Monday, July 24, 2017

To CHI and Back: A Journey of 85 Hospital Beds in Kitsap County, Washington

Last week, the Washington State Department of Health (DOH) agreed to reconsider CHIs’ proposal to relocate 250 hospital beds from Bremerton to Silverdale.  A public hearing will take place, the date and location of which are to be decided.    

I have spent the weekend reflecting on this news, personally and professionally.  CHI's rebuttal to the reconsideration request was submitted by Thomas Kruse, Senior Vice President and Chief Strategy Officer for CHI.  It focused on whether the individuals requesting reconsideration were actually “affected” persons. 

I confess this is my first rodeo.  I am neither knowledgeable nor experienced in the Certificate of Need (CON) process.  I was not aware that as an “affected” and “interested” person, submission of a request for reconsideration could make a difference.  There is an opportunity to be heard in light of granting reconsideration by the State DOH.  My passion for this issue was ignited after visiting Harrison Bremerton ER for the first time as a patient recently.    The care provided by nurses, physician, and ancillary staff was exemplary.  The facility location in Bremerton was convenient and accessible to my residence.

Reconsideration is not in direct opposition to CHI expansion plans;  rather, this effort is focused wholly on retaining  85 hospital beds (74 general plus 11 psychiatric) to ease the burden of access to care facing many after the Bremerton facility closes and to ensure Kitsap County residents have choice.

The Bremerton Hospital is ailing and in need of repair; it can be torn down and rebuilt or remodeled and repurposed.  If the Bremerton community can regain 85 of the 250 beds conditionally relocated to Silverdale, a small-scale Harrison "Healthplex" could be erected, to include a hospital and primary care clinic. 

The City could attract an outside corporation, a teaching institution, or raise capital funds by creation of a hospital district and passing a bond or levy to build a community-owned facility.  I do not have all the answers, however, for progress to be made; the City of Bremerton must be able to clarify how residents would substantially benefit from access to emergency and hospital services INSIDE city boundaries. 

Many have inquired how to support this effort.  Here are my thoughts:

To effectively support the notion we need 85 hospital beds in Bremerton, I propose we present (either verbally or in writing) 85 compelling accounts which best illustrate the reasons access to emergency and hospital services is essential for the health and wellness of city and county residents.  11 of the 85 beds are psychiatric, so I am in search of at least 11 persuasive narratives showing the impact of mental health illness locally.   

If you are not comfortable sharing your “story” publicly, I am offering to collect them, removing all identifying information to keep them confidential, and asking volunteers to present them at the hearing on your behalf.  I need help editing, compiling, and organization these submissions. 

I would like these letters to accurately reflect our community composition, being inclusive of all racial, religious, educational, and socioeconomic backgrounds and representative of all cultures, ethnicities, and citizenship statuses.  It is my understanding most reconsideration hearings permit submission of written testimony prior to hearing commencement, though am not certain public comment will be allowed.  Irrespective to outcome, we should not miss this opportunity to ensure our voices are heard and acknowledged by decision makers at the Department of Health. 

Ideally, all submissions should be assembled by August 15, 2017 to ensure readiness when hearing day is announced or arrives.  Finally, I encourage all INTERESTED and AFFECTED Kitsap County residents attend the reconsideration hearing in person.  Our solidarity may move mountains.  We will never know, if we do not try. 

Any suggestions, offers of assistance, and additional coordination efforts are welcome.  Please know many who are unable to speak for themselves are cheering us on from behind the scenes, crossing their fingers, and holding their breath.  If we successfully retain 85 hospital beds, we will have transformed the future of healthcare, for ourselves and other struggling communities across the country. The nation is watching us; let us unite and give this our very best effort.  

One Vision.  One Voice.  Our Choice.

Tuesday, July 18, 2017

An Open Letter to the Future Mayor of Bremerton:

The single most critical issue facing your tenure will be improving access to healthcare for the population of Bremerton.  On May 1, 2017, the state Department of Health granted Catholic Health Initiatives (CHI) a long awaited Certificate of Need to transfer all of the available hospital beds outside of the city and complete a $600 million dollar hospital expansion project in Silverdale, at the expense of healthcare access. 

Recently, I attended a town hall meeting where neighbors came to brainstorm how to best advocate for themselves and hospital staff, who are struggling under the cost-cutting measures being implemented to prop up revenue.  We learned  a great deal about the experience of Piece County residents after CHI merged with Franciscan three years ago. 

St. Joseph Hospital in Tacoma sent $21 million in profit to headquarters in Denver rather than reinvesting it locally, quality ratings have fallen to an F grade, and the population lives 7 years less than the state average while paying $1000 more to reach that substandard milestone. 

On February 13, 1965, Harrison Hospital opened a new facility, the one in which I was born almost 10 years later.  At its inception, Harrison was a source of pride for our community.  Originally, the ER was staffed by community physicians of all specialties, including my father, who volunteered for monthly 12-hour shifts.  As a non-profit organization, Harrison was exempted from paying property taxes in exchange for providing charity care to citizens when necessary.  For decades, Harrison Memorial remained true to its mission, contributing a great deal to the health and wellness of our residents. 

