[Homestead] number and people - - -

Toni Hawryluk tonihawr at msn.com
Fri Sep 10 20:40:09 EDT 2004


http://www.msnbc.msn.com/id/5958367/<http://www.msnbc.msn.com/id/5958367/>

The population of Sultan, Washington State, is
3,344 - had yesterday's total of 1,000-plus 
Americans to die in Iraq all lived here, 1 of 3 adults
would be leaving behind children/siblings/spouses
parents in this little town ....

The clinic that refuses to die

By JENNIFER LANGSTON
The Seattle Post Intelligencer

USA - SULTAN -- The doctors first heard there was something wrong with Judy Perkins' left leg from the bank manager, her chiropractor and the owner of the auto parts store.

On the day she went to the hospital for tests, announced by a "closed" sign on her flower shop, it took only five hours for friends to learn why she was having trouble walking -- golf-ball-sized brain tumors.

Perkins is one of nine cancer patients who get regular house calls from the doctors at Sky Valley Family Medicine -- the only medical clinic along the 77-mile stretch of U.S. Route 2 between Sultan and Leavenworth. 

Folks who live here have come to expect intensely personal health care. 

"It's a big responsibility," said Sky Valley's Dr. Mark Raney, who gets asked to diagnose rashes or juggle some family crisis while shopping in the produce section of the grocery store. "You're kind of like priest and doctor and bartender rolled into one."

Those bonds explain the uproar when Medalia Medical Group, a large physician network linked to Providence Medical Center-Everett, announced last year that it would sever its affiliation with Sky Valley, causing the money-losing Sultan clinic to close. 

Medalia suggested moving Raney and the other three doctors about seven-plus miles west to Monroe. They refused.

The intimate linkages forged from practicing medicine in a small town may explain the selfless and improbable behavior here that, so far, has kept Sky Valley operating in Sultan. It's a story in which nearly everyone involved has made sacrifices so the community might win.

"People here love those doctors," said Merlin Halverson, chief of the rural fire district. "Clinics are having a hard time surviving, and we know we're running against the tide, but we're going to do everything .. to make sure they stay here."

Elderly patients raised canes at a protest rally 18 months ago, helping persuade the taxpayer-supported Valley General Hospital in Monroe to buy the clinic's equipment, pay its bills for a year and temporarily assume any operating losses while everyone sought a solution.

The hospital's foundation also volunteered to raise $100,000 from private donors to help the clinic survive on its own and is more than halfway to that goal

Next month, Sky Valley Family Medicine will spin off from the hospital and become independent, a financially risky move for the doctors and their families.

Raney, whose freezer is full of elk steaks brought by patients and whose office will soon be overwhelmed with zucchini, said the yearlong reprieve gave Sultan's doctors time to dig into the clinic's books and their own souls.

They eventually concluded that becoming a non-profit or rural health clinic would add costly layers of administration.

Three of the clinic's four doctors -- Raney, Vickie Baker-Hall and Scott Weber -- decided to contain costs and stick it out on their own.

Every time they became faint of heart, someone noticed a patient on a food-bank budget stuffing a $20 bill into one of the cardboard donation boxes that sprouted across the valley.

"To see a whole group of patients supporting us was something really new to me and really very heartwarming and satisfying," said Weber. "They let us know we really are worth something and not just a liability like we'd been told."

Despite a clamoring for personalized health care, independent family doctors across the Northwest have had a difficult time staying afloat, said Stan Garlick, a Port Angeles doctor and president of the Washington Academy of Family Physicians.

Sky Valley Family Medicine, which conducts football team physicals and sees feverish babies and ailing grandparents, doesn't do many high-paying procedures.

It has a high percentage of Medicare and Medicaid patients, government programs that reimburse doctors for only a fraction of what it costs to provide care, the doctors said.

The clinic did hit the jackpot by finding a company willing to provide malpractice insurance to new clients. But the economic climate in which primary care doctors work is so difficult that no new independent practices have opened up in Snohomish County in at least a decade, said Kevin Ware, president of the Snohomish County Medical Society. 

The trend over the past five years has been for family doctors to seek refuge under the umbrella of hospitals or large physician networks. They can afford to subsidize money-losing primary care clinics if they generate referrals to more lucrative specialists, Garlick said.

