Month: October 2015

Editorial Sunshine

It’s no secret we are a very diverse community – especially politically!  But, who can deny that we are also a very special community? Even with our differences, we care deeply for one another and never fail to come together when needed.  This is one of those times when we definitely need to come together. As I collected the materials for this blog, an overarching theme emerged. The choices became surprisingly clear. Are we going to believe the best about our neighbor and stand together to address what must be done? Or are we going to let outside special interest groups come in and foist their objectives on us? There are serious issues on the table and we are a passionate group! But we are also intelligent and innovative! We are creative and determined! We the people of San Juan County are capable of addressing the issues on the table. Don’t let our community be exploited by those who would welcome an impending “legal storm” to further their own purposes.That’s not what we’re about.

Who is writing this blog anyway?

The anonymity behind the blog was not borne out of sinister intent and I am very sorry for the suspicion that this has created. Our family took out the 1/4 page ad in the San Juan Journal last week (10/21) advertising the blog, and it reads “paid for by the Holt Family” which I expected readers would associate with the blog.(In case you are wondering, yes, it was scary to put our name out there solo!)

We paid for that ad with our own hard earned dollars and it was not in affiliation with any candidate. We have lived on this island 17 years, we are raising 4 children here, we have a blue collar family business and we are very involved in our community. For perspective, we do not have traditional health insurance and we are private pay. We receive care at PIMC and San Juan Healthcare. We believe so strongly about this election that we are willing to put our money and our name on the line. We love and respect all of our neighbors — even the ones that don’t agree with us.

I absolutely did not want to create the blog nor give up the dollars to pay for an ad. However, after attending the forums and reading the advertised candidate materials, my husband and I were frustrated. Many pertinent facts that will matter to voters are being left out of the conversation. Candidate statements are going unchecked and many of them are misleading — either lacking context or prompting voters to arrive at inaccurate conclusions. It simply is not right and it became impossible to just sit by and watch it happen.

I am a mere mortal. The blog is not entirely comprehensive, nor is it perfect in every regard. I did not have the time research every candidate and issue as thoroughly as I would have liked. Instead, I focus on what I believe are important areas that have been overlooked: The litigious history/tendencies of one candidate, considering Death with Dignity and women’s healthcare issues in the context of our community, and exploring candidate conflicts of interest. The blog examines other topics and provides many voter/candidate links all in one place for ease of comparison. I have tried to be objective and provide links to primary source documents. I do pose questions related to the information presented. I did not intend for the blog to be slanted toward any one candidate, but it became obvious where was the biggest gap between information presented and not presented for voter consumption. The blog does not endorse or promote any candidate.

I stayed up more than 48 hours straight to create the blog and carefully present the facts I researched. You must know I had no partisan or sinister motives, only to provide relevant information for the benefit of our voters. Our family believes your family deserves that.

Very Sincerely Believing the Best about our amazing community,

Koshi Holt

Women’s Healthcare Issues

Based on the way the women’s issues have been presented by the candidates, (similar to Death with Dignity) would it surprise you to know:

  • At this time, implying that Peace Health is violating the law in this matter is purely opinion!
  • IIMC did not offer abortion services. IIMC doctors decided for themselves they would not provide this service.
  • Peace Health complies with the Affordable Healthcare Act, as far as women’s healthcare issues are concerned, as far as what is considered primary care. Patients can have STD testing at PIMC, women can obtain birth control, and no one will be denied services based on ability to pay. 
  • In addition, we do already have Planned Parenthood in this community, an organization who desires to provide this type of healthcare.
  • It is very, very rare for small rural hospitals like ours to offer any kind of abortion, let alone elective abortions. Very typically, the demographics do not support the infrastructure necessary to offer that kind of procedure.
  • “Peace Health announced that abortions will not be provided…Exceptions are provided, according to Peach Health documents, ‘when a woman’s life is in danger or in the case of an imminently lethal fetal anomaly.’ Emergency contraception (“Plan B”) will be offered in cases of sexual assault. Vasectomies and tubal ligations are performed ‘when it is determined that such a procedure is medically indicated.’
  • When the Washington State Attorney General wrote an opinion for Kevin Ranker, Monica Harrington and the Coalition for Healthcare Transparency regarding the definition of “maternity care”, he chose not to opine as to what would constitute “substantially equivalent benefits, services or information”, about how a PHD might comply with an obligation to provide them, or whether the PHD could meet any lawful obligations through a provider in the district other than the PIMC. He also states that “Nothing in I-20 requires that a public hospital district provide maternity care benefits, services, or information to women.”  AG Opinion
  • The Attorney General’s Opinion leaves room that if the community determines it wants or needs certain services, it is not necessarily incumbent upon the hospital to provide said services. It may be another provider within the Hospital District, in this context Planned Parenthood or possibly San Juan Healthcare, that may provide the service.

