Just over a week after announcing in a press release that it was leaving Vashon, Sea Mar Community Health Centers reversed course and said it wanted to continue to operate at the Sunrise Ridge clinic, retaining the staff currently employed there and eventually building its own new clinic on Vashon — all without a continued relationship with Vashon Health Care District (VHCD), or its considerable tax subsidy.

The Beachcomber learned of Sea Mar’s intention to stay at the clinic on Friday, Sept 2, following interviews and email correspondence with Mike Leong, the senior vice president of corporate and legal affairs for Sea Mar, and Mary Bartolo, the nonprofit’s executive vice president.

On Sept. 2, after Bartolo and Leong had detailed Sea Mar’s goal to build its own clinic on Vashon, despite its split with VHCD and exit from Sunrise Ridge, The Beachcomber posed a question via email to the executives.

The Beachcomber asked, “Would Sea Mar be willing to continue to operate the clinic on Sunrise Ridge, without a subsidy, while it looked for a site for a new clinic — if VHCD was not involved in the operation of the clinic? Is this a possibility that Sea Mar or VHCD has considered, in order for Vashon not to have a gap in health care coverage on the island?”

In a detailed response, Bartolo replied in the affirmative — adding that Sea Mar has never left a community that it has agreed to go into.

“Over the last couple of days, we have received a lot of feedback from our patients and staff centered around Sea Mar staying on Vashon and continuing to provide health care to the community,” Bartolo wrote. “After much thought and consideration, we have decided to remain on Vashon and continue our commitment to staff, our patients and the community.”

Bartolo said Sea Mar’s intention also included plans to build a new clinic, expand services and also explore the possibility of building affordable housing on Vashon as well, as the organization has done in other communities throughout Washington.

“Based on community need, we would plan to expand medical services and behavioral health services as well as adding dental or other services as needed,” Bartolo wrote. “We want very much to continue our mission to provide access to health care for communities who have struggled with access. We are proposing to remain without any subsidy from [VHCD], freeing up funding to go back to the community or go toward other services.”

Bartolo also said the Sunrise Ridge clinic would also maintain its present hours, and continue to see all the patients currently served at the clinic as well as accept new patients, regardless of insurance ability or ability to pay.

Last week, both Bartolo and Leong told The Beachcomber that Sea Mar had always had a goal to operate on Vashon without a subsidy.

The organization had, in fact, proposed in recent contract negotiations with VHCD that Sea Mar’s annual subsidy — currently set at $1.5 million a year — be lowered by $400,000, they said.

“If we were to independently establish a clinic, we would operate at a loss for a short time frame, but as with all our other clinics we would be financially sustainable,” Leong said.

​​Sea Mar Community Health Centers currently operates more than 50 medical and dental clinics throughout Washington, as well as many other facilities including affordable housing, and contracts with numerous other public agencies.

However, other than on Vashon, Sea Mar currently does not partner with a health care district such as Vashon’s, Bartolo said.

VHCD responds to Sea Mar’s turnabout

Tom Langland, president of VHCD’s board of commissioners, said that he was greatly surprised by Sea Mar’s pivot to now remain at Sunrise Ridge as a base to carry out other ambitious plans.

Late last week, Langland said, Bartolo had also reached out by email to VHCD administrator, Eric Jenkins, expressing some of these goals, but this communication had not been as fulsome as the statement provided to The Beachcomber.

Langland deferred further response until he learned more about Sea Mar’s plans, instead speaking broadly about VHCD’s mission, which was written around the time of VHCD’s formation, which won 70% voter approval on the ballot in 2019.

Primary in VHCD’s mission statement, he said, is the pledge to “support accessible quality health care through community partnerships, shared decision making, transparency and responsible stewardship of resources.”

VHCD’s purpose, he said, is to ensure that the community has an ongoing voice in the delivery of our health services.

“The community elected five commissioners to collect and interpret public inclinations about their care, and then work to bring these concerns to any current provider organization,” he said. “Our island has invested heavily in this health care, and we believe [islanders] are entitled to real input and an ongoing voice.”

Langland also detailed the history of community involvement in the clinic since its formation in the 1970s.

At that time, he said, the Vashon Maury Health Center Board of Directors was comprised of dedicated local citizens and volunteers who worked alongside clinic practitioners Gary Koch and Michael Kappelman, among others, to support and grow the clinic care model for the island.

