Vashon Health Care District (VHCD) has begun looking for a new partner to operate its community clinic at Sunrise Ridge after receiving notice from Sea Mar Community Health Centers that it will terminate its operating agreement with VHCD, effective Dec. 31.

The termination notice, received Aug. 24, came as an unwelcome surprise to VHCD, which in October 2020 contracted with Sea Mar to operate the clinic in return for a generous tax subsidy.

In a press release announcing its departure from Vashon, Sea Mar said that during its time operating the clinic, VHCD had “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 [VHCD’s] vision.”

“We had agreed to operate the Vashon clinic because we feel strongly that every community should have access to affordable, quality health care,” said Rogelio Riojas, Sea Mar’s executive director. “It was a difficult decision to leave the island, but we feel it is the right decision that will allow the Health District to operate the clinic in a way that fulfills their vision.”

VHCD is officially a public hospital district, authorized by law to provide health care services for its residents either directly or indirectly, through a contract with a provider. While VHCD delegated the day-to-day operation of the Sunrise Ridge clinic to Sea Mar, an off-island provider, it did not cede all decisions concerning health care on Vashon to Sea Mar.

Sea Mar Community Health Centers, which operates more than 50 medical and dental clinics, as well as other facilities including affordable housing, contracts with numerous other public agencies, said Mary Bartolo, its executive vice president. However, other than on Vashon, it currently does not partner with a health care district such as Vashon’s.

Sea Mar’s decision to leave the clinic rather than working to accommodate VHCD’s role in representing the community is unfortunate, Langland said.

“We’re the island’s elected health care leaders,” said Tom Langland, chair of VHCD’s board of commissioners. “Our neighbors expect us to play a role in determining what health-care services are offered, and where. They expect off-island providers to listen to us when key decisions are made. They expect us to be good stewards of their tax dollars.”

In contrast to the departures of previous providers at Sunrise Ridge, money is not a factor in Sea Mar’s departure. Since November 2020, VHCD has provided Sea Mar with a total of $2.75 million in subsidies, and the clinic is operating with a budget surplus.

According to commissioners and VHCD’s administrator, Eric Jensen, Sea Mar’s decision to depart came in the midst of negotiations to renew the contract between VHCD and Sea Mar.

According to Jensen, VHCD had proposed changes to the contract that included a request for a defined list of primary care services to be offered at the clinic, and an agreement on minimum operating hours for the clinic.

Another change in the contract proposed by VHCD was a request that Sea Mar submit a clinic budget by Nov. 1 for the district to use in setting its annual levy.

The proposed contract also included a $400,000 annual reduction in Sea Mar’s subsidy from VHCD, which Bartolo said Sea Mar had proposed.

The subsidy had been $1.5 million a year since Sea Mar arrived, though commissioners said they had repeatedly requested that it be lowered.

Langland said that VHCD’s 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, Mike Leong, who is the senior vice president of corporate and legal affairs for Sea Mar, said in an email to The Beachcomber 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.

With Sea Mar’s impending departure, Langland said VHCD is already “laser-focused” on finding a new provider for the clinic, with no interruption in service.

“We’ve gone through transitions like this several times before,” Langland added. “If anything, we’re in a stronger position now than we were when we signed our contract with Sea Mar two years ago.”

Langland also said the VHCD will work to ensure that the Sunrise Ridge doctors and other clinic staff — many of whom live on Vashon — will be able to stay on Vashon to work at the clinic with the new provider.

“Our expectation is that the new provider group will readily hire those practitioners and staff who are interested and already well-known and respected within our community,” Langland said. “They’ve shown their commitment to the health of the island over many years — we want them to stay.”

Langland acknowledged the tightness of the timeline of VHCD’s work, and said VHCD “is asking Sea Mar to allow us a bit more time in order to make the best decision possible for a replacement group to serve our neighbors.”

Leong, however, in his email response to questions from The Beachcomber, did not seem open to such an extension of the four-month notice previously agreed to in Sea Mar’s agreement with VHCD.

