned on the sirens, which he didn’t for the drill, Green said.

“As you can see, our times are well within those limits (of 90 minutes), so we are very pleased,” Green said.

After the drill, hospital staff convened to discuss how they could make the process even better.

John McNeill, with Bellevue Medic One, commended the hospital for orchestrating the drill, but he advised people to call 911 if they think they are having a heart attack.

Often, people who are in denial or who don’t understand the gravity of the situation will come to Snoqualmie Valley Hospital, which can waste time they could be using getting to the cath lab.

“We can get there quicker,” McNeill said.

Laura Geggel: 392-6434, ext. 221, or lgeggel@snovalleystar.com.

Washington state Attorney General Rob KcKenna is scheduled to be the guest speaker during a Youth Prescription Drug Abuse Community Education Forum at Mount Si High School Feb. 24. Experts from the Snoqualmie Valley Hospital and Seattle’s SAMA Foundation will join him.

The forum will address a major cause of drug-related deaths in King County, prescription drug abuse by youths. The forum’s organizers ask adults to check, lock and dispose of prescription drugs.

The Snoqualmie Valley Hospital Foundation is hosting the forum. Foundation president and Snoqualmie Police Chief, Jim Schaffer is asking local businesses and community groups to help promote the forum. It will be moderated by Encompass Executive Directory Gregory Malcolm.

For more information, contact SVHF at 425-831-3404 or email foundation@snoqualmiehospital.org.

Doctors are notorious for their scrawling handwriting on charts and prescription slips, but with the advent of electronic medical charts their legibility may soon become an antiquated joke.

Registered nurse Heidi Gerber uses a computer on wheels to enter patient data into Snoqualmie Valley Hospital’s electronic medical record software. In 2010, the hospital will use electronic medical records in all of its clinics. Photo by Laura Geggel

Snoqualmie Valley Hospital began making the switch from paper to electronic charts in 2006 at its hospital, and administrators plan to incorporate the electronic charts into clinics during the 2010 calendar year.

Kim Witkop, a Snoqualmie Valley Hospital physician and vice president of medical affairs, said the change has helped healthcare workers in their daily operations.

“You want a way to have record keeping that is legible, that is organized and is easily navigated, in addition to just documenting the records,” Witkop said. “It provides you a very detailed organization as far as test results and medications.”

Hospital administrators initiated the switch in part because they needed a better accounting system. They decided to buy software from Healthland, an electronic medical record company targeting the rural healthcare market, according to Healthland’s Web site.

Now, when a service or a drug is administered to a patient, the bill automatically shows up on the patient’s account, expediting the billing cycle. The software lets one accounting person do the work of five, Witkop said, but since the hospital acquired the software during a period of growth, administrators were able to reassign workers to other areas, “so it prevented us from having to do additional hiring,” she said.

Like Snoqualmie Valley Hospital, other local healthcare facilities are now using electronic medical records, including parts of Evergreen Medical Center, Group Health Cooperative and Virginia Mason Medical Center. In spite of the electronic records movement, most hospitals buy programs that are not compatible with software at other hospitals, meaning patient records still must be faxed or mailed if a patient gets care at different facilities.

Tasks the software performs

The Healthland software streamlines a variety of tasks. In addition to accounting, healthcare workers can order tests for patients online and set timers for when a patient’s medication is due to be taken. If a patient needed an antibiotic at 2 p.m., for example, a nurse could set an alarm using the electronic medical record software.

“Historically a nurse would have to pay attention to the clock,” Witkop said. “Now it’s on the computer because the nurse is on the computer doing documentation.”

If doctors need to order a prescription, the software will list cheaper, generic drugs they could order. It will also check the drug to make sure it will not cause any problems with other medications the patient is taking — a task that usually fell on the doctor or pharmacist — before it sends the prescription to a pharmacy.

The software reminds doctors when to renew prescriptions, give vaccinations and order screenings. It checks the patient’s insurance to confirm their plan covers a medication or service and links healthcare workers to best practice guidelines so they can consult with the current standard of treating a particular malady.

Federal funds may help foot costs

Witkop said the software was expensive, but she expects the hospital to apply for federal funds from the American Recovery and Reinvestment Act of 2009, which President Barack Obama signed into law in February. The law provides about $19 billion over the next five years to help healthcare facilities transition to better health information technology systems, which includes electronic medical records, according to the American Medical Association.

The law will award Medicare and Medicaid healthcare providers who implement electronic systems, with incentives as high as $18,000, for a limited time. With a few exceptions, those who do not transition to electronic medical record systems will be penalized with smaller Medicare reimbursements starting in 2015, according to AMA.

