Submitted by Chairwoman Lopez Island Fire and Emergency Medical Services Board of Commissioners Becky Smith and Fire Chief Jim Ghiglione

It’s fitting that as we write this letter to the Lopez Community the current Health Matters from Catherine Washburn Medical Association arrived. As you read the how, why and “isn’t it wonderful” news of UW Medical Clinics taking over Lopez Clinic, ask yourself what’s missing in the story? Emergency services and how that fits into the picture is never mentioned.

This isn’t a mistake or an oversight – EMS and emergency care was never part of the plan with the transfer of Lopez Clinic to UW Medicine. In fact, we have been told by members of CWMA and the new Lopez Hospital District Board (LHDB) that this subject was a “deal breaker” for UW, that any attempt to pursue emergency care in the contract “UW would walk” so it was removed from the discussion. CWMA began negotiating with UW Medicine at least 8-10 months ago and knew emergency services were not part of the scope of practice. They chose to not make this public before the vote to form the public health district. Instead, all advertising to support the new taxing district just said: “Keep our Clinic.” Lopez Island Fire and EMS took this to mean all services would remain the same – including the current providers and staff. The fire district was shocked when we first heard in May, 2-3 weeks before the contract with our newly formed hospital district was signed with UW Medicine, that emergent care was not part of the services provided.

Chief Jim Ghiglione and I, as chair of the fire commission board, pushed for a meeting with the new LPHD. After three rather contentious meetings with a representative group from CWMA, LPHD and UWMC we quickly realized this was not a reversible or negotiable subject. CWMA had negotiated a contract with UWMC that was then passed on to the new LPHD to sign — the delivery of emergency services was not included. The fire department was left out of any dialog including presenting how we respond to emergencies and the role the clinic plays. It has been acknowledged in hindsight this omission was an error but the fact remains we were not included and you the community will have to accept the consequences.

In the past month, there has been much applause and credit given to CWMA for saving our clinic. UW Medicine spoke at a packed town hall meeting about the wonderful things they will do for our community. And by reputation, the UW probably will do a great job of what they are — a primary care clinic. The fault lies in the lack of definition of what that means exactly. The scope of practice in a primary care setting does not include emergency care. Is this the best fit for an isolated island community like Lopez?

So what does this mean when you call 911 with a medical emergency after the takeover? It means Lopez EMS will respond as they have for more than 40 years with its highly trained paramedics and volunteer EMTs. They will assess your needs, consult with medical control (may continue to be Dr. Bob Wilson), treat as they are able and then transport you to the nearest hospital if you need further care or evaluation. The current practice of going to the clinic for evaluation and treatment first will not happen – especially after clinic hours.

UWMC did present the fire district with a contract to sublease the back treatment room at the clinic after hours but the language is clear there is no involvement with staff (including doctors) or equipment if we occupy the room while waiting to transport a patient. The patient is ours, not the clinic’s, as this does not fit with their scope of practice. UW, in fact, is removing all emergency care equipment from this room. We see no advantage in negotiating the further use of the room and delaying transport.

We understand this is new information for people and concern to most. When you have a medical emergency you want immediate and the best care available — that is what our focus will continue to be. Unfortunately, that may mean more patients are transported off-island — even for minor injuries or illness. We also recognize this brings other issues into play with family or friends needing to follow by car to where ever you are transported to. We will be investigating all possibilities with WSF, Airlift NW, Island Air Transport out of Friday Harbor and the sheriff’s department boat to come up with alternatives. Changes to fire department personnel and vehicles to accommodate off-island transports may take place as well, that may also require a complete rewrite of our strategic plan and the need to request additional funding through a tax levy lid increase, to cover the increased cost to your fire district.

There are still some unanswered questions and things could change but we are not hopeful after our meetings with UWMC. They seem pretty clear with their mission and unfortunately, it does not allow for the close working relationship Lopez EMS has always shared with the clinic. We have been true partners in care for our patients because most of you are also patients of the clinic — it is a unique relationship that has served this community very well. Our approach has been to do all that is possible to avoid sending you off-island. That model will not exist with UWMC.

The best advice we can give residents is to join the household membership programs offered by Airlift NW ($79/yr – helicopter service) and Island Air Transport ($39/yr fixed wing transport). Unfortunately, the odds just went up that you may have to use these services in an emergency.

We have stayed quiet about these changes for almost two months at the request of UWMC and the LPHD. We have repeatedly encouraged the LPHD to make a public statement about emergent care and the changes coming. That hasn’t happened and we now feel it is our duty to the taxpayers of this community to inform you of changes in care that will be occurring. We cover these subjects at our monthly board of fire commissioners public meetings. We encourage you to attend and stay informed.