Peace Health’s Goodwill toward Us

  • Did you know Peace Health agreed to partner with SJC when no other providers would? In addition to Peace Health, the Community Hospital Committee had approached UW, Virginia Mason, Swedish, Providence and Island Hospital, all without success. IIMC was struggling and did not have capital to invest in this Hospital venture. Read how Peace Health assumed the disproportionate burden, both fiscally and logistically.  PIMC-Subsidy-Agreement-Contract and also download the Peace Health brochure at
  • Did you know that Peace Health has brought more than 40 new jobs to our community?
  • That Peace Health has save 8,000 off island trips?
  • Has decreased costly emergency medical evacuations by 45%?
  • Did you know that Peace Health has committed to treat the patients in our community regardless of their ability to pay?
  • That PIMC offers all the same services IIMC did, but also so many more?
  • This partnership is only 3 years old! Yes, there is still much to be done, but let’s remember we already have a lot to be thankful for!

PeaceHealthIsland Nondiscrimination

PeaceHealthIsland Admissions

PeaceHealth2013 Financial Assistance

What is up with the 97%?

Let’s see if we can’t shed some light on this topic.

The Public Hospital District receives approximately 6.08% of the total revenue collected from our SJC Tax Levies for an estimated $2.45M. 3.84% of that once went to IIMC and now goes to PIMC. 2.24% goes to EMS.

Of the portion that goes toward PIMC approximately 3% goes toward the running of the PHD Board and, per our subsidy agreement, the remaining “97%” has been designated exclusively for the provision of charitable healthcare services, emergency department services and physician services at PeaceHealth. Descriptions of these are laid out in the 1st Amendment-Subsidy-Agreement and PIMC-Subsidy-Agreement-Contract.

The specificity of the revenue allocation was intentional. The purpose was to clearly indicate that our tax dollars are not, in fact going to support any religious activities. Instead they are being poured back into our community via the services described. This 97% has been referred to in ways that make it seem like a Catholic slush fund and consequently a violation of the separation of church and state. That is simply not the case.

In addition, these funds generated by tax levies account for only about 10% of the PIMC budget.

Plans already in motion…

The comments of some candidates in this election seem to demonstrate a lack of good faith toward the current SJCHD Board. Whether it be the constant call for greater oversight of our tax dollars, or over the EMS budget – it implies what exactly about the current Board?

Or comments like, “I believe I know WHY the public hospital district commissioners on SJI have done what they’ve done. They don’t believe they should have to follow the RPA, and in order to avoid having to follow it, they’ve made up this absurd fiction that it’s somehow reasonable to claim publicly that while they subsidize services for anyone who is NOT pregnant, they deny services to pregnant women. It’s absurd, bordering on crazy…”

Let’s not forget the hard work a very diverse group of individuals came together to do in bringing up the Hospital here to SJI. And their work for us has continued. You can review their agendas and minutes here at, but let’s also touch on a 2 things that have come up repeatedly in the election rhetoric.

Let it be known Urgent Care has already been on the radar of the PHD Board and Hospital Board!

Did you know each of our 4 PIMC physicians leaves 4 open appointments each day for urgent care? That’s 16 appointments total each day between the hours of 8am and 6pm.

In addition, the Hospital Board has hired a 5th practitioner, a Physician’s Assistant. This individual will be purposefully positioned at the clinic and the hospital to further mitigate the Urgent Care vs. Emergency Department dilemma.

With regard to oversight of the EMS, it should be noted that this group has been working diligently to reduce their budget, including the assumption of an 8% pay cut! In light of the last levy failure, the Hospital District sought out expertise in evaluating our EMS, it’s leadership, it’s structure, etc. Based on the findings, the SJCPHD Board and EMS have been working to improve this service to our community.

Death with Dignity

Because of the way this issue has been presented in the election, would it surprise you to know:

  • Peace Health is not out of compliance with Washington State law regarding this Act
  • Death with Dignity was not performed at Inter-Island Medical Center
  • The IIMC physicians decided on their own not to participate in this Act, long before Peace Health came on the scene.
  • The law does not require hospitals or physicians to participate in Death with Dignity (e.g Overlake Hospital, a non-religious hospital in Bellevue, WA does not participate )
  • Death with Dignity only very, very rarely occurs in a hospital setting
  • Placing the burden of Death with Dignity on Peace Health is completely unnecessary and cannot be justified.  a) They have a right to their conscience and B) the Hospital District can find other avenues to Death with Dignity for patients. That is more their role as a PHD. For example, does San Juan Health Care offer this or our local Hospice?
  • Currently, Peace Health would refer patients interested in DWD to the Washington Sate Hospital Association or the Washington Department of Health.
  • If the Hospital District was to present our community with a resource like the Healthcare Ombudsman Jenny Ledford has proposed, it would provide a local advocate entity to which Peace Health could refer patients.
  • Peace Health encourages patients to have Advanced Directives with the intention to honor them, as long they do not contradict with hospital ethics.
  • “Robb Miller, Executive Director of Compassion and Choices, who has worked with PeaceHealth on implementation of the the Death with Dignity initiative, relaxed a little of the tension in the room by saying that he’s worked very well with PeaceHealth. ‘Much better than with other Catholic Hospitals in Seattle,’ Miller said, adding, ‘I want to say that Peace Health has always kept its end of any bargain. Our negotiations about information and referrals have always been honorable and honest.”