Healthcare worker and patient response

Witkop said electronic medical records do change interactions between patients and healthcare workers.

“One of the challenges in the clinic is being able to effectively integrate the use of a computer into your patient interactions,” Witkop said. “That’s not a negative, that’s a challenge. That’s one more skill to learn and develop.”

Registered nurse Heidi Gerber said she started using the software when she came to the hospital in 2008.

“I was fresh out of school so I didn’t have to unlearn anything,” Gerber said. “I thought it was self explanatory. You can find anything right here.”

Witkop said nurses were spending more time on the computer than before, but “that is because we’re getting more and better documentation now because there’s a better tool,” Witkop said.

So far, Witkop reported hearing positive feedback from patients.

“The patients love it,” she said. “They appreciate being able to see that the computer is how their documents are housed — they able to see the efficiencies of medical administration.”

North Bend patient Margaret Olson seemed unfazed by the electronic charts.

“Instead of writing it down, they have to put them in the computer,” Olson said.

Doctors can now look at patient records using a secure network, meaning they can access records from any computer instead of having to come into the hospital or having someone check a patient’s record for them.

“It’s really exciting to know you have that information at your fingertips,” said Snoqualmie Valley Hospital nurse Kristin Parmelee. “You can’t imagine the difference it makes caring for a patient when you have the full picture there.”

“It’s helped me out a quite a bit. Before, I’d wait and get increasingly sicker,” McClain said. The 43-year-old North Bend resident said he is not eligible for insurance at his part-time job at Taco Time, which makes it hard to keep his asthma and back pain under control. He signed up for the program in August at the hospital’s North Bend clinic.

Snoqualmie Valley Chief Executive Officer Rodger McCollum is happy with the progress of the program. “We were looking at the health care needs in our district. The economy was getting worse, people were getting laid off or companies were dropping their insurance. It seemed the right thing to do for us as a hospital, because we already had physicians and clinics.”

McCollum said he expects around 100 people to sign up for the program by the end of the year.

Once enrolled in affordable access, patients can receive primary care at the hospital’s clinic in North Bend, Fall City or Snoqualmie Ridge. There are no income restrictions, and the state Legislature has approved the program to be used by employers to cover their employees.

McCollum said that hospital workers recommend that patients use the program as a supplement to high-deductible catastrophic insurance, since Affordable Access doesn’t cover emergency room visits or specialists.

The hospital’s goal is to break even on the model. Like private insurance, the more people who sign up for it—including healthy patients that might use it infrequently—the better.

In addition to the $30 monthly fee, there is a $45 setup fee and $5 co-pay for each visit. Still, these costs are manageable compared to paying out of pocket, McCollum said.

“Patients who have to pay out of pocket are put on a payment plan, but it’s not the best situation and it’s stressful to the patient and clinic office,” he said.

Since starting the program, McClain said, he’s seen a doctor three times, and that has translated into huge savings. He’s also paying a lot less for insurance than his full-time co-workers, he said.

This model of “subscription insurance” is fairly new, according to McCollum. Similar pre-paid plans are being offered at Alliance in Seattle, Swedish Medical Center in Ballard and the Cascade Clinic in Spokane. Each have similarly small—but growing—numbers of subscribers.

Kenneth Wiscomb, a physician assistant with the hospital and the main provider at the North Bend clinic, said he’s seen around 20 patients who are enrolled in the Affordable Access program.

“People’s diseases are getting much worse. They’re coming in sicker than they normally would if they had had access to primary care,” he said, adding that around one-third of his patients are low-income.

“Once people get used to the idea and start signing up for primary care before they have an urgent need, this could be a long-term solution to a very big problem,” Wiscomb said.

Even for those who might not put off going to see the doctor if they don’t have health insurance, the program can make paying for the visits more feasible, said Derek Miller, a patient in the North Bend clinic who is enrolled in Affordable Access.

“I’m very low-income and this helps me be able to keep up with the payments,” said Miller. “I am actually able to control my debt.”

Enrollment for Snoqualmie Hospital’s Affordable Access Program is going well, according to Clinic Operation Administrator Kris Haight.

“We’ve heard from people in the community who can’t afford health care that this is a great offering,” Haight said. 

The Affordable Access Program will provide primary care services such as checkups, physicals and other visits to the North Bend Medical Clinic for a monthly rate of $30. Beyond the monthly rate, enrollees will pay only $5 per clinic visit, and a one-time $45 set-up fee. The program does not cover specialty and emergency care. 

The program is designed to promote health, prevent disease, diagnose and treat minor illnesses and injuries, as well as manage chronic diseases. 