Much has changed since Harrison Hospital was acquired by CHI in 2013. Over the last that time, spending on charity care has decreased from $27 million to $5 million annually, a reduction of 81%.  The number of patients receiving financial assistance for medical bills has been cut in half, from 10,685 to 5,040 individuals.  Some decrease is in part due to Medicaid expansion under the ACA; however, 11% of the population remains uninsured. 

CHI is in significant debt.  Our local hospital, one of many owned and operated by CHI across the country, is one of the few profitable locations.  As a result, revenue is sent elsewhere to prop up ailing locations.  This revenue should be reinvested in OUR community, not sent out-of-state to support others.  Over the last three years, there have been significant cuts to staffing and availability of necessary medical supplies resulting in a detriment to the health and safety of patients and a decline in quality ratings. 

CHI is a non-profit organization and as a result, currently enjoys a property tax exemption in the City of Bremerton of almost $950,000 annually.  This number does not include exemptions such as federal taxes, payroll taxes, and sales tax to which they are additionally authorized.  Over the next five years, CHI will leave an aging Bremerton facility with no plans for repair.  Re-evaluating the property tax exemption in the City of Bremerton is an issue worth some of your time and energy. 

CHI proposes building a brand new facility offering primary care and urgent care.  This structure will house the Family Practice residency program, training physicians who will hopefully join our community once completing their education.  As part of a non-profit organization, this “new” clinic will reap the benefits from requisite property tax exemptions; money the City of Bremerton will absorb in exchange for having access to charity care for those in the community in need. 

Instead of accepting leftover crumbs from CHI because we are starving for access to care, the City of Bremerton needs a comprehensive plan of their own. Please go back to the drawing board and find suitable alternatives rather than kowtowing to a corporation which is destroying the morale of staff, physicians, and our community.  Do not let CHI do to Kitsap County what it has already done to the Louisville, Kentucky community. 

CHI has demonstrated in the past how they cut costs:  by laying off employees, pruning supply budgets and shrinking employee benefits.  Through social media, countless CHI employees throughout the country have contacted me, including those in Kentucky, Nebraska, and Tennessee.  “Employee morale and retention are at an all-time low.”  The have shared difficulties faced working in an environment which is constantly in upheaval.  In a typical day, senior management changes tactics, outsources more services (like telemetry), and eliminates resources necessary to do our job.” 

They share their experience being pushed to the limits by administrative requirements.  “Profit drives decision making now, patients are no longer the top priority.” High acuity areas are reportedly short-staffed requiring employees to do overtime.  High standards of care are difficult to maintain as staff are being asked to do “training” on downtime during shifts.

In closing, the best predictor of future behavior is past behavior.  Once elected, please consider innovative solutions for solving the issue of reduced healthcare access in the City of Bremerton.  The lives and livelihoods of your constituents depend on it. 

Thursday, July 6, 2017

Welcome to the Kitsap Independent Physicians Group!

Happy Fourth of July!

In the Kitsap Sun, today, is this

example of the solidarity amongst medical professionals in ONE small community. Please share far and wide. I am so very proud to be amongst this group of diverse medical professionals, who collectively are fighting for a future which values the physician-patient relationship above all else.


On this Fourth of July 2017, we, the undersigned independen...t physicians in Kitsap County, solemnly pledge that we will continue to provide the highest quality medical care to our patients through its purest, most original form -- the small private medical office. We hold sacred the one to one relationships we have with our patients. Our allegiance is to you, the individual patient, is unwavering. We commit ourselves to continuing to strive to place you, our patients, at the heart of all that we do. 


Silverdale Pediatrics, LLP
Niran S. Al-Agba, MD,
Saad K. Al-Agba, MD

Achieve Eye and Laser Specialists
Dana Jungschaffer, MD,
Martha Motuz Leen, MD
Deanne Nakamoto, MD,
Todd Zwickey, MD

Bainbridge Anesthesia Associates
Blake E. Reiter, MD,
Carol Wiley, MD

Bainbridge Skin Surgery and Consultative Dermatology
Dr. Whitaker

Cole Aesthetic Center
Eric Cole, MD

Dr. Gillian G Esser
Gillian Esser, MD,

InHealth Imaging
Manfred Henne, MD

Kitsap General Surgery
Kristen Guenterberg, MD,
Tom Wixted, MD

Kitsap Podiatry
Paul Aufderheide, DPM,

Paul Kremer, MD

Member Plus Family Health
Blain Crandell, MD,
Viola Medina, ARNP

Michael Metzman, MD,

Pacifica Medicine & Wellness
Andrea Chymiy, MD
Marie Matty, MD,

Peninsula Cancer Center
Heath Foxlee, MD
R. Alex Hsi, MD,
Berit Madsen, MD
Aaorn Sabolch, MD,

Retina Center Nw David Spinak, MD

Sheila C Lally,DO Sheila Lally, DO

Silverdale Eye MDs
Glen Rico, MD

Sound Family Health
Charles Power, MD,
Brad Andersen, MD
Teresa Andersen, MD,
Mark Hoffman, MD

The Manette Clinic
Alisa Blitz-Siebert, MD,
Bill Minteer, DO
Tanya Spoon, DNP,
Kristen Childress, DNP
Teri Scott, ARNP,

Vintage Direct Primary Care Peter Lehmann, MD

Bronx-Lebanon Hospital: Believe Them the First Time

I remember the first time someone threatened my life as a physician.  It was my day off, so I was not in the clinic that day; a Children’s Hospital specialty group was working there instead, and after a staff member called the police, she notified me.  A father had walked in saying he wanted to kill me for “taking his children away from him.”  Wracking my brain as to this man’s identity, I drew a blank. 