Raney, who understands the palliative effect a cup of coffee and a kitchen table can have on a patient's state of mind, piloted his truck into a Gold Bar driveway on a recent house call.

In the back was Karen Clark, his medical assistant, who has been known to show up unannounced in the bedrooms of sick but stubborn patients who won't come into the office.

Perkins, a feisty 64-year-old cancer patient with a vehicle sporting a "Gun Control: Use Two Hands" bumper sticker, greeted them warmly and teased the doctor for being a hippie born too late.

They chatted on the couch, underneath pictures of her grandchildren, about everything from her pain to appetite to the yoga lessons her neighbor has offered to improve balance and muscle tone.

Clark, who's taking charge of the clinic's operations, wrote down the promises Raney made, such as getting Perkins a handicapped parking pass for the fair, on an orange sticky pad. 

"I'm his brain," Clark said.

"I know," Perkins replied knowingly.

"I'm just a signature with legs," Raney offered.

Gary Perkins, Judy's husband, ordered Raney not to say a word about the cholesterol in his coffee. Cream is good for you, he insisted.

"I go into restaurants, and people literally cover their breakfasts. What do they think I have against food?" Raney said.

The couple have told oncologists and other hospital specialists not to discuss her treatment with them directly. They want all their information filtered through Raney. 

Despite efforts to train them otherwise, some clinic patients who've just undergone major surgery won't even swallow pain pills until their local doctor says it's OK. 

"He knows us, what we think about life, what we want and how we want it," said Gary Perkins. He searched for the word to describe other doctors. He settled on "professional," leaving the coldness that implies hanging in the air. 

The easy banter masked an ugly truth, evident in a purple bruise around Judy Perkins' eye. The former Chamber of Commerce dynamo loses her balance and falls. She's dying.

Intimate moments with a terminal patient, while difficult, offer rewards that make dealing with insurance regulations, budgets and managed care worth it, Raney said.

"That's when that whole world goes away, that moment when you have medicine at its purest form, when you're connecting with a patient and a family and a community."

To keep the business viable, the doctors have made hard-nosed changes, ditching an old X-ray machine and cutting staff in half. Patients still hate the new voice mail. 

For the last eight months, the clinic operated in the black. But that wouldn't have been possible without the widespread effort to keep the doors open.

Carolyn Eslick, the owner of the Dutch Cup Restaurant and a Sultan resident for 26 years, said losing the medical clinic would have been a step backward for the growing valley.

"I think most of us are concerned about the elderly who can't drive those extra seven miles to Monroe because one day we're going to be there," she said. "When you put an APB out in the community, people just come out of the woodwork." 

Snohomish County Fire District 5, which realized its medical-aid calls would go up if the clinic closed, sought a $15,000 grant from the Washington Health Foundation that paid for attorneys and accountants.

The board at Monroe's Valley General Hospital initially agreed to buy the practice, float the clinic's expenses for a year and make upfront investments in operating systems that the doctors will pay back over time. 

The hospital extended that temporary arrangement by six months while the physicians labored to find malpractice insurance.

In raw numbers, the hospital will likely lose about $125,000 on the deal, said Executive Director Mark Judy. But board members took a longer-term view.

"We saw it as a way to protect access to primary care and the needs of this community," he said. "I think there were people ... who just believed it was the right thing to do."

Peg Stevenson, who's been a clinic patient for years, said it's rare to have so many people make decisions that aren't based on the most obvious bottom line. Stevenson, who lived downwind from Hanford years ago, has been battling lung cancer.

She just decided to forgo chemotherapy for cancer that reappeared in May, wanting to maintain what quality of life she has left. 

One of her surgeons insisted she see another specialist, which left her feeling like he was just trying to line his buddy's pockets.

Stevenson's no quitter, having survived a laundry list of lung disease. But she needed a doctor who would respect a choice she knew to be right for her.

Raney told her: Good for you, go fish. And when the pain gets bad, he promised to come to her house every day after work if that's what it takes.

"It was very important to me that the clinic didn't close," she said. "I had a relationship with Dr. Raney that I trusted and we had history. ... He's got every quality you'd want in a best friend with the knowledge of a doctor."



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P-I reporter Jennifer Langston can be reached at 425-252-5235 or jenniferlangston at seattlepi.com



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