The enrollment deadline for a participant to start the program in September was extended to Aug. 18. Now that the deadline has passed, new enrollees can start the program in October. However, Haight said that since the program is new, the hospital may allow some flexibility for individuals who want to participate in the program before October.

 “Primary health care services must be able to focus on long-term health and promotion and disease prevention, in addition to addressing more immediate patient needs in order to truly benefit the community,” North Bend Clinic Physicians’ Assistant Ken Wiscomb said. “Financial barriers often stand in the way of both levels of service. Folks end up receiving urgent care in the emergency room or putting off other health concerns until they too become urgent. This increases costs and further limits access. I believe providing affordable access to primary care is the first step towards fixing this problem and improving the health and well-being of our community.”

For more information about the program, contact the hospital at 831-3430 and leave contact information to receive a return call, or send an e-mail to affordableacess@snoqualmiehospital.org, or simply drop by the North Bend Medical Clinic at 213 Bendigo Boulevard North, Suite 1.

A pilot program for the Snoqualmie Valley Hospital District’s primary health care coverage plan begins Aug. 1.

The program is designed to make access to primary health care coverage more affordable for uninsured and underinsured individuals. For $30 a month, and a one-time $45 registration fee, participants can see primary care physicians at the North Bend clinic for a $5 co-pay. 

If the program is successful, it will expand to the district’s other clinics. 

The pilot program will last for 60 days. It will only register 100 for primary care coverage. However, if the program expands, there will be no cap on the number of people who can participate, said Hospital District CEO Rodger McCollum.

Dr. Ken Wiscomb at the North Bend clinic thinks that there are many people who could benefit from this type of primary care health coverage that focuses on preventive care. Wiscomb has seen what expanding access to primary care can do to turn peoples’ lives around. He helped organize free clinics in 1986 after seeing an increased demand for services at area food banks and other social service providers.

Wiscomb has never forgotten the number of lives the free clinics were able to change. He said one of the first patients was a recent college graduate with a broken ankle. Without health insurance, the woman was unable to afford health care, and eventually ended up homeless. After receiving treatment for her injuries, she was working within six months, Wiscomb said.

“If we want to fix health care in the U.S., we must focus on disease prevention, instead of problem solving,” Wiscomb said.

A troubling sign of the times that Wiscomb sees now are the number of patients who pay in cash, instead of using health insurance. Wiscomb said that the North Bend clinic gets more cash payments than any other clinic he has worked in, which is a strong indication that people don’t have health insurance. 

For many people, an unexpected health care emergency can be the straw that breaks the camel’s back in terms of their personal finances.

“I think there are folks out there who could use this,” Wiscomb said.

McCollum doesn’t see the problem of people without health insurance or with too little insurance going away. During the recession, many small businesses have stopped offering health insurance benefits for employees, or are moving to plans with high deductibles. Individuals have also been cutting back on their health insurance coverage, moving away from expensive plans that provide full coverage to plans that cover only catastrophic injuries or illness. 

The hospital CEO does not see those companies or people going back to full coverage, once the economic recession is over. He thinks that, as the economy picks up, programs like the hospital district’s primary health coverage program will become more viable. 

Only individuals, not businesses, can sign up for the hospital district’s primary health care plan. Businesses that are interested in providing primary health care coverage to their employees as a benefit will have to work out arrangements with their employees who, as individuals, can choose to participate in the program.  

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248.

The Snoqualmie Valley Hospital District is getting closer to its goal of building a new hospital for the Valley. 

The hospital hopes to close on the purchase of eight acres for its new building on July 22. The hospital site is located in Snoqualmie near the Snoqualmie Parkway I-90 exit. The hospital district is purchasing the land for approximately $5 million. 

The funds for the land purchase come from $21 million in limited tax general obligation bonds that were sold June 14, and approved by the hospital board at a special meeting late last month. The bonds will be paid with the existing property tax revenue stream that supports the hospital district. The hospital district collects 35 cents per every $1,000 of assessed property. The district can collect up to 75 cents, but would have to get voter approval before raising taxes.

Hospital district CEO Rodger McCollum said that $15 million from the bond sale would be used to restructure the district’s short and long-term debts. The remaining funds from the bond sale will be used for the hospital design, permits and other costs.

After the land purchase, the hospital will continue with the design process for the new building. Construction is expected to start in spring 2010. The King County Department of Health will review the design and construction plans for the new facility.  

To finance the construction of the new hospital, the district has an agreement with the Snoqualmie Tribe to purchase the existing hospital on Ernie Wade Road adjacent to the tribe’s casino. The tribe has agreed to buy the old building and the 50-acre tract it sits on for $30 million. The tribe plans to convert the old hospital into a tribal health center. 

The new building is planned to be 65,000-70,000 square feet, which is more than twice the size of the existing hospital.

