Ebb MD
Public Health looks at ending clinic services

By CYDNEY GILLIS
Staff Reporter

David Gallaher is close to getting his retirement benefits. But not as close as he’d like to be.

For 20 years, Gallaher worked at the Boeing plant in Everett, making all kinds of tubing for airplanes — tubes for fuel, for hydraulic fluid, even oxygen. He had already undergone three surgeries for a back injury when, one day, he bent over at the shop and that was it: He couldn’t stand up again.

That was in 2000. Gallaher took a medical retirement, but the Bitter Lake resident can’t get his pension or retiree medical benefits until he turns 55 in two years. In the meantime, he has health coverage through Medicare.

But Medicare and its counterpart for the poor, Medicaid, pay so little that Gallaher says that he had a hard time finding a doctor who would take him. After a long search, he ended up going to the county-run North Public Health Center in Northgate, where he gets primary care from one doctor who knows the history of his spinal problem.

At public clinics, “No one is refused services,” he says — at least for now. But the days of county clinics providing primary care to people like Gallaher appear to be numbered.

Last fall, after years of revenue shortfalls, Public Health of Seattle & King County proposed closing the Northgate clinic, its nearby dental office, and another small clinic in Bothell in order to save about $12 million. The reason, in a nutshell: The primary care services that Gallaher and the growing number of uninsured people get at Public Health’s 10 clinics have eaten a hole in the budget faster than the county can shovel money in.

During last fall’s budget process, the county executive and council came up with enough money to get the clinics through the year. But the council also passed a budget addendum, or proviso, calling on Public Health to come up with a plan for restructuring clinical services.

As part of the proviso, a task force of health experts will be appointed this month. Among their potential recommendations, which are expected in late spring or early summer, health board members say the primary care clinics could be discontinued, sold, or contracted out to community clinics, the way Pierce County does.

County Councilmember Julia Patterson, who chairs the county Board of Health, says the recommendations will be made in time for this year’s budget process, with the proviso earmarking $2.7 million for a transition that could include moving patients to other service providers.

Any changes would fall to Public Health’s new director, Dr. David Fleming, a global health expert from the Bill & Melinda Gates Foundation who’s expected to take over this month.

“We talk about a safety net, but what does that mean to a person who doesn’t have a doctor or insurance?” asks health board member Dr. George Counts. “Should the [county] clinic be there? Is that the best way for the dollars to support that person? Those are things that should come out of the discussion.”

But, if the county gets out of primary care, says Michael Lippman, a North Clinic doctor with Communities for Public Health, it’s unlikely any nonprofit service providers will be able to take his or other Public Health clinic patients.

“Why shut down a system that’s been taking care of these patients when there’s no possible alternative?” Lippman asks.

The Board of Health had already been looking at the issue as part of a public health master planning process that began last year. A budget report submitted to the County Council last fall shows why: Even though the county has kept Public Health’s budget at $186 million for the past three years, the report says increasing costs — including serving more patients with no insurance and no way to pay — have led the county to use more of its general fund each year. In 2003, the county put $15 million toward clinical services. This year, it’s $28 million.

In the past, the county could rely on state funding, but in 1999, when voters passed Initiative 695, they cut the state’s only dedicated source of public health funding: the motor vehicle excise tax. Since then, the Legislature has plugged most of the hole and, in 2005, created a joint committee to look at the problem.

In November, the group released a report recommending that the Legislature provide an additional $50 million a year for public health, with the committee’s chair, Rep. Shay Schual-Berke, D-Normandy Park, and Sen. Rosa Franklin, D-Tacoma, recently introducing bills to do just that.

The money would come from a tax of 23 cents per pack that cigarette smokers already pay. But the hitch, as Schual-Berke told the Board of Health in October, is that the money is not intended for primary care, but “core” public health functions such as communicable disease and emergency preparedness — services aimed at whole populations, not individual people.

Counts says another core function is to help people access quality care. “But what is the role of Public Health in doing that?” he asks. “To contract for services? To form partnerships? To provide services directly? That’s all a part of what Public Health must evaluate.”