With slightly more than a week before the Franciscan clinic is set to close, talks are continuing with the health network that may begin running the health center at Sunrise Ridge, but no firm agreement is yet in place.

“We do not have a deal, but we are working toward a deal,” Dr. Gary Koch, the medical director at the clinic, said late last week. “There is plenty of interest by all parties to make it work.”

Those close to the situation say they remain cautiously optimistic that an agreement will be reached, but at least some gap period is likely, and — as they have said before — community support for the clinic will be essential. Meanwhile, some members of the island’s health care community are encouraging health center patients to plan ahead for their medical needs.

Last Thursday, Koch said he had hoped an agreement would have already been reached, but that he expects to know more by the end of this week.

Several individuals involved with the talks met again recently, including representatives from the Vashon health center, King County, the state legislature and the health network, which still prefers not to be named. Koch, who was among the attendees, called it a “healthy discussion” and said the network is doing its due diligence, examining raw data and financial projections, and that network administrators are being careful not to make a commitment they cannot honor.

“Like all things, it is about money and finding out where that reservoir exists,” Koch said. “The financial part has to be worked out. … They have not solved all the issues that need to be solved.”

Koch added that health network officials have assured him once the financial hurdles have been cleared, they will be able to move quickly. Regardless, he cautioned people to expect — at least — a short-term gap.

“I wish it were more clear cut for the community,” he added.

Sharon Nelson, an islander and state senator involved with the proceedings, noted that for any arrangement to work, the community will have to support the clinic financially and by using its services.

“We are going to ask people to help them be successful because we need this clinic,” she said.

She noted that the clinic had been subsidized with funds from Granny’s Attic before the Franciscans’ started running it and that a subsidy would likely be needed again, but that those details are still being worked out.

Koch echoed her words about the importance of support.

“It will not fly unless people use it. It also may not fly without some direct contribution,” he said.

In the event of a gap period, islanders will have limited options for seeking care at an island clinic. Vashon Natural Medicine currently has five providers, owner Kelly Wright said: two naturopathic physicians, two medical doctors and a nurse practitioner. Four of the providers can accept some new patients, but the clinic does not accept Medicare and has limited room for patients covered by Medicaid. Naturopathic physician Nicole Maxwell at Maxwell Family Medicine said she can accept some new patients, but does not accept Medicare or Medicaid, although she provides a discounted rate for patients with that coverage. Finally, Dr. Gail Fulton, owner of Fulton Family Medicine, said that clinic is not able to accept new patients at this time.

At the Vashon Pharmacy, co-owner Tom Langland said staff there are encouraging health center patients to make sure their prescription medications have at least three months of refills left, and if they do not, to call the clinic soon to get a refill extension. Additionally, he said, the pharmacy can only provide refills when prescriptions are less than one year old, so those dates are important to check as well. Both the refills available and the prescription date are found on medication bottles.

By law, Langland added, the pharmacy must have current refill orders on file, or staff cannot provide medication.

“No refills, no pills,” he said, “We would have no recourse but to send people for emergency care.”

Vashon Island Fire & Rescue (VIFR) has also ramped up its efforts, as they have previously indicated.

Like Langland, VIFR Interim Assistant Chief of Operations Bob Larsen encouraged Franciscan clinic patients to prepare for a period without the health center.

“At this time of health care crisis, islanders need to be proactive about their health care,” he said. “We know it is happening. It is important to make arrangements.”

He also encouraged those affected to have an adequate medication supply and not to wait too long to obtain care if they think they need it.

Firefighter and emergency medical technician Randy Tonkin, head of the local firefighters’ union, responded similarly, though he stressed the department has a finite ability to assist with expanded medical needs.

“We encourage people to remember that this is an island, and our local resources are limited. With that in mind, if you experience medically concerning symptoms, go to a hospital or urgent care. Do not wait until it gets worse. Obviously, if it feels potentially life-threatening, call 911 immediately,” he wrote in an email.

In the first two weeks after the clinic closes, Larsen said, the department will increase the number of people on duty from its own ranks and evaluate what services will be required of the department going forward. If the gap period extends beyond two weeks, two other fire districts have offered to send a team of emergency medical technicians to assist during the day, paid for by King County, but Larsen cautioned that is a stopgap measure.

Acknowledging the challenges and uncertainty ahead, Larsen stressed people should call for help when they need it.

“If you have an emergency, call. That is why we are here,” he said.

Washington State Ferries is also aware of the situation and is having discussions about it, according to spokesperson Brian Mannion.

“We do anticipate there will be an impact, but we cannot speculate what that will be,” he said.

He added officials there are working to get a better sense of what the situation might look like, from increased aid cars taking patients off the island to more car traffic in general.

“We are looking at all those angles,” he said.

Nelson noted that she is aware that the fate of the clinic is on many islanders’ minds. At Strawberry Festival, she said, many people thanked her for being involved in the health care effort and shared their feelings about the importance of saving the clinic. There has been substantial progress in recent weeks, she noted, and the efforts are focused.

“Right now, we need to keep that clinic open, period,” she said.