The only hitch in the council’s decision to change the uses allowed for the piece of property known as S-21 was whether or not to allow a drive-thru restaurant on the property. Snoqualmie has typically not favored drive-thru restaurants, but since the S-21 site is next to Interstate 90, the council eventually decided that a drive-thru in that area would be okay. 

The Snoqualmie Valley Hospital needed the city’s decision to move forward with its deal on the property, which was contingent on being allowed a change of land use. The Ridge developers would like to bring a hotel and possibly more retail to the site.

Developer Dave Dorothy said that he was discussing selling property for a hotel with a hotel developer. He told the council that allowing a drive-thru could encourage a developer to locate a hotel on the spot. He said that the hotel developer viewed the hospital as an anchor for the site. In developer’s terminology, an anchor is any business that brings customers to the development.

“We don’t want to be hamstrung by having only one or two uses there,” Dorothy said.

Councilman Jeff MacNichols made it clear that he was against allowing a fast food restaurant on the property. However, he also made it clear that he was in favor of the site as a location for the new hospital.

“Once you open the uses up, you can’t close them,” MacNichols said. 

Other members of the council thought that a drive-thru restaurant could be designed in an attractive way. They pointed to the Shell gas station and convenience store at the intersection of Douglas and Snoqualmie Parkway. 

Councilman Robert Jeans made the point that the S-21 property was not adjacent to the official gateway to the city. He said that people going to Snoqualmie would drive up the hill from the freeway and see the “Welcome to Snoqualmie” and the view of the Valley from the Ridge. He said that a drive-thru at S-21 would serve interstate travelers, and that allowing one on the site wouldn’t have a snowball effect of bringing more of those businesses to town.

MacNichols questioned whether a drive-in restaurant would take business away from other dining establishments in the city. Councilwoman Kathi Prewitt argued that it wouldn’t because a drive-thru would serve a different demographic.

City Attorney Pat Anderson said that it wasn’t a smart idea to drive away a possible retail establishment in a down-turned economy. He also questioned the legality of approving land uses for the site on a case-by-case basis, which was suggested by MacNichols as a way to get over his objections to a drive-thru restaurant. Anderson said that such an approach could be found to be arbitrary and capricious exercises of the city’s power to regulate land use. 

Councilwoman Maria Henriksen said that a drive-thru would be compatible with freeway use, and would also be compatible with the hospital and a hotel. 

Councilman Kingston Wall said that he agreed with Jeans’ assessment that the true gateway of the city was up the hill from the site.

Councilman Charles Peterson said that it was important to support the hospital, and not hold it up with an argument on other land uses at S-21. 

“If we’re going to get a hospital built in the Valley, it’s going to be now,” Peterson said. 

MacNichols cast the only vote against the change to the allowed uses for the property. 

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248.

In the first quarter of 2009 the Snoqualmie Valley Hospital generated a profit of $240,000. As of the end of April, the hospital district has made a profit of  $360,000. In both March and April, the hospital district broke the $2 million mark in gross revenues.

In year’s past, hospital finances have struggled to keep up with expenses. 

According to Galer, most of the boost to hospital revenue has come from inpatient services and emergency room visits. He said that, beginning in January, the hospital saw dramatic increases in revenue. However, the hospital has not seen a significant increase in patient counts. Galer explained that this indicates higher levels of acuity, or more serious health problems – in those patients who visit the hospital’s emergency room.

He said that the hospital has seen more patients admitted for overnight, inpatient treatment after visiting the emergency room.

“Part of what is going on is the communities we serve are really beginning to rely on the health care services of the district,” Galer said. “That wasn’t the pattern in 2005.”

News of the hospital’s profitability came at a good time, as the hospital administrators received the results of a state audit. At its May meeting, the district reviewed a report on the state audit that covered a two-year period from Jan. 1, 2006 to Dec. 31, 2007. The audit questioned the hospital’s ability to meet its financial obligations. In 2004 the district began to implement long-term plans to expand the services it offers to the community, according to the district’s response to the state’s audit.

In its statement responding to the audit, the hospital described its losses as start-up costs for developing its healthcare network. 

About half of the tax revenue that the district receives goes to debt service. Since 2004, the hospital has restructured its debt service so that its bond repayment obligations do not exceed the hospital’s tax revenue.

The hospital’s response to the audit noted that hospital revenues have grown every year since 2004, and that in 2008 the district undertook new cost-control procedures. 

The audit also pointed to mistakes in accounting control standards by the hospital. The district failed to approve inter-fund transfers by a resolution of the district’s board of directors until after costs were incurred. 