“That local input was reduced when fiscal realities required ceding clinic ownership and a lot of the operational control to hospital-based companies like Highline, CHI Franciscan and eventually the federally qualified organization NeighborCare,” he said. “Not until the formation of the [VHCD] was a vehicle for this meaningful and responsive local input re-established.”

Langland said that while VHCD awaits details of Sea Mar’s exact strategy for realizing their latest stated goals and generous plans, VHCD would continue its search for other provider organizations to operate the clinic, and work to ensure that current Sunrise Ridge staff who wanted to work for a new provider would have that opportunity.

“It is most regrettable that this provider contract negotiation has tipped away from true community health care concerns into more politically-charged questions, but we will need to listen carefully to each other before we make a move that will erase local control of a crucial service like health care,” Langland said.

Last week, Langland also reaffirmed VHCD’s recently-announced goal to build its own new clinic on Vashon.

Timeline of events

On Aug 25, a press release from Sea Mar headlined “Sea Mar Community Health Center to leave Vashon Island,” indicated that tensions had arisen in its relationship with VHCD, leading to Sea Mar’s decision to cease operations on Vashon by Dec. 31.

“During Sea Mar’s time operating the clinic, [VHCD] voiced its desire to be more directly involved in the operations of the clinic, and it became clear that Sea Mar’s need to operate independently within its established model of care differed from the Vashon Health District’s vision,” the press release said.

Subsequently, both Sea Mar executives and VHCD commissioners described a rupture between the entities which had culminated in a letter of termination sent by Sea Mar to VCHD on Aug. 24.

According to Langland, the termination letter also came as a surprise, arriving as VHCD was attempting to negotiate improvements in its contract with Sea Mar.

Sea Mar’s corporate leadership had rejected all but one of the proposed changes on Aug. 23, and then sent the termination letter the following day, Langland said.

Eric Jensen, VCHD’s administrator, said that proposed changes to the contract had included, among others, a request by VCHD for a defined list of primary care services to be offered at the clinic, and an agreement on the clinic’s minimum operating hours.

Langland said that these and other requests at the bargaining table did not constitute micro-management of Sea Mar’s operations.

“While our new provider agreement draft did ask for more regular accountability to the community through the VHCD, I can think of no instances of our attempts to micromanage anything,” said Langland. “Frankly, we know little of the day-to-day operational things required to run a clinic, while [Sea Mar] knows a great deal.”

However, Leong, of Sea Mar, said in an email to The Beachcomber last week that VHCD had, in fact, asked for more control over the clinic’s operations than any of the other agencies with which Sea Mar works in Western Washington.

“None of Sea Mar’s relationships with the many other public agencies with which Sea Mar works have the level of control desired by [VHCD],” Leong said.

On Tuesday, Aug. 29, as the Sept. 1 issue of The Beachcomber went to press, both Leong and Bartolo told The Beachcomber, in a phone call, that Sea Mar hoped to retain the services of the clinic staff on Vashon, as well as continue to pursue Sea Mar’s own longtime goal to build a clinic on Vashon.

“We have a difficult working relationship with the health district, but that doesn’t mean we’re abandoning the community,” Leong said, at the time. “Our mission is to serve the underserved portions of the state, and that includes the rural population of Vashon.”

Sea Mar, both Leong and Bartolo said, has a long history and considerable expertise in building its own clinic facilities as well as low-income housing projects.

SEA MAR/VHCD HISTORY

Vashon Health Care District (VHCD) was established in 2019, after a 70% approval margin by voters to establish the taxing district.

VHCD’s urgent task in 2020 — during the start of the COVID-19 pandemic — was to secure another healthcare provider after an announcement by Neighborcare, who had occupied the Sunrise Ridge clinic since 2016, that it would exit the clinic.

In October of 2020, VHCD contracted with Sea Mar to operate the clinic in return for a generous subsidy — tax dollars that have now amounted to a total of $2.75 million in subsidies and allowed the clinic to operate with a budget surplus.

Sea Mar opened its operation at the Sunrise Ridge clinic in November of 2020.

​​In June of 2022, the latest month for which numbers are available, Sea Mar had 957 patient visits on Vashon, an average of 44 per day, with the clinic open 22 days that month, according to Sea Mar’s monthly clinic financial report to VHCD.