“Sea Mar believes that the timeframe is not unduly short as Sea Mar had assumed the clinic operations with Neighborcare’s departure within a shorter timeline,” he wrote. “Sea Mar is prepared to continue serving patients of the Vashon community at Sea Mar’s Tacoma and Seattle clinics.”

On Tuesday morning, as The Beachcomber went to press, both Leong and Bartolo told The Beachcomber, in a phone call, that Sea Mar too, hoped to retain the services of the clinic staff on Vashon, as well as 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. “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.

District’s plans for new clinic

Langland said the news of Sea Mar’s departure would not derail VHCD’s plan to construct a modern and larger replacement clinic in a central location on Vashon — a project announced in July.

In late May, Senator Patty Murray formally asked Congress to appropriate $5 million to VHCD for the design and construction of the new primary care clinic on the island. At VHCD’s Aug. 3 board meeting, however, it was reported that the request for Vashon did not make the cut at the Senate Appropriations Committee.

To build the new clinic, VHCD also hopes to additionally tap $3 million in state funding, originally appropriated in 2018 to the clinic’s former provider, Neighborcare Health. for the purpose of building a clinic on Vashon. In 2021, that appropriation was transferred to Sea Mar Community Health Centers after Neighborcare left in 2020.

Leong, of Sea Mar, told The Beachcomber that Sea Mar acknowledged that the $3 million appropriation is for building a clinic on Vashon.

“If Sea Mar is not building a clinic on Vashon, Sea Mar will transfer these funds to whoever would be building that clinic,” he said.

According to Langland, some tensions had arisen over the past several months during VHCD’s discussions with Sea Mar about the upcoming building project.

“We were not able to reach an agreement on whether Sea Mar or VHCD would lead in the design/build process, and whether the island would end up owning and controlling this community asset when complete,” he said. “We stated in July that Sea Mar supported the concept of building a new clinic — they made it clear since their arrival here that they could not operate for very long out of Sunrise Ridge.”

However, Langland said the commissioners had learned, over time, that “input from our community on design, use and ownership of the new facility was not welcome,” adding he could not say to what extent this particular impasse may have led to Sea Mar’s decision to terminate their provider agreement.

Despite the current impasse, Langford said he and other commissioners had no regrets in terms of bringing Sea Mar to Vashon in 2020.

“We were fortunate to get them and Sea Mar is a highly regarded source of health care in the great Northwest,” he said. “While I have no regrets with that initial contracting decision, I do regret that Sea Mar’s mainland corporate culture and our island’s priorities, culture and demographic may not align enough to enable a mutually-beneficial long-term relationship.”

Health care leaders express concern

In June, 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.

Where will those patients go, if there is an interruption in service at Sunrise Ridge?

Matt Vinci, Fire Chief of Vashon Island Fire & Rescue, said that his staff at Station 55 on Vashon already sees a substantial daily volume of walk-in patients, which increases on weekends when the health care clinic is closed.

“We’re like the walk-in clinic on the island,” he said, detailing that the care requested of medics at VIFR includes blood pressure checks, lacerations, cardiac chest pain, testing for COVID, and other ailments.

With an interruption of healthcare clinic operations on the island, VIFR’s work in this regard would only increase, he said.

“I want the island to know we are here to support the island’s needs and we have trained professionals to do that — but we’re going to need the resources to sustain it,” he said, referring to VIFR’s current staffing shortages.

Dr. Kelly Wright, of Vashon Natural Medicine, said that she too was concerned about a possible interruption of health care options at VHCD’s clinic, especially for those on Medicare.

“Our office is not accepting new patients, and we are unable to bill Medicare,” she said. “We provide primary care services for approximately 5,000 patients, and will be gaining another practitioner in January to accommodate the increase in services that we already need.”

Wright recommended Indigo Urgent Care, in Ruston, for those who need urgent care, as well as Swedish Urgent Care in West Seattle.

Correction: This online article adds information about a formal request for a $5 million federal appropriation from Patty Murray for VHCD to build a new clinic on Vashon: at VHCD’s Aug. 3 board meeting, it was announced that the appropriation had not made the cut to be included in the appropriation bill of the Senate Appropriations Committee. We regret the omission.