In order to spend the proceeds of bonds directed toward specific costs, a resolution of the board is required. This helps to track the costs that are paid out of bond proceeds. In its response to this audit finding the district thanked the auditors for bringing this to their attention and promised to comply with bond covenants in the future. 

State audits like the one that the Snoqualmie Valley Hospital District received are designed to provide guidance for institutions that spend public funds.

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248.

On May 14, the board of directors of the King County Hospital District No. 4, approved the creation of a prepaid primary health care plan. So far, only two medical providers in the state — one in Seattle and another in Spokane — offer some form of prepaid plans. 

The plan will allow people to pay $30 a month and a $5 co-pay to be seen by primary care physicians at any of the district’s three clinics. The plan is intended for people without insurance or with high-deductible insurance plans.

Hospital district employee Joe Larson developed the plan after speaking with many Valley employers and workers. 

Larson said that his experience as an employer is that providing health insurance as a benefit is a costly proposition. 

When he was putting together the plan, he spoke with several struggling workers at the Mt. Si Helping Hand Food Bank, who told him stories about how their lives were impacted by not having affordable access to primary health care. One man lacerated his arm after falling off a roof. He bandaged his arm with duct tape, and a week later had to go to the hospital for a severe infection. Another man had an untreated upper respiratory infection for several months, before having to go to the emergency room. His bill at the emergency room was $15,000. 

Larson hopes that a prepaid health plan will encourage people to prevent more serious and costly medical problems by visiting primary care physicians. He also hopes that expanding access to affordable primary care will help people develop relationships with doctors that lead to healthy lifestyle changes. 

The prepaid plan is not insurance. Individuals can enroll in the plans on their own or with assistance from participating employers. 

Valley clinics have about 15 percent open capacity at their clinics. If the plan is successful clinic hours could be extended. The price of the plan can be adjusted by the district, and plans do not cover any hospital visits, surgical procedures, or testing like blood work or x-rays. Larson said that he wants the billing process to be transparent, so that patients can consult with their doctors about the costs and benefits of tests. 

The hospital district hopes to enroll 250-500 people in the prepaid plan. Enrollment will begin in July and people who participate in the plan can begin seeing clinic doctors in August. 

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248.

The main issue that the board discussed was whether or not the hospital would have any liability under the new law. 

Voters approved the death with dignity law in a referendum during the November 2008 elections. The law, known as Initiative 1000, allows doctors to assist with suicides by writing prescriptions for lethal doses of medicine.

At the hospital board’s April meeting, the commissioners determined that they did not want physician-assisted suicides to take place on hospital district property. At the same meeting, they had put off making a decision on whether hospital district doctors could help with ending a patient’s life, to better determine if the hospital district would be exposed to any liability.

Hospital district legal counsel and state representative Jay Rodne told the board that, as long as the procedures under the new law were followed, that the hospital district would be immune from liability. Rodne noted that, since the law is new, there have been no legal cases in Washington state. In Oregon, where there is a similar law, there have been no suits against hospitals whose doctors assisted with ending someone’s life. 

Rodne said that there were a number of procedural safeguards in the law. Two physicians have to sign-off on a decision to allow a patient to self-administer a lethal dose of medication, and the patient must be deemed competent before they are allowed to terminate their life. 

The hospital board voted four to one to allow district physicians to assist in suicides. Board President Dick Jones cast the only vote against issue. 

Hospital Internal Medicine Specialist Kim Witkop clarified what the board was voting on. She said that physicians would be allowed to consult with patients about assisted suicides, and to be the attending physician of record. Hospital doctors can write prescriptions for lethal drugs, and can participate in a patient’s suicide. However, they will not allow assisted suicides to be performed on hospital district property.

In other business, the hospital district approved a contract with the Lasso Group to provide marketing services for the hospital. The contract is for $32,000 and will run through January 2010.

The board approved a plan to add a modular building to provide office space at the Snoqualmie Valley Hospital. The space should allow the hospital to accommodate about two more patient beds. The modular unit, essentially a doublewide trailer, will cost the hospital district about $25,000 in one-time costs, and $1,250 a month in lease payments. 

The board also approved paying about $60,000 a year to staff the Adult Day Health Program at the Snoqualmie Valley Senior Center in Carnation. Adult Day Health Programs were cut out of the state’s budget this year.  

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248.

With the clock ticking down to the end of the 2009 Legislative session April 26, the District No. 4 Hospital Board heard an update about the work being done in Olympia at its April 2 meeting.

Brenda Suiter, Vice President for Rural and Public Health of the Washington State Hospital Association, presented the Legislative update to the hospital district commissioners. Before going into a grim discussion of budget cuts to state healthcare providers, she gave the board some good news. She told the board that on April 1 the state House of Representatives approved a bill that would help Snoqualmie’s hospital by adding to the number of swing beds used for rehabilitative care. The Legislation is going to the governor’s office, where the bill is expected to be signed. 

