Photo by Don Nelson Barry Pentz, respiratory therapist at Three Rivers Hospital, with an older model EKG monitor that still uses floppy disks.

Photo by Don Nelson

Barry Pentz, respiratory therapist at Three Rivers Hospital, with an older model EKG monitor that still uses floppy disks.

Two proposals are back on the ballot for district residents

By Don Nelson

The staff at Three Rivers Hospital in Brewster practices modern medicine in a facility that, at times, seems to be from another era.

All of the hospital’s vital equipment works and provides the necessary diagnostic and treatment support. But some of it is older than many of the hospital staffers. Parts are hard to come by for long-discontinued machines. Factory representatives have been known to laugh when they’re read the serial number of a piece of equipment that needs repair, Three Rivers CEO Scott Graham said during a hospital tour last week. A few of the patient beds date back to the 1970s.

Graham and his staff may occasionally joke that some of the hospital’s back-to-the-future equipment could just as well be in a medical museum. But that’s out of frustration rather than amusement.

The halls, treatment areas and patient rooms at Three Rivers are sparkly clean, neat and well lighted. However, the 1950s-vintage building’s oft-patched roof leaks, and its heating and cooling systems are antiquated. The emergency room is awkwardly situated for optimum response when patients come in.

Graham, the hospital’s other administrators and its board of directors have developed detailed plans for replacing equipment, upgrading the building and improving patient care. But like many small, rural, cash-strapped hospitals, Three Rivers has little ready cash on hand to cover those needs.

As a public, nonprofit facility that serves the Methow Valley, Pateros, Mansfield, Bridgeport, Brewster and surrounding communities including portions of Douglas County, Three Rivers relies on locally generated property taxes for a good portion of its operating expenses.

“We can’t save enough out of operations to make infrastructure improvements,” Graham said.

Two levy proposals

So the hospital board is once again asking the residents it serves to approve tax increases that will pay for much of the necessary equipment and infrastructure improvements in relatively short order.

On the Aug. 2 primary election ballot, where Three Rivers will be identified as Okanogan Douglas District Hospital 1, will be two proposals:

• The hospital is asking for a levy lid lift that would increase the levy from .63 per $1,000 assessed valuation to .75 per $1,000, the maximum ongoing amount the hospital is allowed to levy under state law. That would bring the tax bill to $75 per $100,000 of assessed valuation if a majority of voters approve it. The permanent levy lid lift would generate an additional $200,000 per year for ongoing maintenance, repair, equipment and other investments, he said.

• In a second levy proposition, the hospital is asking for a one-time “excess levy” of  $1 per $1,000 per assessed valuation, or $100 per $100,000, to be paid in 2016. This levy requires a supermajority vote of at least 60 percent of the votes cast to pass. The tax would expire in 2017. If approved, the one-time excess levy would raise $1.8 million based on current valuation.

Graham said funds raised through the tax increases would be used to modernize and upgrade the hospital, particularly the emergency room. The funds would allow the hospital to relocate the current emergency room to a more modern portion of the building that will provide more space and more efficient monitoring of patients, Graham said.

The money would also be used  to replace the roof; fund purchase of X-ray and EKG equipment, patient beds, and an operating table; repair and replace heating and cooling systems throughout the hospital; staff training and education; and centralized patient monitoring, Graham said.

Requests unchanged

Similar measures were put to hospital district voters at the November 2015 general election. Although Okanogan County voters supported the proposed annual property tax increase by a slim margin, the measure failed because voters in Douglas County rejected it. The levy lid lift proposed by the hospital received 49.11 percent in favor and 50.89 percent opposed.

The special one-time levy proposal received a small majority in favor — 50.75 percent overall — but needed a 60 percent approval rate from voters to pass.

“We were disappointed but super grateful that it was as close as it was,” Graham said of the November vote.

Although the hospital staff is not allowed to campaign for the measures, Three Rivers has been hosting informational forums throughout the district to answer questions and explain the hospital’s needs.

“We’ve had good questions, and people have heard what we’re up against and what we’re doing,” Graham said.

Three Rivers will host a public information session on Thursday (July 14) from 6–7 p.m. at the Education Station on the TwispWorks campus. Graham will be at the session, along with other hospital staffers and board members.

Rural hospitals around the country face the same challenges. Medical insurance reimbursements usually don’t cover actual costs. The smaller facilities don’t have the critical mass of a large hospital, or of a massive health care system, to absorb those gaps.

As a designated Critical Access Hospital, Three Rivers is required to treat anyone who shows up, regardless of what or whether they can pay. State and federal reimbursements don’t begin to cover the hospital’s costs.

Three Rivers has initiated cost cuts, improved efficiencies and streamlined operations to reduce expenditures, Graham said, and it has been steadily paying down the warrants owed to Okanogan County — from more than $2 million a few years ago to less than $1 million now.

“We’ve worked hard to be prudent,” Graham said.

Facilities needed

Increasing taxes is a lot to ask in an area that is among the state’s most economically challenged, Graham acknowledged. “We don’t take that lightly,” he said. “To give patients an ideal experience, we have to have the facilities.

Melanie Neddo, the hospital’s chief operating officer, said that while they are competitive, all the medical care providers in the region help each out. “We have cooperative relationships with other local providers,” she said. “We’ve leaned on each other many times.”

“Our goal is for everyone to be successful,” Graham said. At the same time, he added, “we’d like them [customers] to choose us.”

Three Rivers’ goal, Graham said, is to provide high-quality, cost-effective care in a customer-friendly environment.

“As a small community, it’s important to have a hospital,” Neddo said. But hospitals are not always top-of-mind in people’s daily lives — until they are. “You only need them when you need them,” she said, “and then they’re really important.”

If one or both of the levies fail again, Graham said, the staff and board will continue to look for ways to make improvements, although they may come more slowly. “We’re not giving up,” he said.