The police found him in a local park a short time later and judged him to be “harmless.”  Somehow, I did not share their reassuring sentiment.  I figured out who the individual was, tracked down his mother, and promptly explained the situation.  She provided a recent photograph so my staff could be trained to recognize him and contact the authorities the moment he entered our building.  That photograph still hangs in our “Most Wanted” section of my front office, amongst other pictures which have been added.  Occasionally, I request an updated picture to make sure we are keeping our office environment safe. 

The second time a parent threatened my life was over the phone.  I was taking call on the weekend for a group of pediatricians.  One of them had evaluated a child for a finger injury and had not quite done their due diligence.  It sounded infected and in need of repair as the father described its appearance over the phone.  I recommended he take his daughter to the local Emergency Room.  He threatened to stab me instead.  I called to warn the ER staff and then notified the other practice.  The response was less than vigorous from my call partners, “you must have done something to upset him.” Their reaction astonished me; “blame the victim” is an unacceptable response to a colleague in this situation.    

When a patient or disgruntled coworker threatens to kill us, that threat should be taken very seriously.  Physicians must become less tolerant. Tolerance is defined as an objective or permissive attitude toward opinions, beliefs, and practices that differ from our own.  In my opinion, the administration of hospitals and some large clinics are far too permissive of violent threats against their staff.  I have heard numerous stories from across the country of physicians being told the “patient is always right” as patient satisfaction scores reign supreme. 

We have been taught when a patient threatens to commit suicide, we take them at their word.  Why is it any different when our very own lives are at stake?  The idea that physicians, nurses, pharmacists, and ancillary medical staff are expendable is ridiculous and policies must be enacted to protect the lives of medical personnel.

As I reflect on the tragic events that unfolded inside the Bronx-Lebanon Hospital last weekend, it is difficult to comprehend. My first thoughts are for the victims and their families, in particular those who knew Dr. Tracy Sin-Yee Tam.  She was a family practice physician in the hospital that day by chance, filling in for a colleague.  My second thought is to recall a quote from Maya Angelou, “When people show you who they are, believe them the first time.” 

According to the New York Times, Dr. Henry Bello had a background which spelled trouble right from the start.  His life story reveals a chaotic trajectory of bankruptcy, alleged addiction, workplace difficulties, homelessness, and brushes with the law.  He declared bankruptcy in 2000.  In 2004, Dr. Bello was charged with unlawful imprisonment and sex abuse involving a 23 year old woman in Manhattan.  In 2009, there were allegations of unlawful surveillance when he was caught using a mirror to look up the skirts of two women. 

In 2014, he was hired by Bronx-Lebanon Hospital as a family practice physician with a limited medical license and in February 2015 was forced to resign in lieu of termination after an allegation of sexual harassment.  After his resignation, Dr. Bello warned former colleagues he would return someday to kill them.  On Friday, June 30, he exacted his revenge, entering the Bronx-Lebanon Hospital carrying an AR-15 rifle and opening fire — fatally shooting a physician and wounding six others before killing himself.  Something more should have been done about this man to protect the hospital staff and patients. 

This post was not penned to “Monday-morning-quarterback” the events of last Friday.   I want to emphasize in the future, these threats should be taken seriously and closely monitored to keep those inside the hospital, medical facility, or clinic walls safe.  Two hours before the shooting, Dr. Bello emailed the New York Daily News to say the allegations that ended his medical career were “bogus.”  He stated, “This hospital terminated my road to a licensure to practice medicine.”  In addition, a week prior to the rampage, he was reportedly fired from his job assisting AIDS and HIV patients by the city.  This was a clear sentinel event and foreshadowed the possibility of something ominous. 

Physicians on the “front-lines” are facing a battle for their survival, literally and figuratively.  Friday, June 30, I lost a physician colleague in a senseless tragedy.  We do not handle threats haphazardly when they occur in airports, schools, or police stations.  We cannot properly care for a patient when we are in fear for our lives.  It should not be tolerated any longer.  There are many valuable lessons to be learned from the events of June 30th. We need to sit up, pay attention, and make changes.  The loss of Dr. Tracy Sin-Yee Tam and injuries to the other victims should not be in vain; physicians and other medical staff deserve to feel safe in their work environment while trying to save the lives of others.  

My sincere condolences go out to the friends and family of everyone inside the Bronx-Lebanon Hospital that day.  May you find peace, hope, and healing and may we, as collective communities of healers, refuse to tolerate serious threats to our lives, those of our colleagues, and those of the patients we serve.