Suiter described the bill as a compromise between hospitals and nursing homes. The bill will allow hospitals to designate 10 hospital beds as swing beds on July 1, 2009, and 10 more on July 1, 2010. This will bring the total number of swing beds available to 25. Currently, only five swing beds are allowed at critical access hospitals like the Snoqualmie Valley Hospital.

The bill only applies to the Snoqualmie Valley Hospital and the Chewelah hospitals, and changes rules that prohibit more than five swing beds in a critical access hospital within a certain distance from a nursing home.

At the meeting, Snoqualmie resident Gene Pollard challenged the district’s support of the bill, claiming that it could hurt Mt. Si Transitional Health Center, a North Bend nursing home. Suiter said that, after the compromise that would phase in implementation of the change, the state’s nursing home interest group dropped its opposition to the bill. This was confirmed by state Representative Jay Rodne, who is also the hospital district’s legal counsel.

“The last thing that we want to do is harm Mt. Si Transitional. We want to support and make them better,” Snoqualmie Valley Hospital CEO Rodger McCollum said.

The rest of Suiter’s presentation could only be described as “bad news,” as she listed the various cuts to healthcare expected to come in this year’s budget. The state budget is facing a $9 billion deficit, and various healthcare programs are being pared down or eliminated.

According to Suiter, the governor’s proposed budget would cut $346 million from health care, the senate’s budget would cut $347 million, and the house budget would cut $381 million. The different budgets all include cuts to the state program that provides general assistance for people who are temporarily disabled or have mental health needs. The governor’s budget eliminates the program completely, cutting its $291 million budget. The senate budget would take $68 million from the program, and the house budget would cut only $32 million. The state’s mental health system would also see cuts to Regional Support Networks. Other cuts include $245 to $275 million to the state’s Basic Health Plan for low-income workers, and cuts to the Apple Health for Kids program.

Hospital Board Chairman Dick Jones said that the cuts would probably mean more emergency room visits by people who can’t afford to pay for healthcare.

Suiter encouraged the board to help get the word out to the community about the cuts and to contact state lawmakers in support of a revenue package to support healthcare providers. She noted that a revenue package would be difficult because of restraints on tax raises, which require a two-thirds majority vote of the Legislature and a majority vote of the people to win approval. 

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248. 

A bill before the Washington state House of Representatives could help the Snoqualmie Valley Hospital.

“What we’re trying to do is keep the hospital there,” state Senator Cheryl Pflug said. 

The bill known in the state Senate as Senate Bill 5423 was moved to the House of Representatives after approval by the Senate. If the House approves the bill, it could become law this summer.

The bill would allow Snoqualmie Valley Hospital to designate up to 25 beds for long-term care, without a certificate of need. Hospitals in cities without nursing homes could designate beds for long-term nursing care, and be reimbursed for those beds. The hospital could use up to 15 in-patient beds as swing beds this year, with the remainder becoming swing beds after July 1, 2010. 

A press release from Pflug notes that the Snoqualmie Valley Hospital will use this flexibility to develop a geriatric psychiatric service. The hospital would like to collaborate with other nursing care providers, such as the Mount Si transitional nursing center in North Bend to develop long-term health care service programs for the community. 

“We are greatly encouraged that Senate Bill 5423 is progressing through the legislative process and are very appreciative of Senator Pflug’s support for our community and our hospital by stewarding this bill through,” Snoqualmie Valley Hospital CEO Rodger McCollum said.

“It will have a great impact on senior care services in our community and we will no longer need to turn patients away when we have empty beds available,” McCollum said. 

Rural hospitals that are designated as critical access hospitals, like the Snoqualmie Valley Hospital, can receive enhanced reimbursements from Medicare to help sustain their operations. Swing beds are allowed under federal law for critical access hospitals. 

“I’m pleased to help the Snoqualmie Hospital District,” Pflug said. “Since it is also partially supported by local tax dollars, I want to do anything I can to help residents receive care in their communities, rather than be forced to travel to other facilities in the region far from home and family.” 

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434, ext. 248.

Mount Si students attend Hospital Commissioner Board meeting

Two Mount Si High School students and several community members challenged the board of directors of King County Hospital District No. 4 to answer their questions about the fate of the proposed teen health center at a public meeting Feb. 12.

“I see a need everyday and many don’t have a way to obtain these services,” said Gillian Kenagy, about the need for teen centric health services. “The services are desperately needed.”