PeaceHealthIsland End of Life Statements

A Legal Timeline

  • In Fall of 2012, part-time resident Monica Harrington organizes Coalition for Healthcare Transparency & Equity. They meet just before the September 18, 2012 SJCPHD Commissioner meeting and then circulate a letter to the Hospital Commission at that meeting.     Text of letter
  • “After getting access to the agreement between PeaceHealth and the San Juan Island hospital district commissioners through a public records request, I asked the ACLU to review it as well. I subsequently drafted and was one of more than a hundred signatories to a letter asking State Senator Kevin Ranker to seek an opinion from the Attorney General with respect to whether the agreement entered into by the hospital district commissioners on San Juan Island with PeaceHealth violated WA state law or the Washington State Constitution.”  Monica Harrington from a letter she later wrote to the Department of Health regarding the Certificate of Need.                                                     Monica CofN Comments DOH Aug 5 2013
  • January 2013 Subsequent to being contacted by Monica Harrington of the Coalition for Health Care Transparency and Equity, ACLU sends letter to SJPHD #1, stating: “It has come to our attention…”                                2013-01-03 ACLU Ltr to SJCPHD (2)
  • August 2013 AG Opines – partially. Though political activists cite his opinion for their purposes, the AG intentionally does not offer an opinion about what constitutes “substantially equivalent benefits, services or information”, about how a PHD might comply with an obligation to provide them, or whether the PHD could meet any lawful obligations through a provider in the district other than the PIMC. He also states that “Nothing in I-20 requires that a public hospital district provide maternity care benefits, services, or information to women.”                                       
  • February 2013 Various advocacy and legal organizations (including Monica as Washington Women for Choice) send  “comments” to the DOH as to what assurances they want regarding the Certificate of Need application made by Skagit County and United General Hospital.  Letter to DOH re CON UGH from various
  • April 2013 Various political activist groups, including Monica Harrington, as co-chair for Washington Women for Choice, provide their comments on the Certificate of Need Application for Peace health and United General Hospital.  CON comments re UGH
  • May 2013 ACLU and company, including Monica Harrington with Washington Women for Choice, request Governor Inslee institute an immediate 6 month moratorium on Certificate of Need applicationsACLU Hospital Mergers Ltr to Gov
  • June 2013 Gov Inslee sends a reply back to the ACLU, et. al. sharing their concerns, but stating he does not have the legal authority to do what they’re asking.   He will, however, direct the Department of Health to immediately begin rulemaking to update the Certificate of Need process. Gov response to ACLU
  • June 2013 Gov Inslee directs Washington State Department of Health to commence rulemaking in an expeditious and efficient manner. Gov directive to DOH
  • Dec 2013  DOH files the revised code, to be implemented Jan 2014. DOH Appeal news
  • June 2014 Thurston County Superior court rules to invalidate the new code and subsequent appeals lead to the Washington State Supreme Court. Thurston County
  •  Feb 2015 ACLU sues Skagit Regional Health over abortion access

    “The suit is part of a larger ACLU effort to ensure that hospital districts statewide comply with the act. It has sent letters to three other hospital districts it believes are not complying with the law in Mason County, Jefferson County and Whidbey Island”

“The ACLU of Washington is ramping up and aggregating funds to fight for a state-wide solution, the first in the country…” Valerie Torico Article

“It makes perfect sense that the ACLU would file a lawsuit in Skagit first. I believe the issues decided in that case will apply to several hospital districts around the state and will make litigation against the SJI public district even easier. The ACLU has already made clear that this lawsuit is part of a broader initiative to bring ALL public hospital districts into compliance with State law.” Monica Harrington’s Opinion Piece

  • July 2015 Washington State Supreme Court rules unanimously in favor of the Washington State Hospital Association and against the Department of Health and all the entities that tried to circumvent the legislature and achieve their purposes through Direct order. Unanimous Supreme Court decision
  • July 2015 ACLU sends letter to SJPHD Board of Commissioners, along with several other Washington Hospitals/Hospital districts, in a statewide effort to assert they are not in compliance with the Reproductive Privacy Act.       07-08-2015 ACLU-WA Letter to San Juan PHD1

Note: At the inception of this partnership between Peace Health and SJCPHD, when the contract was created, it was carefully reviewed by SJCHD Board attorneys,  as well as, Peace Health attorneys. It was also submitted to the Washington State Auditor’s office & assistant attorneys general for the State of Washington. The contract met the requirements of all.