Kenagy and fellow Mount Si High School student Ben Olson wanted to know if the teen health center was on hold indefinitely, and they wanted to know the reason behind the postponement. The students were previously told that the teen health center could open this month.

Snoqualmie Valley Hospital CEO Rodger McCollum said that the reason for the hold was financial. He said that whether or not the program can be funded would depend on the state budget, noting that the state deficit is between $7-$8 billion and many programs are on the chopping block.

McCollum and the school district looked into locating the teen health center at a proposed new high school, but this plan became impossible when voters failed to approve a bond issue in 2008 to fund new school construction. Mount Si High School does not have the space for the teen health center, McCollum said. The plan then changed to locating the health center at the North Bend Clinic, perhaps setting aside one day a week to offer mental and physical health services to area teenagers.

McCollum agreed that there was a need for this type of service. He said that his daughter, a student at Mount Si, was close friends with a girl who committed suicide.

“I am personally committed to offering these services,” McCollum said, during back-and-forth comments with the students and other teen health center supporters.

The hospital CEO noted that all of the district’s clinics were available and capable of providing mental and physical health services to teenagers.

The organization Friends of Youth has been working with Kenagy and Olson to start the teen health center. State funding for the organization is uncertain, McCollum said. Grants have been applied for, but awards will not be made until June. The students said the hospital district’s lack of commitment on the project might derail the attempts to get grant funding.

McCollum and the hospital district board of directors told the students and other teen health supporters that they would work with them.

“We’re all in favor of doing this. It’s a matter of figuring out some format to make this work,” board president Dick Jones said.

Two Rivers teacher Jack Webber and several others spoke in support of the teen health center.

“Please consider any postponement. The need is much greater than anyone realizes,” Webber said.

The issue of the district’s new hospital was also raised during the public comment period at the board meeting. Fall City resident William Cleaver asked the board to carefully consider plans to build a new hospital, suggesting that the board should wait until the economic difficulties have passed.

“Wait, wait, wait,” Cleaver said at the conclusion of his comments.

The hospital intends to close on property off of Snoqualmie Ridge Road near Interstate 90 sometime this summer. The new hospital will have 65,000-70,000 square feet of space, which is about triple the size of its existing 25,000-square-foot building.

The building will be funded in part by the sale of the old hospital and its accompanying 50 acres to the Snoqualmie Tribe, which intends to use it for a tribal health facility. The tribe has offered $30 million for the old hospital and land, which is adjacent to the Snoqualmie tribe’s reservation and casino. Other funds for the construction will come from the sell of bonds. The new hospital is expected to cost $45-$50 million. McCollum hopes to break ground on the new hospital in October 2009.

McCollum disputed Cleaver’s assertion that the board would have to raise property taxes to pay for the new building. Currently the hospital district collects 35 cents per $1,000 of accessed property. The district can collect up to 75 cents, but would have to get voter approval before raising taxes.

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 392-6434. 

If all goes according to plan, King County Hospital District No. 4 could break ground at a new site by October 2009.

The health district has a contract to purchase land on the west side of Snoqualmie Parkway north of Interstate 90, within the boundaries of Snoqualmie. 

“The new hospital will have a better location. It will be more visible. People will see it and use it more,” said Rodger McCollum, CEO of Health District No. 4.  

A rendering of what the new King County Hospital District No. 4 complex will look like

The site of the proposed hospital is across the parkway from property previously eyed by the health district for its new hospital building. Efforts to get the previous property fell through when the King County Council declined to extend Snoqualmie’s urban growth area to include the property. Since the new site is already within Snoqualmie’s urban growth area, the health district will not have to get approval for the site from the County Council.

Although residential building in the area is slowing due to poor economic conditions, the Snoqualmie and North Bend communities are still expected to grow. The need for a new hospital will only increase, as more residents move to the Valley. 

“We feel that this project will take care of health care in our community for the next 10 to 20 years,” McCullom said. 

According to McCollum, studies show that new critical access hospitals like the one planned by the health district typically increase their revenue 20-25 percent. 

The location for the new hospital will likely also mean that more local residents will use the facility. McCullom expects Snoqualmie Ridge residents to take advantage of the close facility, once it is open. 

McCollum said that the project is expected to go before the Snoqualmie City Council in February for zoning approval, which should be completed in March. The health district wants to close on the purchase of property for the hospital in June 2009 and to begin preparing the site for construction immediately after the purchase to take advantage of good weather. They hope to have the design phase completed and a building permit issued by the time the site is ready for an official groundbreaking. 

After the groundbreaking, the project will take between 18-24 months to complete. The new hospital could be open as soon as late 2010 or early 2011. 

The health district has an agreement with the Snoqualmie Tribe to purchase its existing hospital on Ethan Wade Way Southeast and the 50 acres it sits on, which are already adjacent to the Snoqualmie Casino. The sale of the hospital and its property could bring $30 million to the health district.   

McCollum described two ways the district might fund the $50 million building project and land purchase. The health district may use the $30 million from the sale of its old building and approximately $20 million in bonds, or it could use the $30 million to pay off the district’s existing debts and issue new bonds for the hospital construction. 

The district currently has $22 million in outstanding debt. State law allows the health district to issue approximately $55 million in bond obligations, without getting voter approval. 

McCollum said that the health district commission would likely make a decision on how to fund the project by June or July. The district and its commissioners are waiting to see if the bond market is favorable for a bond issue in the summer.

The new hospital will increase the number of patient beds from 14 to 28. It would also double the health district’s hospital space. The existing hospital on Ethan Wade Way Southeast is a 25,000 square-foot facility. The new hospital will likely provide between 65,000 – 70,000 square feet of space.

McCullom said that the district would like to have 90,000 square feet, but could not fit the extra space into the budget. However, the new building will be designed to allow expansion in the future.

The Snoqualmie Tribe’s plans for the old hospital building are to convert it into a tribal health center. 

Reach reporter Michael Bayless Rowe at mrowe@snovalleystar.com or 425-392-6434 Ext. 248.

Susan Hankins used to get her exercise through swimming and aerobics. These days, however, she’s found a better way to keep in shape.

Hankins has joined S.A.I.L. — an acronym for Stay Active and Independent for Life — a program coordinated by the Mt Si Senor Center and the Snoqualmie Valley Hospital.

“I’m still really active, but my aerobics wasn’t doing it,” said Hankins, who battles rheumatory arthritis.

The program was developed by the Northwest Orthopedic Institute in Tacoma after examining the results of a three-year project called the Washington Department of Health Senior Falls Prevention Study. Snoqualmie Valley Hospital became involved with S.A.I.L through a grant from the Washington Health Foundation in 2006.

 “We are interested in preventing falls for the elderly,” said Nancy Rickerson, director of Rehabilitation Services at Snoqualmie Valley Hospital. “The whole point is for fitness and to remain independent.”

The hour-long class is held at Mt Si Senior Center, 411 Main Ave. S., North Bend every Monday, Wednesday and Friday at 10 a.m. Classes cost $3 and are led by Carla Orellana, who also teaches yoga and belly dancing in North Bend. The next class will be Jan. 5. To learn more, call the senior center at 888-3434. 

North Bend resident Cathy Brumbaugh began taking the classes when they first started in June 2007. 

“Before we moved here, I did a jazzercise class,” Brumbaugh said. “Then I had arthroscopic knee surgery and had to hold back on all of my exercises.”

A friend alerted Brumbaugh to S.A.I.L., and now she attends three times a week, often with her husband Harley. 

“There’s no embarrassment if you can’t do something,” Brumbaugh said. “Over the years, people have come who have just come out of surgery or illness. (The instructor) was very good at saying ‘when you start, don’t overdo it.’”

S.A.I.L. exercises are aimed at keeping older adults fit and independent. Approximately one-third of older adults fall at least once a year and one in ten of those results in an injury requiring hospitalization.

With faltering vision and hearing, some older adults need an extra boost to stay in shape. Weight-bearing exercise also slows bone loss and helps keep osteoporosis at bay as participants strengthen their muscles and improve their balance.

The class consists of a warm-up period to gradually increase both heart rate and circulation. before the 20-minute aerobics portion. Adults get in the zone as the music pulsates. 

“I’m really excited because I have a huge variety of music,” Orellana said, describing her collection of swing, rock and roll, fun fifties and melodies from around the world.

During aerobics, participants can walk briskly around the classroom, swing their arms, touch their elbows to their knees and step-kick to the rhythm.

Next, the instructor combines the balance workshops with the cool down process.

“The balance work is really great,” Hankins said. “You walk heal toe and sometimes we use balls. We pretend like we’re walking over logs.”

Hankins admitted she initially felt skeptical about the class, thinking it would be too easy and not worth her while.

“But that is not the case, it’s very rigorous,” Hankins said. “It’s as rigorous as you want it to be.”

The class concludes with strength training and flexibility workouts. An education component at the end teaches participants how to stay safe at home. Bright lighting, hand railings, clear pathways and shoes with good tread can help prevent falls and injuries. 

“It’s a fun, low-impact class to improve flexibility, coordination and self confidence,” Orellana said. “It’s a great way to have fun and get oxygen in your lungs and make some new friends.”

Reach reporter Laura Geggel at 392-6434 .221 or lgeggel@snovalleystar.com.